Kneeling may be one of those movements that you've never thought twice about — until you start noticing knee pain when kneeling.
So, what gives? Pain in the knee when kneeling can be caused by a handful of different things, but most of the time, it comes down to inflammation in the knee joint, tightness in the surrounding muscles and lack of mobility of other seemingly unrelated joints. The lower body is, after all, one long chain, so when one joint or muscle is off, it can throw everything else out of whack.
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If you can't kneel on your knee, or kneeling just feels downright painful or uncomfortable, here's what might be going on and how to fix it.
Warning
If you hear a popping noise, feel your knees buckling when kneeling or have a sharp, stinging pain on the outside of your knee when kneeling, that could be a sign of an injury like a meniscus tear. Always talk with a sports medicine doctor or physical therapist if you tore something or seriously hurt yourself.
1. Your Quads Are Tight
In younger people, trouble kneeling often stems from tightness in the quads, Madison Yamane, PT, DPT, at Real Rehab Sports + Physical Therapy, tells LIVESTRONG.com.
"One of the quad muscles — rectus humerus — crosses both your hip and knee and attaches at the bottom of your kneecap," she explains. "When that one is really tight, kneeling can be painful because it's pulling the patella (bone in front of knee joint) toward the hip."
It's common for this muscle to be pretty tight, even if you're pretty active. "And since everyone is WFH right now, it's really tight because we sit in this flexed state so much," Yamane says.
Tightness in your quads might cause pain in your kneecap, sides of your kneecap or just above your kneecap, Yamane says.
Fix It
A quad stretch can feel really good and can help relieve tightness. Any quad stretch will do, whether you’re lying on your side and pulling your foot toward your butt, or doing a traditional standing quad stretch.
“If it’s really tight, you can always use a strap, belt, towel or anything else around your ankle to help pull it up,” Yamane says.
It’s important to be consistent, so make sure to stretch every day to reap all of the benefits. Do a three- to five-minute warm-up before doing a deep stretch and stretch after your workout. If you're stretching every day and still feeling pain when you try to kneel, it’s worth checking in with a physical therapist.
“Sometimes muscles are so tight because they’re either weak or compensating for another weak muscle,” Yamane says. To fix that, you may need more than just a good stretching routine.
2. You Lack Hip Mobility
You need a good amount of hip mobility — particularly in the hip flexors in the front of the hips — to be able to kneel. "If you're having a hard time bending at the hip, then you might do more at the knees and get a little bit of knee pain," Yamane explains.
If hip mobility is the source of your kneeling issues, you'll also feel discomfort when you squat, Yamane adds. And if you spend a lot of your day sitting, your hip flexors are probably pretty dang tight.
Fix It
Again, stretching is your BFF when it comes to improving hip mobility. It’s best to work on it every day, if possible, to really notice an improvement.
Yamane recommends Child’s pose. “It’s a great one to help open up your hips and sinking back into that position gives you a similar feeling to kneeling but it's a lot more adjustable than being in a kneeling position,” she says. “You can control the bend in the knees, height of your butt and the weight that goes into your hips versus your hands.”
While static stretching (holding the stretch for a period of time) can help improve flexibility, you also want to do dynamic stretches, where you move your hips through a full range of motion. This is what really increases your mobility so that you can move comfortably — to kneel or perform any other movement that requires your hips to flex.
Add these dynamic hip flexor stretches into your routine to loosen up and improve joint mobility.
3. Your Ankles Aren't as Mobile
Yes, your ankles matter, especially when it comes to knee pain.
"People think knee pain has to do with the knee, but the knee doesn't do that much and doesn't have as much mobility as your hip or ankle," Yamane says. "If you have knee pain, any physical therapist will take a look at both the hips and ankles, because sometimes these joints aren't moving correctly and your knee is getting the brunt of it."
Fix It
When you kneel, try both curling your toes under and straightening them so that the top of your foot and toes are flat on the floor. “Playing with that can change things all the way up the chain,” Yamane says. “It might be more comfortable to do one or the other.”
Calf stretches can help, too. “Usually dorsiflexion is the issue when you’re bending the ankle to get the knee over the toe,” Yamane says. Stretching your calf muscles can help with that.
You can also try balancing on one foot for 10 to 30 seconds to help strengthen your ankles.
4. You Have Arthritis
"Arthritis typically makes it pretty painful for people to kneel," Yamane says. Osteoarthritis, the most common kind of arthritis, happens when the cartilage that cushions your joints wears down over time, causing pain, stiffness and inflammation.
Osteoarthritis is more common with age, so this is a more likely explanation for the over-50 crowd. Other forms of arthritis that are caused by inflammation in the joints (like rheumatoid arthritis and psoriatic arthritis) are typically associated with an autoimmune disease.
People tend to get osteoarthritis most commonly in their hips and knees, and pain or limited mobility in either place can impact your ability to kneel.
Fix It
There’s no quick fix for arthritis — it’s a progressive disease that needs to be managed throughout life. The truth is, for some people, getting into super flexed or extended knee positions is always going to be a little more painful “because there’s so much more pressure on the joint in that position,” Yamane says.
The best fix is usually modifying the way you kneel or using a prop to avoid excess pressure. For example, try putting a yoga block under your butt instead of going into a full kneeling position, Yamane suggests.
"You're still technically kneeling but your knees aren't totally squished and bent." You can also try using a stool instead of kneeling or placing a pad underneath your knees.
Strengthening the supporting muscles around your knee can also help relieve knee arthritis. These exercises for knee osteoarthritis may be especially helpful.
5. You Have Knee Bursitis
Knee bursitis is a condition where small fluid-filled sacs in the joint, called bursa, become inflamed, according to the American Academy of Orthopaedic Surgeons (AAOS). It's often caused by overuse, injury or sustained pressure on a joint.
"When this bursa becomes irritated, it can swell and become highly irritated," says Bianca Beldini, PT, DPT, a physical therapist, acupuncturist and owner of Sundala Wellness in New York. "Swelling increases fluid both inside the sac and outside into the surrounding tissue, which can cause a decrease in range of motion and pain upon compression, impacting the ability to kneel."
Knee bursitis can cause a sharp, needle-like pain in the knee when kneeling. Bursitis can happen in both the front (anterior) and back (posterior) of the knee. Behind-the-knee swelling commonly occurs with osteoarthritis, gout, ACL tears, meniscal tears or even after knee replacement surgery, Beldini says.
Fix It
Treat it like any other overuse injury: Rest, use ice or cold packs and take OTC non-steroidal anti-inflammatories (NSAIDs), like ibuprofen and naproxen, to reduce pain and inflammation. Then, once the swelling has gone down, you can work on strengthening and mobilizing the joint to regain proper range of motion.
Anterior Bursitis
“As the patient begins their re-entry into exercise, they should begin by performing an isometric contraction of the quadricep also called a ‘quad set,’” Beldini says.
Isometric means contracting or engaging the muscle without changing the position of the joint. “This type of contraction helps to turn on the muscle while at the same time decreases any stress on the knee joint itself,” she explains.
How to do it: With the affected leg extended, statically contract the quadriceps for a total of 3 to 5 seconds for 10 reps. Do this up to three times per day.
“To know if you are doing this correctly, put your fingers over the inside of your quad or lightly tap your inner quad while contracting,” Beldini says.
Next, focus on stretching the muscle and soft tissue with a gentle prone quad stretch.
How to do it: Lie on your stomach, bend your knee and pull your foot toward your butt. Wrap a strap, belt or elastic band around the ankle to assist if you’re super tight.
“If it feels stiff or stuck, you can perform a contract, relax and stretch technique,” Beldini says.
While lying on your belly, with your knee bent, perform the static contraction of the quad like you did in the initial quad set exercise. Hold this contraction for 2 seconds, then relax and then try to bend the knee further to see if the pain-free range of motion improves. Do this three to five times, two to three times per day.
Posterior Bursitis
“Rehabbing this type of condition requires time and patience because it can take time to see the swelling dissipate,” Beldini says. “Sometimes if the swelling or pain is so severe, a cortisone injection or removal of the fluid can be required.”
Once the swelling subsides, the goal is to keep the posterior chain flexible. You can do that with a gentle hamstring and calf stretch. “An easy ‘leg up the wall’ stretch can focus on hamstring flexibility,” Beldini says.
How to do it: Lie on your back in a doorway. Extend one leg through the doorway and place the leg of the hamstring you want to stretch up on the wall. Try to hold this position for up to 45 seconds.
“If you are inflexible at first, slide yourself farther away from the wall putting less stretch through the hamstring,” Beldini instructs.
“To encourage fluid and lymphatic drainage, gently pump your ankle/foot 10 to 15 times,” she adds. “This helps to contract the calf, which encourages an improved circulatory flow of blood to return to the heart from the lower extremities. It also helps to clear swelling.”
Another great stretch is a standing calf stretch.
How to do it: Lunge forward toward a wall, keeping the back leg straight. Hold for 5 to 10 seconds and perform 5 reps.
“To improve lymphatic and circulatory flow, add a gentle pulsing bend of the knee being stretched,” Beldini says. “Gently bend and straighten the knee in a pulsing manner for 5 to 6 reps, then finish with the static stretch.”
6. You Have Runner’s Knee
Another reason you can't kneel or find it difficult to is runner's knee, or patellofemoral pain syndrome, which is pain in the front of the knee. It's caused by repetitive use of the knee joint — like the beating the joint takes from running. Runner's knee can also happen if you run or do high-impact exercises more than you're used to, so start slow.
Runner's knee causes dull pain and stiffness in the knee joint. Depending on how severe it is and where exactly the pain is, kneeling on your kneecap might really hurt.
Fix It
Resting and avoiding the activity that caused the overuse injury is the best way to get rid of patellofemoral pain syndrome. Icing, compression and elevation can also help, as can taking NSAIDs to reduce swelling, according to the AAOS.
Once the swelling and pain heal, you can focus on strengthening the muscles that support your knees. Specifically, your quads and core. This can help take some of the pressure off the knee when you start running again, so that you avoid another bout of runner’s knee.
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