Yoga Shouldn't Hurt

Avoid injuries on the mat with this practical guide to caring for your knees, hamstrings, and sacrum.

By Roger Cole

If you practice yoga, no doubt you're aware of its health benefits. But like any physical activity, it's not completely risk free. If you've been practicing for long, you or someone you know has probably pulled a hamstring, tweaked a sacrum, or experienced some injury while on the mat. Close to 9,000 Americans received medical treatment for yoga-related injuries in 2004 and 2005, according to the U.S. Consumer Product Safety Commission. Still, there are only two yoga injuries reported for every 10,000 times it is practiced, according to American Sports Data.

Injuries can be great teachers. They invite you to uncover your yoga demons—misalignments or overzealous attempts to force your way into poses—and make corrections. But it's smart to learn proper technique, especially when it comes to your inner knees, hamstring tendons, and sacroiliac joints. These parts are vulnerable to damage and take time to mend. But if you understand what causes trauma to these areas, it's easy to adjust your practice to avoid or help heal injuries. Here's a primer on each.

Inner Knee

The Road to Injury

Have you always found it difficult to get into Padmasana (Lotus Pose) and felt tempted to force your legs into the position to join your serene-looking classmates for meditation? If you are thinking of traveling down this road, please reconsider. You may have discovered that rather than leading you to the blissful land of the Lotus, pushing yourself in this way dead-ends with a sickening "pop" in the knee, followed by years of pain and limited mobility.

When you hurt your inner knee doing yoga, it's usually because you've tried to force a leg into Padmasana or one of its variations. Sometimes the injury occurs after one or both legs are already in Lotus position and you attempt a pose that adds a back-bending movement, such as Matsyasana (Fish Pose), or a forward-bending movement, such as Ardha Baddha Padma Paschimottanasana (Half-Bound Lotus Seated Forward Bend).

To understand how Lotus can hurt your knee, visualize lifting your right foot up and placing it atop your left thigh. To get into this pose safely, your thigh will have to rotate outward about 115 degrees. For many of us, though, the thigh cannot turn out that much, either because of its bone structure or because tight muscles and ligaments inhibit its movement. If your thigh stops rotating but you keep lifting the shin and foot, you'll bend the knee joint sideways, which will pinch the inner-knee bones together—the upper inner end of the shin-bone pressing against the lower inner end of the thighbone. Between these bones lies the medial meniscus, which is a protective rim of cartilage that pads the knee joint and guides its movement. When you lift your foot, you are using your same-side shinbone as a long lever. If the thighbone doesn't rotate enough, you'll apply tremendous pinching pressure to the meniscus—as if your shinbone and thighbone were a giant pair of pliers. Forcing this lift even moderately can do serious damage. Similarly, if you are in Lotus and your top knee is not on the floor, pushing that knee downward can apply enormous damaging force to the meniscus.

Prevent and Prepare

To prevent this injury, the first rule is to never force your legs into any Lotus variations—either by pulling the foot strongly upward, pushing the knee downward, or thrusting your body forward or backward. Don't let your yoga teacher push or pull you into any of these poses either. Janu Sirsasana (Head-of-the-Knee Pose) and Baddha Konasana (Bound Angle Pose) can cause similar (though usually less severe) pinching of the inner knee, so practice them cautiously, too. Stop going deeper and back off if you feel pressure or pain in the knee. The structures that need to loosen up in these poses are all located around the hip area, so that's where you should feel stretching or releasing sensations as you go deeper.

The safest way to practice Padmasana and related poses is to strongly rotate your thigh outward at the hip and not go deeper into the pose when you reach the limit of your outward rotation. This means that you'll have to stop lifting your foot when your thigh stops rotating, so you may not get your foot on the opposite thigh. (Remember the upside: happy, functional, pain-free knees.) You can use your hands or a strap to help rotate your thighbone outward. Whether using your hands, a strap, or a cloth, if your knee ends up dangling in midair, support it with a folded blanket so you do not inadvertently force it downward as you turn the thigh outward.

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