A Prospective Study on Yoga for Anterior Knee Pain in Adolescents.

Abstract

Background: Anterior knee pain (AKP) is one of the most common musculoskeletal complaints in adolescents. Several causes have been attributed to this, with many aspects of the pathology being traced back to flawed biomechanics. Yoga has been used as an alternative therapy for many types of musculoskeletal ailments. Although studies have shown that yoga has positive effects on biomechanics, its impact on AKP in adolescents has not been investigated.

Hypothesis: If pediatric patients with AKP were to complete an 8-week yoga protocol focusing on flexibility and strengthening, there would be improvements in both objective measures of flexibility and patient-reported outcomes in regard to their knee pain and function.

Methods: A certified yoga instructor developed 2 separate videos for study participants to perform 3 to 4 times per week for a total of 8 weeks. The first 4 weeks, the participants completed a 20-minute video with an emphasis on flexibility. For the second 4 weeks, they completed a 16-minute video with an emphasis on strengthening. Popliteal angles and prone heel-to-buttock (HTB) distances were taken at the initial visit and at the 8-week follow-up. PROMIS PIS/PSS (Patient-Reported Outcome Measurement Information System - Pain Interference Survey/Perceived Stress Scale) and Pediatric International Knee Documentation Committee (Pedi-IKDC) scores were collected at the initial visit and again at the 8 weeks. Patient-reported adherence to the yoga protocol, as well as return to sport/activity data was also collected.

Results: Baseline and 8-week follow-up data were collected on 24 patients (15 M, 9 F, avg age: 13.25 ys) who were diagnosed with a mixture of nonstructural causes for AKP. There was a 23.82-point increase in Pedi-IKDC scores (P-value <.01), 8.54 point decrease in PIS (<0.01), and 4.06 point decrease in PSS (<0.01). Popliteal angle measurements increased by 10.14° on the right side (<0.01) and 13.05° (<0.01) on the left side. HTB measures decreased by 1.48″ on the right side (<0.01) and 1.58″ on the left side (<0.01). Symmetry between popliteal angle and HTB measurements also improved after 8 weeks of yoga (<0.01).

Conclusions: When compared to baseline measurements, all study measures showed statistically significant improvement at the 8-week mark. Targeted yoga has the potential to be a formidable adjunctive treatment option in the management of AKP in adolescents.

Clinical trial registration number: UT Austin IRB Approved Submission ID: STUDY00004289-MOD01 Date approved 8/25/2023.

Key concepts: (1)Whether a multiweek yoga program has beneficial effects in improving objective measures of thigh muscle flexibility, specifically popliteal angle and heel-to-buttock measurements.(2)Whether previously mentioned objective improvements also correlated with subjective improvements in relation to pain scales and patient-reported knee function surveys.

Level of evidence: IV.