Isolated rupture of the lateral collateral ligament during yoga practice: a case report

Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres

This study was aimed at exploring the biomechanical characteristics of the lower extremity amongst three typical yoga manoeuvres. A total of thirteen experienced female yoga practitioners were recruited in the current study; they were all certified with the Yoga Alliance. A three-dimensional motion capture system with 10 cameras combined with four synchronised force plates was used to collect kinematics of the lower extremity and ground reactive force whilst the participants performed the crescent lunge pose, warrior II pose, and triangle pose. One-way repeated ANOVA was used in exploring the differences amongst the three yoga movements, and the significance was set to alpha < 0.05. The triangle pose performed the largest range of motion (ROM) of the hip (90.5° ± 22.9°), knee (68.8° ± 23.1°), and ankle (46.4° ± 11.3°) in the sagittal plane and the hip (54.8° ± 6.5°), knee (42.4° ± 12.8°), and ankle (4.8° ± 1.7°) in the frontal plane amongst the three manoeuvres (P < 0.05). No significant difference was found for the hip and ankle joint moment amongst the three manoeuvres (P > 0.05). Knee joint travelled into 9.5° of extension and slight adduction of 1.94° whilst expressing the largest knee joint adduction moments (0.30 ± 0.22 Nm/kg) in the triangle pose. The distribution of the angular impulse of the lower limb joints indicated that the hip joint contributed significantly the most in the sagittal and frontal planes of the three yoga manoeuvres (P < 0.05), ranging from 51.67% to 70.56%. Results indicated that triangle pose may be superior to the other two manoeuvres, which improved hip joint ROM, strength, and dynamic stability. However, knee injuries such as osteoarthritis (OA) should be considered because of the large knee extensor angle and adductor moments.

Non-operative management of an isolated lateral collateral ligament injury in an adolescent patient and review of the literature

We present a rare case of isolated traumatic pure ligamentous rupture of the lateral collateral ligament of the knee in an adolescent high-level footballer managed non-operatively with a good functional outcome and return to sport in 4 months.

Injuries and musculoskeletal pain among Norwegian group fitness instructors

OBJECTIVE

To examine the prevalence and factors associated with instruction-related injuries and musculoskeletal pain among group fitness instructors.

DESIGN

Descriptive epidemiology study.

SETTINGS

Online survey.

PARTICIPANTS

Group fitness instructors from three fitness centre companies in Norway (n = 1473). Assessment of independent variables: questions regarding duration of working as a group fitness instructor, weekly instruction and exercise loading and modality, instruction-related injuries, musculoskeletal pain, use of alcohol, tobacco, snuff, menstrual dysfunction and disordered eating (Eating Disorder Inventory, EDI). The respondents were divided into high instruction loading (HIL), ≥5 h/w with instruction; and low instruction loading (LIL), <5 h/w with instruction).

RESULTS

The response rate was 57% (n = 837). Mean total loading (instruction and exercise) was 11.8 h/w and 6.3 h/w in the HIL and LIL groups (p < .001), respectively. The prevalence of acute (9% vs. 6%, p < .05), overuse (38% vs. 24%, p < .001) and both acute and overuse injuries (25% vs. 10%, p < .001) was higher in the HIL than in the LIL group (OR: 3.9, CI: 2.7, 5.5). The most prevalent injury locations were ankle and lower leg. The most frequent location for musculoskeletal pain was the shoulder/neck region. Factors associated with injury were instruction loading (h/w), years working as an instructor and EDI score. A high total EDI score predicted musculoskeletal pain.

CONCLUSION

The high prevalence of injuries and musculoskeletal pain suggests a need for prevention strategies in the fitness industry. There is a need for limits regarding weekly instruction loading, especially for classes with high metabolic and/or mechanical loading.

A large-scale survey of adverse events experienced in yoga classes

Background

Yoga is a representative mind-body therapy of complementary and alternative medicine. In Japan, yoga is practiced widely to promote health, but yoga-associated adverse events have also been reported. To date, the frequencies and characteristics of yoga-related adverse events have not been elucidated. This study was conducted to elucidate the frequencies and characteristics of adverse events of yoga performed in classes and the risk factors of such events.

Methods

The subjects were 2508 people taking yoga classes and 271 yoga therapists conducting the classes. A survey for yoga class attendees was performed on adverse events that occurred during a yoga class on the survey day. A survey for yoga therapists was performed on adverse events that the therapists had observed in their students to date. Adverse events were defined as “undesirable symptoms or responses that occurred during a yoga class”.

Results

Among 2508 yoga class attendees, 1343 (53.5%) had chronic diseases and 1063 (42.3%) were receiving medication at hospitals. There were 687 class attendees (27.8%) who reported some type of undesirable symptoms after taking a yoga class. Musculoskeletal symptoms such as myalgia were the most common symptoms, involving 297 cases, followed by neurological symptoms and respiratory symptoms. Most adverse events (63.8%) were mild and did not interfere with class participation. The risk factors for adverse events were examined, and the odds ratios for adverse events were significantly higher in attendees with chronic disease, poor physical condition on the survey day, or a feeling that the class was physically and mentally stressful. In particular, the occurrence of severe adverse events that interfered with subsequent yoga practice was high among elderly participants (70 years or older) and those with chronic musculoskeletal diseases.

Conclusions

The results of this large-scale survey demonstrated that approximately 30% of yoga class attendees had experienced some type of adverse event. Although the majority had mild symptoms, the survey results indicated that attendees with chronic diseases were more likely to experience adverse events associated with their disease. Therefore, special attention is necessary when yoga is introduced to patients with stress-related, chronic diseases.

Isolated fibular collateral ligament injuries in athletes

Isolated injuries to the fibular collateral ligament (FCL) are rare. Although recent data suggest that operative and nonoperative treatment can both result in good functional outcomes, limited data exist on return to play for nonoperative treatment of FCL injuries and the value of magnetic resonance imaging in predicting prognosis. In this article, we present a review of the current literature and present a focused review regarding the diagnosis, treatment, and prognosis of FCL injuries, as well as the senior authors experience and a cohort of National Football League players. Magnetic resonance imaging can be useful to predict the length of disability in isolated FCL injuries, and both operative and nonoperative management of isolated FCL injuries successfully resulted in return to play in all players in several series of elite athletes; however, nonoperative management may result in faster return to play. Evaluation of potential concomitant injury is imperative in treatment of FCL injuries.

Adverse events associated with yoga: a systematic review of published case reports and case series

While yoga is gaining increased popularity in North America and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga. Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder stand, lotus position, and forceful breathing were the most common yoga postures and breathing techniques cited. Twenty-seven adverse events (35.5%) affected the musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case (1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice, yoga should be practiced carefully under the guidance of a qualified instructor. Beginners should avoid extreme practices such as headstand, lotus position and forceful breathing. Individuals with medical preconditions should work with their physician and yoga teacher to appropriately adapt postures; patients with glaucoma should avoid inversions and patients with compromised bone should avoid forceful yoga practices.

A pilot study of yoga as self-care for arthritis in minority communities

BACKGROUND

While arthritis is the most common cause of disability, non-Hispanic blacks and Hispanics experience worse arthritis impact despite having the same or lower prevalence of arthritis compared to non-Hispanic whites. People with arthritis who exercise regularly have less pain, more energy, and improved sleep, yet arthritis is one of the most common reasons for limiting physical activity. Mind-body interventions, such as yoga, that teach stress management along with physical activity may be well suited for investigation in both osteoarthritis and rheumatoid arthritis. Yoga users are predominantly white, female, and college educated. There are few studies that examine yoga in minority populations; none address arthritis. This paper presents a study protocol examining the feasibility and acceptability of providing yoga to an urban, minority population with arthritis.

METHODS/DESIGN

In this ongoing pilot study, a convenience sample of 20 minority adults diagnosed with either osteoarthritis or rheumatoid arthritis undergo an 8-week program of yoga classes. It is believed that by attending yoga classes designed for patients with arthritis, with racially concordant instructors; acceptability of yoga as an adjunct to standard arthritis treatment and self-care will be enhanced. Self-care is defined as adopting behaviors that improve physical and mental well-being. This concept is quantified through collecting patient-reported outcome measures related to spiritual growth, health responsibility, interpersonal relations, and stress management. Additional measures collected during this study include: physical function, anxiety/depression, fatigue, sleep disturbance, social roles, and pain; as well as baseline demographic and clinical data. Field notes, quantitative and qualitative data regarding feasibility and acceptability are also collected. Acceptability is determined by response/retention rates, positive qualitative data, and continuing yoga practice after three months.

DISCUSSION

There are a number of challenges in recruiting and retaining participants from a community clinic serving minority populations. Adopting behaviors that improve well-being and quality of life include those that integrate mental health (mind) and physical health (body). Few studies have examined offering integrative modalities to this population. This pilot was undertaken to quantify measures of feasibility and acceptability that will be useful when evaluating future plans for expanding the study of yoga in urban, minority populations with arthritis.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01617421.

Musculoskeletal injuries related to yoga: imaging observations

OBJECTIVE

The purpose of this article is to describe the imaging appearances of musculoskeletal injuries related to yoga. We performed an automated search in the database of a large tertiary care center and conducted a retrospective analysis of the imaging findings in 38 patients over a 9-year period.

CONCLUSION

The most frequently encountered musculoskeletal injuries were tendinous lesions, including tears of the supraspinatus, Achilles, and peroneus brevis tendons and fibrocartilaginous tears involving the medial meniscus, acetabular labrum, glenoid labrum, and lumbar disk with extrusion.

Complementary and alternative medicine for rheumatic diseases

Complementary and alternative medicine includes a heterogeneous spectrum of approaches to health and wellness, in addition to disease treatment, which span ancient to new-age modalities. Over the last 5 years, there has been a substantial increase in the use of specific complementary and alternative medicine therapies, particularly mind–body interventions. Patients with rheumatic diseases and musculoskeletal conditions such as osteoarthritis, fibromyalgia and rheumatoid arthritis may suffer not only from the physical manifestations of illness, but also from the nutritional, emotional, social and spiritual context in which their illness arises. The majority of these patients seek adjunctive care outside the medical mainstream. This article provides an evidence-based assessment of the therapeutic benefits of some mind–body interventions for several of these disorders.

Osteopathy and (hatha) yoga

Differences and points of contact between osteopathy and yoga as regards their history and practical application are outlined. Both seek to promote healing. Yoga seeks the attainment of consciousness; osteopathy aims for providing support to health. One fundamental difference is the personal involvement of the individual in yoga. Teacher and student alike are challenged to re-examine the attitudes of mind they have adopted toward their lives. Osteopathy generally involves a relatively passive patient while the osteopath is active in providing treatment. Practical examples are used to highlight points of contact between yoga and osteopathy. The text includes a discussion of the importance of physicality and a description of ways of using it in healing processes. Furthermore, processes of attaining consciousness are outlined. Possible reductionist misconceptions in yoga and osteopathy are also pointed out. Fundamental attitudes and focus that complement each other are presented, taking the concept of stillness as a particular example.

Treatment of magnetic resonance imaging-documented isolated grade III lateral collateral ligament injuries in National Football League athletes

BACKGROUND

Isolated high-grade tears of the lateral collateral ligament (LCL) of the knee are rare, as most injuries are part of a broader pattern of damage to the posterolateral corner. Limited data exist in the literature about the ideal management of isolated LCL injuries, especially in elite-level athletes.

HYPOTHESIS

Operative and nonoperative treatment of MRI-documented isolated grade III LCL injury can produce equal results in terms of return to play in the National Football League (NFL).

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

The NFL Injury Surveillance System was used to identify all players with lateral ligament injuries of the knee from 1994 to 2004. In addition, the medical staffs of all NFL clubs were surveyed about injuries during the same period. Nine players with MRI-documented isolated grade III LCL injuries were identified through this process. The medical staff for each respective player then completed a data questionnaire. Statistics were analyzed using 1-way analysis of variance.

RESULTS

Four players underwent direct surgical repair of their injuries; they missed an average of 14.5 weeks of play and did not return within the same season. Five players were managed nonoperatively and missed an average of 2.0 weeks (P = .0001). Four of the 5 players in the nonoperative group returned within the same season at an average of 10 days; 1 missed the rest of the season. All 9 players were able to return to play the following season, and played for an average total of 2.8 (operative) and 4.4 (nonoperative) additional seasons (P = .253).

CONCLUSION

Nonoperative management of MRI-documented isolated grade III lateral collateral ligament injuries in NFL athletes results in more rapid return to play without subjecting the player to the risks of surgery, while achieving an equal likelihood of return to play at the professional level.