Yoga as effective as strength exercises for osteoarthritis pain relief
 
 
 
    Share on PinterestYoga could help relieve knee osteoarthritis pain, new evidence suggests. Image credit: Pedro Merino/Stocksy.
Yoga is as effective for addressing knee pain due to osteoarthritis as muscle-strengthening exercises, according to a new study.
The new randomized clinical trial has also found that yoga may improve health-related quality of life and reduce depression in people with knee osteoarthritis.
Experts say that neither yoga nor strengthening exercises alone are likely to be the most effective way to help treat osteoarthritis knee pain, but can be elements of a broader treatment strategy.
Adverse effects from both yoga and strengthening exercises reported in the study were minimal.
 
Knee pain specialists use various therapeutic approaches for helping patients with knee pain due to osteoarthritis. A new study directly compares the effectiveness of two of those therapeutic approaches, yoga and muscle strengthening.
In a randomized clinical trial of 117 participants, yoga’s beneficial effect on knee pain was found to be “noninferior” to that of muscle strengthening after a 12-week study period.
Its findings appear in JAMA Network OpenTrusted Source.
The trial, which took place in Tasmania, Australia, involved individuals with a mean age of 62.5 years. Women comprised 72% of the cohort. Participants reported an initial moderate knee pain level of 53.8 according to the 100-point visual analog scale (VAS).
They were divided into two groups, one of which received yoga therapy (58 individuals), and one of which was treated with muscle strengthening (59 people).
The condition of participants’ knees was tracked in multiple ways. These included VAS, as well as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee pain, function, and stiffness. Neuropathic pain and global health assessments were undertaken, as were physical performance measures leg muscle strength tests.
Individuals were also questioned regarding their health-related quality of life and feelings of depression.
Individuals in the yoga group reported modest reductions in depression at 12 weeks compared to those in the muscle-training group, and improvements in quality of life at 24 weeks.
Yoga performed slightly better at 24 weeks for WOMAC pain, function, and stiffness, in the global assessment, and for scores in a fast-paced walking test.
There were no significant adverse effects reported for either yoga or strengthening exercises.
 
 
Osteoarthritis: Yoga is not a sufficient treatment by itself
Bert Mandelbaum, MD, not involved in the study, is the co-director of the Regenerative Orthobiologic Center at Cedars-Sinai Orthopaedics in Los Angeles. To him, the study nails down just one detail regarding knee-pain treatment.
Speaking to Medical News Today, Mandelbaum said that, “what we need to know is that [yoga’s] not going to hurt us, but it’s not going to be that robust for us [for treating] arthritis just by itself.”
“Yoga is a good exercise,” he explained, “and it could be utilized in a multiple-mode exercise regiment. Yoga is not going to hurt you. It’s an important part of an overall program that deals with aerobic conditioning, anaerobic conditioning, interval training, flexibility, and yoga, as well as strength training.”
Timothy Gibson, MD, medical director of the MemorialCare Joint Replacement Center at Orange Coast Medical Center in Fountain Valley, CA, also not involved in the study, further pointed out that with yoga being low impact, it “offers the ability to strengthen without aggressive movements in a joint that may be painful to move.”
For older patients especially, Gibson said, yoga can be a great help with balance and fall prevention.
“Yoga can be great for knee osteoarthritis symptoms,” orthopedic surgeon Pamela Mehta, MD, not involved in the study, also told us. “It helps with mobility and stretching, which can greatly impact pain.”
“I’m also not surprised that it had a greater effect on quality of life and mood — yoga is a fantastic mindfulness activity. That said, I don’t find that yoga alone helps my patients in the way this study suggests,” Mehta also cautioned.
How yoga compares to muscle strengthening exercises
Mandelbaum noted that osteoarthritis and its symptoms occur in a continuum along which symptoms tend to progress with time and age. As a result, a patient’s appropriate mix of therapies must be continually re-assessed and adjusted as the condition progresses.
“My view of this is to have something that is a controlled multimodal approach where we evaluate where you are in that continuum. Any prescription should be a combination of aerobic conditioning, and then also consider yoga and exercise training.”

– Bert Mandelbaum, MD
Each element in the response to an individual’s current condition offers a unique benefit to the mix, as is the case of the two modalities compared in the study.
“Yoga,” explained Mehta, “is fantastic for mobility, balance, and flexibility. It helps restore smooth movement in the knee and reduces stiffness, both of which help reduce knee pain from osteoarthritis.”
“Yoga also helps with mindfulness and can improve mental health in a way that exercises don’t. This has a huge impact on how we experience pain,” she added.
Strengthening exercises, as one would expect, work more directly on musculature. They, said Mehta, “are all about support and muscle balance. The muscles that surround the knee joint help the joint move smoothly as you bend, walk, and run.” This can be critical for pain relief.
“Stronger muscles, well-balanced against other leg and hip muscles, help stabilize your knee joint as it moves. This helps to reduce pain in a very functional way, ensuring your knee is moving how it’s supposed to,” Mehta explained.
Gibson pointed out that strength exercises can be handy because they require less instruction and supervision. Moreover, he noted, “having purely more leg strength improves function, especially with ascending and descending stairs.”
Different as they are, the two approaches exemplify how multiple modalities can complement each other, according to Mehta:
“Yoga and strengthening exercises are perfect together, so long as you don’t overdo either one. I always recommend to my patients to practice gentle yoga for mindfulness and mobility while building up their muscle strength with exercises.”

Background
Although the emphasis in many modern yoga classes is on the physical practice of yoga postures, Yoga as a philosophy is broader than that. Patanjali’s Yoga Sutras describe eight interrelated limbs of Yoga philosophy. The first two limbs, the yamas and niyamas describe personal and relational practices. Asana, or the physical practice of postures is the third limb.

As we move up the limbs outlined by Patanjali, they get less concrete and more subtle. Limb number four, pranayama, or breathing practices, is considered by many to bridge that transition between more concrete and more subtle practices. Some schools and styles of yoga that emphasize the subtle more than the concrete may focus more on limbs six and seven. Those are dharana (concentration) and dhyana (meditation).

The fifth limb, pratyahara, however, is often left out of both practice and philosophical discussion in modern yoga classes. The author of the philosophical study that we summarized here was interested in why pratyahara often gets left out of modern yoga practice. She explored what it is conceptually to modern yoga practitioners, and what its role is in contemporary yoga practice.

Research question
What is pratyahara and how does contemporary yoga practice incorporate it?

Research methods
The author conducted an in-depth literature review on the concept of pratyahara. She researched its role in contemporary yoga. She then developed a philosophical hypothesis on how we might use the practice of pratyahara to understand ourselves and the world in new ways as well as orient towards social change.

Results
The author divided her findings into three categories. Those were: conceptual origins of pratyahara, pratyahara through contemporary ontologies, and pratyahara as resistance. More specifically, the author identified several themes and proposed some applications of pratyahara practice based on her in-depth exploration of the literature.

Based on the author’s findings in the literature, the concept of pratyahara could be summarized as a practice of withdrawing from the sense impressions left by the material world to move towards spiritual freedom from identification with material or sensory experience.

The author’s key findings and interpretation of the literature
Initial research suggests health and wellness benefits of pratyahara practice may include reduced anxiety, decreased stress response, and increased relaxation.
Pratyahara practices may also influence our orientation and perspective regarding how we experience our inner and external worlds.
The author describes a potential tension in modern postural yoga between the practice of withdrawing from sensory experience as part of broader yoga practice and using the idea of a particular sensory experience resulting from yoga (calm, peaceful) to commercialize and sell yoga.
Additionally, the author describes a conflict between the concept of pratyahara as the withdrawal of the senses and pressure from the yoga industry which idealizes a particular aesthetic as the material appearance of health.
The author proposes that engagement in pratyahara practices has the potential to provide a refuge from discrimination and/or pain that practitioners may experience in the external world.
Finally, the author also proposes that when thoughtfully applied, pratyahara practices could result in greater discernment. Through that lens, it could better enable practitioners to engage with social change.
Why is this relevant to yoga practitioners?
Most contemporary yoga practice centers asana practice. For that reason, it’s easy to get caught up in the achievement of postures and miss the wider experience of yoga practice. While yoga practice certainly offers physical health and wellness benefits, Patanjali’s Yoga Sutras suggest these are actually side benefits of a holistic yoga practice.

When we practice all of Patanjali’s eight limbs of yoga, we recognize the possibility of experiencing samadhi, a spiritual transformation where we recognize the oneness of consciousness and no longer see ourselves as separate. Pratyahara practice has the potential to support us on that path. It allows us to experience discernment and reduce our identification with immediate sensory experience. This in turn can support us in healing, as well as cultivate an awareness of when to thoughtfully engage with the world and when to withdraw.

 
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Conclusion
The author suggests that skillful pratyahara practice can allow for greater discernment. She suggests we could apply that to deciding when to withdraw from worldly experiences and when to engage with the world, specifically to support social change.