There are many causes of a chronically painful knee. The only common "bursitis" of the knee is pre-patellar bursitis or "housemaid’s knee," where there is a swelling directly over the kneecap. It is usually brought on by kneeling on hard surfaces. However, the vast majority of painful knees (99%+) come from other kinds of knee problems unrelated to bursitis.

Many folks with chronic knee pain under age fifty have some irritation of the under surface of the knee cap (called chondromalacia patella). It is often worse with kneeling or things that put pressure on the knee cap. They will often have discomfort with walking up and down stairs (particularly down). Lots of walking or running can also be bothersome. Kneeling or the bridge pose could cause pain for these folks as well. They tend to have little or no swelling.

Over age fifty, chronic knee pain is more likely knee arthritis (osteoarthritis) and is quite common, particularly in women or those who are obese. Since this involves an actual degeneration of the joint, walking, standing, or holding the legs in one position for extended periods tends to worsen discomfort with this.

Folks of any age can have other knee problems including cartilage tears (medial meniscus tears) or ACL tears (anterior cruciate ligament tears) which have usually happened as an injury. They can have pain, joint swelling, locking, and "giving way" as problems. Most of these folks will be have been evaluated by a physician for this, although they may have a chronic problem that isn't very amenable to treatment.

How to handle a painful knee? Our general recommendation as physicians for knee problems is, "if it hurts, don't do it!" (For those with knee arthritis we will suggest an exercise program, even if it's a little painful, but try to have the patient stay within practical limits.) We generally recommend strengthening exercises for the thighs and range of motion exercises for the knee joint as good basic things no matter what the cause of the knee pain.

If you have someone who has pain when they kneel, you could try having them kneel on a soft surface (like a folded up towel or foam pad). If they are comfortable when they do it this way, it's likely fine for their knees, but if they have pain avoid these poses. If they have pain in bridge pose, I'd have them do thigh-strengthening exercises and see if this helps. If it's still painful, I'd have them not do that pose.

If your student has chronic knee problems and has never seen a physician, a single doctor's visit may clarify the problem and provide some helpful guidelines for working with their knee discomfort.

I'm a family doctor in primary care medicine and treat lots of orthopedic problems. I've taught Raja Yoga and cared for yogis medically at Ananda for over 20 years.

From Allyson Cannata

Hello,

I am a licensed physical therapist as well as a yoga instructor, so perhaps I can offer some general info. This may be long, but I want to be thorough:

Bursitis is inflammation of a bursa.

Bursae (plural of bursa) are sacs filled with synovial fluid that reduce/prevent friction that occurs when a muscle or tendon rubs against another muscle, tendon or bone. They are located in various joints throughout the body, including the knee.

The knee itself contains 6 bursa, so I can only offer general info, since I don't know without an evaluation which of her bursa are involved.

When there is bursitis in general, resolution of the inflammatory process while maintaining full range of motion is the first priority. She may benefit from treatment by a physical therapist, or at least use ice packs on the area for 15 minutes, 3 times per day and avoid painful positions.

You may have to avoid both postures completely for a while depending on the type of bursitis, but if she can handle variations without increasing her pain, you may try the following:

FIRM POSE. Avoid the full firm pose during this stage. Modify the posture by placing folded blankets between her thighs and calves to a degree that is comfortable to her. Do not force the posture.
BRIDGE POSE. Make sure that the ankles are in line with the knees throughout the posture, that her feet are parallel to each other with arches lifted, and that the knees don't "flare out." Perhaps also don't lift hips quite as high as usual.

I hope this helps. There is more that I could say, but I decided to let you call me with further questions.
Currently I work as a physical therapist and a yoga instructor, and have my own business where I integrate the two modalities to promote wellness. I also provide individualized programs for companies and athletes. I graduated from AYTT in 1996 and return as often as possible for personal retreats.

Allyson Cannata, PT, RYT
760-845-1044

From Marilee Algie

I don't know if you have received any answer to your question about the bursitis, but I can tell you that you are not supposed to recommend any treatment except for your student to see his or her doctor. The bursa is a little pillow that protects the bones from rubbing together at the joint. Sometimes the area gets inflamed from overuse and not enough proper body maintenance.

I am a massage therapist and graduated from the Ananda YTT Jan 2001. I have been studying the body for the past 6 years. I also do personal training and am a Registered Diet Tech. I realize that you have concern for your student, but you are not supposed to diagnose or prescribe treatments – this can be done only through the doctor’s care with permission.

Marilee