New research has found that people with knee osteoarthritis who took a 12-week online yoga program saw improvements in their physical function — at least while they were doing the course.
However, the benefits of yoga, along with people’s participation in the online classes, dwindled in the weeks following the end of the program. The results were published on September 19 in the journal, Annals of Internal Medicine.
While the current study shows that subjects who participated in the online yoga program didn’t see an improvement in their pain symptoms, other studies have seen positive results.
According to Maryland-based yoga therapist Pamela Stokes Eggleston, founder of Yoga2Sleep, yoga is “definitely helpful” for knee osteoarthritis. It can increase mobility and reduce the pain, she added, which in turn, can decrease the need to take pain medication.
Eggleston said she knows this not just as a yoga therapist, but as someone with knee osteoarthritis.
While some people with knee osteoarthritis can have pain severe enough to limit their daily activities, she told Healthline that when her symptoms first appeared, “the pain was not debilitating, but it hurt enough for me to get x-rays and an MRI.”
For her, there was no question of finding some relief from yoga. “It’s about what ‘medicine’ from yoga can I use to help me better?” she said.
Benefits of exercise for knee osteoarthritis
Osteoarthritis of the knee occurs when the cartilage in the knee joint breaks down, allowing the bones to rub together. This can cause pain and other symptoms.
This condition occurs more commonly in people 50 years of age and older, although younger people can also develop it.
In people with knee osteoarthritis, the muscles supporting the joint may be weak, which can lead to balance problems and an increased risk of falls.
Because of this and other health risks related to inactivity, exercise is recommended for people with knee osteoarthritis to decrease their pain, improve their physical function and boost their quality of life.
Regular physical activity can also help people maintain a healthy weight — carrying extra body weight can add stress to the knees and increase inflammation in the joint.
In particular, low impact activities such as walking, cycling, and yoga can help people stay active while being gentler on the knees than higher-impact activities such as running.
When Eggleston first developed knee osteoarthritis, she said walking became, and remains, her “go-to” cardiovascular activity. She also does a daily yoga practice and uses a rebounder, or mini-trampoline — “any low impact activity that is going to get my heart rate up,” she said.
In addition, she said she eats a largely plant-based diet and limits her intake of added sugars to maintain a healthy weight and reduce inflammation in her body. But any healthy balanced diet should still be balanced with a regular exercise regimen.
How Knee Exercises Provide Pain Relief
Exercise can help relieve the pain from knee osteoarthritis by strengthening the muscles around the joint. Stronger muscles ease the stress placed on the knee joint and act as shock absorbers, deflecting some of the day-to-day strain caused by walking and other activities. The AAOS guidelines emphasize that a wide range of exercises can improve knee pain, including weight-bearing, low-impact, and water-based activities.
Most non-impact exercises are good for knee health. In a study published in the journal PLOS ONE in 2015, women with osteoarthritis who did yoga movements three times a week experienced a reduction in knee pain after 12 weeks. Another study published in Pain Research and Management in 2015 found that people with osteoarthritis who walked for at least 150 minutes a week reported less pain than their more-sedentary peers.
Online yoga for knee arthritis
Earlier research supports the use of yoga for knee osteoarthritis, showing that it may improve pain, physical function, and joint stiffness. However, none of these prior studies looked specifically at online yoga programs for people with this condition, until now.
The new study involved 212 people with knee osteoarthritis. All participants had access to online information about osteoarthritis, treatment options, and the benefits of physical activity, weight loss, and healthy sleep habits.
Researchers randomly assigned around half of the people to do a 12-week self-paced online yoga program.
The program consisted of a series of 12 pre-recorded 30-minute videos. People were asked to do one video a week, three times during the week.
The classes included a slow-paced mix of static and dynamic yoga poses designed to stretch and strengthen the muscles of the core and legs.
Instructors also offered different modifications and levels of the poses, so people could adapt the program to suit their personal needs and abilities.
However, the classes focused on physical postures but didn’t include other aspects of yoga, such as deep relaxation, chanting, and meditation, which could also help reduce pain.
Physical function improved with yoga
After 12 weeks, subjects who did the yoga classes saw greater improvements on average in their physical function, knee stiffness, and quality of life, compared to those who only had access to online osteoarthritis education.
Still, there was only a small difference between the two groups in the level of knee pain while walking at 12 weeks.
After the program ended, researchers followed up with participants another 12 weeks later. By then, both groups had similar levels of physical function, pain, knee stiffness, and quality of life.
This loss of benefits seen in the yoga group may be because many people stopped doing the yoga classes after the 12-week program ended.
During the last week of the course, over two-thirds of participants completed at least two classes a week. By the end of the follow-up period, though, fewer than one-third were still doing the online yoga program regularly.
“Not all participants were adherent [to the yoga program], which may have attenuated detection of any true benefits of yoga,” the authors wrote in the paper.
Other factors may have also made it difficult to determine the true benefits of yoga for knee osteoarthritis.
For example, the authors note that “because the yoga program was unsupervised, we do not know whether the yoga elements were performed correctly or completely.”
Finding a specialized yoga class
For people with knee osteoarthritis who are interested in trying yoga for the first time, Eggleston recommends finding a yoga therapist or yoga teacher who specializes in teaching yoga for this condition or for arthritis in general. “This may not be a regular studio class,” she cautioned.
The “My Joint Yoga” program used in the new study was designed by the researchers in collaboration with yoga therapists, as well as a physical therapist and people with knee osteoarthritis. The full 12-week program is available online.
The poses used in the course are ones found in typical yoga classes, but with various modifications and levels. They include:
- Goddess pose in a chair
- Warrior 1 Pose
- Intense Side Stretch Pose
- Leg lifts, standing or prone
- Bridge Pose
- One-leg balance, standing or seated
- Triangle Pose, chair-supported
- Warrior 2 Pose, optional chair-supported
- Wide-Leg Forward Bend, seated
Many of these poses strengthen the muscles around the knee, which Eggleston said is important for stabilizing the joint.
One movement that she has found personally helpful is moving slowly into and out of Chair Pose. A variation of this can also be done with your back against the wall for support.
For Eggleston, though, there’s much more to yoga than doing poses on a mat. “It is really about interoceptive awareness — being fully aware of things going on in my body,” she said.
6 Ways to Build Strength and Stretch Your Knees
Regularly performing some of these recommended exercises for knee osteoarthritis may help improve your function and mobility:
- Straight leg raises Roy Altman, MD, a professor of rheumatology in the department of medicine at UCLA in Los Angeles, routinely teaches his patients how to do straight leg raises, which strengthen the quadriceps. This move can be done either sitting or lying down.
- Sitting Sit back in a firm chair, keeping your back straight, and straighten one leg out in front of you. Count to 10, and then slowly lower to the floor. Repeat 10 to 20 times with each leg.
- Lying down Bend your left leg at the knee so that your left foot is on the floor. Keep the other leg straight and lift it up until it forms a 45-degree angle with the ground. Count to five, then lower, repeating 5 to 20 times with each leg.
- Wall slides This movement targets your quadriceps and glutes. Lean your back and buttocks against a wall, keeping your legs shoulder-width apart and your feet 6 to 14 inches in front of you. Slowly slide down the wall by bending your knees until they form about a 45-degree angle. (Bend less if you experience pain.) Pause, then slowly slide back to the starting position. Perform three sets of 10 to 15 reps. Don’t do this exercise if you’re in pain or hear crunching or cracking in your knees.
- Standing heel raises This exercise strengthens your calf muscles. With your hands placed on a sturdy table, stand up straight and tall. Lift both heels off the floor so you’re standing on your tip-toes and tighten your quadriceps to keep your legs straight. Don’t allow your knees to bend. Hold for one second, then slowly lower your heels to the floor. Repeat 20 times.
- Hamstring stretches Stretching can increase your flexibility and help your joints move through their full range of motion, according to the Arthritis Foundation. To stretch your hamstrings, sit on a flat surface with your legs extended. Bend one of your knees up and then drop that knee over to the side, so that your foot is against the inside of your other leg. Lean forward from your hips and reach your hands toward the toes of the extended leg, feeling the stretch in that hamstring. Hold for 20 seconds, then switch legs.
- Calf stretches Standing with your forearms against the wall, slide one leg back behind you and bend the knee of the front leg. Lean forward with your hips and press the heel of the extended leg down against the floor. (You will feel a gentle stretch in the knee, calf, and heel.) Hold for 20 seconds, then switch legs.
- Rear leg lifts Strengthening the muscles at the back of your leg helps provide support for the knee. Lie flat on the floor on your stomach, resting your head on your arms. Use your gluteus and hamstring muscles (on the back of your thigh) to raise one heel toward the ceiling. Hold for five seconds, then lower. Repeat 10 times, then switch legs. As this exercise gets easier, add ankle weights for an added challenge.
Talk to your doctor before making any changes to your exercise routine, and consider consulting with a physical therapist about which movements to do and when. Once you begin exercising, be sure to take it slow and easy. And remember: Activity, not inactivity, will bring the best results.