As Good as Their Patients' Words

Physical Therapy Yoga for Knee Pain

Published on January 21, 2016

Did you know that physical therapy yoga poses can help your knee pain? Learn how to reduce knee pain with these 3 simple physical therpay yoga poses. 


 

How to help KNEE PAIN

May people needlessly suffer from knee pain and turn to physical therapists for help. Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in physically active individuals, most prevalent from age 15 to 30 years and higher in females than in males.1-3

The most reported complaint is retropatellar (under the knee cap) pain or diffuse peripatellar (around the knee cap) pain during activities such as running, ascending and descending stairs, squatting, and sitting with flexed knees for prolonged periods of time.4,5

 

Causes of knee pain

Several causative factors of PFPS have been related to a certain malalignment of the lower body. Altered or excessive foot pronation (bottom of the foot caved inward) may result in a compensatory internal rotation of the tibia (turning inward of the lower leg bone) and increased valgus stress (knee turns inward).6-9 This malalignment is often associated with weakness of the quadriceps muscle on the inside of the thigh, especially the distal portion just above the knee cap called vastus medialis obliquus (VMO), combined with tightness of the soft tissue on the lateral side of the knee cap, including the iliotibial band (ITB), the distal lateral quadriceps, the lateral patellar retinaculum, and the lateral hamstrings.10-12

This combination of malalignment and soft tissue imbalance can lead to the knee cap being pulled off the track that it normally glides along in the femoral groove. When the knee cap gets pulled off its track, the cartilage below it can get rubbed, which can result in pain, inflammation, and reduced mobility.

Picture (A) below shows normal alignment, while picture (B) displays the alignment that may lead to PFPS.

 



treatment for knee pain 


To treat this condition described above, the goals would be to strengthen the medial (inside) portion of the quadriceps and lengthen the lateral (outside) soft tissue while mindfully correcting the malalignment. There are a few yoga poses that may help to achieve these goals.

  1. Goddess Pose (Utkata Konasana)

  • Try holding this pose for 1 minute. For more intensity, lift the heel of the unaffected leg. You should feel the inside of your thigh working, if not, try turning your feet out more and repeat the 1 minute hold.

 

  1. Crescent Lunge (Anjaneyasana)

  • Again, hold this pose for 1 minute with the affected leg forward. To get more medial (inside) quadriceps activation, press down in the lateral (pinky toe edge) of the forward foot.  Also be mindful that your front knee isn’t collapsing inward.

 

  1. One Legged Revolved Abdomen Pose (Eka Pada Jathara Parivrtti)

  • Whereas the first two poses are suggested to strengthen the medial quadriceps, this pose is intended to lengthen the lateral soft tissue. If you don’t feel the stretch in your lateral (outside) thigh, try pointing your toe down toward the ground. If you still don’t feel the stretch in the outside of your thigh, you may want to purchase a foam roller and “roll out” your IT Band and distal lateral quadriceps.


About the author:

I've been a Yoga and Meditation teacher for the last 8 years, receiving my training through Krishnamacharya Yoga Mandiram via their International Yoga Teacher Training Program that spanned over 3 years in Chennai, India. The research I did to complete my Doctorate in Physical Therapy through California State University, Northridge is going to be published in July of 2016 in the Journal of Physical Therapy Education. Other than yoga, meditation, and research, I'm passionate about trail running, rock climbing, snowboarding, and eating amazing/healthy food. I love my career as a Physical Therapist because I get to help people achieve their fullest potential.

Joshua Chambers, DPT
Doctor of Physical Therapy
Treating Knee Pain with Yoga Poses in Encino California
Athletic Physical Therapy 5353 Balboa Blvd Encino California 91361
818-986-4100

References

1.Kannus P, Natri A, Paakkala T, Jarvinen M. An outcome study of chronic patellofemoral pain syndrome: seven-year follow-up of patients in a randomized, controlled trial. J Bone Joint Surg Am. 1999;81:355–363.

2. Boling M, Padua D, Marshall S, et al. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20:725–730

3. Witvrouw E, Lysens R, Bellemans J, et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two-year prospective study. Am J Sports Med. 2000;28:480–489.

4. Thomee R. A comprehensive treatment approach for patellofemoral pain syndrome in young women. Phys Ther. 1997;77:1690–1703

5. Fredericson M, Powers CM. Practical management of patellofemoral pain. Clin J Sport Med. 2002;12:36–38.

6. Shelton GL, Thigpen LK. Rehabilitation of patellofemoral dysfunction: a review of literature. J Orthop Sports Phys Ther. 1991;14:243–249.

7. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33:639–646.

8. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. J Orthop Sports Phys Ther. 1987;9:160–165

9. Witvrouw E, Werner S, Mikkelsen C, et al. Clinical classification of patellofemoral pain syndrome: guidelines for non-operative treatment. Knee Surg Sports Traumatol Arthrosc. 2005;13:122–130.

10. Thomee R, Augustsson J, Karlsson J. Patellofemoral pain syndrome: a review of current issues. Sports Med. 1999;28:245–262

11. Witvrouw E, Lysens R, Bellemans J, et al. Open versus closed kinetic chain exercises for patellofemoral pain: a prospective, randomized study. Am J Sports Med. 2000;28:687–694.

12. Holmes SW Jr, Clancy WG Jr. Clinical classification of patellofemoral pain and dysfunction. J Orthop Sports Phys Ther. 1998;28:299–306.

 

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