You’ll know from our recent article ‘Why Do My Joints Make Odd Popping Noises’ that some noises when we move our joints in their range of motion are fairly normal. However, awareness about the correct alignment of our joints ensure these noises don’t become sinister and we keep our joints healthy and mobile for as long as possible, especially our knees. Because our knees are weight bearing, it’s important to make sure we have the correct amount of muscular strength around to support them.
The kneecap (patella) itself slides up and down in a dent like groove in the femur (thigh) bone. Ideally we want this to be a gliding and smooth motion, but when we aren’t lined up properly, the kneecap can begin to drag against the softer cartilage beneath, designed to cushion and lubricate the motion. We can expect a little wear and tear as we get older, but degeneration is made worse when our knees aren’t aligned properly, which results in an uncomfortable grinding sound and sensation as you bend and straighten your knees. The cushioning effect of the cartilage is key for keeping knees safe and mobile.
The good news is, cartilage can and does renew, (even though it’s a slow process), so it’s important to correct what is putting pressure on the knee in order for the cartilage to regrow quicker than we can wear it away.
Why Does Misalignment Happen?
Sometimes the knees are out of proper alignment because of imbalances in the quadriceps tendon. The quadriceps tendon are the ends of the 4 quad muscles in your thigh. They attach and surround your kneecaps and also attached further down to the shin bone – tibia. As you straighten you leg, the quadriceps tendon acts like a pulley, shortening to pull the shin bone to the thigh bone.
When the quadricep tendon pulls more on one side than the other, the movement of extension or straightening the leg isn’t gliding as smoothly as it should and this is where friction starts to build.
The quadricep of the four that tends to work more in this pulley motion is the outer quad – known as the vastus lateralis. On the other side, the inner quad – the vastus medialis, whose job it is to help keep the pulling motion central. When the vastus medialis is weak (which is often is), the vastus lateralis dominates, and the patella (knee cap) gets pulled out of line. The key to healthy knees with good alignment will typically lay in strengthening the vastus medialis.
How Do I Check My Knee Alignment?
Once you know what’s going wrong, you can pay attention to correcting the tracking. A good way to check is to sit on the edge of a seat with your legs straight out in front of you, with the feet parallel to each other. Engage the quadriceps and just watch how the kneecap moves up towards your hips. Do they move straight up or is it a little wonky? If it’s not aligned correctly, you may have a structural imbalance which needs correcting and strengthening the vastus medialis is the best way to do that.
Provided you are not knock-kneed or have bow legs or any other structural problems, you should be able to safely work on correcting alignment and supporting your knees. Also, be mindful if you are hyperextention (see more about hypermobiliy in our blog), this too can affect how well you repair your knees – extra care should be taken not to hyper extend your knees rather than just strengthening it.
How to Strengthen the Vastus Medialis
Begin by sitting in stick pose – dandasana (staff pose) on the floor with your legs straight out in front of you. You can sit against a wall too if you wish to keep your back upright. Use a blanket or yoga mat rolled up underneath your knees.
Engaging your thighs firmly, rotate your right leg out to the right by around a quarter of your capacity. Place your fingertips around one to two inches away from the inner top corner of your kneecap, feeling for the vastus medialis. Straighten you leg a little more to feel this muscle switch on further and continue to straighten until you feel fully engaged in that muscle. Hold that contraction for around 10 seconds and relax. Do 3 reps all together, being sure not to lock the knee joint. Repeat with your left leg.
Do this again, but without rotating your leg. See if you are able to engage your inner part of your quadriceps as strongly as you can the outer part of your quadriceps.
You can do these exercises a few times a day until you get stronger and notice your kneecap pulls up in a straight line. Little and often is the key rather than bashing the muscle and tiring it out.
Strengthening Your Inner Thigh Muscles
There’s a lot more you can do to strengthen your inner thigh muscles, but here’s a good one to get you started. You don’t have to have a pilates ball and could use a rolled up towel instead, but the pilates ball has a little more give and can easily be purchased online or in a sports shop.
Bent Knee Standing Poses – What to Focus on For Knee Health
If you are in a weight bearing standing pose like Warrior 1 or 2, you have the front knee bent at a 90 degree angle which can be very strengthening for your vastus medialis. Alignment is critical here and ideally we want all four quadriceps to be working in harmony, without stressing the knee with imbalances. Generally it’s easier to isolate the vastus medialis muscle when straight legged as explained above, but this takes mindfulness and effort to get right.
This is the case in a well-aligned warrior pose and any good yoga or pilates teacher will make sure you’re knee is on track, but there are a few things you can easily check yourself.
Top tips for Knee Safety in Warrior 2 Pose
1. Make sure your knee is directly over your ankle as shown in the picture. If your knee overshoots the ankle, then widen your stance a little. Roughly your legs should be around one leg lengths worth apart.
2. Push down through your front heel and big toe mound, then try to lift the inner arch of your foot. Your toes should be relaxed and not gripping the floor. These two actions together of lifting and grounding prevent your knee from swaying either out or in too much. Imagine you have something really heavy in your hip and try to drop your outer hip towards the floor.
3. Aim to get your thigh parallel to the floor so your leg is at a right angle, the more it is, the harder the muscles will have to work.
4. Ensure your knee tracks straight ahead, in line with your 2nd and 3rd big toe. Your knee, 2nd toe and sit bone should all be on the same plane. If you look down and can’t see your own big toenail, then your knee is collapsing too far in because the arch in your foot isn’t lifted. This places extra stress on the knee and the vastus medialis is not engaged properly. Open the knee a little so you can just see your big toenail peeping around. See the picture for reference. If you were to do Warrior 2 against a wall, your hip, outer leg, outer knee and outer foot would all be touching it.
Remember, you can always confirm if the vastus medialis is engaged by giving it a gentle poke! It should feel as firm as the other muscles in your thigh.
Straight Legged Poses
Once you’ve done the base work in learning how to identify and engage your vastus medialis, you can apply it to the straight legged poses, like triangle pose (trikonasana). You can tell if you’re using it correct, as when you engage your quads and watch your kneecap pull up towards your hip. you’ll see it draw straight up and it won’t be possible to lock your knee back into hyperextension.
A note in pigeon pose or eye of the needle pose – Be careful to flex your ankle and pull your toes back towards your knee. This brings the tibia and fibula to surround and support the knee cap. Hero pose is not for everyone! If you ever feel any sharp pain at all in your knee, come straight out of the pose and ask your teacher for a modification or alternate pose.
We hope you’ve enjoyed this fascinating journey into understanding the knees, and hope you’ll take the advice to practice safely. Remember, all our teachers here at Mary Ann Weeks Aveda Guildford are keen to help you know your body and practice yoga in a safe and healthy way.
Book yourself a class and learn more about the wonderful benefits of practising of yoga and Pilates.