Arthritis of the knee affects 10% of men and 13% of women over the age of 60 in the United States. Osteoarthritis, (OA) the most common form, is a slowly progressive disease resulting in the loss of normal joint cartilage. There is no reliable medical or surgical treatment to reverse this disease process yet; however, we can control the symptoms - the most common of which are pain and loss of mobility.
One of the more effective options for improving, or at least maintaining knee range of motion (ROM), and one that is advocated by the American Academy of Orthopaedic Surgeons, is structured physical therapy (PT). The goal of a structured PT program is to reduce pain and improve knee motion through the use of strengthening and stretching exercises, as well as postural education to reduce positions that cause pain. The ultimate goal is for the patient to be able to perform these exercises at home and create a daily practice. Like most forms of exercise, the benefits of PT are only seen once it is made into a routine.
Two complementary and alternative (CAM) modalities, which also emphasize gentle range of motion and muscle strengthening, are Tai Chi and Yoga. In this post, I will spend some time going into the scientific evidence for their effectiveness in the treatment of symptomatic knee arthritis.
Tai Chi
Tai Chi is a mind-body practice that combines slow body movements with balance, deep breathing exercises and meditation. There is scientific evidence that regular practice may alleviate pain related to knee osteoarthritis. The majority of these studies, however, compared patients who underwent 12 weeks of Tai Chi practice to a control group who had no treatment at all. More recently, a study from the Annals of Internal Medicine compared patients with symptomatic knee OA who underwent 12 weeks of Tai Chi practice, to those who participated in 6 weeks of structured physical therapy. The authors found no difference in pain relief and similar improvements in quality of life and symptoms of depression between the groups.
These studies make no conclusions about the effectiveness of the mental component of Tai Chi in relieving the symptoms of knee arthritis. They are, however, suggestive that Tai Chi’s physical component (gentle improvement in range of motion, muscle strengthening and balance) may be responsible for its effectiveness in treating knee arthritis. With very little downside to its use, it is a reasonable option for sufferers of knee pain from osteoarthritis. For more information on Tai Chi and its health benefits, please visit: https://nccih.nih.gov/health/taichi/introduction.htm
Yoga
Like Tai Chi, yoga is also a mind and body practice which focuses on breath awareness or pranayama and static body positions called poses or asanas. The most popular styles of yoga include Hatha, Vinyasa, Ashtanga, Iyengar, and Bikram.
A few brief words on styles:
-Hatha: Slower moving, poses held longer, good for beginners.
-Vinyasa: Aka Flow, a dynamic, faster paced practice. Strenuous and good cardiovascular exercise.
-Ashtanga: In this variant, six series of poses are performed, usually in the same order every class.
-Iyengar: Body form and alignment are stressed. Props such as blocks, straps and chairs may be used to aid in correct form and technique.
-Bikram: A 90 minute, predictable series of 26 poses and two breathing exercises. Performed in a room heated to around 100 degrees Fahrenheit. Hydrate before, during, and after!
Yoga has been cited for its health benefits by its practitioners and teachers for as long as it has been in practice, though only recently have these claims been investigated scientifically. Because it is a physical activity with a spiritual component, the question remains whether the health benefits of yoga stem from the activity itself, or from the intangible mental component.
In 2011, a study was performed which compared yoga, self-care and a stretching program in the treatment of chronic low back pain. 228 patients with chronic low back pain were randomized to participate in either 12 weeks of a once weekly yoga class, conventional stretching exercises, or a self-care book. The study found that after 12 weeks, patients who did yoga felt less pain and better function than those who had the self-care book. There were no significant differences between patients who did yoga and those who did conventional stretching.
A 2005 study performed by the Division of Rheumatology at the University of Pennsylvania evaluated whether Iyengar Yoga was effective in the treatment of knee arthritis. In this study, patients with knee OA attended a 90 minute yoga class, once a week. After 8 weeks, participants noted significant reductions in pain scores and improvement in function scores compared to their status before the course of treatment. While this study had no direct comparison group, it does suggest that yoga may have a role in non-surgical treatment of osteoarthritis of the knee.
While tai chi and yoga do share some similarities, yoga poses greater risks, especially to inexperienced practitioners. If you are interested in beginning a yoga practice, find a center with a good reputation for training beginners, and be sure to select a class appropriate to your comfort level, fitness and flexibility. For more information on yoga and its health benefits, please visit: https://nccih.nih.gov/health/yoga/introduction.htm
Some closing thoughts:
A well respected professor of orthopedic surgery, and a mentor of mine, would often tell his patients, “movement is life.” I believe that any activity that gets your body moving, and allows you to stretch and strengthen parts of your body that you do not use every day, is a good one. In the end, it probably does not matter which form of exercise you choose, so long as it is one that is safe, led by experienced instructors, and most importantly, one that you enjoy.