Academic journal article International Journal of Yoga

Additional Effect of Iyengar Yoga and EMG Biofeedback on Pain and Functional Disability in Chronic Unilateral Knee Osteoarthritis

Academic journal article International Journal of Yoga

Additional Effect of Iyengar Yoga and EMG Biofeedback on Pain and Functional Disability in Chronic Unilateral Knee Osteoarthritis

Article excerpt

Byline: Gopal. Nambi, Amisha. Shah

Background: There are limited data about Iyengar Yoga and EMG biofeedback in knee OA, although the efficacy of EMG biofeedback in the rehabilitation of patients with quadriceps muscle weakness secondary to immobilization, contracture, and joint surgery has been well established. Materials and Methods: Thirty subjects who have fulfilled inclusion and exclusion criteria were selected and divided into two groups (Group A and B). Both the groups were treated with EMG biofeedback, knee muscle strengthening exercises, and TENS. Group A received additionally Iyengar Yoga for 8 weeks. Both groups were evaluated by Visual Analog Scale and Modified WOMAC-Western Ontario McMaster Universities Scale. Results: Patients in both groups experienced significant reduction in pain and improvement in functional ability. In VAS scale Group A showed reduction of 56.83% ( P = 0.001) when compared with Group B 38.15% ( P ≤ 0.001). In modified WOMAC Scale, Group A showed reduction of 59.21% ( P = 0.001) when compared with Group B 34.08% ( P = 0.001). Conclusion : Adding Iyengar Yoga along with conventional therapy provides better results in chronic unilateral knee osteoarthritis in terms of pain and functional disability.


Osteoarthritis (OA) is the most common form of arthritis characterized pathologically by both focal loss of articular cartilage and marginal and central new bone formation. [sup][1] Although biomechanical and biochemical processes occur mainly on the articular cartilage, the entire joint, including subchondral bone, synovial membrane, joint capsule, and ligaments, are affected in OA. [sup][2] Cytokines (IL-1 and TNF-b) activate enzymes causing proteolytic digestion of cartilage and tissue growth factor and insulin growth factor causes cartilage synthesis. When catabolism exceeds cartilage synthesis, OA develops. [sup][3] After few years, the reparative process exhausted and this leaves cartilage degradation unopposed leading to progressive OA, which results into inflammation, pain, and structural damage leading to loss of function. [sup][4]

OA disease causes pain, swelling, and loss of motion of the joint due to the bones under the cartilage rubbing together. [sup][5] Endogenous factors such as age, sex, hereditary, post-menopausal changes, exogenous factors such as macro trauma, lifestyle factors such as (alcohol, tobacco), obesity, [sup][6] or overweight, repetitive joint surgery leads to OA.

Pharmacological drugs such as non-opioid analgesics, opioid and topical analgesics, NSAID, hyaluronic acid injections, and intra-articular steroid injections are given in the initial stages. Surgical procedures such as Cartilage Repair Techniques, Osteotomy, and TKA can also performed in later stages. [sup][7] Various interventions such as Acupuncture, LASER , TENS, Ultrasound, Hydrotherapy, and Manual therapy techniques can be applied for acute and chronic stages and Braces and orthosis are prescribed for the supportive purposes. [sup][8]

Yoga is one intervention which has off late been considered as a treatment for OA. Of the various schools of Yoga, Iyengar Yoga is a form of Hatha Yoga created by BKS Iyengar and stresses strength, balance, breathing, and the alignment of the body. It allows the use of various assistive devices such as chairs or blocks to aid balance and straps to facilitate stretching. It can be performed by anyone at any age and level of fitness. Because the body can be supported and balanced by these techniques, beginners can achieve many postures that would otherwise be literally, out of reach. [sup][9]

Another intervention which is frequently used in the treatment of OA is EMG biofeedback. EMG biofeedback is generally used to provide muscle re-education and to regain muscle strength in cases of muscle weakness. [sup][10] A patient's compliance to the exercise program can be improved by addition of EMG biofeedback to the rehabilitation programs. …

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