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      Comparative study of role of physiotherapy alone versus physiotherapy combined with yoga in rehabilitation after a sports injury. What can a primary physician offer?

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          A BSTRACT

          Background:

          Posttraumatic rehabilitation of sports injuries involves physiotherapy. Additionally, nonsurgical treatment of sports injuries involves regular physiotherapy as a major treatment therapy. This study aimed to evaluate the effects of yoga in addition to regular physiotherapy on these patients.

          Materials and Methods:

          In the present comparative study, we evaluated the effects of regular physiotherapy alone versus physiotherapy combined with yoga on 212 patients following various knee injuries treated nonsurgically. The study was conducted after obtaining hospital ethical, committee clearance, and written informed consent from patients. The patients were assigned into two groups: group C (Conventional) and group Y (Yoga group). The patients in the regular group received physiotherapy rehabilitation program, whereas the yoga group received additional yoga once every day by a yoga expert during their hospital stay. We provided written guidelines and photographs of the yoga asanas and instructed to perform them 3 days/week once they were home. The data on WOMAC score were collected at 6 weeks, 3 months, and at 6 months from the day of discharge from the hospital.

          Results:

          We noted that the yoga group patients showed a significant improvement ( P < 0.05) in all modalities like pain, stiffness, and function subscales of the WOMAC scale. They experienced significant reduction in pain and stiffness compared with the regular or conventional group on the seventh postinjury day, 6 weeks, 3 months, and 6 months after the initial injury.

          Conclusion:

          In this study, a combination of regular physiotherapy and yoga provided better functional outcomes than physiotherapy alone.

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          Most cited references60

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          2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.

          Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.
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            Effects of Yoga on Mental and Physical Health: A Short Summary of Reviews

            This report summarizes the current evidence on the effects of yoga interventions on various components of mental and physical health, by focussing on the evidence described in review articles. Collectively, these reviews suggest a number of areas where yoga may well be beneficial, but more research is required for virtually all of them to firmly establish such benefits. The heterogeneity among interventions and conditions studied has hampered the use of meta-analysis as an appropriate tool for summarizing the current literature. Nevertheless, there are some meta-analyses which indicate beneficial effects of yoga interventions, and there are several randomized clinical trials (RCT's) of relatively high quality indicating beneficial effects of yoga for pain-associated disability and mental health. Yoga may well be effective as a supportive adjunct to mitigate some medical conditions, but not yet a proven stand-alone, curative treatment. Larger-scale and more rigorous research with higher methodological quality and adequate control interventions is highly encouraged because yoga may have potential to be implemented as a beneficial supportive/adjunct treatment that is relatively cost-effective, may be practiced at least in part as a self-care behavioral treatment, provides a life-long behavioural skill, enhances self-efficacy and self-confidence and is often associated with additional positive side effects.
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              Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study.

              Yoga and exercise have beneficial effects on mood and anxiety. γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. The yoga subjects (n = 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n = 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
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                Author and article information

                Journal
                J Family Med Prim Care
                J Family Med Prim Care
                JFMPC
                J Family Med Prim Care
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                2249-4863
                2278-7135
                December 2022
                17 January 2023
                : 11
                : 12
                : 7691-7699
                Affiliations
                [1 ] Department of Orthopedics, Base Hospital, Guwahati, Assam, India
                [2 ] Consultant Dermatologist, Skin Diseases Centre, Nashik, Maharashtra, India
                [3 ] Consultant and Yoga Therapist, Agrawal Medical Centre, Haridwar, Uttarakhand, India
                [4 ] Department of Physiotherapy, Base Hospital, Guwahati, Assam, India
                Author notes
                Address for correspondence: Dr. Sanjay K. Rai, (MBBS, MS –Ortho), Associate Professor, Department of Orthopedics, Base Hospital Guwahati - 781 029, Assam, India. E-mail: skrai47@ 123456yahoo.com
                Article
                JFMPC-11-7691
                10.4103/jfmpc.jfmpc_1215_22
                10040995
                36994034
                250f7629-6a6c-4633-bbbd-d263ab7e4100
                Copyright: © 2023 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 06 June 2022
                : 29 July 2022
                : 01 August 2022
                Categories
                Original Article

                nonsurgical treatment,physiotherapy,sports injuries,yoga

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