Research suggests that a tailored yoga practice can help reduce pain and improve function in patients with knee osteoarthritis. Potential mechanisms include strengthening, improving flexibility, and altering gait biomechanics.
by Richa Mishra MD and Sharon L. Kolasinski MD, Lower Extremity Review May 2010
Osteoarthritis, OA, is a chronic disease of cartilage and surrounding tissues characterized by biochemical and morphologic alterations in the synovial membrane and joint capsule, erosion of the articular cartilage, bony hypertrophy, and subchondral sclerosis. It is the most common form of arthritis, affecting more than half of adults over the age of 65 and resulting in well over a half-million total joint replacement surgeries annually.
OA is a leading cause of physical disability, increasing healthcare utilization, and impaired quality of life in developed nations. Women are twice as likely as men to develop symptomatic OA. Although women have a lower prevalence of OA than men before age 50, there is a marked increase in prevalence among women over 50, particularly in the hands and knees.
Studies have shown that mechanical actions in the joint have physiologic effects at the cellular level. Chondrocytes, cells within the cartilage that produce components of the extracellular matrix but fail to function properly during the pathogenesis of OA, can sense and respond to mechanical and physiochemical stimuli via several regulatory pathways.
It is well known that exercise can have a positive impact on osteoarthritis symptoms and associated disability. However, it can be difficult for these patients to begin and continue exercise programs. Yoga offers an additional approach to the incorporation of exercise into the management strategy for patients with osteoarthritis, and a number of studies have begun to provide evidence to support its use.
What is yoga?
Yoga is an ancient practice that aims to create a harmonious balance between mind and body. The Sanskrit word from which the term “yoga” is derived is “yuj,” meaning to yoke or unite. Yoga is thought to permit a union of mind, body, and spirit. By combining mental and physical fitness, yoga may reduce stress, strengthen the body, and increase flexibility. The holistic perspective from which yoga derives seeks to develop self-awareness, emotional stability, and peace of mind.
The practice of yoga was initially developed around 150 BC by Patanjali in ancient India, and it has evolved over time. Yoga has six traditional branches of which hatha yoga, or “the yoga of posture,” is the most well known in Western nations. This branch of yoga uses physical poses, or asanas; breathing techniques, or pranayama; and meditation to achieve improved health and spirituality.
There are many styles within this path of which Iyengar yoga has become particularly popular in the U.S. Iyengar yoga is characterized by its precise focus on body alignment. It uses aids like cushions, benches, blocks, and straps to help practitioners achieve asanas more easily, more fully, and with less muscular effort than might otherwise be possible if unaided. Standing poses emphasized in Iyengar yoga are said to build strong legs; increase general vitality; and improve circulation, coordination, and balance.
Richa Mishra MD is a rheumatology fellow at the University of Pennsylvania. Sharon Kolasinski MD is professor of clinical medicine at the University of Pennsylvania School of Medicine, interim director of the division of rheumatology, and rheumatology fellowship program director.Kolasinski-2005-Iyengar-Yoga-for-oa-knee
Iyengar Yoga for Treating Symptoms of Osteoarthritis of the Knees: A Pilot Study, Kolasinski SL, Garfinkel M, Tsai AG, Matz W, Van Dyke A, Schumacher HR. The Journal of Alternative and Complementary Medicine 08/2005; 11(4):689-93. DOI: 10.1089/acm.2005.11.689
Yoga for Arthritis in Johns Hopkins Arthritis Center
Scientific Evidence on the Therapeutic Efficacy of Iyengar Yoga, A Compilation of Research Papers, Iyengar Yoga National Association of the United States, IYNAUS