From healthline.com
- A new study found that online yoga improved physical function in people with knee osteoarthritis.
- Results showed that the benefits of online yoga, including relief from knee pain, decreased after the 12-week program, as did participation in the activity.
- Still, other studies have shown that a regular yoga practice may offer relief from knee osteoarthritis.
New research has found that people with knee osteoarthritis who took a 12-week online yoga program saw improvements in their physical function — at least while they were doing the course.
However, the benefits of yoga, along with people’s participation in the online classes, dwindled in the weeks following the end of the program. The results were published on September 19 in the journal, Annals of Internal Medicine.
While the current study shows that subjects who participated in the online yoga program didn’t see an improvement in their pain symptoms, other studies have seen positive results.
According to Maryland-based yoga therapist Pamela Stokes Eggleston, founder of Yoga2Sleep, yoga is “definitely helpful” for knee osteoarthritis. It can increase mobility and reduce the pain, she added, which in turn, can decrease the need to take pain medication.
Eggleston said she knows this not just as a yoga therapist, but as someone with knee osteoarthritis.
While some people with knee osteoarthritis can have pain severe enough to limit their daily activities, she told Healthline that when her symptoms first appeared, “the pain was not debilitating, but it hurt enough for me to get x-rays and an MRI.”
For her, there was no question of finding some relief from yoga. “It’s about what ‘medicine’ from yoga can I use to help me better?” she said.
Benefits of exercise for knee osteoarthritis
Osteoarthritis of the knee occurs when the cartilage in the knee joint breaks down, allowing the bones to rub together. This can cause pain and other symptoms.
This condition occurs more commonly in people 50 years of age and older, although younger people can also develop it.
In people with knee osteoarthritis, the muscles supporting the joint may be weak, which can lead to balance problems and an increased risk of falls
Because of this and other health risks related to inactivity, exercise is recommended for people with knee osteoarthritis to decrease their pain, improve their physical function and boost their quality of life.
Regular physical activity can also help people maintain a healthy weight — carrying extra body weight can add stress to the knees and increase inflammation in the joint.
In particular, low impact activities such as walking, cycling, and yoga can help people stay active while being gentler on the knees than higher-impact activities such as running.
When Eggleston first developed knee osteoarthritis, she said walking became, and remains, her “go-to” cardiovascular activity. She also does a daily yoga practice and uses a rebounder, or mini-trampoline — “any low impact activity that is going to get my heart rate up,” she said.
In addition, she said she eats a largely plant-based diet and limits her intake of added sugars to maintain a healthy weight and reduce inflammation in her body. But any healthy balanced diet should still be balanced with a regular exercise regimen.
Earlier research supports the use of yoga for knee osteoarthritis, showing that it may improve pain, physical function, and joint stiffness. However, none of these prior studies looked specifically at online yoga programs for people with this condition, until now.
The new study involved 212 people with knee osteoarthritis. All participants had access to online information about osteoarthritis, treatment options, and the benefits of physical activity, weight loss, and healthy sleep habits.
Researchers randomly assigned around half of the people to do a 12-week self-paced online yoga program.
The program consisted of a series of 12 pre-recorded 30-minute videos. People were asked to do one video a week, three times during the week.
The classes included a slow-paced mix of static and dynamic yoga poses designed to stretch and strengthen the muscles of the core and legs.
Instructors also offered different modifications and levels of the poses, so people could adapt the program to suit their personal needs and abilities.
However, the classes focused on physical postures but didn’t include other aspects of yoga, such as deep relaxation, chanting, and meditation, which could also help reduce pain.
After 12 weeks, subjects who did the yoga classes saw greater improvements on average in their physical function, knee stiffness, and quality of life, compared to those who only had access to online osteoarthritis education.
Still, there was only a small difference between the two groups in the level of knee pain while walking at 12 weeks.
After the program ended, researchers followed up with participants another 12 weeks later. By then, both groups had similar levels of physical function, pain, knee stiffness, and quality of life.
This loss of benefits seen in the yoga group may be because many people stopped doing the yoga classes after the 12-week program ended.
During the last week of the course, over two-thirds of participants completed at least two classes a week. By the end of the follow-up period, though, fewer than one-third were still doing the online yoga program regularly.
“Not all participants were adherent [to the yoga program], which may have attenuated detection of any true benefits of yoga,” the authors wrote in the paper.
Other factors may have also made it difficult to determine the true benefits of yoga for knee osteoarthritis.
For example, the authors note that “because the yoga program was unsupervised, we do not know whether the yoga elements were performed correctly or completely.”
Finding a specialised yoga class
For people with knee osteoarthritis who are interested in trying yoga for the first time, Eggleston recommends finding a yoga therapist or yoga teacher who specializes in teaching yoga for this condition or for arthritis in general. “This may not be a regular studio class,” she cautioned.
The “My Joint Yoga” program used in the new study was designed by the researchers in collaboration with yoga therapists, as well as a physical therapist and people with knee osteoarthritis. The full 12-week program is available online.
The poses used in the course are ones found in typical yoga classes, but with various modifications and levels. They include:
- Goddess pose in a chair
- Warrior 1 Pose
- Intense Side Stretch Pose
- Leg lifts, standing or prone
- Bridge Pose
- One-leg balance, standing or seated
- Triangle Pose, chair-supported
- Warrior 2 Pose, optional chair-supported
- Wide-Leg Forward Bend, seated
Many of these poses strengthen the muscles around the knee, which Eggleston said is important for stabilising the joint.
One movement that she has found personally helpful is moving slowly into and out of Chair Pose. A variation of this can also be done with your back against the wall for support.
For Eggleston, though, there’s much more to yoga than doing poses on a mat. “It is really about interoceptive awareness — being fully aware of things going on in my body,” she said.
Listening to the body during yoga
Charlotte Nuessle, a Massachusetts-based yoga therapist said that yoga is about learning to honor and listen to the body. For people with knee osteoarthritis, this means “they shouldn’t push their knee until they feel pain,” she told Healthline.
A simple way for people with knee osteoarthritis to listen to their body is by putting a folded blanket or a pillow under the knees in kneeling poses, Nuessle said, “enough of a pad so that the knee doesn’t feel the weight of the body, especially on a hardwood floor.”
In standing poses, Nuessle recommends that people learn to hold the pose without locking their knees. “When we lock out our joints, we’re not asking our body’s core to engage as deeply or with the same awareness,” she said.
This requires being able to activate the muscles of the core — which is more than just the abdominal muscles — and bringing this support to the yoga poses.
Dynamic yoga poses — which Nuessle refers to as “gentle mobilization and repetition” — can also help people engage the muscles surrounding the knee without straining the joint.
“Every time we repeat a movement, we have an opportunity to bring our awareness to it,” she said. “We have an opportunity to make a subtle adjustment. We have an opportunity to find a new way to do it.”
New research shows that online yoga may not be an effective long-term treatment for knee pain associated with osteoarthritis, though it may provide temporary relief.
However, a large body of evidence supports a consistent yoga practice for improving pain, function, and stiffness in people with knee osteoarthritis. Anecdotal reports from teachers and practitioners support yoga for knee pain relief as well.
If you’re curious about how yoga may be able to help you manage your knee pain, be sure to check with your doctor to see if it’s right for you. It’s also a good idea to find a teacher or yoga therapist who specializes in working with individuals with this condition.
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