4. Have slightly more weight on the heels than on the forefoot. 5. Stay in the posture for 5–10 breaths. 6. To exit, inhale as you straighten your legs and relax your arms.
Modifications using props: 1. If unable to stand without support, keep your arms parallel, the palms facing forward, resting on a wall or chair (Wörle et al., 2010).
POSES FOR STRENGTHENING
maximus (Beazley et al., 2017). Warrior II pose produces the highest activation of the vastus lateralis (Lui, 2021). Triangle pose produces the highest activation of the psoas major of the front leg and the gluteus maximus and medius of the back leg (Kumar, 2018). The single-leg asanas half-moon, tree, and warrior III have the highest muscle activation of the gastrocnemius, biceps femoris, and gluteus medius (Kelley et al., 2019). Based on these findings it can be concluded that the half-moon, tree, and warrior III poses can be utilized after TKA for calf, hamstring, and hip abductor strengthening; warrior I pose for hip extensor strengthening; and triangle pose for hip flexor, hip extensor, and hip abductor strengthening. Exercises that engage the quadriceps are often essential after TKA. Since the chair pose has a high activation of the rectus femoris, warrior I pose the vastus medialis, and warrior II pose the vastus lateralis, all three can be used as a therapeutic intervention for quadriceps strengthening after TKA. The yoga asanas can be instructed to be held (5–30 seconds) for isometric strengthening or performed in repetition (3 sets of 10) for concentric or eccentric strengthening. Regardless of the strengthening parameters, most of the yoga asanas will involve cocontraction of agonist and antagonist muscles to provide joint stability. For example, warrior III pose has been shown to produce high EMG activity in both the biceps femoris and rectus femoris (Kelley et al., 2019).
Strengthening is often a crucial part of postoperative TKA recovery. Clinical practice guidelines recommend implementing high-intensity strength training starting in the early post-acute period (Jette, 2020). This, according to Jette et al. (2020), is due to emerging evidence that suggests more intensive rehabilitation using progressive resistance exercise and functional strengthening can improve patient function without compromising safety. One of the randomized controlled trials used to develop the CPG evaluated the safety and efficacy of a high-intensity progressive rehabilitation program after total knee arthroplasty. The program consisted of resistance exercises targeting all major lower extremity muscle groups and a rapid progression to weight-bearing exercises. The study determined that early high-intensity resistance training is as safe as low- intensity resistance training, with knee ROM (flexion or extension) not compromised when initiated 72 hours after TKA (Bade et al., 2017). Many yoga asanas involve high-intensity, weight-bearing, progressive strengthening. Surface electromyography (sEMG) has been used to assess muscle activation during specific yoga asanas. In order to determine which yoga asanas would work best for strengthening after TKA, it is important to establish which muscles are activated. Using sEMG, the chair pose has been shown to elicit the highest muscle activation of the rectus femoris (Kelley et al., 2018; Liu et al., 2021). Warrior I pose produces the highest activation of the vastus medialis (Liu et al., 2021) and gluteus
Chair pose (Utkatasana) Indications : Quadriceps strengthening. Warrior I pose (Virabhadrasana I) Figure 4: Warrior I Pose
Instructions: See “Range of Motion” (Wörle et al., 2010).
Instructions: 1. Stand erect with both the feet together (mountain pose/ tadasana ). 2. Walk your feet one leg length plus one foot length apart; adjust the distance so that you feel stable and well stretched. 3. Maintaining a neutral lumbopelvic position, elevate your arms vertically overhead keeping them parallel, palms facing each other. 4. Turn the right foot and leg 90° outward, the left foot and leg 45–60° inward, and your pelvis and trunk 90° to the right; both heels are in line. 5. The central front line of the trunk and the tip of the nose are facing forward; the kneecaps are pointing forward. 6. Exhale as you bend your right knee until the shin bone is vertical. 7. Join your palms if this is possible with straight arms. 8. Hold the posture for 5–10 breaths. 9. To exit, inhale as you straighten your right knee, and turn your pelvis and trunk to the center, feet parallel. If necessary, relax your arms. Repeat on the left side. Modifications using props: 1. If unable to keep your knee in the correct alignment, hold a yoga brick between your upper shin bone and a wall or pillar. 2. If unable to bring the rear heel onto the floor, rest it on a rolled mat; gradually decrease the height of the roll (Wö rle et al., 2010) .
Indications : Quadriceps and hip extensor strengthening.
Page 115
Book Code: PTNY1024
EliteLearning.com/ Physical-Therapy
Powered by FlippingBook