Largest-Ever Study Says: Yoga Eases Pain, Improves QOL for Arthritis Patients
In the largest-ever randomized trial of yoga in sedentary adults with arthritis, researchers at Johns Hopkins have found that eight weeks of yoga modified for people with arthritis resulted in significant improvements in pain, energy, mood and mobility. This study was led by psychologist Susan J. Bartlett Ph.D., an associate professor at Johns Hopkins (now at McGill University). Co-investigators included Clifton Bingham III, M.D., a rheumatologist, associate professor at Hopkins and director of the Arthritis Center, and Steffany Haaz Moonaz Ph.D., a yoga therapist now at Maryland University of Integrative Health.
Dr. Bingham told OTW, “Many of my patients had asked whether yoga could help them, and until this study, I did not know for sure. We weren’t sure if yoga was realistic for people with arthritis, and whether we could develop a yoga program that was respectful of individual limitations. We began by identifying concerns for specific joints that were injured or weakened by arthritis. We essentially deconstructed common poses and looked at how they impacted shoulders, hands and wrist, knees, ankles and feet. Next, we reviewed modifications that might be required. These patients were not in a typical yoga class at the local gym; each person received an individualized assessment and modifications developed with the research team, which included rheumatologists.”
Dr. Bartlett reported, “Our first concern was safety. None of the patients experienced yoga-related events during the study, including arthritis flares.”
Dr. Bingham added, “As a rheumatologist, I was concerned some patients might try to push too hard. Instead, they told me that with yoga, they were much more comfortable with their bodies and aware of their limitations.”
Said Bartlett, “Our second interest was impact. We looked at how yoga affected physical function, fitness, mood, and quality of life. We found doing yoga was associated with about a 20% improvement in physical health—much less difficulty with physical aspects of work, home, other activities, with similar improvements in pain, energy, and mood.”
The team has also created a checklist of considerations for doctors for their patients interested in trying yoga. Dr. Bingham noted, “It’s important to talk about possible modifications and hazards of certain poses. For instance, with hip replacement, the surgical approach (anterior or posterior) has implications for the poses they should avoid. We recommend gentle, integral, prenatal yoga, chair, and other programs for people with limitations.”
Dr. Moonaz commented to OTW, “Yoga is best learned under the guidance and supervision of an experienced yoga teacher or therapist familiar with arthritis. Videos can facilitate home practice between classes once an individual learns safe and appropriate modifications. People with arthritis should arrive before the class to talk with the teacher about their condition, any movement limitations, doctor recommendations, and concerns they have.”
Bartlett concluded, “Arthritis patients need to remain active to live a full life and manage their disease. Now we have good evidence that suggests yoga—modified to fit individual needs and limitations—can be a safe, effective way to improve pain, mood, and quality of life.”
For additional information concerning the yoga program and modified poses please see: http://www.hopkinsarthritis.org/patient-corner/disease-management/yoga-for-arthritis/
UV Research Offers Tibial Tunnel Placement Suggestions
Where should that pesky anterior cruciate ligament (ACL) tibial tunnel go? “The issue of anatomic femoral tunnel placement has largely been settled, ” said Mark Miller, M.D., the S. Ward Casscells Professor of Orthopaedic Surgery at the University of Virginia, to OTW. “Now, researchers are turning their attention to establishing the same degree of certainty for placement of the tibial tunnel. Since 1994, most of us have used the posterior border of the anterior horn of the lateral meniscus as a landmark for tibial tunnel guide pin placement. Newer studies indicate that it is biomechanically, and perhaps clinically superior to have the graft more anterior. There are those, however, who advocate for posterior placement because of the risk of roof impingement.”
“We undertook a matched pair cadaveric study with six specimens in each group (anatomic and trans-tibial). None of the grafts impinged when using an anatomic (independently drilled) femoral tunnel; however four of the six grafts impinged with trans-tibial femoral tunnel positioning. When I presented the findings at the Herodicus and the ISAKOS (International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine) meetings, they were well received. People did ask, ‘So where do we put the tibial tunnel?’ We don’t have the answer yet, but we are now on to the next phase of our work, which will hopefully shed light on this.”
“Our new study—a randomized controlled trial—is underway, and compares anterior versus a more posterior tibial tunnel placement. We have enrolled six patients and are aiming for a total of 100 in each group. We are taking intraoperative fluoroscopic images at the time of pin placement; we put two guide pins in place, take a lateral image; and then measure the anterior-posterior distance. After placement of both pins, we open the randomized envelope to determine which location to over drill.”
“The bottom line is that most people have been using an artificial landmark for the tibial tunnel, and this does not yield a consistent A-P [anterior-posterior] distance on lateral radiographs. At this point, we know that we can safely move the tunnel more anteriorly, but we don’t know if that will yield the best results.”
Jonathan Mathers, M.D. Joins OrthoAtlanta
Jonathan Mathers, M.D. has joined the team at OrthoAtlanta, bringing with him 10 years of experience in orthopedic surgery and sports medicine. Dr. Mathers holds a special interest in advanced arthroscopic surgery for rotator cuff and ACL tears. He also has expertise in fracture care and work related injuries.
Dr. Mathers earned his medical degree at Georgetown University School of Medicine, during which time he was a fellow at the National Institutes of Health. Dr. Mathers completed his orthopedic surgery residency at Greenville Hospital System University Medical Center and Shriners’ Hospital in Greenville, South Carolina. He completed his sports medicine fellowship training at Baylor University School of Medicine in Houston Texas, including advanced training in arthroscopic shoulder and knee surgery. Dr. Mathers also holds an undergraduate degree in Biomedical Engineering from Duke University. Dr. Mathers gained experience in the treatment of collegiate and professional athletes as an assistant team physician for the Houston Astros, Houston Texans and University of Houston Cougars.
Dr. Mathers told OTW, “My first priority is to become an integral part of the OrthoAtlanta team of great physicians and staff. I not only look forward to bringing my own relationships with other providers and the community into the practice but also forging new connections. Ultimately, I will strive to earn the trust and privilege of taking care of patients in this community by helping them make well informed decisions regarding their care.”
