A different view of knee alignment

Knee problems are common, and in yoga classes we are often given a lot of tips on how to align our knees in various poses. While many of the alignment tips I have received and offered over the years are beneficial, my studies in biomechanics have made me re-think the common yoga cue to line up your kneecap with your toes or even your second toe.

First of all, your foot may not be optimally aligned to make this cue useful. Secondly, your kneecap may not be centered on your thigh bone.

Here’s why. Your kneecap is a floating bone, and behaves like a puppet on the string of your quadriceps muscles, which are located at the front of your thigh. Strength in one of the quadriceps and relative weakness in another can pull your kneecap toward the stronger muscle. Typically, the outer quad (vastus lateralis) is stronger than the inner quad (vastus medialis).

So if you are standing in Mountain Pose, for example, and you adjust your stance so that your kneecaps are pointing forward, you many actually have internally rotated thighs. This internal rotation can, in those who have some joint laxity, reinforce the tendency to hyperextend the knee joint.

By rotating your things inwards and/or “locking out” the knee, you bypass the structures in your knee (ligaments and tendons) that are designed to keep the knee from hyperextending. This can, over time, create issues in your knees, hips, low back and pelvic floor. Your feet and ankles can be affected, too.

Whether you are in a yoga pose or moving in your daily life, give thought to the alignment of your thigh, rather than in what direction your kneecap is pointing.

Try this at home!

You will need to have a full-length mirror or a friend to guide you.

Part 1:

  • Wear shorts or pull your yoga tights or trousers up above your knees.
  • Line up your feet so that they point forward and space them hip-distance apart. Bend forward from your hips and peak back at the mirror to look at the backs of your knees. What do you see? If you are like most of us, the backs of your knees will be turned out to the sides.

Part 2:

  • From standing as above, bend your knees slightly and externally rotate your thighs. This action comes from your hips. Keeping this external rotation, slowly straighten your knees. Your kneecaps now may look like they are turning out to the sides instead of facing forward.
  • Maintain this thigh rotation and fold forward from your hip joints again.
  • You should notice that your popliteal fossae (knee pits) have turned to face the mirror now.
  • Come back up to standing and feel into the new alignment for your knees. Notice any areas of effort and/or strain.

Caution: If you notice strain in your knees, it could be an indication of just how much you internally rotate your thighs and how your body has adapted to this rotation. When in doubt, back out. Explore within your pain-free range of motion. Here are a couple of ways to do this:

  1. Take your weight to the outside edges of your feet, even allow the base of your big toes to lift off the ground.
  2. Keep a bit of a bend in your knees as you externally rotate your thighs and align your knee pits.

Of course, you wouldn’t walk around like this. The idea here is to explore the rotation of your thighs and alignment of your knee pits to bring awareness to your postural habits and to your alignment both on and off your yoga mat. On your mat, this awareness will serve you well in yoga poses such as Mountain, Tree, Triangle, Half Moon, and more.

Bonus: Maintaining external rotation of your thighs will help counteract the tendency to hyperextend your knees if that is your tendency.