The Benefits of Yoga in the Osteoarthritic Knee
by Katherine Scarpino, OMS-II
Osteoarthritis (OA) is defined as degeneration of the articular cartilage in the joint. This debilitating disease causes pain, stiffness and restricted motion at and around the affected joint. In patients over the age of 60, the prevalence of OA of the knee is 9.6% for men and 18% for women, and often leads to surgical treatment with a knee replacement (Ebnezar 2012). More conservative approaches to treatment include physical therapy, pain and inflammation management (NSAIDs), and corticosteroid or viscosupplementation injections before a knee replacement is considered. When conservative approaches fail, patients often seek a knee replacement followed by physical therapy post-operatively. However, there are other alternative therapies that are not often considered for treatment both pre- and post-operatively.
Yoga is an ancient Indian practice that focuses on posture poses, meditation, and breathing exercises as a therapy to promote physical and mental well-being. As yoga gains popularity in modern exercise and mindfulness practices, it has been shown to decrease stress and the effects of the sympathetic nervous system (“fight or flight”). Decreasing sympathetic nerve impulses relieves psychological distress, a factor that may lead to earlier signs of degenerative diseases such as OA (Ebnezar 2012). Other studies have shown that yoga may even reduce fluid pressure, reducing production of inflammatory factors, leading to more preserved cartilage in the joint to slow progression of the disease and decrease inflammatory pain (Cheung 2014). Other yoga benefits include increased flexibility, muscular strength, balance, and proprioception − all considered in therapy for OA patients. Although many patients have pain with activity, inactivity may also cause pain in OA patients. Inactivity often leads to tendon shortening, weakened ligaments, and articular capsule contraction− all relieved with the slow stretching movements in the practice of yoga (Haaz 2012). Yoga allows for light to moderate, activity, that limits pain from both harsh activity and inactivity. Overall, yoga seems to have beneficial qualities that may help to decrease the need for surgery in OA patients and may also be beneficial in post-operative rehabilitation after total knee replacement (TKR).
As a more conservative treatment before the decision to have a TKR, yoga has shown great benefits in decreasing the pain associated with OA of the knee. In a study done at the Ebnezar Orthopedic Center, OA subjects were exposed to 40 minutes of yoga therapy in addition to typical treatments such as electrical stimulation and ultrasound. These yoga practices included loosening and strengthening, relaxation, physical postures, breathing regulation, meditation, and lectures and counseling. This yoga intervention showed significant differences when compared to the control group for resting pain, early morning stiffness, anxiety scores, blood pressure, and pulse rate (Ebnezar 2012). Stress influence on behavioral and cognitive function in patients with OA has shown to be a large influence on pain perception. The decreased stress in response to yoga practices may also have been a large influence on the decrease in the perception of pain in subjects exposed to yoga therapy (Ebnezar 2012). Intervention in patients with OA of the knee was shown to increase quality of life, physical functioning and improved energy, fatigue levels, emotional well-being, and social functioning (Ebnezar 2012). In another study focused on older women with osteoarthritis, the patients had one 60-minute session of yoga for 8 weeks with in-home yoga sessions four times a week. The study showed that the yoga therapy was a safe and acceptable practice for older women and did show some therapeutic benefits in pain reduction and improvement of function scores. All participants agreed that they would suggest the yoga practice to others suffering from OA (Cheung 2014).
Even less studied than the effects of yoga pre-operatively is the effect of yoga therapy post-TKR. In a study done at the Sancheti Institute, scores for pain and stiffness were taken 3 days, 6 weeks, and 3 months post-operatively for the control and experimental group that received daily, modified yoga asanas (body posture yoga) in addition to traditional physiotherapy rehabilitation program. The study found that patients with the additional yoga intervention had less pain and stiffness and more functionality (Bedekar 2012). No adverse events were encountered, ensuring the safety of the practice post-operatively with correct pose modifications (Bedekar 2012). Shavasanas (relaxation yoga) was also used in the therapy, inhibiting painful nerve impulses from the brain, and therefore relaxing skeletal muscles and decreasing overall pain. Stretching in yoga also works directly on the muscle tendon (Golgi tendon organs) to promote muscle relaxation (Bedekar 2012). Although few studies are available on this topic, this study seems to show benefit of post-operative yoga therapy.
Overall, there seem to be many benefits associated with the practice of yoga in the osteoarthritis patient both pre- and post-operatively. Yoga may be considered in the treatment plans of those patients pre- and post-operatively if the prescribing physician believes that the practice would be safe and beneficial for the specific patient. Some setbacks include lack of physician knowledge of yoga practices, shortage of instructors qualified to teach yoga in a disabled population, and lack of data on both pre- and post-operative benefits. Future studies may focus more on benefits associated solely with OA patients and the benefits of specific versions of yoga available to these patients with qualified instructors. Future studies may also show more long-term effects of the yoga intervention both pre- and post-operatively as current studies are conducted for a relatively short period of time. In conclusion, yoga has many beneficial effects for those with and without degenerative diseases and with physician approval, and may be considered as an option for patients suffering from osteoarthritic knee pain.
Bedekar, N., Archana, P., Shyam, A., Sancheti, K., and Sancheti, P. Comparative study of conventional therapy and additional yogasanas for knee rehabilitation after total knee arthroplasty. International Journal of Yoga. 2012: 5(2): 118-122.
Cheung, C., Wyman, B.R., Resnick, B., and Savik, K. Yoga for managing knee osteoarthritis in older women: a pilot randomized control trial. BMC Complementary and Alternative Medicine. 2014; 14(160).
Ebnezar, J., Nagarathana, R., Yogitha, B., and Nagendra, H.N. Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study. International Journal of Yoga. 2012; 5(1): 28-36.
Haaz, S. and Bartlett, S.J. Yoga for arthritis: A scoping review. Rheumatic Disease Clinics North America. 2012.