EFFECT OF VARIED YOGIC PRACTICES ON SELECTED PHYSIOLOGICAL AND

PSYCHOLOGICAL VARIABLES AMONG OSTEOARTHRITIC MEN.

Thesis Proposal Submitted to the Tamil Nadu Physical Education &

Sports University, Chennai for the partial fulfilment

for the Degree of

MASTER OF SCIENCE

in Yoga Therapy

SUBMITTED

BY

A.T.HARIHARAN

Reg No. DE.11080008002

GUIDED BY

Dr.S.Selvalakshmi

DEPARTMENT OF YOGA

TAMIL NADU PHYSICAL EDUCATION & SPORTS UNIVERSITY

CHENNAI –600 048

APRIL/MAY - 2013

EFFECT OF VARIED YOGIC PRACTICES ON SELECTED PHYSIOLOGICAL AND PSYCHOLOGICAL VARIABLES AMONG OSTEOARTHRITIC MEN.

INTRODUCTION

Osteoarthritis (OA) is the most prevalent of the chronic rheumatic diseases and is a

leading cause of pain and disability in most countries worldwide. Osteoarthritis of the knee is a

major cause of mobility impairment. The prevalence of Osteoarthritis increases with age and

generally affects women more frequently than men. Most of the Osteoarthritis disability burden

is attributable to the hips and knees. Global statistics revels over 100 million people worldwide

suffers from Osteoarthritis, which is one of the most common causes of disability. Current

treatment for this incurable condition largely focuses on pain management.

Osteoarthritis is the most common type of arthritis and is characterized primarily by

articular artilage degeneration and a secondary peri-articular bone response. Worldwide the

prevalence rate of OA is 20% for men and 41% for women and it causes pain or dysfunction in

20% of the elderly. In India, OA is the 2nd most common rheumatological problem and has a

prevalence rate of 22 to 39 %. Relieving pain and stiffness, and improving physical function

are the important goals of present day therapy Nonopioid analgesics and anti-inflammatory

drugs which form the mainstay of drug treatment do reduce pain and inflammation but their

longterm use is associated with many adverse effects.

The need for safer treatment of osteoarthritis has led to research into many alternative

and complementary therapies. There are several research conducted tests (RCTs) that have

used non-pharmacological interventions for OA knees.

In fact, Osteoarthritis is the precipitating diagnosis for more than 90% of the increasing

number of total hip or knee joint replacement operations being undertaken worldwide.

Now-a-days people are looking towards natural ways of approach in health and

happiness. This search has brought yoga in our daily life. Yoga keeps our inner body and inner

mind clean and clear to lead a life of benevolence. The practice of yoga exercises or asanas can

improve one’s health, increase one’s resistance and develop one’s mental awareness.

The purpose of this study is to evaluate the efficacy of yoga therapy with the

therapeutic exercises in Osteoarthritis (OA) of the knee joints. Yoga has specialized in this

subject for thousands of years, and streamlined the methods to attain this aim. These days,

yoga classes are being held at most health and wellness centers across the United States.

(Iyengar, 2001)

OSTEO ARTHRITIS

Arthritis means inflammation of the joints. Osteoarthritis (OA) is a degenerative

disease caused by break down of cartilage. Cartilage is the tough elastic material that covers

and protects the ends of bones. Normally the cartilage acts as a shock absorber but when the

joint develops osteoarthritis the cartilage gradually becomes rough and thin, and the bone

underneath thickens.

The term Osteoarthritis is derived from the Greek word part osteo-, meaning "of the

bone", combined with arthritis: arthr-, meaning "joint", and -itis, the meaning of which has

come to be associated with inflammation. The -itis of osteoarthritis could be considered

misleading as inflammation is not a conspicuous feature. Some clinicians refer to this condition

as osteoarthosis to signify the lack of inflammatory response.

Osteoarthritis Pathology

Osteoarthritis pathology starts in the cartilage and gradually involves the whole of the

joint. Initially cracks develop on the surface of the cartilage and it becomes irregular.

Gradually these cracks get deeper and wider and erode a portion of the joint cartilage. This

occurs in some places whereas others areas of cartilage remain uninvolved.

Swelling and deformity can produce stretching of ligaments making the joint unstable

and more vulnerable to injury. Pain causes the patient to avoid activity this leads to weakening

of the muscles. These weak muscles are unable to support the joint efficiently leading to more

damage.

Thus can see that cartilage breakdown and inflammation leads to weakening of joint

protectors which leads to further cartilage breakdown and producing a vicious cycle that causes

rapid progression of the disease.

Signs and symptoms:

Among the symptom pain, loss of mobility and stiffness are the major one. In

osteoarthritis patient experience muscle spasm & contraction in the tendons. Generally the pain

associated with osteoarthritis is described of sharp ache or burning sensation. Osteoarthritis can

occur in any joint, but usually it affects the hands, knees, hips or spine.

Causes :

Although the exact root cause of osteoarthritis is not known but the primary cause like

age, gender, obesity, heredity, trauma, or overuse of knee joints has been out lined as causative

factor. Research has established that one of the root causes is the destruction of the

chondrocytes. The logical way of solving this problem lies in building up substances in the

joint that are chondro-protective and chondro-regenerative, and simultaneously reducing

inflammation in the degenerative joint. Such substances provide arthritis pain management and

relief for joint pain and inflammation without harming the joint itself.

Causes of Arthritis according to ayurveda and yoga:

- Anadhija (non-stressborn) like Infections (acute, chronic, reactive), Injuries (acute phase, chronic phase, with deformities)

- Adhija(stress born) like Osteo arthritis (Rheumatoid arthritis), Arthraldias, Musculo skeletal pain, Osteoporosis

The aim of Yoga is to strengthen the immune system to fight better & to prevent &

correct deformities. To minimize pain & swelling and improves condition.

Treatment options in osteoarthritis:

Osteoarthritis is a chronic degenerative disease. The primary goals of the treatment are

to improve the function and quality of life. The role management of the disease is critical and

proper understanding will allow determining the therapeutic need of patient. The treatment

approaches should consist of:

Exercise

Weight control

Rest and joint care

Pain relief techniques

Medicines

Therapeutic Yoga practices

Alternative therapies

Surgery

As pain is the primary symptom of osteoarthritis non steroidal anti-inflammatory drugs

(NSAIDs) are prescribed.  These NSAIDs causes gastrointestinal side effects without treating

the root cause. Recent research aim is to halt the progressive degeneration of articular cartilage

which in turn will help to slow or reverse the structural and pathological alternation occurred in

osteoarthritic joints.

The current dynamics involved in alternative therapy has proved that some nutritional

supplements like glucosamine, chondroitin sulfate, Vitamin C, Methylsuphonylmethane,

Vitamin E, Vitamin D and certain trace elements can halt the degenerative progress of

osteoarthritis. 

Yoga (cure) Treatment for Osteo Arthritis

Yoga benefits osteoarthritic people in various ways. Asanas, pranayama, meditation

and yognidra are the helpful tools in one’s efforts to re-establish a relief from the ailment.

Yoga therapy for Arthritis, in particular Osteo Arthritis is growing day by day. Yoga

therapy provides a methodically graded training in slowly improving one’s range of

movements. But this happens only when practiced with deep internal awareness. Yoga therapy

for Arthritis not just helps mobilize stiff joints it even helps retard the aging process. Even

though one’s damaged cartilage might not be replaceable, through Yoga therapy one can

certainly arrest further deterioration and wearing out.

In cases of chronically damaged Osteo Arthritis joints where there is severe pain and

deformities, the surrounding tissues could have become very weak. This is the result of long

standing inactivity. Like physiotherapy a lot of Yoga therapy practices when done with deep

internal awareness and regularly, definitely helps the sufferer to strengthen the tissues and

muscles around. Some specific Yoga therapy practices are Sakti Vikasaka Sukshma Vyayamas

that are known to provide non-weight bearing isometric besides isotonic exercises which help

to strengthen the muscles. This provides the weight bearing support to the joints. The

supplementary contribution of Yoga therapy’s Sukshma Vyayama is the deep relaxation. This

helps get rid of muscle fatigue.

Next comes, the inner equilibrium and composure, sense of contentment, complete

courage and confidence to accept all ups and downs of life. This most certainly helps to arrest

the process of further aging. Moreover, Yoga therapy gives the sufferer of arthritis a re-

changed refreshed life with a complete change in his / her world view, taking the person

towards a more positive outlook. One great benefit here is stress reduction at the deep level of

notional correction.

The physical yoga practices provide a systematically graded training in gradually

increasing the range of movements when practiced with deep internal awareness. This not only

helps to mobilize the stiff joints but can prevent further aging process. Although the damaged

cartilage may not get replaced, further deterioration and wearing out can be arrested.

In chronically damaged joints with pain and deformities, the surrounding muscles

would be very weak because of long standing inactivity. Similar to physiotherapy many yoga

practices when practiced with deep internal awareness and repeated, can help you to strengthen

the muscles around. Sakti vikasaka Suksma vyayamas are specific practices that provide the

non-weight bearing isometric as well as isotonic exercises that strengthen the muscles,

providing the weight bearing support to the damaged joints. The additional contribution of

yogic Suksma Vyayama is the deep relaxation, which takes away the muscle fatigue.

In addition the inner equipoise, contentment, absolute fearlessness and confidence to

accept all ups and downs of life would almost arrest the process of further aging. It would give

you a re-changed refreshed life with a total change in your world view, moving towards

positive outlook. Stress reduction at this deep level of notional correction is the one that can

revert the programmed gene function to a normal rate of cell repair in the cartilage.

OBJECTIVES OF THE STUDY

To find out whether there would be any significant improvement in the osteoarthritic men, if yogic practices are followed by them.

To find out whether there would be any significant differences in the physiological variables among men.

To find out whether there would be significant improvement by way of reduction or stoppage of taking medicines to overcome osteoarthritic ailment due to following yogic practices.

REASONS FOR THE SELECTION OF THE TOPIC AND VARIABLES.

Yogic practices are the most time tested ancient fool-proof result oriented techniques.

Yoga is a science; and it is also a way of life. It acts holistically and cures all ailments visible

or invisible. Osteo arthritic ailment is seldom taken seriously among people, and they fail to

see the big picture behind. Osteo arthritic ailment is like a small tip of the iceberg. The lurking

dangers are manifold and they affect the sufferer mentally, physically and spiritually too.

Medicinal intervention in curing the osteo-arthritic disorders treats the symptoms only and the

underlying problem goes unnoticed. Yogic practices are ancient time tested non-invasive

remedies. Yoga is a gift from ancient sages (seers) for the mankind. And the relevance of yogic

practices still hold good than in any other time.

SIGNIFICANCE OF THE STUDY

1. This study may be helpful for osteoarthritic men to reduce their sufferings through varied yogic practices.

2. This study may be helpful to the future research scholars to select new problems related to the topic.

3. The significance of the this study is to improve the knowledge about osteoarthritis among men and to provide a systematic approach of varied yogic practices which in turn is useful to assess the degree of improvement in the ailment.

4. The study is also useful for students of yoga and serves as a guide to demonstrate the importance of yogic practices in the overall development of men as well as women.

5. This study predominantly focuses on psychological, physiological variables in the alleviation of osteoarthritis among men through varied yogic practices.

6. In India the victims of osteo arthritic disorders are yet to be properly identified and their woes are not yet researched well. Yogic researchers have a vast untreaded field ahead of them.

STATEMENT OF THE PROBLEM.

The purpose of the study was to find out the effect of yogic practices on selected

physiological and psychological variables among osteoarthritic men.

HYPOTHESIS.

It is hypothesized that there would be significant differences in the physiological and

psychological variables among osteoarthritic men if they follow yogic practices.

DELIMITAIONS.

1. The study is to be delimited only on people attending a two week yoga camp.

2. The samples are men only.

3. Age of the subject would range from 35 to 55 years only.

4. The study was delimited to men who attend the training camp and during their specific

period of stay only.

5. The studies are to be delimited to the following variables only.

Osteoarthritic men and physiological and psychological variables.

6. The independent variable would be the yogic practices.

7. As the samples are to be selected from a dynamic unknown group of participants, their

day to day routines would, however, not be monitored during the period of study.

LIMITATIONS.

1. Certain factors like, life style, body structure, personal habits, family health, motivational factors are not to be taken into consideration for the study.

2. Certain other factors like, diet, environment and climatic conditions, economical background are not to be taken into consideration.

DEFINITION OF THE TERMS.

Yoga: The word yoga means to join, unite or merge. Yoga is the science of right living and, as

such, is intended to be incorporated in daily life. It works on all aspects of the person: the

physical, vital, mental, emotional, psychic and spiritual (Swami Satyananda, 2008)

Breath holding time: Breath holding time has been defined as the duration of time through

which one can hold his or her breath without inhaling or exhaling.

Resting Pulse Rate: Number of heart beats per minutes in medical terms it is called arterial

palpitation of a heart beat.

Psychological Variables.

Stress:

Stress is the body's reaction to a change that requires a physical, mental or emotional

adjustment or response. Stress can come from any situation or thought that makes you feel

frustrated, angry, nervous, or anxious. Stress is caused by an existing stress-causing factor or

"stressor."

Stress can have wide ranging effects on joints by virtue of how stress affects all the

body's systems.  But there is one concept about stress that give us tremendous hope.  That is,

our response to most stressful situations is what determines how stress will affect our

health.  In other words, how we cope with stressful events largely determines the negative

affects of stress.

Stress can also lead to depression, which definitely makes OA feel worse. A recent

study of people with mild to moderate knee OA showed that the ones who were depressed had

symptoms that were much worse than would be expected based on x-rays of their knees.

REVIEW OF RELATED LITERATURE.

Various information are available on osteoarthritis and the ways and means to tackle

the problem. Before taking up the thesis, a review of related literature was made and the

following aspects were studied.

i) Yoga therapy for Osteo-ArthritisYoga therapy for Arthritis, in particular Osteo Arthritis is growing day by day. Yoga

therapy provides a methodically graded training in slowly improving one’s range of movements. But this happens only when practiced with deep internal awareness. Yoga therapy for Arthritis not just helps mobilize stiff joints it even helps retard the aging process. Even though one’s damaged cartilage might not be replaceable, through Yoga therapy one can certainly arrest further deterioration and wearing out.

In cases of chronically damaged Osteo Arthritis joints where there is severe pain and deformities, the surrounding tissues could have become very weak. This is the result of long standing inactivity. Like physiotherapy a lot of Yoga therapy practices when done with deep internal awareness and regularly, definitely helps the sufferer to strengthen the tissues and muscles around. Some specific Yoga therapy practices are Sakti Vikasaka Sukshma Vyayamas that are known to provide non-weight bearing isometric besides isotonic exercises which help to strengthen the muscles. This provides the weight bearing support to the joints. The supplementary contribution of Yoga therapy’s Sukshma Vyayama is the deep relaxation. This helps get rid of muscle fatigue.

Further comes the inner equilibrium and composure, sense of contentment, complete courage and confidence to accept all ups and downs of life. This most certainly helps to arrest the process of further aging. Moreover, Yoga therapy gives the sufferer of arthritis a re-changed refreshed life with a complete change in his / her world view, taking the person towards a more positive outlook. One great benefit here is stress reduction at the deep level of notional correction.(Source:http://www.yogawiz.com/yoga-therapy/yoga-therapy-for-arthritis-osteo-arthritis.html)

ii) Studies on the Effect of Iyengar yoga and strengthening exercises in subjects with knee OA

A study by Bukowski and colleagues also looked at the effect of Iyengar yoga and strengthening exercises in subjects with knee OA. Fifteen participants were assigned to a traditional stretching and strengthening regimen, Iyengar yoga, or no exercise. Low back and hamstring flexibility and quadriceps strength and function were monitored before and after the program. The WOMAC Osteoarthritis Index and a global assessment questionnaire were also used to assess improvement. After the six-week intervention period, functional changes and improvement in quality of life were noted in the traditional exercise and yoga groups compared to the controls. Those with the greatest improvements in flexibility and quadriceps strength had the greatest improvement in WOMAC scores.

Two subsequent studies have suggested that at least part of the effect of yoga on subjects with knee OA involves alteration of gait. Evangelisto and colleagues looked at biomechanical changes following an eight-week yoga intervention in the knee as assessed by formal gait laboratory analysis. WOMAC pain, stiffness, and disability and visual analog scale (VAS) scores were used to assess the improvement. All subjects met ACR criteria for knee OA. They participated in eight weekly 90-minute Iyengar yoga classes. Three-D motion analysis revealed a statistically significant reduction in ankle dorsiflexion, an increase in plantar flexion, and an increase in the total range of motion for pelvic tilt between baseline and follow-up evaluations. Analysis of footfall parameters from baseline to follow-up revealed significant increases in walking speed as well as maximum moments during hip rotation, hip flexion/extension, and knee varus. Three of four subjects who completed seven of eight yoga classes had reductions in WOMAC pain, stiffness, and disability. The increased walking speed and modified ankle motion during gait may underlie the improvements in WOMAC scores. Thus, improved biomechanics may lead to a reduction in symptoms.

A second study used gait analysis to elucidate the potential role of Iyengar yoga in treating elderly patients with impairments in ambulation. Participants were nonobese, yoga-naive subjects older than age 62 who did not require assistive devices. Nineteen individuals completed the eight-week study, which included two 90-minute Iyengar hatha yoga classes each week, as well as a minimum of 20 minutes of home yoga practice five times a week. Relative to baseline values, both peak hip extension and stride length at comfortable walking speed demonstrated significant increases after the intervention. The researchers also observed a trend toward a decline in average pelvic tilt from baseline to eight weeks. Change in peak hip extension was strongly and positively related to change in ankle plantar flexion and ankle joint power. Stride length was strongly and positively related to all three secondary outcome measures, including walking speed.(http://lowerextremityreview.com/article/yoga-practice-enhances-management-of-knee-oa)

iii) Times of India Article on Osteo arthritis.

Osteoarthritis is India's No. 1 ailmentTNN Sep 6, 2007, 12.00am IST

NEW DELHI: If you thought diabetes was the most prevalent ailment affecting Indians, you could be wrong. While much has been said about the high incidence of diabetes, HIV and cancer in India, a recent study suggests that osteoarthritis beats them all to claim the No. 1 spot among ailments in the country.

Osteoarthritis is a condition in which the cartilage that acts as a cushion between bones in joints begins to wear out, causing inflammation and pain in joints, thereby restricting movement. Osteoarthritis is also known as degenerative arthritis or degenerative joint disease.

The high incidence of osteoarthritis in India is the result of its prevalence among women who fall victim to it. Menopausal women are especially prone to it. The disease is, however, not restricted to women, although diabetes and hypertension remain the most prevalent ailments among men.

Shockingly, the study — conducted by TNS and called TNS Arogya — found that in the age group 25-35 years, osteoarthritis figures as the second most prevalent disease after diabetes. It also found that while there is high incidence of osteoarthritis, awareness about the disease is very low compared to awareness about diseases like diabetes, HIV and cancer.

Says Dr Shishir Rastogi, professor, orthopaedics, at AIIMS: "There are many reasons for the high prevalence of osteoarthritis in India. Genetic is the strongest reason which makes us more pre-disposed to it. Several other factors like the popular squatting position in India, rising obesity, sedentary lifestyle and poor diet are responsible for its high incidence."

Doctors claim that not only is there a lack of awareness about the disease, it is also often confused with osteoporosis. Says Dr S K S Marya, director, orthopaedics, Max Healthcare: "Osteoporosis and osteoarthritis are both common in India. But they are two different diseases. In many people, both are seen together. While osteoporosis affects the bones, osteoarthritis impacts the joints. The poor musculature of Indians and rising obesity are primarily responsible for the high numbers hit by osteoarthritis."

There are two kinds osteoarthritis — primary and secondary. While primary osteoarthritis is a result of old age, secondary osteoarthritis is a result of a disease or an injury which, in turn, leads to it. "The best way to keep osteoarthritis under check is to exercise regularly, avoid squatting and cross-legged positions, maintain a healthy diet and keep weight in control. High uric acid is also likely to make you more susceptible to osteoarthritis," says Dr Naveen Talwar, consultant orthopaedic surgeon, Sir Ganga Ram Hospital.

Source:http://articles.timesofindia.indiatimes.com/2007-09-06/india/27968801_1_tns-arogya-osteoarthritis-hiv-and-cancer

iv) Effectiveness of Yoga Therapy with the Therapeutic Exercises on Walking Pain, Tenderness, Early Morning Stiffness and Disability in Osteoarthritis of the Knee Joint - A Comparative Study.

The study revealed that an adjunctive program of integrated approach of yoga therapy

for OA knees reduces walking pain, tenderness, early morning stiffness and disability better

than the therapeutic exercises. It thus offers a good value addition non-pharmacological

intervention in the management of OA knees. (Ebnezar J, Yogitha B [2012])

METHODOLOGY

For the purpose of this study sixty osteo arthritic men were selected as subjects and

their age ranged between 35 to 50 years. All the subjects were randomly assigned to one

control group (I) and two experimental groups (II and III) each consisting 20 subjects. II and

III groups were treated as experimental group and named as Vyayama Group and Asanas

group respectively.

The daily routine included a 40 minutes practice as follows:

• Yogic sukshma vyayamas (Loosening and strengthening practices): These are safe, rhythmic, repetitive stretching movements synchronized with breathing. These practices mobilize the joints and strengthen the peri-articular muscles.

• Relaxation techniques Three types of guided relaxation techniques were interspersed between the physical practices of sukshmavyayamas and asanas.

• Asanas (physical postures) Asanas are featured by effortless maintenance in the final posture by internal awareness. We selected asanas in standing, supine and prone positions that would relax and strengthen the knee joints.

• Pranayama The practice of voluntary regulated breathing while the mind is directed to the flow of breath is called Pranayama These practices promote autonomic balance through mastery over the mind.

• Meditation Patanjali defines meditation (dhyana) as effortless flow of a single thought in the mind without distractions (pratyaya ekataanata dhyanam). This has been shown to offerphysiological benefits through alertful rest to the mind body complex.

• Lectures and Counseling Yogic concepts of health and disease, yama, niyama, bhakti yoga, Jnana yoga and karma yoga were presented in the theory classes. These sessions were aimed at understanding the need for life style change, weight management and prevent early aging by yogic self management of psychosocial stresses.

Selection of variables.

1. Independent variable

Yogic practices (viz.)

Standing AsanasTadasanaArdha Kati ChakrasanaArdha ChakrasanaPrasarita padahastasana

Lying AsanasBhujangasanaShalabasanaViparita Karani

Deep Relaxation Technique(DRT)- is a 3 phase guided relaxation technique with relaxation from toes to the head, feeling of letting go, chanting OM and feeling of limitless expansion through visualization. 5.0 mins

Nadi Shudi Pranayama- Nadishuddhi Pranaayama is a slow rhythmic technique of alternate nostril breathing involving the phases of inhalation and exhalation using nasika mudra. 3.0 mins

OM Meditation- is done seated in any comfortable meditative posture repeating the syllable OM mentally. 2.0 mins

2. Physiological variables.

Resting Pulse Rate

Breath holding time

Blood pressure

3. Psychological variables.

Stress

Depression

Anxiety

STATISTICAL TECHNIQUES:

Two data obtained were analyzed by Analysis of Co variance (ANCOVA) to assess the

significance among the groups between the pre-test and post-test on physiological and

psychological variables to find out the effects of varied yogic practices among insomnia

affected men. The normality of the data collected is to be tested through ‘F’ ration

(ANCOVA). The data and the regression were plotted and found to be in the standing straight

line and thus tested for normality of data and found the data are normal. The adjusted post ten

men differences among the experimental groups were tested and if the adjusted post test results

were significant the Scheffe’s post hoc test was used to determine the significance of the paired

means differences.

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