Friday Q&A: Alignment of the Knees

Q:  Here is a question for you.  I was practicing Utkatasana Tuesday and as I sat down into the pose I got a twinge in my inner left knee.  (Slightly forward of the seam line, between the upper and lower leg bones.) I straightened up and repeated the pose squeezing a block between my knees. The little pain was gone. How did squeezing a block between my knees change the alignment of the knee?

A:  Utkatasana, mistakenly called “Chair Pose” by some, comes from the Sanskrit root word utkata, which Richard Rosen defines as “exceeding the usual measure, immense, gigantic; richly endowed with, abounding in; drunk, mad, furious; excessive, much; superior, high, proud, haughty; uneven; difficult” (from his book Original Yoga ).  If you have spent any time in this pose, you can certainly get behind the difficult part, but we try to avoid it feeling uneven. (We like to call it "Powerful pose.")

Whenever you have pain in a joint in a yoga pose, look not only to that joint, but also one or two joints above or below that one as you look for an explanation of your pain. Not being able to see our questioner in person, it is hard to say why the pain showed up in the first variation, but any time you are standing and bearing weight on your legs, and you bend the knee joint, there is the potential to compress the joint in an uneven fashion that could result in pain. As I have discussed elsewhere regarding arthritic joints and creating space in the joint, creating a feeling of lift of the femur bone (the upper leg bone) away from the lower leg bones is always a good starting place to see if you can eliminate the pain.

In this situation, placing a block between the thighs and squeezing has many effects, any one of which could have alleviated the knee pain. Squeezing the blocks may change the way the feet are aligned, as they may come closer together, and the weight might shift more towards the inner foot. So, if the feet were the underlying cause of the knee pain, the block squeeze could re-balance the feet.  When looking at the knees, if someone is a bit knock-kneed, with the knees dropping toward one another, the block could move the knees outwards slightly and make more space in the outer knee joint and bring the inner knee joint closer together. If the knees are a bit bow legged, the block squeeze could bring the knees closer together, opening the inner knee joint and narrowing the outer knee joint.  Again, these shifts could alleviate pain in the pose.

If the inner thigh muscles are weak, the squeeze of the block is going to contract them more actively using the five adductor muscles, and this could bring the vertical alignment of the thigh bones back towards even if one is bowing or sagging in or out through the femur bones. And if the outer buttock and hip muscles are really tight and pull legs apart or tend to roll the femurs out a bit into external rotation at the hip joint, the squeeze of the block could help internally rotate the thigh bones to help them adduct a bit closer together, resulting in better alignment at the knee joint. Finally, the block also can activate the quadriceps muscle that tends to be weakest, the vastus medialis (which I believe is discussed in one of my earlier posts on knees). This can help balance out the stronger vastus lateralis, which would tend to pull the femur to the side and roll it out a bit at the knee.

And although this list of possible effects of blocks between the knees is not exhaustive, as you can see there are many potential impacts that could have led to the disappearance of your knee pain.

If you have pain in Utkatasana every time you do it without the block, I’d suggest you use the block regularly for a while, then try it without the block, but with the same alignment and muscle work that you feel when the block is in place. Hopefully this will resolve any pain in this pose, which is one of the original asana that Richard Rosen identifies in his book. He has other useful suggestions for Utkatasana in that book, which is a must-read for any yoga enthusiast!

See Featured Pose: Powerful Pose (Utkatasana) for our instructions on how to do this pose.

—Baxter