As research continues to improve and advance, it is important to stay abreast of current trends. One of those trends is the development of yoga as a therapeutic intervention. While yoga has been practiced for thousands of years, its popularity for fitness has increased worldwide. In conjunction with this increase in practice comes an increase of research evaluating the therapeutic effectiveness of yoga on different diseases and populations.

There have been some recent literature reviews that evaluate the state of the current research and can help practitioners gain an understanding of alternative and complementary forms of treatments.  Yoga has been routinely associated with breathing, movement and mindfulness that can improve stress levels.  Indeed, one of the benefits of yoga is the ability to decrease stress. This reduction in stress has additional health benefits including the regulation of breathing, decreasing hypertension and potential to modulate PTSD, anxiety and depression. It has also been shown to be an adjunctive therapy for asthma.

The focus of the breath with yoga helps to regulate breathing and improve lunge capacity. Recently, a study looked to see if this improvement in breathing ability transferred to actual physical performance. A small sample of matched female participants were measured for cycling performance before, during and after being in a yoga group or a control. The practice group showed improvements in lung regulation and capacity at rest, but no improvement in cycling performance or VO2 max. So, while yoga may help with regulating breathing, it is still important to undergo training modalities to achieve physiological adaptation.

Another common reason to perform yoga is to improve balance and flexibility and both of these outcomes are achieved with routine practice of yoga. Athletes have even seen improvements in these areas compared to those that did not practice yoga. Unfortunately, no study has evaluated the on field transfer, prevention or rehabilitation potential of yoga on injury risk and performance measures. It still remains to be seen if yoga is a viable standalone prevention or rehab strategy.

An area of rehabilitation that does show promise is chronic low back pain. One of the main reasons for participants to choose yoga relates to low back pain (20%). Yoga practice has demonstrated effectiveness in decreasing the pain and dysfunction associated with chronic low back pain. Yoga also improves the symptoms and function of those suffering from knee arthritis. Yoga can help to decrease the pain, swelling and stiffness associated with OA.

While the use of yoga is showing promise as a therapy, there are definite opportunities to learn more and it is important to note a few things regarding its effectiveness as a therapeutic modality; the overall number of different yoga styles and instructors makes it very difficult to standardize yoga therapies, and thus, hard to compare outcomes to traditional therapies. The differences of the styles, instructor, location, class level and overall vigor of practice all have an effect on how a client will respond to the intervention. As studies regarding yoga become more robust we can make better recommendations to athletes and clients regarding its use, but currently our knowledge is limited to a few areas.

Conclusion:

• Yoga can improve pain and stiffness of OA and improve chronic low back pain
• Yoga can improve balance, flexibility and strength
• Yoga can decrease stress including the regulation of breathing and decreasing hypertension
• Yoga may have a positive benefit on PTSD, anxiety and depression
• Yoga may be useful as a complementary practice for treatments, but more standardization and research is required to make specific recommendations

References:
Beutler, E., et. al. (2016). Effect of regular yoga practice on respiratory regulation and exercise performance. Plos One, 11(4).
Chang, D., et. al. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedic Rheumatology, 3(1), 1-8.
Field, T. (2016). Yoga research review. Complementary Therapies in Clinical Practice, 24, 145-161.
Jeter, P., et. al. (2015). Yoga as a therapeutic intervention: A bibliometric analysis of published research studies from 1967-2013. The Journal of Alternative and Complementary Medicine, 21(10): 586-592.
Park, C., Braun, T., & Siegel, T. (2015). Who practices yoga? A systematic review of demographic, health related and psychosocial factors related to yoga practice. Journal of Behavioral Medicine, 38, 460-471.
Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga, 4(2), 49-54.

ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?

After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception, strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news, of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those that return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.

In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following shows the exercises and the discharge criteria that was deemed successful:
                     
                        Discharge tests and criteria used during the study period
6 part return to sport tests with Discharge permitted when criteria was met

1. Isokinetic test at 60, 180 and 300 degrees/sec  with Quadriceps deficit <10% at 60 degrees/sec
2. Single leg hop with Limb symmetry index >90%
3. Triple hop with Limb symmetry index >90%
4. Triple crossover hop with Limb symmetry index >90%
5. On field sport specific rehab with rehab Fully completed
6. T test completed in under 11 sec

In addition to the tests above, athletes that had lower hamstring to quadriceps strength ratio were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.

Conclusion:
This study highlights a couple of key points when rehabilitating ACL injuries:

• Prior to return to play, athletes should be fully recovered with equal strength bilaterally
• They should be able to seamlessly perform multidirectional drills
• Athletes should have adequate hamstring strength. Most of us do not have access to isokinetic testing, but spending time having athletes perform hamstring strengthening during their rehabilitation is essential.

By incorporating some of these exercises into rehab, athletes and practitioners can gauge where they are in the rehab process and make informed decisions regarding return to play on an individual basis.

Reference:
Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50. http://bjsm.bmj.com/content/early/2016/05/23/bjsports-2015-095908.abstract