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Friday Practical Pointers: Who Should Avoid Certain Knee Movements?

by Baxter

Flexion and Eternal Rotation by Melina Meza

Our tour through the body’s major joints continues today with a look at who should avoid certain knee movements. When it comes to possible movements, the knee joint is a quite a bit simpler than the hip and the shoulder as it is mostly about bending and straightening. But because of its role in standing, walking, and running, the knee is one of the most commonly injured joints and very frequently affected by the wear and tear of osteoarthritis. 

Movements of the Knee Joint

Flexion: Bending your knee (moving the lower leg bones backwards toward the upper leg). You make this movement when you move into bent-knee standing poses such as Warrior 1, 2 and Side Angle Pose when the front leg goes from straight to bending the knee over the ankle. The movement is also essential for bending your knee more deeply, such as when sitting in Hero pose (Virasana) or Child’s pose (Balasana). 

Extension: Starting from a bent knee position, straightening your knee (moving the lower leg bone forward and away from the upper leg). The opposite movement of flexion is extension, so anytime your knee is bent and moves towards straightening, your knee is going into extension. You make this movement when you exit from Warrior I or 2 (Virabradrasana 1 or 2) or Extended Side Angle pose (Utthita Parsvokanasana) or in the transition from Warrior 1 to Warrior 3. You also make this movement when you lift your back leg in Hunting Dog pose, come into Cobra pose (Bujangasana) from Child’s pose (Balasana), or move into Downward-Facing Dog pose (Adho Mukha Svanasana) from all fours. 

Internal Rotation: When your knee is bent, rolling the lower leg bones in, towards the midline of your body. The lower leg can internally rotate a small amount at the knee joint only when the knee is in flexion. You make this movement in Hero pose (Virasana), both seated and reclined versions, as well as in the many seated poses that have one leg in Hero pose. 

External Rotation: When your knee is bent, rolling the lower leg bones outward, away from the midline. The lower leg can externally rotate a small amount at the knee joint when the knee is in flexion. You make this movement in many bent-knee seated and reclined poses, including simple ones like Cobbler’s pose (Baddha Konasana), both seated and reclined, more complex ones like Half and Full Lotus poses (Padmasana). 

Note: When the knee joint is in full extension, such as in Mountain pose (Tadasana), your lower leg cannot independently rotate from the knee, either internally or externally. In this case, when your upper leg rotates from the hip, your lower leg goes along for the ride. You can see this when you turn your front leg out to prepare for pose a standing pose like Triangle pose (Trikonasana) or in a straight leg seated pose, such Wide-Angle Seated Forward Bend (Upavista Konasana).

Cautions for the Knee Joint

Now let’s look at who should avoid or minimize certain knee movements. Keep in mind, however, that we want to maintain as much of our full range of movement of the knee joint as possible. So, in many instances, my caution will not mean “don’t” or “never,” but rather approach cautiously and stop if the movement worsens pain. In general, you should avoid or minimize any knee movement if you have:

1. Acute painful injury to the knee area that gets worse with that movement, whether from a sports activity, such as acute ligament sprains, or a problem like acute bursitis that is the result of bumping your knee cap or over use.
2. Chronic issues that flare with that movement, such as those with knee joint arthritis or those with meniscal and ACL ligament injuries that have not been repaired or even, in some cases, that have been surgically repaired. 

Now for the specific movements. Who should avoid or minimize the following movements?

Flexion

1. Those with significant swelling in the joint, whether from an acute injury or the flare of a chronic condition, such that the swelling actually inhibits movement or elicits significant pain when movement takes place.
2. Those with Patellar Femoral Syndrome, a fairly common condition affecting the knee cap and knee joint, which often is worse with flexion.
3. Those with arthritis of the knee that become more painful with flexion.
4. Those with bursitis at the kneecap area or with a Baker’s cyst at the back of the knee.
5. Those with ACL repairs who need to avoid extreme flexion, such is in full Child’s pose (Balasana).

Extension

1. Those with tears to the ACL ligament need to avoid sudden strong extension, such as stepping from Lunge pose (Vanarasana) to Downward-Facing Dog pose (Adho Mukha Svanasana), or jumping from Standing Forward Bend (Uttanasana) to Downward-Facing Dog pose.
2. Those with hyperflexible knees may want to avoid full extension in straight leg poses to avoid wear and tear on the internal knee structures and ligament over-stretching.

Internal Rotation 

1. Those who experience increase pain in the knee in poses where the knee is both flexed and internally rotating, such as Hero pose (Virasana), both seated and reclined, and the seated twists where one leg is in Half Hero pose (Adra Virasana).
2. Those with tears to the meniscus (the half moon cushion of the knee) where increased pain or locking of the knee occurs with flexion and internal rotation.

External Rotation

1. Those who experience pain in the knees where the knee is both flexed and externally rotating, such as Cobbler’s pose (Baddha Konasana), both seated and reclined, Half and Full Lotus poses (Padmasana). 
2. Those with tears to the meniscus (the half moon cushion of the knee) where increased pain or locking of the knee occurs with flexion and external rotation.

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