PYRAMID POSE (PARSVOTTANASANA) Figure 9: Pyramid Pose
3. Straighten your knees, make your quadriceps muscles firm, and pull your kneecaps up. 4. Stand in this position for 5–10 breathes. Modifications using props: 5. If unable to balance with feet together, stand with feet slightly apart (Wö rle et al., 2010). WARRIOR I POSE (VIRABHADRASANA I) Indications : Double-leg balance. Instructions: See “Strengthening” (Wörle et al., 2010). CHAIR POSE (UTKATASANA) Indications: Double-leg balance. Instructions: See “Range of Motion” (Wörle et al., 2010). GODDESS POSE (UTKATA KONASANA) Indications : Double-leg balance. Instructions: 1. Stand erect with both the feet together (mountain pose/ tadasana ). 2. Walk your feet one leg length apart. 3. Bend the elbows at shoulder height and turn the palms facing each other. Turn the feet out 45°. 4. Exhale as you bend the knees over the toes squatting down. 5. Look straight ahead with the chin parallel to the floor; keep the arms active, as if they were holding a big ball over your head. 6. Stay in the posture for 5–10 breaths. 7. To exit, inhale as you straighten your legs; reach the fingertips to the ceiling, then lower the arms to your sides. Modifications using props: 1. If unable to balance without support, stand with your back against a wall or table (Wörle et al., 2010).
Indications : Double-leg balance. Instructions: 1. Stand erect with both the feet together (mountain pose/ tadasana ). 2. Walk your feet one leg length apart. 3. Turn the right foot and leg 90° outward, the left foot and leg 75° inward; the left heel is in line with the right foot. 4. Turn your pelvis and trunk 90° to the right; the kneecaps and the toes are pointing forward. 5. On an inhalation, spread your arms out to the sides. On an exhalation, internally rotate your arms, bend your elbows, and bring your palms together behind your back. 6. Exhale as you bend over the right knee; lengthen the spine to fold toward the floor without rounding your back. 7. Gently play with the rotation of your pelvis until the central line of your trunk is exactly in line with the front leg. 8. You may keep your hands behind your back or place them on the floor on the sides of your front foot for balance. 9. Stay in the posture for 5–10 breaths. 10. To exit, inhale as you lift your trunk upright, turn your feet parallel, and turn your pelvis and trunk to the center. Perform to the left side. Modifications using props: 1. If unable to reach the floor without rounding your back, place yoga blocks under your hands (Wö rle et al., 2010) . TREE POSE (VRKSASANA) Indications : Single-leg balance. Instructions : See “Strengthening” Wörle et al., 2010). WARRIOR III POSE (VIRABHADRASANA III) Indications : Single-leg balance. Instructions : See “Strengthening” (Wörle et al., 2010). planted joint. It’s important to make sure patients keep toes and knees tracking in the same direction in poses such as warrior 1 and goddess, to avoid torque forces through the knee joint. Con- trary to popular belief, kneeling is not necessarily injurious to a new knee replacement. A recent study showed that a majority of patients who had a total knee replacement could kneel after sur- gery (Wallace et al., 2019). For yoga poses that require kneeling, using props such as blankets or cushions under the knee may help ease any discomfort. provide greater compliance due to their universal recognition. Yoga poses, once learned, may be easier for patients to remem- ber and practice long-term. Continued exercise after completion of formal rehabilitation is important for full recovery after TKA. At the conclusion of a formal physical therapy program, TKA patients could easily transition from their yoga-based therapeutic exercis- es into a recreational yoga program. Additionally, there are also “adaptive” and “senior” classes accessible in most areas.
Safety considerations According to the American Academy of Orthopedic Surgeons’ most recent clinical practice guidelines, participation in high- impact activities with high joint load (e.g., running) should be avoided due to the subsequent risk of premature wear after joint replacement surgery (McGrory, 2016). Torque or twisting forces across the knee joint should also be avoided. Yoga poses are low impact, can be performed regardless of age or level of experi- ence, and can be modified to suit patients’ needs. Alignment in yoga is the most important factor in the safety of the newly im- Final recommendations Yoga is a strong alternative for therapeutic intervention after knee replacement, as it provides a comprehensive, integrated ap- proach. Certain poses can address multiple rehabilitation goals at once. For example, the chair pose was shown to address knee range of motion, strength, and balance separately, and could tar- get all three simultaneously. Requiring fewer individual interven- tions could reduce the number of prescribed exercises, improving compliance and performance at home. Yoga poses could also
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