Email
January 2006

Every year, nearly 11 million Americans (as well as many around the world) complain to doctors about knee pain.  We can only guess how many more are experiencing knee pain without going to the doctor.  Orthopedic surgeons operate more often on the knees than on any other body part.  If you have ever experienced knee pain, you know how frustrating and limiting it can be.  It is not unusual to have small misalignments in the knee. Repeated over months and years of running, hiking, dancing, doing yoga etc, these small misalignments can contribute to pain and joint injury.  The good news is that strengthening the key muscles that support the knees in a balanced way is a wonderful tool for building strong healthy knees.   Staying aware of knee alignment during activities will help keep you injury free.
 
The knee is so vulnerable and sensitive to alignment because it is a shallow, basically unstable joint.  Picture two long columns stacked atop each other, the thigh bone and the shin bones.  The flat surfaces of the bones make the knee dependent on ligaments and tendons to hold it together.  Any side-bending or twisting endangers these supporting tendons and ligaments. 
 
The best indicator of knee alignment is the relative positions of the foot and the kneecap.  The foot acts like a pointer showing the rotation of the shin and lower leg, while the kneecap shows the rotation of the thigh bone.  When standing with legs either straight or bent, the kneecap should point over the center of the foot.  Stand in front of a mirror with your feet parallel and your knees straight, like in the mountain pose in yoga.  Notice the angle of your knee caps, do they fall inward or bow outward?  Is it difficult to keep the feet pointing straight ahead, do they want to toe inward or outward?  Notice the back of your knees are they hyper extended and bowing backward, or is it difficult to straighten them at all?  As the wise women tell us, awareness is the first step toward change.
 
To learn proper leg alignment, it can be helpful to practice these two simple exercises, in both it is helpful to stand in front of a mirror.
 
In the first exercise, lean back against a wall with your heels about a foot from it; slowly slide down the wall; as the knee bends, make sure the kneecap points straight out over the center of the foot and the feet are parallel.  Notice the muscles you are using to keep this alignment.  Do the knees want to spread apart, do they want to come together?  Stay active in the feet pressing the four corners of the feet strongly into the floor and lifting the toes (all of them). 
 
In the second exercise, stand with your left hand on a counter of the back of a chair; put your right foot on the broad side of a yoga block.  Make sure that the right knee stays centered over the foot as you step onto the block and as you set the left foot back on the floor.  Stay focused.

As part of your warm-ups before activity stretch and open the hips. If the hips are tight then they less stable joint of the knees will have to accommodate and move in a larger range of motion than is healthy. The butterfly or bound angle pose in yoga will open the inner groins. Simply sitting cross legged with the feet about 8 inches from the body and bending forward from the hips will open the back of the hip, repeat this with the other foot on top. A minute in each position is a minimum for allowing those muscles to release.

As long as we stay aware of proper alignment and avoid acute injury our knees should stay pain free. It is not necessary to avoid bending them. As a matter of fact it is important for the health of your joints to keep them moving. Moving the joints within their proper range of motion keeps them lubricated and prevents stiffness. As with any other part of our body, mind and spirit, balanced strength and flexibility keeps us healthy.