○ Physical therapists should not use continuous passive motion (CPM) machines for patients who have undergone primary, uncomplicated TKA due to evidence to support that there is increased risk, harm, and cost. ○ Physical therapists should design, implement, teach, and progress patients in high- intensity strength training starting in the early post-acute period (i.e., within 7 days after surgery) to improve function, strength, and ROM. ○ Physical therapists should include motor function training (e.g., balance, walking, movement symmetry) to improve participation in activities of daily living.” (Jette et al., 2020) In addition to postoperative physical therapy, individuals who are status-post TKA can also benefit from occupational therapy, with concurrent aims to reduce pain, improve occupational performance, and improve overall functional outcomes (Torpil & Kaya, 2022). While there are not professionally endorsed clinical practice guidelines for this patient population exclusive to occupational therapy, it is common for occupational therapy Yoga is a popular form of physical activity practiced worldwide. According to data from the 2017 National Health Interview Survey (NHIS), 12% of the U.S. population (35 million people) practice yoga. More notably, the survey revealed a 5% increase in practice since 2012 (Clarke et al., 2018). The growing popularity can be attributed to an increased awareness of the health and wellness benefits associated with yoga. In the past decade there has been a significant scientific exploration of yoga as a medical treatment. A search of the literature by Wieland et Yoga asanas The majority of yoga practiced in today’s modern era is hatha yoga. Hatha means the physical practice of yoga. Some of the major styles of modern yoga—including Ashtanga yoga, Iyengar yoga, Bikram yoga, and Vinyasa yoga—are all practices of hatha yoga. Hatha yoga poses are referred to as asanas, which is Sanskrit for “posture.” Yoga asanas generally consist of the basic positions of standing, sitting, lying, forward bending, back bending, twisting, inversion, and balancing. They are typically slow, rhythmic movements of various joints and muscles to a
to be consulted after surgery and prior to discharge to educate on overall service delivery expectations and evaluate needs for activities of daily living (ADL) training, adherence to precautions, home modifications, and education on compensatory strategies (such as durable medical equipment, adaptive equipment, or other assistive devices) to work around expected limitations of pain, limited range of motion, strength, and motor function (Dorsey & Bradshaw, 2017; Hiraga et al., 2019). The client- centered approach of occupational therapy can aim to improve physical health in conjunction with positive impacts on quality of life and satisfaction. A systematic review published by the American Occupational Therapy Association (AOTA) by Dorsey and Bradsaw (2017) focused on the importance of investigating the effects of occupational therapy interventions for individuals with lower extremity musculoskeletal disorders and articulated a strong role for occupational therapy. Occupational therapy practitioners can maximize their role with individuals status-post TKA by demonstrating service competency in yoga practice.
YOGA PREVALENCE
al. (2021) found 322 publications evaluating yoga as a health intervention. A majority (79%) of the publications were explicitly about yoga as a treatment for a health-related condition, most commonly mental health or musculoskeletal conditions. A vast majority (92%) of the articles were published in the past decade, and half were published in medical specialty journals. These findings suggest that the scientific community has shifted beliefs about yoga from the realm of complementary medicine into the mainstream healthcare system. definite posture for a static state of holding. These holds are generally held anywhere from a few seconds (one or two breaths) up to five minutes. The names of asanas are Sanskrit words and usually correspond to the posture depicting the meaning of the word (e.g., downward-facing dog – adho mukha svanasana ). A common misunderstanding is that yoga asanas predominantly focus on increasing flexibility; however, many poses emphasize appropriate postural alignment, musculoskeletal strength and endurance, and balance.
Healthcare Consideration: Yoga is a complementary and alternative therapy. Techniques from this practice are not included in entry-level education programs certified by the Commission on Accreditation of Physical Therapy Education (CAPTE) or the Accreditation Council for Occupational Therapy Education (ACOTE). Therefore, most therapists learn about yoga through self- practice rather than through evidence-based education. Research suggests that more and more physical therapists are introducing yoga therapeutically in clinical practice and the home exercise program. The research reveals, however, that most practitioners learn about yoga through personal experiences, with safety being a primary concern when recommending yoga to patients (Wims et al., 2017). Compared to rehabilitation programs after knee replacement surgery, therapeutic yoga could provide superior compliance and benefit in the long term. Yoga poses, once instructed, may be easier for patients to remember and practice because the poses and their associated names are often universally recognized. Knowledge of safe and effective evidence-based yoga asanas for knee rehabilitation may provide an opportunity for therapists to expand treatment strategies and improve compliance after total knee replacement. Evidence-based practice (EBP) Yoga asanas have been shown to improve pain, function, and mobility for rehabilitating knee patients compared to conventional physical therapy interventions. A 2018 study by Patel et al. examined the effectiveness of yoga asanas over conventional physical therapy interventions in patients with knee OA. The yoga program consisted of the following yoga asanas performed a total of 3 sets of 10 repetitions: mountain pose, tree pose, chair pose, wind-removing pose, warrior i pose, head-to-knee pose, and triangle pose. Participants allocated to the yoga group achieved a greater improvement in pain (VAS), functionality (WOMAC), and mobility (30-Second Chair Stand Test) after four weeks compared to those who performed conventional physical therapy exercises (Patel, 2018). Another 2018 study looked at the effects of a biomechanically based yoga exercise program in patients with knee OA. The yoga program consisted of alignment-based postures that activate the lower limb musculature while maintaining a low knee adduction moment, including chair pose, warrior i pose, warrior ii pose, triangle pose, and bridge pose. The yoga-based exercise program produced clinically meaningful improvements in pain, self-reported physical function, and mobility in patients with clinical knee OA compared to a traditional exercise- based program (Kuntz, 2018). Only one study exists in the literature on the effects of additional yoga therapy on conservative physical therapy management of total knee replacement. The additional yoga asanas performed after TKA included corpse pose, mountain pose, seated forward bend, wind-relieving pose, bound angle pose, half locust pose, warrior i pose, and chair pose. The study concluded that a combination of physical therapy and yoga asana protocol is more effective at improving functional outcomes than physical therapy protocol alone (Bedekar et al., 2012).
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