In this article, we explore effective strategies for protecting the knees and back during the yoga practice. Proper alignment cues and suggested modifications are provided for the prevention of injuries, while still enjoying the transformative benefits of yoga.
The Growing Popularity of Yoga
The practice of Yoga dates as far back as the fifth and third centuries BCE with the first known mentioning of “yoga” in the Upanishads, being part of ancient Vedic teachings. Yoga has since spread widely in the western world and it’s current popularity is astonishing, with Yoga Teacher Programs being offered at most yoga studios and schools and even online.
“Yoga” is derived from the Sanskrit word “yuj”, meaning “to yoke” to “to unite”. Swami Sivananda, a yoga guru inspiring a Yoga tradition that spread worldwide, defines Yoga for us in multiple ways:
Yoga is taking care of body/mind/spirit, not seeking after fitness or beauty, or health.
Yoga is finding the cause of our suffering and showing the way to get out of it — to be free from it.
Yoga is a system of education for the body, the mind, the intellect, and the inner spirit.
Yoga is a way of life.
Yoga is universal, not sectarian or separate.
Yoga helps us to go to the root of our suffering, spiritual ignorance (not knowing who we really are).
Yoga brings individual peace of mind and collective peace.
Yoga is unity in diversity.
Yoga is self discipline.
Yoga is life.
Yoga is simple life.
Yoga is moderate life.
Yoga helps us to deal with stress.
Yoga helps calm emotions.
Yoga is a balanced mind, strong and steady.
In the context of modern Yoga, there is an emphasis on the physical postures (asanas) and on outer image (beauty). Contemporary Yoga classes tend to resemble fitness classes and there is an observable attention on the outward appearance. True and traditional Yoga, by contrast, is a spiritual practice with the aim of realizing (knowing) the self through various practices, such as meditation, asanas, breathwork (pranayama), self-study, service to others, lifestyle changes, and more.
An individual aspiring to take up a Yoga practice may find it challenging to find proper guidance for the following reasons:
Yoga Teacher Trainings have become so widely accessible and with variable teaching standards. Finding a proper teacher has become a challenge and identifying authenticity and true expertise in a teacher, even moreso.
Yoga has been commercialized to an extent that the original objective of the practice (spiritual evolution and self-realization) has been compromised or forgotten. The teachings and practice have become a business. Many Yoga Studios therefore resemble fitness studios more than true schools of Yoga.
The asana practice has been emphasized in contemporary Yoga classes at the expense of other valuable parts of the practice, such as meditation, proper breathing, proper relaxation, proper diet, ethical guidelines for living, philosophical guidance in scripture, and more. Yoga is more than a practice performed 2–3 times per week for an hour at a time. It is a lifestyle and its holistic application brings the greatest results in the context of one’s personal development.
Injuries with the Yoga Practice
This article will describe common injuries with contemporary Yoga, especially due to the lack of knowledgable and reputable Yoga Teachers and the emphasis on physical asana postures at the expense of other Yogic practices.
When attending Yoga classes, is it important that students inform their teachers of any pre-existing conditions. Educated Yoga teachers should also be proactive in mentioning any contraindications of a pose. Teachers should also know how to adjust a student’s practice to avoid risk related to preconditions.
A survey from 2008 revealed that the most common injuries in the Yoga Practice were injuries to the hamstrings, knees and lower back. We will focus on knee and lower back injuries in this article.
Knee Injuries
Knee injuries are common for the following poses: Virabhâdrâsana (warrior pose) I and II, utthita trikonâsana (extended triangle pose) padmâsana (lotus pose), eka pâda rajakapotâsana (onelegged king pigeon pose), and virâsana (hero’s pose). (Image 1)
Image 1: Illustrating the Yoga poses accounting for most knee injuries.
Protecting the Knee Joint in Standing Poses
Because the knee joint shares muscles with the hip and ankle joints, its stability depends on the alignment and mobility of the hips and ankles (Image 2). The knee is also surrounded by ligaments and tendons to ensure its stability and limit its range of motion to extension and flexion (Image 3).
Image 2: Illustrating the anatomy of the knee joint and its relationship to the hips and ankles.
Image 3: Illustrating the anatomy of the knee joint.
Warrior Poses and Trikonasana (Image 1)
The warrior poses put a lot of demand on the hips and therefore risk the knee’s stability and safety, as the force of the pose can be transmitted to the knees. A narrower stance in these poses can protect the knees and put less of a demand on the hips and thigh muscles. To protect the bent knee, students might consider using a chair or practicing near a wall (Images 4–6).
Image 4: Warrior 1 Pose using a chair to protect the knee joint and put less demand on the hips and thighs.
Image 5: Warrior 2 Pose using a chair to protect the knee joint and put less demand on the hips and thighs.
Image 6: Warrior 2 Pose using the wall to stabilize the knee and put less stress on the hip joints and thigh muscles.
While performing these poses, it is recommended to align the center of the knee with the center of the foot. Students are also encouraged to adjust their stance to reflect the actual, not “ideal,” opening of their hips.
To protect the front leg’s knee from hyper-extending in Trikonasana, press down the mound of the big toe and do not lock the knee. (Image 7)
Image 7: Avoiding hyperextension of the front knee in Trikonasana.
Protecting the Knee Joint in Other Poses
Lotus pose also requires considerable hip flexibility and, when hips are tight, students force this pose by pulling the foot up with their hands. This puts a lot of stress on the ligaments and tendons around the knees. Rather than go into lotus pose immediately, students are encouraged to prepare with seated and standing poses that open the hips and promote mobility in the hip joints. The teacher should model how to carefully enter and exit lotus pose to protect the ankle and knee joints.
If the hips are still relatively tight after such preparation, they can consider alternative poses to lotus, such as baddha konasana (bound-angle pose) and sukhasana (easy pose). If the knees need support, students can place props under the hips and knees. (Images 8–9). Props can also be used in virasana (hero’s pose) and eka pada rajakapotasana (one-legged king pigeon pose) to protect the knee joint. (Images 10–11).
Image 8: Baddha Konasana with props, elevating the hips and supporting the knee joints.
Image 9: Sukhasana with props to elevate the hips and support the knee joints.
Image 10: Use of props to reduce stress on the knee ligaments and tendons in hero’s pose (Virasana).
Image 11: One-legged king pigeon pose with props to reduce stress on the hips, knee joints, and lower back.
Those with previous knee injuries or surgeries should progress very carefully to and respect their limits in these poses. Ask the teacher for support with props as needed for comfort and to reduce pain.
Low Back Injuries
Low back injuries are common with the following poses: Seated and standing forward bends, twists, and backbends. (Image 12)
Image 12: Illustrating the Yoga poses accounting for most back injuries.
Protecting the Lower Back in Forward Bends
In the context of forward bends and injuries to the lower back, we consider the anatomy of the spine, pelvis, and legs. (Image 13)
Image 13: Demonstrating the role of the spinal muscles, hamstrings and pelvis in forward folds.
In standing and seated forward folds (Image 12), tight hamstrings can prevent the pelvis from tilting, resulting in flexion of the lumbar spine rather flexion of the hips. (Image 14)
Image 14: Demonstrating the difference between flexion in the lumbar spine (rounded back) vs flexion in the hips (flat back).
Performing a forward fold with a round back (indicating tight hamstrings) could potentially contribute to or exacerbate complications in the lower back, such as disc herniation and sprains of spinal ligaments or muscles. To protect the lower back, tilt the pelvis forward toward the legs as a first step to any forward bend.
To protect the lower back in a forward flexion, broaden your stance (feet hip width apart), bend the knees and extend the thoracic spine away from the pelvis (Image 15). Props, such as a chair or blocks, can also be incorporated to further support the lower back in this posture by reducing weight of the upper body (Images 16–17).
Image 15: Demonstrating how to protect the lower back from injury in a standing forward fold: Broaden stance, bend knees, and extend thoracic cage away from the pelvis.
Image 16: Using a chair to protect the lower back in a standing forward fold.
Image 17: Using blocks to protect the lower back in a standing forward fold.
Proper preparation can also reduce injuries in forward flexion. Supta padangusthasana (unilateral forward flexion with the spine supported) (Image 18), can prepare the body for more demanding forward folds such as uttanasana and pascimottanasana (seated and standing forward flexion). This pose will lengthen the hamstrings while providing support and proper length for the spine.
Image 18: Supta padangusthasana
Protecting the Lower Back in Twists
Ardha matsyendrasana (Image 19) can involve excessive flexion, and flexion combined with rotation puts force on the spinal discs. Precaution can be taken in this pose by elevating the hips, tilting the hips forward, maintaining the natural arch and length of the lumbar spine, and flexing both feet to protect the knee joints. (Image 20) Students should also refrain from using their arms to force themselves into a more aggressive twist.
Image 19: Ardha matsyendrasana performed without precaution.
Image 20: Protecting the lower back and knee in ardha matsyendrasana.
In place of ardha matsyendrasana, jathara parivartanasana (Image 21), can be performed. In reclined twists, the floor helps to maintain length in the spine and evenness in the shoulders. Props can be used to reduce effort in reclined twists, as shown in image 21.
Image 21: Jathara parivartanasana
Protecting the Lower Back in Backbends
Lower back injuries are more likely in backbends such as ustrasana (camel pose) (Image 22) and ûrdhva mukha svanasana (upward-facing dog pose) (Image 23). This is because the lumbar spine is forced into overextension due to reduced thoracic extension mobility.
Image 22: Ustrasana
Image 23: Upward facing dog
In such poses, students should be careful not to over-contract the lower back. The intention of these poses is not to exploit flexibility. When practicing back bends, keep the following in mind:
Maintain steady strength in your legs
Root the tailbone down
Lift up through the whole upper body and bend in the upper back as much as you can
Curl your shoulders and chest back
Keep the head (cervical spine) in line with the spine
Teachers should pay attention for asymmetries in the body that could stress isolated parts of the spine.
Preparatory poses for active backbends include the following poses:
Passive backbends with props to encourage symmetrical length of the thoracic spine (Image 24)
Bhujangasana (cobra pose) to stabilize the tailbone and actively extend the thoracic spine (Image 25)
Setu bandhasana (bridge pose) to both strengthen and stretch the front thighs and increase thoracic and shoulder mobility (Image 26)
Image 24: An example of a passive backbend.
Image 25: Cobra pose
Image 26: Setu bandasana
Seeking Proper Guidance
Many of these adjustments may be challenging to make for students who are new to the Yoga practice. Even for those who are more experienced, the observation and feedback of an experienced practitioner and teacher is invaluable. Students are encouraged to be discerning when selecting a studio and teacher that can support them in practicing safely. If a student desires one-on-one support, they can seek feedback from an experienced Yoga Teacher or Yoga Therapist in private one-on-one session. Such a session will enable them to receive individualized feedback based on their personal history and anatomy. Teachers should always emphasize the importance of respecting one’s limits and students should always be welcome to vocalize questions and concerns during a class so that they can use class time to learn and receive valuable feedback.
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