IN MOST YOGA CLASSES, you’ll often (hopefully!) hear cues meant to help protect your knees. For example, angle the knee no more than 90 degrees, or, if you feel pain in your knees, back off. And perhaps one of the most popular: strengthen your quadriceps to lift your kneecaps. Cues like these are crucial, as injuries and pain originating in the patella, or kneecap, can be quite common—and quite slow to heal.
However, what these cues don’t address is the importance of the core, hip abductors (outer hips), and glute muscles when it comes to knee health. That’s because traditionally, treatment for pain in the front of the knee focused on strengthening the innermost quadriceps muscle, called the vastus medialis oblique, or VMO. It was thought that when the VMO was weak, the patella was more likely to drift out of alignment, ultimately causing issues. Interestingly, new ndings published in the Archives of Physical Medicine and Rehabilitation and the Journal of Athletic Training show that strengthening the core,
hip abductors, and glutes—in addition to stretching the quads—is actually much more effective at easing knee pain than solely strengthening the VMO.
To understand how these muscles affect the knee joint, it’s helpful to think of the knee in the context of the entire leg and pelvis. The patella is a mobile bone structure between the foot and the pelvis; any wobble that travels up from the foot or down from the pelvis affects the patella. While instability in the foot or ankle can contribute to knee pain and dysfunction, it’s a less likely culprit than instability in the pelvis—which is where a strong core, hip abductors, and glutes come into play.
These three muscle groups all surround the pelvic bowl, which means the stronger and stabler they are, the stabler the pelvis will be. This is important, because the orientation of the femur (thighbone) at the hip joint causes a small degree of normal rotation at the knee joint during flexion and extension. However, any pelvic instability caused by imbalances in the core, hip abductors, and/or glute muscles creates pressure that travels to the knee, leading to abnormal wear and tear that can potentially cause chronic pain. For example, internally rotated femurs create a knock-kneed position, called valgus, an angle that’s frequently associated with anterior knee pain. Strengthening the hip extensors, which externally rotate the femurs, helps to counterbalance this pain-inducing angle.
Of course, focusing on the muscles that provide pelvic stability alone isn’t enough; the quadriceps are still important for healthy knees. You must couple strengthening the VMO—that innermost quad muscle—with improving flexibility in the quads, in particular the rectus femoris, which crosses the hip and the patella. When this quad muscle is tight, as is common with most people, it can inhibit kneecap mobility and prohibit proper kneecap alignment, leading to abnormally high pressure where the patella connects to the femur. But when you keep that muscle flexible, the kneecap is free to move as it should.
The poses and cues to follow will go a long way toward helping you stabilise your pelvis by strengthening your core, outer hips, and glutes, as well as by releasing tension from the quadriceps. The result? Happy, healthy, pain-free knees.
Natarajasana – (Lord of the Dance Pose), variation
Start with this pose to release tension in the quads and strengthen the glutes—both of which are key actions for preventing and treating front-of-the-knee (anterior) pain.
Using a wall for balance, bend one leg and, with the opposite hand, lasso the ankle with a strap to draw the heel toward the buttock. At the same time, squeeze your buttocks to engage your gluteus maximus on the bent-knee side. (Engaging your glutes tilts your pelvis back and down and focuses the stretch in the rectus femoris, while bending the knee stretches the other three quad muscles.) Hold for 30 seconds, and then switch sides. Repeat three times.
Supta Padangusthasana – (Reclining Hand-to-Big-Toe Pose), rotated variation
This pose helps to stretch and strengthen the hip abductors against resistance. Lying on your back, bring one leg across the body. Use your opposite hand or a strap to hold the outer arch of your foot. When you feel a stretch in your side hip, press up into your hand or strap, as if you were coming out of the pose. This strengthens the abductor muscles at the hip. At the same time, engage the quadriceps, including the VMO, by turning the top leg slightly outward as you straighten the knee, which draws the kneecap into alignment. Hold for 30 seconds, and then switch sides. Repeat three times.
Practice Warrior I to strengthen the glutes of the back leg, while stabilising the hip and the ankle of the front leg. To protect your front knee, progress gently toward, but not beyond, 90 degrees of flexion. Press the balls and outsides of both feet into your mat at the same time: This grounds the legs and lifts the arches. Engage the glutes of your back leg as you straighten that knee; very subtly drag the back foot toward the midline. In the front leg, imagine simultaneously pressing the inside and outside of that knee into an immoveable object like a post. This is a co-contraction of the muscles around the hip, and takes a bit of practice. Feel your hip settle into the socket. This action stabilises and aligns the knee, strengthens the muscles of the hip, and improves your sense of joint position.
FINISH – Close with some core work, such as Forearm Plank. Press the forearms into the mat as you attempt to drag them toward your feet, simultaneously and firmly contracting the glutes.
About the author:
Teacher Dr. Ray Long is an orthopedic surgeon and the founder of Bandha Yoga, a website and book series dedicated to the anatomy of yoga. He trained extensively with B.K.S. Iyengar. Model Nicole Wienholt is a Boulder, US–based yoga teacher and the co-founder of Yoga Pod, a national chain of studios.