Yoga therapy better than exercise therapy in reducing disability from osteoarthritic knees

Yoga-Bhudjangasana-Cobra-PoseIn a recent prospective, randomized controlled trial, participants at the Ebnezar Orthopedic Center, Bengaluru who were assigned hatha yoga therapy showed significantly higher improvement on all disability variables over exercise therapy as an adjunct to conventional physiotherapy for osteoarthritis (OA) of the knee. The study involved 250 outpatients with OA knees, aged 35-80 years.


“An integrated approach of hatha yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving walking pain, range of knee flexion, walking time, tenderness, swelling, crepitus, and knee disability in patients with OA knees.”
-Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med. 2012 May;18(5):463-72.


Key Point: Drug treatment for osteoarthritis (OA) can be costly and have adverse effects when used continuously, so patients seek alternative and complementary therapies. Yoga is shown to be more effective than exercise as an adjunct therapy to conventional physiotherapy. Clinicians should consider incorporating yoga therapy for management of OA knees.

The prevalence of OA in India is 22%-39% and is the second most common rheumatological problem in India. OA is characterized by articular cartilage degeneration and a secondary peri-articular bone response to mechanical damage in joints. Pain and stiffness caused by OA is often treated with non-opioid analgesics and anti-inflammatory drugs, but these drugs may cause adverse effects if used continuously. Additionally, pharmacotherapy can be costly to patients who pay medical bills out of pocket. An alternative therapy option for patients with OA knees that is less expensive and without drug-related adverse effects is hatha yoga therapy with conventional physiotherapy (CP).

The study at Ebnezar Orthopedic Center, Bengaluru compared yoga therapy to exercise therapy on OA knees, both as adjuncts to CP (transcutaneous electrical nerve stimulation (TENS) and ultrasound).

  • Yoga therapy included 20 minutes of CP followed by 40 minutes of shithilikarana vyayamas (loosening practices), sakti vikaasaka (strengthening practices), yogasanas and relaxation techniques with devotional songs.
  • Exercise therapy included 20 minutes of CP followed by 40 minutes of loosening practices, strengthening practices, brief rest, specific knee practices, supine rest and light music.
  • After 2 weeks of supervised therapy, patients in the study were asked to continue their yoga or exercise daily for an additional 12 weeks in their homes with follow-up.

The outcome variables measured were pain while walking, knee disability score, degree of knee flexion, tenderness, swelling of the knee, crepitus, and walking time. Results from patient assessments, which were performed pre-program, post-day 15, and post-day 90, show that while both groups improve in outcome variables, a significantly better improvement was seen in the yoga than the control group.

The yoga therapy group saw significant improvements in the outcome variables:

  • Walking pain score reduced 37% to 65% by day 15 and 90, respectively.
  • Knee disability score reduced 60% to 83% by day 15 and 90, respectively.
  • Right/Left knee flexion improved approximately 13% to 28% by day 15 and 90, respectively.
  • Knee tenderness decreased 52% to 86% by day 15 and 90, respectively.
  • Swelling decreased 55% to 86% by day 15 and 90, respectively.
  • Crepitus decreased 44% to 79% by day 15 and 90, respectively.
  • Walking time improved 27% to 53% by day 15 and 90, respectively.

The findings from this study were similar to an earlier finding by Tekur et al. on the effects of comprehensive yoga programs to improve pain, anxiety, and depression in patients with chronic low back pain. Seven days of intensive yoga therapy was significantly more effective at improving patient’s pain, anxiety, depression, and spinal mobility than physiotherapy exercises.

This study by Ebnezar et al. highlights the effectiveness of hatha yoga therapy over exercise therapy for reducing disability in patients with OA knees, and provides patients with an alternative, non-pharmacological intervention option. Clinicians should consider incorporating yoga therapy for management of OA knees.

References (click to show/hide)

  1. Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med. 2012 May;18(5):463-72. doi: 10.1089/acm.2010.0320. Epub 2012 Apr 26. Available at: http://online.liebertpub.com/doi/abs/10.1089/acm.2010.0320
  2. Tekur P, Nagarathna R, Chametcha S, Hankey A, Nagendra HR. A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT. Complement Ther Med. 2012 Jun;20(3):107-18. doi: 10.1016/j.ctim.2011.12.009. Epub 2012 Jan 28. Available at: http://www.sciencedirect.com/science/article/pii/S0965229912000040

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