Is this why my knee is hurting?

My right knee is hurting, again.

As I noted yesterday, there was a little “pop” during a Marichyasana D adjustment, and nothing seemed immediately amiss. But the day after, it’s awfully tender — a very familiar feeling.

And that’s the thing: familiarity. The pain — it may just be discomfort, really — is very specific. It hurts precisely when I bend my leg into half lotus or just in that direction. It has for the past year. Same thing. It gets a bit better and then it gets a bit worse.

Full flexion straight on or in something like Virasana doesn’t hurt. It’s just when I bring my foot and lower leg inside of my thing/femur.

Finally, during lunch today, I thought maybe I ought to see why this is. (Pretty smart, huh?) And I bet you know where that took me: And there I found this:

There are two movements that when combined would put the most amount of pressure on the medial meniscus. The two movements are flexion of the knee and internal (medial) rotation of the tibia. In lotus both the femur and the tibia have to rotate externally. If the tibia doesn’t have enough outward rotation, there still could be enough in the hip to make up for it, or vice versa. If however both the tibia and the femur lack in their ability to do external rotation then what you have is more internal rotation, which by itself can put pressure onto the medial meniscus. When you combine this with the knee being flexed, as it is in lotus you end up with even more pressure on the medial meniscus.

I don’t even have to do the test. I know that’s the issue. I’ve seen how, in lotus, my right knee gets no where near the floor.

The question, now, is whether I’m satisfied that all that’s happening is my medial meniscus is getting compressed. Or is it something more (aka a tear)? My guess — and seemingly everyone else’s, from yoga teachers to doctors — is that’s all it is. It doesn’t hurt all the time and, again, it is a very specific movement to pain dynamic.

This particular “stiffness” is proving very hard to undo, though.

And that’s today’s lesson from this infuriating practice.

Posted by Steve

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Two Ashtangis write about their practice and their teachers.

10 thoughts on “Is this why my knee is hurting?”

  1. Steve, I have had the same exact issue since last June in my left knee – pain in the medial part of the knee, but only with full flexion and external rotation – as in padmasana. (Janu sirsasana A was also uncomfortable for months.) Yet, full flexion like Janu B or virasana felt painless. Kind of a bummer.

    Have hope. Here’s what I have been doing for the last four months or so, and I finally have gotten back to doing lotus (it’s still not as “tight” as it once was, but it is a pain-free padmasana). Janu A has returned, too, although the knee is still a bit high.

    1. Be really – really patient. You have your whole life to do asana – dirga kala. Trust the practice.
    2. Get bodywork. Through this, a few months ago, I found that I had a lot of scar tissue in my hamstrings and in my quad – unbeknownst to me – and that that was a big part of the problem. The shortened, stiffer muscles limited the extension and external rotation of the femur.
    3. Put oil on it, every evening, before you got to bed. I have found that ayurvedic mahanarayan oil, used for inflammation, seems to help (I have more external rotation when I practice the next morning after using it the night before). Or, just sesame oil at night is fine, too. Every night. (Wear some lousy pj’s so you don’t mess up your sheets.)
    4. Dry brushing to increase circulation on the areas over the scar tissue, if there is any, and on the knee, and daily oil self massage.
    5. Practice every day (except moon days, yada yada), but modify on the side that hurts. Ahimsa!
    6. Whenever you go into Janu A or padmasana, use your hands to externally rotate your thigh and calf, gently. (Of course, this is hard to do when you are practicing without dinking around, but you gotta do what you gotta do.)
    7. When you are practicing “without dinking around” – as in a led class – just go to the posture as it is today, and breath. Don’t force it to go deeper – don’t go into pain. Trust the practice. Breath. Vairagyam!

    Hope this helps.

  2. Hello Steve,
    I am neither a doctor nor a yoga teacher, but I have had that exact problem before with my right knee; actually, “had” is not the right word choice here: It still comes and goes, but there is a specific pain to movement dynamic, as you mentioned.

    In my experience–as well in the experience of several teachers I know who have had similar problems–the only real long-term solution is to work on gradually lengthening and stretching both the quadriceps and the adductors while at the same time flexing the external rotators. It is by doing this that one can gradually get these muscles to do more of the work of bringing the body into lotus and in so doing, reduce the pressure on the knee/meniscus. Personally, I have found that doing hip-openers like double pigeon and various modifications of baddha konasana outside the practice really help to engage and open the external rotators. Poses like Virasana help with the quadriceps. At the same time, really paying attention to what muscle groups you are stretching and what muscle groups you are engaging while going into any poses that involve lotus or half-lotus variations really help. In this way, one can gradually bring awareness to this part of the body (we’re talking about months, maybe even two or three years…). I like to think of it as a process of cultivating pratyahara: Less focus on the external results, more focus on the process of bringing inner awareness to “shine” on that part of the body.

    Of course, there is, in theory, another possible solution: Stop doing/avoid any lotus or half-lotus poses altogether! But as Tim Miller would say, “Avoidance is not the answer…”

    Just thought I’d share, even though all this is totally unsolicited advice.

    1. Yes, those poses are so helpful, Nobel! And, yes, it takes a long, long time to get past a wonky knee. Patience is a virtue.

      One thing that’s been helping me, too – I found putting the foot (as best as I can) into the same side of the groin in Janu A helps really opens the adductors really well. In other words, right knee bends 90 degrees, right heel to the right side of the pubic bone/groin, vs. just at the groin or against the opposite thigh. It’s a deeper stretch of the adductors that way (a method I found via Gregor Maehle’s excellent book on the Primary series.)

  3. I´m sorry to read this, four months ago I´ve surgery of the medial meniscus in my right kneww. Your story sound very familiar to me. I was to hurry with asanas and not listening and respect to my body. I hope you develope carefully patient and wait till pain disappear.

  4. Oh, I just read Michelle’s comment, and have one more thing to add: This may be one of those situations where you have to let go of the “No Dinking Around” rule. I mean, sure, it’s great to not dink around, but if taking a few more breaths to work with half-lotus postures is what your body needs in order to heal, then,,, it is what it is (in my humble opinion, at least. Others may beg to differ.).

    Besides, it is possible to become too attached to rules, including the “No dinking around” rule 🙂

  5. Hey to you both.

    First off, Nobel. We live by this rule (so to speak): “I must create a system or be enslaved by another mans; I will not reason and compare: my business is to create.” — William Blake

    So we don’t get too attached to rules, don’t worry.

    Here’s what’s strange — the pain is really in just lotus and Janu B. I absolutely cannot bend my right leg enough to go into B on that side. But Virasana (even my lame, still stiff one)… no problem. So it is the slight rotation involved that’s the issue. I think, at least. That’s a bit different from your experience, Michelle — for whatever that’s worth.

    How will Bobbie take to this oil regiment? 🙂

    My recent body work has been to try to fix my neck / shoulder. Perhaps we’ll work down toward the knee. It’s been an issue for more than a year — it was going into the final padmasana once (as in finishing poses) that was the real, big “tweak.”

    On the externally rotating by hand — I do that in lieu of garba pindasana a lot. Trying to work on getting the leg and knee to the floor. That’s why I think part of the issue is in my hip (although my hips are supposedly not that bad). So maybe it’s somehow in the leg more?

    I think also in this solution, as Nobel notes, is adding into the daily virasana. Perhaps some thoughtful and focused half lotuses to try to loosen things up there?

    Sounds like the answer becomes: Lots of stretching! This all would be easy if it weren’t for this day job (at a desk, no less).

    Thanks to you both for the comments (and, I’ll extrapolate, the concern).


    1. Yes, absolutely concern for you, Steve! I know what a profound drag it is to come face to face with this obstacle (injury/pain) in practice.

      In Janu B – do you point or flex the foot underneath you? Both are permissible, I believe, and you may get some relief from the pain if the foot is not flexed in B, but pointed. Again, modify with compassion to do the best you can today.

      Also, watching this last Fall helped me get a little perspective on injury – although you have probably seen it, too! Tim, at his best.

      It’s kind of nice to know that Patanjali knew all about the obstacles to practice (maybe his knee bothered him at one time, too?!) and that there are means of dealing with the obstacles that are tested and true. (Trust the practice!)

  6. Glad you found the Yoganatomy site! (David is my teacher.) There is a great video by David on gently opening the lotus when you have inner knee pain…you can find it on his site. Another thing that he suggests and that has been helpful for many of my students with the same issue is folding the knee around a small towel when you are taking lotus position. The towel seems to act as a sort of “spacer” and prevents some of that pinching of the menicus while often moving more of the stretch to the hip where the tighness is coming from. Good Luck!
    Enjoying all of your posts!

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