15-Minute Routine to Ease Chronic Knee Pain - Monthly Yoga With Abi

Nov 22, 2016
by Abi Carver  
Yoga For Knee Pain

This month I’m going to base my article on a question I received about knee pain.

“About 18 months ago my knees gave way to patella-femoral joint pain with patella tendinopathy and iliotibial band insertional pain (from my physiotherapist’s notes). I purchased some of your routines before knowing this as I could feel something was not right. It was all too late and I have been off the bike for too long now trying to undo years of bad technique, bad training (i.e. none) and binge riding. I wish I’d seen your advice sooner and ignored the stereotype of yoga and men. From what I can gather it is common amongst riders who only ride when they get free time (away from work, family etc.) and don’t have the time to do what they are supposed to, train, stretch and cross train. I am under the impression that I have only trained the group of muscles that are required for cycling and neglected the other muscles, which have led to my knee being pulled out of alignment by the now dominating muscles of my leg. Can you develop a routine that stretches the muscles associated with cycling and strengthens the muscles that are not?”

Yoga for knee pain

This question perfectly illustrates how yoga can be used to relieve the pain caused by muscular imbalances resulting from your sport. As I’ve explained in previous articles, yoga works on (at least) three different levels: stretching tight muscles, strengthening weak muscles and calming the central nervous system. So how does this apply to knee pain?

The causes of knee pain:

The most common pattern of imbalances that can pull the kneecap (patella) out of alignment and damage the soft tissue in and around the knee joint is:

- Weak inner thighs (vastus medialis and adductors) from underuse and tight outer thighs (vastus lateralis) from overuse.
- Overdeveloped quads.
- Weak core and glutes.
- Tight calves, hamstrings, and hips.
- Weak feet and ankles.
- Poor ankle flexibility.

How to correct these imbalances:

- Strengthen the inner thigh (vastus medialis and adductors).
- Stabilise the ankles, knees, hips and pelvis.
- Strengthen the feet, legs, glutes and core.
- Foam roll the outer thigh (vastus lateralis/IT Band) and calves.
- Stretch the quads and hamstrings.
- Open up the hips.
- Increase ankle mobility.

I’ve covered the flexibility components of this protocol – for the quads, hamstrings and hips – in previous articles, so in this 15-minute routine, we’re going to focus on strength and stabilisation.

Alignment

It’s crucial that you focus on your alignment in this sequence so that you’re effectively strengthening the muscles that are weak and not causing further damage. If you’re suffering from chronic pain or injury, please check with your doctor or physical therapist before attempting any of the exercises.

Here are some pointers for the three central poses. Make sure you've nailed these before practicing the full sequence.

Chair

Chair Pose strengthens the glutes.

Alignment

- Stand with your feet hip-width apart, toes pointing straight ahead. 
- Sweep your arms forward and up, directly overhead. Bring your hands shoulder-width apart, palms facing each other. 
- Bend your knees, draw your hips back and sit back in Chair.
- Distribute your weight evenly between your toes and heels and don’t let your knees come forward over your ankles.
- Check that both knees point straight ahead and do not fall in towards each other or out to the sides.
- Without moving the position of your feet, you should feel as though your heels are turning in towards each other. This will stabilise your hips and align your kneecaps correctly.
- Reach through your fingertips and contract your abs. Draw your ribs in to prevent your lower back from arching.
- Hold the pose for 5 deep breaths, in and out through your nose. It should not be easy!

Warrior 1

Warrior 1

Alignment

- From Downward Dog, turn your left foot out 45 degrees and press into your palms to make room for your right foot to step in between your hands. 
- Inhale, keep your hips low and sweep your arms out and up into Warrior 1. Exhale, sink into the pose. You can bring your hands together or keep them shoulder-width apart. 
- Line up your front and back heels.
- Check that your front knee points straight ahead and comes directly above your right ankle.
- Turn your hips to face forward and try to bring your front thigh close to parallel with the mat.
- Engage the glutes on your back leg as you straighten your back knee. This will stabilise your left hip.
- Draw your ribs in to avoid overarching your lower back. 
- Hold the pose for 5 deep breaths, in and out through your nose.
- Step back to Downward Dog for the other side.

Bridge

Bridge Pose

Alignment

- Lie on your back with your knees bent and your feet flat on the mat, hip-width apart. Check that your toes point straight ahead.
- Rest your arms by your sides, palms facing down. Walk your feet back until your fingertips graze your heels. 
- Screw your feet into the mat and lift your hips all the way up. Check that your knees point straight ahead and do not fall out to the sides or in towards each other.
- Roll your shoulder blades underneath you and come up to your edge.
- Contract your glutes to stabilise your hips.
- Hold the pose for 5 deep breaths, in and out through your nose.
- Release the pose and hug your knees into your chest.

The 15-minute video

Views: 10,492    Faves: 132    Comments: 4


Other Resources

This video comes from the Yoga 15 Strength series – 15 x 15-minute videos that alternate between upper body, lower body, and core, to strengthen muscles, stabilise joints, improve posture and relieve pain. You can download the complete series here. One-legged standing poses are also very effective for stabilising the hips and core, especially Dancer, Warrior 3 and Crow. You can find instructions for these poses in my article on Balance and Agility.

This is just meant to be a starting point. It’s crucial that you see a physical therapist if you’re suffering from any chronic pain conditions because the causes and rehabilitation guidelines are going to vary wildly from person to person. Hopefully this video and a better understanding of what might be going on will kick off your road to recovery.

As always, please let me know if you have any questions: abi@yoga15.com.



Previous Yoga with Abi:

The Most Effective Style of Yoga to Increase Your Flexibility
Easy 15-Minute Yoga Routine To Loosen Up Tight Joints
How To Release Tight Quads And Increase Your Power
How To Release Chronically Tight Hamstrings
A Challenging One-Hour Yoga Flow Class
Take Control of Your Mind and Push Your Personal Limits
Yoga To Relieve Pain In Between The Shoulder Blades
15-Minute Routine To Unlock Tight Hips
15-Minute Yoga Routine To Build Core Strength
Short Yoga Routine To Help With Lower Back Pain in Bikers
15-Minute Yoga Routine To Enhance Balance and Agilityl
15-Minute Post-Ride Yoga Routine
8 Quick Yoga Stretches To Do At Work


MENTIONS: @yoga15app



Must Read This Week

75 Comments

  • + 45
 I'm too tired to do yoga this week
  • + 1
 i m tired too but i wouldnt even if i wasnt
  • + 8
 @RedBurn: Nobody likes honest people. Why can't you say that you are just tired? Wink
  • + 2
 @irus: thats what i thought i was not gonna lie! haha
  • + 1
 seems like everyone came just to see those videos haha xD
  • + 1
 Just watching those videos gets me tired. Yoga is too intense for me!
  • + 1
 Uhh huhuhuh.... You wuss
  • + 28
 I genuinely think these are some of the best articles on Pinkbike. I struggled with jumper's knee(patellar tendonitis) for a couple years so I wish I manned up and tried yoga years ago. Thank you Abi.
  • + 12
 Thank you. I'm so happy to her these routines are improving your riding. You still have time!
  • + 2
 I was having issues with this last year and early this year. Especially when i was doing more miles on the road bike. Best fix for me was a bike fit, stretching all the muscle groups in the lower body at least three times a week, focusing on the inner side of the quads in the gym and strengthening up the glutes. A bit of running helps with the ankle flexibility and calves too. The final bit of the puzzle was ditching my leg warmers on the road bike and loosening or dropping my knee pads on climbs on the mtb. The tiny bit of tension added put through my knee due to those made a huge difference!
  • + 1
 @dhridernz: Thank you. I'm sure all that info will be super useful for other riders.
  • + 0
 @yoga15app: is there some exercise that would be good for the cruciate ligament in the back of the knee, I have seen a physio and had an mri scan on my knee and the ligament has broken on both sides leaving around 30% in the centre of the ligament not damaged, my knees ache most of the time but I have an engineering job that requires standing up all day so I put the aches down to that most of the time, I mainly ride downhill but try and do a trail ride around once a month and notice my knees ache more the next day, any advice please, brilliant articles by the way
  • + 0
 @mark3: I'm so sorry. Has the physio been able to recommend some strengthening exercises? Maybe you could benefit from a second opinion. Please take any of these routines super slowly and don't continue with any movement that causes you pain.
  • + 16
 Thank you so much for this! Having runners knee, I'm always looking for ways to relieve the pain. Depends on the day but my knee soreness sometimes overpowers my muscle exhaustion. Looking forward to trying these exercises this evening.
  • + 1
 And to add, my misalignment of my patella is due to both overdeveloped quads and weak inner thighs. Do you have any specific movements or workouts that will balance this?
  • + 2
 @joalst: This is exactly what I'm dealing with as well. Mine started over the summer and I went to physio before my Whistler trip....Stuck to DH the whole week in Whistler which was somehow completely fine on the knee with over 50,000 vertical feet of descending. I came home and did one trail ride and the pain started right back up. I hope to hell this routine works!!!

Thanks!
  • + 3
 @joalst: this is really something you need to go and see a physio about. This routine is just a starting point and to give you a better understanding of what might be going on.
  • + 2
 This is a very common problem that's simple to identify, and is a huge cause of knee pain in cyclists:

www.youtube.com/watch?v=TF-1qGEe6lE
www.youtube.com/watch?v=zs7Lal8ii7M
www.youtube.com/watch?v=LJLFyIi5eqc

There are more parts, and he has some other really good videos too.
  • + 1
 Indeed, I'm hopeful that i got answers to my knee pain from this! Time will tell. Those exercises are feeling good so far though.
  • + 5
 I suffered from patellar tendinopathy for quite a while. Got it from heel strike running. At the time I did some research, it's not like other tendonitis, it's degenerative not inflammatory. Yoga is okay but I found that the best way to fight it is eccentric exercise, precisely eccentric squats on a decline.

There's plenty of information about it if you look through the literature, and as far as my research went, it's the most successful protocol. Your physio should know that and point you to the correct exercises (as long as you've been diagnosed this particular condition, knee pain can come from plenty of sources, each with its own specific treatment).

Worked amazingly for me. Now I just have to stay fit, keep the quads tone. Moved to barefoot/minimal/forefoot strike running and never had a knee problem again in years.

Everything above obviously comes from my personal experience which is limited and anecdotal, it's a medical condition and you should seek proper medical advice.
  • + 6
 Have dealt with knee pain since starting cycling.. hoping this helps! Thanks Abi!
  • + 2
 Not a problem!
  • + 2
 An ounce of prevention is worth a pound of cure. I know, it sounds silly.... silly until your knee goes on the bunk, then you will try anything and everything that will make the pain go away. Too late. Do what ever it takes to keep your body strong, flexible and balanced and you will stay on your bike instead of the sofa
  • + 1
 I usually don't suffer from knee pain when riding, but sometimes when I start running again after having not done that for a while. Is that the same cause, would these exercises help? Of course they wouldn't do any harm either. Other than that downward facing dog (I've developed incredibly short hamstrings over the years) these other exercises seem fairly doable, I'll give them a shot Smile .
  • + 2
 Absolutely. Strengthening the knee, hips, inner thigh and glutes and stretching the quads, hamstrings and calves will really help. And check out this post for your hamstrings:

www.yoga15.com/blog/a-complete-solution-for-releasing-tight-hamstrings
  • + 1
 @yoga15app: Thanks Abi, I'll do. I'm currently recovering from a broken collarbone from last week (had surgery last Tuesday) so I'll probably be running before I can ride the mtb properly. I might not be able to execute all those recommended yoga postures yet but I'll see how well it goes.
  • + 2
 @vinay: Look after yourself!
  • + 2
 @yoga15app: Thanks Abi, I'll do. The collarbone feels reasonably fine, but my back is killing me. It doesn't quite like that sling and it has probably taken a beating as well in that crash. This fall/winter will, next to some low speed tech, have a huge focus on strength and mobility. My girlfriend will finish her pre-teacher yoga training this month (tomorrow actually) and will start a full yoga instructor training in January. So I have someone to practice along with. She has a background in karate instead of mountainbiking/running/unicycling/soccer (like I do) so she is pretty agile already.
  • + 2
 @vinay: If your girlfriend can give you some guidance in terms of proper alignment, it will make the poses even more effective. And also you can motivate each other to stay consistent. That is where the real benefits come. If either of you has any questions, you can email me at: abi@yoga15.com.
  • + 1
 @yoga15app: Thanks for the offer Abi! She thinks you do an amazing job and loves your voice as well Smile . Your videos are very clear but we'll get back to you if we everl have questions. Cheers!
  • + 2
 all this is sweet, all this seems to relate to my job that I do (high-rise window cleaner) Our human body kills everyday and this a a great source of information for all of our day to day life. Thanks so much
  • + 1
 My pleasure. I hope it helps you to give something back to your body!
  • + 0
 I was hoping this would help with my wrecked knees but I cant put them knee-cap down on the floor for even a second as they been damaged from working down on my knees a lot. There has got to be a programme out there for people with similar symptoms?
  • + 1
 I have been getting some twinges in my knee after taking a knock back in July. Its not to bad but its not right and not going away so I think I will be giving this a go. Thanks Abi
  • + 2
 Sounds like you could benefit from some regular strategic stretching and strengthening sessions.
  • + 0
 @yoga15app: You are probably right. I do try and look after my core and stretch whenever I go to the gym which is at least once a week, but I doubt it is enough and I know my flexibility could be much better.
  • + 2
 I need something for tendonitis on the inside of the elbow. I seem to have golfer's elbow that won't go away, and I don't own a set of golf clubs.
  • + 1
 Go talk to your doctor about PRP injections. Proven to be very effective in the elbow, the knee not so much. I had one injection for horrible tennis elbow.... gone!
  • + 0
 @Mojoronnie: I have golfers and tennis elbow in both arms, and I don't even play either, what are prp injections, I have had several cortisone injections and they work for a limited time, never heard of PRP ones though, I have heard mentioned about having your blood injected into the tendon but not heard if it works well or not
  • + 1
 @mark3:
I have suffered greatly on both arms with this.......i would not suggest any injections. go see a physio therapist and get healthy the old fashion way by working the problem out. learn how to manage the problem yourself with exercises, ice and rest. itll work but take a while. well worth it in the end
  • + 1
 @mark3: PRP injections are very successful in the elbow. I would definitely give them a try if nothing else has given you relief.
  • + 1
 @payback: Not sure if your familiar with PRP injections but they are nothing like cortisone injections. It's your own blood, spun in a centrifuge separating the incredibly powerful healing proteins. The proteins are then injected into the area of the tendon causing pain. It's your own blood, not side effect to the treatment. I battled tendonitis for years, hired a physio, iced, stretched, strengthened all to no relief. One PRP injection and could return to normal activities. Highly recommend
  • + 1
 neat, as severe knee pain has been keeping me off my bike as i've been too scared to go too far out incase it gives up or locks up.
  • + 1
 Take rehab super slow. It sounds like you need to see a physio as soon as you can. Few things are more important than the health of your joints.
  • + 1
 @yoga15app: i've been seeing a physio and orthopedic consultant since feb, but no one can find out what's wrong, so i've been sticking to light exercises and weight management to see if strengthening the muscles, tendons,and ligaments, as well as seeing if losing weight helps it.
  • + 1
 @ashyjay: Some light yoga will also be good to get you moving through full range of motion. And you might get some benefit from Pilates. eFit30 is a good channel on You Tube.
  • + 1
 Thanks for this, Abi. The years of wear and abuse have not been as enjoyable as the activity was at the time. Been chasing and trying to remedy the pain, so this will help.
  • + 2
 No problem. It really should help with the aches and pains. You may have to start off doing these routines several times a week, but as you body loosens up, you'll be able to dial it back.
  • + 1
 I need to do something once im able to start walking again. I've been on crutches and one foot for the past 3months due to foot surgery
  • + 1
 This is EXACTLY what I need. My knees have been rally aching the last 3-4 months and I think this will help a lot, thanks Abi
  • + 1
 Let me know how you get on.
  • + 2
 I recently broke my knee cap and this will be awesome for me. Thanks a lot Abi and Pinkbike !
  • + 1
 No problem. Make sure you check with your doctor first and take it easy.
  • + 1
 Femoral patella is why I started mountain biking and now why i call canada and these epic trails home Smile
  • + 1
 Is this knee pain set on your app? If so, where can I find it? I use the hip openers routine often and it's a big help.
  • + 1
 Awesome. The knee pain vid is Strength 5 on the app. And in fact, any of the lower body strength vids will help.
  • + 2
 great timing for this!! Thanks Smile
  • + 1
 For me, an hour session of yoga is harder than a 40 mile ride with 10,000 elevation gain.
  • + 1
 Maybe you should work on that
  • + 1
 Looking forward to trying these out. Cheers!
  • + 2
 Let me know if you have any questions. The poses can be quite hard.
  • + 2
 what is a downward dog
  • + 1
 What happens if you have very tight aductors and relaxed quads?
  • + 1
 Stretch your adductors and do some squats!
  • + 0
 @yoga15app: I got my adductors from powerlifting. I rely on them too much when I squat. I need to focus more on activation my quads I think.
  • + 1
 i fight the chronic pain with The Chronic.
  • - 2
 Off to the beach
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