6. To exit, exhale as you release your hands and come back into a symmetric position, either with your legs bent or straight. Repeat for the left leg. Modifications using props: 1. If unable to clasp both hands around your knee, wrap a belt or towel around your knee and hold onto the ends with both hands. 2. If limited in hip mobility, bend the knee of your extended leg and place your foot flat on the floor instead (Wörle et al., 2010). BOUND ANGLE POSE (BADDHA-KONASANA) Indications : Knee flexion range of motion. Instructions: 1. Sit upright with both legs straight. 2. Bend your knees and allow them to fall open to the sides. 3. Try to bring the soles of your feet together. 4. Hold your feet or ankles with your hands, with your elbows straight. 5. Stay in the posture for 5–10 breaths. 6. To exit, release your legs one by one to a straightened position. Modifications using props: 1. If unable to sit upright, sit with your back against a wall for support. 2. If unable to release your knees toward the floor fully, place yoga blocks, pillows, or folded blankets under your knees. 3. If unable to bend the knee fully, move your feet further away from the groin (Wörle et al., 2010). EQUESTRIAN POSE (ASHWA SANCHALANASANA) Indications : Knee flexion range of motion. Instructions: 1. Stand erect with both the feet together (mountain pose/ tadasana ). 2. Walk your feet one leg length plus one foot length apart.
3. Turn the right foot and leg 90° outward, the left foot and leg 45° to 60° inward, and your pelvis and trunk 90° to the right; both heels are in line. 4. The central front line of the trunk and the tip of the nose are facing forward; the kneecaps are pointing forward. 5. Lower the left knee to the back of the mat, heel lifted. 6. Exhale as you bend the front leg into a deep lunge. 7. You may place your hands on the sides of your feet for support, or raise your arms overhead, palms facing each other, alongside the ears. 8. Arch the lower back and roll the shoulders back. 9. Hold the posture for 5–10 breaths. 10. 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 lunge fully, place your hands on a yoga brick or on a chair, depending on your flexibility (Wörle et al., 2010). CHAIR POSE (UTKATASANA) Indications : Knee flexion range of motion. Instructions: 1. Stand erect with both the feet together (mountain pose/ tadasana ). 2. Elevate your arms toward the ceiling with your arms parallel and palms facing each other; join the palms if this is possible with straight arms. 3. Exhale as you bend your knees as far as possible, keeping heels on the floor and the trunk and arms lifted. 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
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 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). CHAIR POSE (UTKATASANA) Indications : Quadriceps strengthening. Instructions: See “Range of Motion” (Wörle et al., 2010).
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