Teaching: What if a student has a knee injury? What modifications can I suggest?

Knees are fragile and complex joints. It is a hinge-type synovial joint, which mainly allows for flexion and extension and a small degree of medial and lateral rotation. It is formed by articulations between the patella, femur, and tibia.

Every student’s knees are unique and will feel different from pose to pose and different on each side of the body. Something that could feel wonderful in your knees could be excruciatingly painful for somebody else.

Firstly, steer away from offering medical advice to your students regarding knee injuries or any injuries for that matter, as that is not our role as yoga teachers. However, do advise students to seek professional support from a physiotherapist, Registered Massage Therapist, and/or Osteopath if they require further assessment on their specific case.

Things you can do to support your students who are working with knee injuries in your class is to offer lots of options! This will empower your students to make choices that serve their unique body at that moment and will ensure your classes remain inclusive and accessible to everyone. Props, modifications, and variations are your best friend as a teacher when it comes to guiding students through practice with knee injuries.

Here are some tips for students working with knee sensitivity:

1. Avoid what hurts; always work within a pain-free range of motion.
2. Stretch before you strengthen; use safe, slow, gentle, and conscious stretching techniques, in addition to active forms of stretching.
3. Always practice forward folds with knees bent, as well as with the core and lower back muscles engaged.
4. Strengthen muscles adjacent to the knees: quads, hamstrings and especially adductors, which tend to be weak.
5. Grip the mat (when in standing poses) with the pads of toes to engage/contract intrinsic and extrinsic muscles of the feet.
6. It's important to prevent further injury. Go slowly. Listen to your body. No striving, no straining, no pushing. Be kind to yourself.

When offering modifications for knee injuries or any injuries, it is important to emphasize to the students that if they experience pain, they have autonomy over their bodies and can make choices to back off from the place of pain.

Use props and modifications to support the joints. Amy Matthews suggests paying more attention to what movements cause the pain, and less time trying to identify what the anatomical cause is. Here is a useful link to one of her youtube videos: Click Here>>

Below are some prop and modification options to support knee sensitivity:

• Fold part of the long edge of the mat over to add extra cushioning under the knee.
• Tuck or untuck the toes on the back foot depending on what feels comfortable.
• Place a blanket or soft chip foam block under the knee.
• Raising the hips with a prop may help to alleviate pressure in the knees during seated asana.
• Place a bolster or rolled-up blanket between the pelvis and the heels in asana such as Child’s pose or Rock pose.
• Sit in a chair or lean against a wall with legs extended instead of practicing Easy Pose/Sukhasana.
• In Pigeon Pose, Sukhasana, Gomukhasana or other asana requiring deep knee flexion, try adding more dorsiflexion to the ankle.

Some teachers are concerned that if they have a knee injury they may be unable to demonstrate all the asana and their variations. You don’t have to! If you are working with injury, yourself, you might be inclined to share that information with your students and explain to them how you are modifying and adapting poses to serve your body. This can be extremely insightful and empowering for your students as you lead by example.

You also do not have to physically demonstrate every pose and variation. Verbal cueing can be just as impactful and can guide your students safely without the teacher having to show a visual demonstration. Sometimes experiencing an injury can make us better teachers. We become more aware, more compassionate, and more attuned to the limitations injury can bring while exploring creative solutions so we can continue to practice and serve our students and our own bodies at the same time.

Your Yoga Flow Faculty member and Teacher Nancy shares:

“I have battled with knee issues since a young age; with tight hamstrings, hyperextended knees (and ballet lessons starting at 3 years old). During my first yoga training, I tore the meniscus in both knees very badly from overdoing postures with too much flexion, in particular Pigeon and Sukhasana. It's been a long journey of AWARENESS of how I am/move in my body. I stopped pushing my knees into hyperextension and have had tons of bodywork including cranial sacral, fascia work, and osteopathy.

Awareness of my feet and walking pattern, how I am yielding into my feet for standing poses, awareness of shapes that strengthen my core (as an entire torso), and practicing joint-freeing/stabilizing movements have all resulted in much happier knees. The greatest gift of yoga to me has been awareness to all of my layers.”