by Barrie

My post today is designed to help you align, strengthen, and stabilize your knees to keep them healthy, happy, and functioning well! This is targeted work worth giving some time and attention to especially if you often hear a snap crackle pop when you bend or straighten your legs, if you tend to hyperextend your knees, and definitely if you experience chronic knee pain, knee instability, or osteoarthritis.

I’ll start with a little anatomy lesson. I’ll be getting a little technical, so if you’re not interested in learning about the anatomy and biomechanics of the knee, feel free to skip this talk and head directly to the class. I’ll then provide information about how to stabilize and align your knees.

Knee Anatomy

Did you know that the knees are the largest joints in the body? Yes! They regularly bear quite a lot of weight. With every step we take, every stair we climb, every time we get down or up from sitting the knees are working for us. And, unlike the hip joints, the knees only move in a single plane—they are what’s known as a modified hinge joint, which means they are designed to move forward and backward—with very little possibly for rotation or ability to withstand pressure from the sides. This is why strengthening work to stabilize the knees from side to side is so important for the health of the knees.

The three bones that make up the knee joint are: the patella, or the kneecap, the femur, or thigh bone, and the tibia, one of two shin bones.

There are a few important structural reasons why the knees are predisposed to wear and tear, chronic misalignment, and injury.

First, the knee joint is held together by a fibrous capsule and connected via a network of ligaments. This makes it a particularly delicate and unstable structure. This lack of potential stability makes the knees prone to injury often through misalignment and poor mechanics, although also through sudden trauma or overuse.

Second, the knee is an incredibly complex structure, and this complexity lends itself to misalignment and resulting wear and tear. For example, the two ends of the femur bone where it becomes the knee joint, are egg shaped bulbs and they are not the same size. This means that whenever our knees bend or straighten, the center of rotation of the joint shifts to accommodate this different in size. So, the knee joints are constantly adapting whenever we move them, and because of this, any imbalance in the knees is exaggerated and the joints gets more stressed over time.

Third, the kneecaps are structured to slide along a groove in the femurs, and they must move smoothly within that groove to do its job well. If they slide “off track,” which they commonly do, they wears away at the cartilage underneath and destabilizes the knees. If we don’t correct the imbalanced pull of muscles on the kneecaps, we will continue to wear down our cartilage down faster than our bodies can replenish it. This can lead to osteoarthritis in the knees.

Finally, because our hips are wider than our knees in a neutral standing position, there is often an unequal contraction of the quadricep muscles of the thighs (the large muscles on the fronts of the thighs), and therefore an unequal pressure on the knees. This contributes to the issue of the kneecaps not tracking well.

In many people, this is partly a structural issue. For example, some people have knock-knees, where the knees and thighs angle in toward each other and often the arches of the feet are collapsed as well.  Other people have bowlegs, where the knees curve outward. For these two conditions, that inside to outside stabilizing work is important.

Typically, the outer quadriceps (the vastus lateralis) tends to be stronger than the inner quadriceps (the vastus medialis) and this imbalance tends to pull the kneecaps to the outside. When this happens over time, we will start to get pain in the inner knees. What’s happening is that the meniscus, the cartilage that sits between the tibias and femurs that acts as a shock absorber, is getting worn down, and the medial parts of it, the inner knees, tends to wear down before and more seriously than the lateral ones on the outer knees.

Hyperextension of the knees (when the knees straighten too far) makes things worse because when we are hyperextending and weight bearing, we can’t contract the inner quadriceps effectively.

Additionally, collapsed arches in the feet as well as tightness in the hips can contribute to knee issues. Stability in the feet, ankle, and lower leg muscles helps to align and stabilize the knees. Flexibility in the hips means less demand on the knees.

Stabilizing and Aligning the Knees

To stabilize and align your knees, you should focus on three important actions to stabilize and align the knee:

First, you can work on activating and strengthening the innermost quadricep muscle, the vastus medialis. Standing poses where you stand with two straight legs, such as Triangle pose or Pyramid pose, are great for this. Since the vastus medialis is activated only with the last bit of leg straightening, focus on tightening your kneecaps as if you were drawing them up toward the tops of your legs, as you fully straighten your legs in these poses.

Second, you can address the alignment of the knees side to side, so they track better in movement. This involves aligning your feet well, activating your outer shin muscles to stabilize the outer knees and then widening the inner thighs to better line up the leg bones and create more even support for the knees and better tracking.

You can experience this by sitting at the edge of your chair with your feet hips-width apart and flat on the floor. Fold forward and place your hands on your outer shins, below your knees. Then lift your toes slightly and gently press your hands into your shins to active the outer calf muscles. Keeping that, isometrically widen your inner thighs apart.

Then, try the same exercise standing in a wide squat position that I call Downhill Skier’s pose. This time, activate your outer shin muscles by lifting your toes (especially the pinky toe) and widening your inner thighs back and apart against the resistance of your lower legs.

Third, you can focus on the alignment of your knees front to back. As I mentioned above, if you hyperextend your knees, meaning the tops of the shin bones are moving too far back, this can reduce stability and contribute to that improper distribution of pressure inside the knee joints. To help avoid that, you can focus on engaging and strengthening the inner quadriceps and working to strengthen the top part of the gastrocnemius, the large muscle at the back of the calf, to avoid moving the tibia, the shin bone, too far back.

Check out Nina’s post Hyperextension of the Knees and Yoga for information on how to work with hyperextension of the knees in practice.

Strengthening the inner quadriceps and engaging the muscles that stabilize the knee from side to side, and front to back can provide greater stability and better tracking of the knees as they bend and straighten and hopefully, happy, healthy knees.

Over the next few weeks, I’ll be sharing short instructional videos so you can work on each of these elements of strong and stable knees in your own practice. Stay tuned!

 

Download a free class from Barrie’s new Yoga for Times of Change companion video series and learn more about her book Evolving Your Yoga: Ten Principles for Enlightened Practice at www.barrierisman.com.

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