COMPLEMENTARY EFFECT OF YOGIC RELAXATION TECHNIQUE ON PAIN, DISABILITY AND ANXIETY IN PATIENTS WITH COMMON NECK PAIN

Background: Studies have shown that conventional treatment methods with drugs, physiotherapy and exercises for common neck pain (CNP) may not always give the best result. Yoga techniques have been found to be effective complementary therapy in bringing optimal benefits.Objective: The aim of the study was to examine the complementary role of a Yogic relaxation called mind sound resonance technique (MSRT) in non-surgical management of CNP.Methods: This was a single blind randomized control design. In this randomized controlled study, 60 patients with CNP were assigned to two groups (Yoga, n = 30) and (control, n = 30). The Yoga group received Yogic relaxation called MSRT that doesn’t involve any movement or stretching for 20 minutes in supine position throughout the practice after the conventional physiotherapy program for 30 minutes using pre-recorded audio CD and the control group had non-guided supine rest for 20 minutes (after physiotherapy), for 10 days. MSRT provides deep relaxation for both mind and body by introspective experience of the sound resonance in the whole body while repeating the syllables A, U, M and Om and a long chant (Mahamrityunjaya mantra) several times in a meaningful sequence. Both the groups had pre and post assessments using visual pain analog scale, neck disability score (NDS) questionnaire and state trait anxiety inventory-Y1 (STAI-Y1).Results: Mann-Whitney U test showed significant difference between groups in pain (P< 0.01), NDS (P< 0.01) and state anxiety (STAI-Y1) with higher reduction in Yoga (P< 0.01) than that in the control group. Wilcoxon’s test showed a significant improvement in both groups on all variables (P< 0.01).Conclusions: Yoga relaxation through MSRT adds significant complementary benefits to conventional physiotherapy for CNP by reducing pain, disability and state anxiety

WAS SUSRUTAS NASA-SANDHANA DEVELOPED INTO RHINOPLASTY?

Sushruta, a great ancient surgeon and philosopher, and above all a great teacher is considered as the father of surgery and the father of plastic surgery even today. He has compiled a monumental treatise on ancient surgery named Susruta samhita. Sushruta Samhita comprises description of training and practice of surgeons, surgical procedures, drugs of animal, plant and mineral origin. It also includes different surgical procedures including rhinoplasty and various kinds of instruments. Though many consider plastic surgery as a relatively new specialty, the origin of plastic surgery had its roots more than 4000 years old in India, back to the Indus River Civilization. The Gentlemans magazine of London provides us an evidence of an article published in 1794 regarding the procedure of Nasa-sandhana of Indian origin and its gradual development into rhinoplasty

EFFECT OF YOGA THERAPY ON QUALITY OF LIFE AND ANXIETY IN OSTEOARTHRITIS OF THE KNEE JOINT - A RANDOMIZED CONTROL STUDY

Aim: To evaluate the impact of adding Integrated Approach of Yoga Therapy (IAYT) to therapeutic exercises in osteoarthritis (OA) of knee. Materials and Methods: This is a prospective, randomized, active controlled trial. Two hundred and fifty participants with OA of knee joints, between 35 and 80 years of age, were randomly assigned to receive yoga or physiotherapy exercises after transcutaneous electrical stimulation and ultrasound treatment of the affected knee joints. Both groups practiced supervised intervention (40 min/day) for 2 weeks (6 days/week) with follow-up for 3 months. Results: There were significant differences within (P< 0.001, Wilcoxons) and between groups (P< 0.001 Mann Whitney U) in all domains of the Short Form 36 (SF-36) and state trait anxiety inventory (STAI)-1 and STAI-2, with better results in the yoga group than in the control group on both day 15 and day 90. Conclusion: Study showed that the IAYT is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving knee disability and quality of life, and in the reduction of anxiety in patients with OA knees

Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis : a mixed methods review

BACKGROUND: Chronic peripheral joint pain due to osteoarthritis (OA) is extremely prevalent and a major cause of physical dysfunction and psychosocial distress. Exercise is recommended to reduce joint pain and improve physical function, but the effect of exercise on psychosocial function (health beliefs, depression, anxiety and quality of life) in this population is unknown. OBJECTIVES: To improve our understanding of the complex inter-relationship between pain, psychosocial effects, physical function and exercise. SEARCH METHODS: Review authors searched 23 clinical, public health, psychology and social care databases and 25 other relevant resources including trials registers up to March 2016. We checked reference lists of included studies for relevant studies. We contacted key experts about unpublished studies. SELECTION CRITERIA: To be included in the quantitative synthesis, studies had to be randomised controlled trials of land- or water-based exercise programmes compared with a control group consisting of no treatment or non-exercise intervention (such as medication, patient education) that measured either pain or function and at least one psychosocial outcome (self-efficacy, depression, anxiety, quality of life). Participants had to be aged 45 years or older, with a clinical diagnosis of OA (as defined by the study) or self-reported chronic hip or knee (or both) pain (defined as more than six months' duration). To be included in the qualitative synthesis, studies had to have reported people's opinions and experiences of exercise-based programmes (e.g. their views, understanding, experiences and beliefs about the utility of exercise in the management of chronic pain/OA). DATA COLLECTION AND ANALYSIS: We used standard methodology recommended by Cochrane for the quantitative analysis. For the qualitative analysis, we extracted verbatim quotes from study participants and synthesised studies of patients' views using framework synthesis. We then conducted an integrative review, synthesising the quantitative and qualitative data together. MAIN RESULTS: Twenty-one trials (2372 participants) met the inclusion criteria for quantitative synthesis. There were large variations in the exercise programme's content, mode of delivery, frequency and duration, participant's symptoms, duration of symptoms, outcomes measured, methodological quality and reporting. Comparator groups were varied and included normal care; education; and attention controls such as home visits, sham gel and wait list controls. Risk of bias was high in one and unclear risk in five studies regarding the randomisation process, high for 11 studies regarding allocation concealment, high for all 21 studies regarding blinding, and high for three studies and unclear for five studies regarding attrition. Studies did not provide information on adverse effects. There was moderate quality evidence that exercise reduced pain by an absolute percent reduction of 6% (95% confidence interval (CI) -9% to -4%, (9 studies, 1058 participants), equivalent to reducing (improving) pain by 1.25 points from 6.5 to 5.3 on a 0 to 20 scale and moderate quality evidence that exercise improved physical function by an absolute percent of 5.6% (95% CI -7.6% to 2.0%; standardised mean difference (SMD) -0.27, 95% CI -0.37 to -0.17, equivalent to reducing (improving) WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) function on a 0 to 100 scale from 49.9 to 44.3) (13 studies, 1599 participants)). Self-efficacy was increased by an absolute percent of 1.66% (95% CI 1.08% to 2.20%), although evidence was low quality (SMD 0.46, 95% CI 0.34 to 0.58, equivalent to improving the ExBeliefs score on a 17 to 85 scale from 64.3 to 65.4), with small benefits for depression from moderate quality evidence indicating an absolute percent reduction of 2.4% (95% CI -0.47% to 0.5%) (SMD -0.16, 95% CI -0.29 to -0.02, equivalent to improving depression measured using HADS (Hospital Anxiety and Depression Scale) on a 0 to 21 scale from 3.5 to 3.0) but no clinically or statistically significant effect on anxiety (SMD -0.11, 95% CI -0.26 to 0.05, 2% absolute improvement, 95% CI -5% to 1% equivalent to improving HADS anxiety on a 0 to 21 scale from 5.8 to 5.4; moderate quality evidence). Five studies measured the effect of exercise on health-related quality of life using the 36-item Short Form (SF-36) with statistically significant benefits for social function, increasing it by an absolute percent of 7.9% (95% CI 4.1% to 11.6%), equivalent to increasing SF-36 social function on a 0 to 100 scale from 73.6 to 81.5, although the evidence was low quality. Evidence was downgraded due to heterogeneity of measures, limitations with blinding and lack of detail regarding interventions. For 20/21 studies, there was a high risk of bias with blinding as participants self-reported and were not blinded to their participation in an exercise intervention. Twelve studies (with 6 to 29 participants) met inclusion criteria for qualitative synthesis. Their methodological rigour and quality was generally good. From the patients' perspectives, ways to improve the delivery of exercise interventions included: provide better information and advice about the safety and value of exercise; provide exercise tailored to individual's preferences, abilities and needs; challenge inappropriate health beliefs and provide better support. An integrative review, which compared the findings from quantitative trials with low risk of bias and the implications derived from the high-quality studies in the qualitative synthesis, confirmed the importance of these implications. AUTHOR'S CONCLUSIONS: Chronic hip and knee pain affects all domains of people's lives. People's beliefs about chronic pain shape their attitudes and behaviours about how to manage their pain. People are confused about the cause of their pain, and bewildered by its variability and randomness. Without adequate information and advice from healthcare professionals, people do not know what they should and should not do, and, as a consequence, avoid activity for fear of causing harm. Participation in exercise programmes may slightly improve physical function, depression and pain. It may slightly improve self-efficacy and social function, although there is probably little or no difference in anxiety. Providing reassurance and clear advice about the value of exercise in controlling symptoms, and opportunities to participate in exercise programmes that people regard as enjoyable and relevant, may encourage greater exercise participation, which brings a range of health benefits to a large population of people

Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management

Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study

Aim: To study the effect of integrated yoga on pain, morning stiffness and anxiety in osteoarthritis of knees. Materials and Methods: Two hundred and fifty participants with OA knees (35-80 years) were randomly assigned to yoga or control group. Both groups had transcutaneous electrical stimulation and ultrasound treatment followed by intervention (40 min) for two weeks with follow up for three months. The integrated yoga consisted of yogic loosening and strengthening practices, asanas, relaxation, pranayama and meditation. The control group had physiotherapy exercises. Assessments were done on 15 th (post 1) and 90 th day (post 2). Results: Resting pain (numerical rating scale) reduced better (P<0.001, Mann-Whitney U test) in yoga group (post 1=33.6% and post 2=71.8%) than control group (post 1=13.4% and post 2=37.5%). Morning stiffness decreased more (P<0.001) in yoga (post 1=68.6% and post 2=98.1%) than control group (post 1=38.6% and post 2=71.6%). State anxiety (STAI-1) reduced (P<0.001) by 35.5% (post 1) and 58.4% (post 2) in the yoga group and 15.6% (post 1) and 38.8% (post 2) in the control group; trait anxiety (STAI 2) reduced (P<0.001) better (post 1=34.6% and post 2=57.10%) in yoga than control group (post 1=14.12% and post 2=34.73%). Systolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.93% and post 2=−15.7%) than the control group (post 1=−1.8% and post 2=−3.8%). Diastolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.6% and post 2=−16.4%) than the control group (post 1=−2.1% and post 2=−5.0%). Pulse rate reduced (P<0.001) better in yoga group (post 1=−8.41% and post 2=−12.4%) than the control group (post 1=−5.1% and post 2=−7.1%). Conclusion: Integrated approach of yoga therapy is better than physiotherapy exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in reducing pain, morning stiffness, state and trait anxiety, blood pressure and pulse rate in patients with OA knees