People with Knee Osteoarthritis
Can Practice Yoga Safely
by Janet Cuthrell

Yoga East 200hr Teacher Training, June 2022

 Global aging, sometimes referred to as the “Silver Tsunami” or the “Age Wave”, has become one of the greatest sociological shifts in history ^[1]. Americans ages sixty-five and older, make up the fastest growing sector of the U.S. population; this diverse group are living longer, practicing yoga and even running marathons ^[1]. Furthermore, according to the CDC, 41% of these older individuals report that they are in good or excellent health ^[2]. However, although a large percentage report back positively, seniors are often faced with a variety of adverse health conditions which can have detrimental effects on overall quality of life ^[2].  Among these conditions is osteoarthritis ^[2]. 

The most common form of arthritis worldwide is Osteoarthritis (OA), a progressive disease that destroys cartilage and joints, is a frequent cause of pain, functional limitation and disability ^[3].  Osteoarthritis of the knee is a common form of arthritis, and affects nearly 12.4 million seniors, the majority of which are women ^[3]. 

Exercise therapy, including mind-body exercises, yoga, and mental focus along with controlled breathing, have become key elements in the treatment for knee osteoarthritis ^[3]. Additionally, yoga has proven itself to be the superior form of exercise therapy, not only because of decreased pain and improved function, but yoga’s inclusion of meditation and standing exercises has helped seniors decrease anxiety and fear of falling ^[3].

 Sharon Kolasinski, MD, a professor of clinical medicine and a rheumatologist at the University of Pennsylvania in Philadelphia, produced a study on the impact of yoga on those suffering from knee osteoarthritis ^[4]. Kolasinski’s study demonstrated that people who participated in a 90- minute Iyengar yoga class, once a week, for 8 weeks, using props and pose variations, had decreased pain, increased physical function and less joint stiffness ^[4].

Because of yoga’s gentle movements, people with osteoarthritis are increasingly drawn to yoga for a safe and gentle form of exercise along with a way to lower stress, improve mobility and balance. Additionally, yoga is fun and presents people with arthritis a type of exercise that can be done on a regular basis ^[4]. Practicing with an experienced yoga teacher, modifying poses and using props, help to promote knee joint safety and provide a beneficial practice ^[4]. Iyengar yoga, is recommended for people with knee arthritis because it allows the use of props ^[4].

People with knee arthritis should modify yoga poses and use props to protect the knee ^[5]. In poses where the legs are straight, such as Trikonasana (Triangle Pose) hyperextending the knee should always be avoided ^[5]. To prevent knee hyperextension, a slight bend in the knees and keeping weight evenly distributed in the four feet corners is recommended ^[5].

Avoiding deep knee bends and maintaining proper knee alignment in poses like Virabhadrasana II (Warrior II) is another way to protect the knee and avoid knee injury when practicing yoga ^[5]. The bent knee should be aligned over the ankle and in line with the second toe ^[5]. If the knee should go beyond the ankle, the stance should be widened ^[6]. During Warrior II a frequent, but destructive, misalignment is for the thigh to fall inward turning the knee towards the big toe, placing too much stress on the knee ^[6]. Likewise, allowing the thigh to turn outward shifts the knee towards the little toe creating knee stress ^[6]. Pointing the knee in line with the second toe, making sure that the knee and the toe are on the same plane as the sit bone will protect the knee ^[6].

Finally, a common pose where props should be used to alleviate pain and to make the pose achievable is Virasana (Hero’s Pose) ^[7]. Many people with knee OA cannot perform Virasana by sitting upright, with hips in between the feet and knees together ^[7]. One solution is to raise the floor with props, like a sitting on a folded blanket or one - two blocks under the hips ^[7].

Today, “sixty is the new forty”, someone celebrating a sixtieth birthday can expect to live two decades or more, yoga presents the potential for making this chapter of life truly the golden years ^[1]. As a holistic practice that intersects body, mind and spirit, yoga can be a deep and transformative practice during this cherished time, even for those with knee osteoarthritis ^[1].

Bibliography

1. Relax into Yoga for Seniors, Carson, Kimberly MPH, C-IAYT & Krucoff, Carol, C-IAYT, (2007). p. 7-11.
2. Top 10 health concerns for seniors: ASC blog. ASC. (2021, November 17). Retrieved May 23, 2022, from https://www.asccare.com/health-concerns-for-seniors/ 
3. Conservative treatment of knee osteoarthritis: A review of the literature. Lim, W. B., & Al-Dadah, O. (2022). World journal of orthopedics, 13(3), 212–229. https://doi.org/10.5312/wjo.v13.i3.212
4. Yoga Benefits for Arthritis, Susan Bernstein, Arthritis.org
5. Avoid Knee Pain and Injury with Yoga, August 28,2007, Catherine Guthrie, Yoga Journal, yogajournal.com
6. Yoga Therapy for Your Knees, Doug Keller, Yoga International
7. Yoga for Health Knees, Hips and Ankles: 3 Ways to prop Virasana, September 18, 2020, Allison Ray Jeraci, Yoga U Online, yogauonline.com