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Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres

Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 7464719, 7 pages https://doi.org/10.1155/2021/7464719 Research Article Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres 1 2 2 1 2 Elizabeth Whissell, Lin Wang , Pan Li , Jing Xian Li , and Zhen Wei School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada School of Kinesiology, Shanghai University of Sport, Shanghai, China Correspondence should be addressed to Jing Xian Li; jli@uottawa.ca and Zhen Wei; weizhen443@163.com Received 26 June 2021; Revised 2 August 2021; Accepted 5 August 2021; Published 13 August 2021 Academic Editor: Qiguo Rong Copyright © 2021 Elizabeth Whissell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. 1. Introduction strain. Kuntz et al. [7] stated that yoga manoeuvres may affect the alignment of lower limb joints, which could contribute to Yoga is a mind-body exercise developed in India, which has knee injuries. Numerous studies in the current literature have gained popularity worldwide [1, 2]. This exercise can be char- explored the risk factors for yoga injuries, which could be acterised by slow movements, with large body movement related to poor yoga technique, incorrect joint alignment, range when participants are standing, seated, and lying previous injury history, excess effort, and insufficient instruc- supine or prone [3]. Practising yoga has been verified to tions from the yoga instructor [8, 9]. Following to Mears et al. increase muscle strength, joint flexibility [4], and joint range [5], by utilising a motion capture system and force plates to of motion (ROM) [5]; improve balance, coordination [6], explore ankle ROM and moments in different yoga manoeu- and perceived stress and depression [2]; and reduce pain vres, studies on quantifying the kinematics and kinetics of amongst patients with osteoarthritis (OA) [7]. yoga manoeuvres and exploring the possible mechanism of body yoga injuries are still lacking. Despite the potential benefits of yoga manoeuvres, yoga- related injuries should also be considered. Fishman et al. [8] Raub and James [10] have described 57 basic yoga have proposed that long-term incorrect yoga posture may manoeuvres on the basis of traditional Iyengar yoga, of which result in lower back pain and lower limb muscle and ligament several variations can be derived [11]. Different yoga 2 Applied Bionics and Biomechanics During data collection, practitioners were instructed to manoeuvres could have different effects on the physical exer- cise and mechanism of injury [12]. As suggested by a previ- stand on the force plates, and a static calibration trial was ous study, Sauna yoga superiorly improves flexibility, recorded. In calibrating the system, the researcher would strength, and balance [4]; alignment-based yoga exercise conduct a dynamic calibration using a T-shaped wand may be more efficacious for knee OA [7]. Even so, based on (240 mm) with three reflective markers. In practising a typi- current reports, no study has been conducted to investigate cal yoga manoeuvre and standardising the study, participants the biomechanical difference of these typical yoga performed barefoot, and they were randomised in a counter- manoeuvres. balanced order for three yoga manoeuvres. All the practices Therefore, the present study is aimed at exploring the began from the downward dog and returned to the down- biomechanical characteristics of the lower extremity amongst ward dog at their natural speed, and each practice was sepa- three representative yoga manoeuvres, namely, the crescent rated with a break consisting of five deep breaths in the lunge pose (Halasana), warrior II pose (Virabhadrasana II), downward dog (Figure 1). and triangle pose (Trikonasana). These three typical yoga 2.3. Data Reduction and Statistical Analysis. The parameters manoeuvres are commonly found in various styles of yoga and are taught as introductory manoeuvres in many Hatha for the right and left legs were collected, but only the data of yoga classes for beginners and as an intermediary step to the dominant leg were modelled to compute and analyse the more advanced yoga manoeuvres [13, 14]. required variables using Vicon Nexus (version 1.8, Oxford We hypothesise that the biomechanical characteristic of Metrics, Oxford, UK). The dominant leg was determined by kicking a ball [19]. Start and end of data collection were these yoga manoeuvres is different. The triangle pose may have a relatively higher maximum joint angle and moment, obtained as a motion cycle by inspecting the force vector which are superior to the other two yoga manoeuvres, to emitted from the force plate and position of the virtual improve lower limb joint angle and decrease lower extremity marker. Each motion cycle trial was time normalised on a injury risk. The findings of the current study can contribute time basis of 100% to mitigate the effect of the varying speed of each individual using a custom algorithm (MATLAB, in determining the potential mechanisms of injury in yoga exercise and help participants improve their skills to prevent MathWorks, Natick, USA) [20]. The angles in the sagittal injuries. and frontal planes were obtained by calculations derived from the Plug-in-Gait model, which predicted the joint cen- tres of the hip, knee, and ankle in Vicon Nexus (v1.8) to find 2. Method the maximum and minimum angles during each trial, and 2.1. Participants. Thirteen experienced female yoga practi- then, the ROM range was calculated. Raw kinetic data of the GRF from the force plates was filtered with a 6 Hz 2nd- tioners were recruited in the current study (aged 33:1± 5:40 years, body height 161:3± 5:6cm, body mass 63:3± order Butterworth low-pass filter. The kinematic data were 10:4kg, and practice experience 5:5±1:05 years). These modeled to compute the required variables with Vicon Nexus; the inverse dynamic model was utilised to calculate practitioners were all certified with a Yoga Alliance- accredited 200-hour Hatha yoga teacher-training course with the kinetic parameters. The angular impulse was obtained by calculating the integral of the joint moment of each joint a minimum of 5 years of teaching experience [15]. Partici- pants would be excluded if they had musculoskeletal and/or in the sagittal and frontal planes. It is expressed as the sum other medical conditions in the previous 6 months before of the total angular impulse (Nm/kg) of one movement cycle. The profiles of the five successful normalised trials were aver- the study. The experiment was approved by the University Ethical Committee, and all participants signed an informed aged to obtain an ensemble average for each participant. consent before the experiments. 2.4. Statistical Analysis. All data were presented as mean and 2.2. Data Acquisition. All participants were asked to change standard deviation. Shapiro–Wilk’s test was used to test the normal distribution. One-way repeated ANOVA was used into a skin-tight suit, and then, body height and body mass were measured. Forty-five reflective markers (14 mm diame- in exploring the differences amongst the three yoga move- ter) were placed on anatomical landmarks of the participant ments. Bonferroni post hoc tests were conducted to compare specificdifferences. All variables were analysed using SPSS 22 in accordance to the Plug-in-Gait set [16]. The participants were given 10 min to warm up as they choose [17] (i.e., prac- software (SPSS Inc., Chicago, IL, USA). Statistical signifi- cance was set at alpha < 0:05. tice Sun Salutations or other yoga postures) and familiarise themselves with the data collection environment and proto- cols to ensure that participants move at a comfortable level 3. Results of mobility. A three-dimensional motion capture system with 10 3.1. Lower Limb Joint Angle. The three yoga movements cameras (Vicon MX-13, Oxford Metrics, Oxford, UK) was began in the same initial yoga posture, and all three joints used to obtain marker trajectory with a sampling rate of in the frontal and sagittal planes began at the same joint angle 100 Hz. We synchronised four force platforms (Kistler 9287 (Table 1). C, Winterthur, Switzerland) embedded in the middle of the The ROM of the yoga movements was 90.5 for the hip, ° ° testing area in accordance to previous studies; the frequency 83.3 for the knee, and 48.7 for the ankle in the sagittal plane ° ° ° of force plates was set at 1000 Hz [5, 18]. and 54.8 for the hip, 44.9 for the knee, and 4.8 for the ankle Applied Bionics and Biomechanics 3 Crescent lunge pose Warrior II pose Triangle pose Figure 1: Three typical yoga manoeuvres. Table 1: Mean and standard deviation for peak joint angles and range of motion ( ) in the sagittal and frontal planes. Flex/ext Abd/add Max Min ROM Max Min ROM 121:3±0:552:8±27:2 −3:7±3:2 −41:3±28:7 Hip 90.5 54.8 66:9±7:317:1±23:1 41:8±1:313:3±13:6 Yoga averages Knee 83.3 44.9 9:2±1:2 −17:0±18:4 5:8±0:92:1±0:3 Ankle 48.7 4.8 121:3±10:483:3±14:738:0± 13:1 −0:1±5:1 −8:3±5:38:2±3:8 Hip 73:8±17:631:0±18:042:7± 15:342:9±15:017:6±8:925:3±12:7 Lunge Knee 9:1±7:3 −6:6±8:415:7± 7:24:8±2:92:1±2:52:8±1:3 Ankle 120:8±12:643:8±23:977:0± 24:3 −5:5±6:0 −55:3±6:449:7±7:5 Hip 67:7±19:929:9±15:737:8± 14:342:0±8:924:2±9:217:8±9:9 Warrior II Knee 10:4±5:4 −6:3±7:716:7± 6:56:0±3:22:4±2:63:6±1:5 Ankle ∗ ∗ Hip 121:8±11:831:3±22:8 90:5 ± 22:9 −5:5±5:5 −60:3±6:1 54:8 ± 6:5 ∗ ∗ 59:2±23:5 −9:5±6:1 68:8 ± 23:1 40:4±12:2 −1:9±5:4 42:4 ± 12:8 Triangle Knee ∗ ∗ 8:1±9:2 −38:3±7:5 46:4 ± 11:3 6:6±3:01:8±2:4 4:8 ± 1:7 Ankle Note: positive values indicate flexion and abduction and negative values indicate extension and adduction; significant differences ( P <0:05) are highlighted in bold. in the frontal plane. When analysing the individual yoga largest knee joint adduction moments (0.30 Nm/kg) com- movement, we observed that the triangle pose performed a pared with the lunge (0.06 Nm/kg) and warrior II significant and the largest ROM of the hip (90.5 ), knee (0.07 Nm/kg) poses. Notably, the triangle pose was the only ° ° (68.8 ), and ankle (46.4 ) in the sagittal plane (P <0:05) and posture that could generate remarkable knee adduction ° ° ° hip (54.8 ), knee (42.4 ), and ankle (4.8 ) in the frontal plane moment after the initiation of the movement at approxi- (P <0:05) amongst the three yoga manoeuvres. Therefore, mately 40% of the movement cycle. For ankle adductor moving into the triangle pose required the most ROM for moments and eversion moment, the peak value was similar amongst the three manoeuvres (P >0:05), 0.06 Nm/kg for all three joints in both planes. the warrior II pose and 0.07 Nm/kg for the lunge and triangle poses (Table 2). 3.2. Lower Limb Joint Moment 3.2.1. Sagittal Plane. No significant difference was found for 3.3. Lower Limb Angular Impulses. Upon visual inspection the hip flexor moment throughout the entire movement cycle distribution of the lower limb angular impulse, we found that (P >0:05): lunge (1.90 Nm/kg), warrior II (1.45 Nm/kg), and the hip joint contributed significantly the most amongst the triangle (1.38 Nm/kg). Although the extensor moments were three studied yoga manoeuvres in the sagittal and frontal present in the knee joint, knee extension angles could only be planes (P <0:05), ranging from 51.67% to 70.56% of the total achieved when practising the triangle pose, with 9.5 of exten- angular impulse. No significant difference was found for the sion. Furthermore, no plantar flexor moment was generated ankle joint total angular impulse in the sagittal and frontal in any of the yoga movements (P >0:05, Table 2). planes (P >0:05). However, the knee shared the load differ- ently in each individual posture (Table 3). 3.2.2. Frontal Plane. The hip joint adduction moments indi- cated that no significant difference was observed in the trian- 4. Discussion gle (0.85 Nm/kg), lunge (0.69 Nm/kg), and warrior II (0.62 Nm/kg) (P >0:05) poses. The knee joint in the triangle This study is the first to quantitatively investigate three fun- pose travelled into slight adduction of 1.94 , expressing the damental yoga manoeuvres by characterising the kinetics 4 Applied Bionics and Biomechanics Table 2: Mean and standard deviation of bodyweight-normalised peak joint moments (Nm/kg) in the sagittal and frontal planes. Flex/ext Abd/add Max Min Max Min 1:58 ± 0:28 0:08 ± 0:02 0:07 ± 0:03 −0:72 ± 0:12 Hip Yoga averages Knee 0:24 ± 0:14 −0:50 ± 0:38 0:37 ± 0:04 −0:14 ± 0:13 0:67 ± 0:11 0:03 ± 0:01 0:03 ± 0:00 −0:07 ± 0:00 Ankle Hip 1:90 ± 0:34 0:07 ± 0:20 0:08 ± 0:09 −0:69 ± 0:46 0:16 ± 0:20 −0:31 ± 0:15 0:33 ± 0:10 −0:06 ± 0:04 Lunge Knee 0:80 ± 0:11 0:04 ± 0:04 0:03 ± 0:32 −0:07 ± 0:02 Ankle 1:45 ± 0:56 0:06 ± 0:19 0:09 ± 0:11 −0:62 ± 0:41 Hip Knee 0:40 ± 0:34 −0:25 ± 0:12 0:37 ± 0:17 −0:07 ± 0:06 Warrior II 0:61 ± 0:25 0:02 ± 0:03 0:03 ± 0:04 −0:06 ± 0:03 Ankle 1:38 ± 0:38 0:10 ± 0:10 0:03 ± 0:12 −0:85 ± 0:26 Hip 0:16 ± 0:27 −0:94 ± 0:22 0:40 ± 0:21 −0:30 ± 0:22 Triangle Knee Ankle 0:61 ± 0:15 0:04 ± 0:04 0:02 ± 0:03 −0:07 ± 0:03 Note: positive values indicate flexion and abduction and negative values indicate extension and adduction. Table 3: Mean and standard deviation of the total angular impulses (Nm) in the sagittal and frontal planes. Movement Hip Percent Knee Percent Ankle Percent Flex/ext 99.54 61.02% 20.74 12.71% 42.86 26.27% Yoga averages Abd/add 40.21 64.64% 20.18 32.44% 1.82 2.93% Flex/ext 132.35 68.35% 8.51 4.39% 52.78 27.26% Lunge Abd/add 34.41 61.36% 20.01 35.68% 1.66 2.96% Flex/ext 83.64 61.56% 12.69 9.34% 39.53 29.10% Warrior II Abd/add 34.83 60.35% 21.42 37.12% 1.46 2.53% 51.67% Flex/ext 82.61 41.02 25.66% 36.26 22.68% Triangle 70.56% Abd/add 51.4 19.12 26.25% 2.33 3.20% Note: positive values indicate flexion and abduction and negative values indicate extension and adduction; significant differences ( P <0:05) are highlighted in bold. and kinematics associated with the hip, knee, and ankle joints three joints in the sagittal and frontal planes. Practising the amongst yoga practitioners. The findings demonstrated that triangle pose caused the knee to extend over its baseline by the lunge and warrior II poses followed similar joint angle, 9.5 on average, and the increased extension has been shown joint moment, and angular impulse patterns, whereas the tri- to be significantly correlated to anterior cruciate ligament angle pose obtained the largest ROM in all joints in the sag- impingement in uninjured knees [21]. On the contrary, the ittal and frontal planes. hyperextension of the knee also contributed to the excessive strain on the oblique popliteal ligament and posterior cruci- 4.1. Lower Limb Joint Angle. When examining the yoga ate ligament [22]. Therefore, even for yoga experts, it is movement with regard to the joint angle pattern, limited important to avoid hyperextension and associated knee inju- ROM was observed in the knee and ankle joint angles ries during bending the knees in the triangle pose [9, 23]. between the lunge and warrior II poses. Notably, the knee Knee adduction angle could cause reduction in the patella ° ° joint reached a maximal flexion angle of 73.8 and 67.7 in cartilage volume in valgus knees amongst patients with OA [24]. We found that the knee joint in the triangle pose prac- the lunge and warrior II poses, respectively. These manoeu- vres were typically described in yoga training manuals as tice travelled into slight adduction of 1.9 , which was the only having a 90 bend; therefore, the present study found that manoeuvre that showed knee adduction. Therefore, those 16.2% to 22.3% was less than what was classically instructed who suffered from medial compartment knee OA should be in a yoga class. This result partially supported our hypothesis, cautioned during pursuing triangle yoga poses [25]. No which indicated that even experts did not perform the move- increase in joint angles or moments was apparent for the ment as it was ideally described and instructed. ankle joint, indicating that the studied yoga postures did Triangle pose practice was found to be distinct from the not improve the dynamic stability amongst the healthy par- other selected poses as it expressed the largest ROM for all ticipants who utilised ankle strategies for balance [26]. Applied Bionics and Biomechanics 5 The present study has several limitations. Firstly, the 4.2. Lower Limb Joint Moment. Practising the triangle pose may also bring a concern to vulnerable populations, such as motion pattern obtained from this study is only applicable those who suffer from knee OA. Lower knee abductor for the lower extremity of healthy female yoga teachers. Sec- ondly, when using eternal makers for the collection of moments could reduce knee pain, and the progression of knee OA increased 6.46 times with 1% increase in adduction motion capture, skin, clothing, and adipose tissue may cause moment [25]. Individuals with knee OA have significantly artifact movement, thereby creating errors in the calculation reduced isokinetic hip abductor strength. Those who suffered of joint centres. Despite the above-mentioned possible limi- from knee OA increased hip abductor moment to protect tations of this study, motion patterns of yoga movements could serve as a foundation for future applied research and against degeneration of the joint capsule [27]. However, no yoga manoeuvres, which were examined in the present study, clinical applications for people with disease. showed hip abductor moments [28]. Therefore, examining manoeuvres with hip abductor moments or exploring various 5. Conclusion instructional words to encourage hip abductor strength in the The present study proposed that the lunge and warrior II triangle pose, reduce knee adduction moment, and protect those with knee OA is recommended in future studies. poses shared similar motion patterns with regard to joint Reduced lower limb abductor and adductor joint moments angles, joint moments, and angular impulse. The triangle pose may be superior to the other two manoeuvres, which were also found to be prevalent in elderly people [29], and this reduced strength was associated with higher risks of falls [30]. improves hip joint ROM, strength, and dynamic stability. However, knee injuries such as OA should be paid attention The great hip adduction moments present in the yoga move- ments may suggest that the practice of yoga can be considered to because of the large knee extensor and adductor moments. for future studies regarding training mechanisms that reduce These findings will help practitioners when practising yoga by using scientifically based evidence. falls, thereby improving dynamic stability [31]. On average, yoga expressed greater total hip ROM and hip flexor moments compared with activities of daily life (ADL) Data Availability [3, 32], suggesting that yoga should be studied further as a potential training modality to improve daily gait [28, 33, 34]. The datasets used and/or analysed during the current study are available from the corresponding authors upon reason- In addition, the knee abduction angle and abductor moments were greater in yoga than in ADL [30]. Thus, this point should able request. be kept in mind when considering yoga as a therapeutic or rehabilitation approach for knee joint disorders [35, 36]. Conflicts of Interest Yoga solicits the hip joint moment in the frontal plane, No potential conflict of interest was reported by the authors. which is associated with knee health and dynamic stability [37]. Future studies should focus on soliciting more abduc- tion moments to promote overall knee health. Authors’ Contributions Elizabeth Whissell and Lin Wang are co-first authors. 4.3. Lower Limb Angular Impulses. The hip contributed 51.67%–70.56% of the angular impulse in the lower limb in all three yoga movements compared with the knee and ankle, Acknowledgments suggesting that yoga may have a strong training effect on the This work was supported by the National Natural Science hip and may improve hip strength and ROM. 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Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres

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Hindawi Applied Bionics and Biomechanics Volume 2021, Article ID 7464719, 7 pages https://doi.org/10.1155/2021/7464719 Research Article Biomechanical Characteristics on the Lower Extremity of Three Typical Yoga Manoeuvres 1 2 2 1 2 Elizabeth Whissell, Lin Wang , Pan Li , Jing Xian Li , and Zhen Wei School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada School of Kinesiology, Shanghai University of Sport, Shanghai, China Correspondence should be addressed to Jing Xian Li; jli@uottawa.ca and Zhen Wei; weizhen443@163.com Received 26 June 2021; Revised 2 August 2021; Accepted 5 August 2021; Published 13 August 2021 Academic Editor: Qiguo Rong Copyright © 2021 Elizabeth Whissell et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 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. 1. Introduction strain. Kuntz et al. [7] stated that yoga manoeuvres may affect the alignment of lower limb joints, which could contribute to Yoga is a mind-body exercise developed in India, which has knee injuries. Numerous studies in the current literature have gained popularity worldwide [1, 2]. This exercise can be char- explored the risk factors for yoga injuries, which could be acterised by slow movements, with large body movement related to poor yoga technique, incorrect joint alignment, range when participants are standing, seated, and lying previous injury history, excess effort, and insufficient instruc- supine or prone [3]. Practising yoga has been verified to tions from the yoga instructor [8, 9]. Following to Mears et al. increase muscle strength, joint flexibility [4], and joint range [5], by utilising a motion capture system and force plates to of motion (ROM) [5]; improve balance, coordination [6], explore ankle ROM and moments in different yoga manoeu- and perceived stress and depression [2]; and reduce pain vres, studies on quantifying the kinematics and kinetics of amongst patients with osteoarthritis (OA) [7]. yoga manoeuvres and exploring the possible mechanism of body yoga injuries are still lacking. Despite the potential benefits of yoga manoeuvres, yoga- related injuries should also be considered. Fishman et al. [8] Raub and James [10] have described 57 basic yoga have proposed that long-term incorrect yoga posture may manoeuvres on the basis of traditional Iyengar yoga, of which result in lower back pain and lower limb muscle and ligament several variations can be derived [11]. Different yoga 2 Applied Bionics and Biomechanics During data collection, practitioners were instructed to manoeuvres could have different effects on the physical exer- cise and mechanism of injury [12]. As suggested by a previ- stand on the force plates, and a static calibration trial was ous study, Sauna yoga superiorly improves flexibility, recorded. In calibrating the system, the researcher would strength, and balance [4]; alignment-based yoga exercise conduct a dynamic calibration using a T-shaped wand may be more efficacious for knee OA [7]. Even so, based on (240 mm) with three reflective markers. In practising a typi- current reports, no study has been conducted to investigate cal yoga manoeuvre and standardising the study, participants the biomechanical difference of these typical yoga performed barefoot, and they were randomised in a counter- manoeuvres. balanced order for three yoga manoeuvres. All the practices Therefore, the present study is aimed at exploring the began from the downward dog and returned to the down- biomechanical characteristics of the lower extremity amongst ward dog at their natural speed, and each practice was sepa- three representative yoga manoeuvres, namely, the crescent rated with a break consisting of five deep breaths in the lunge pose (Halasana), warrior II pose (Virabhadrasana II), downward dog (Figure 1). and triangle pose (Trikonasana). These three typical yoga 2.3. Data Reduction and Statistical Analysis. The parameters manoeuvres are commonly found in various styles of yoga and are taught as introductory manoeuvres in many Hatha for the right and left legs were collected, but only the data of yoga classes for beginners and as an intermediary step to the dominant leg were modelled to compute and analyse the more advanced yoga manoeuvres [13, 14]. required variables using Vicon Nexus (version 1.8, Oxford We hypothesise that the biomechanical characteristic of Metrics, Oxford, UK). The dominant leg was determined by kicking a ball [19]. Start and end of data collection were these yoga manoeuvres is different. The triangle pose may have a relatively higher maximum joint angle and moment, obtained as a motion cycle by inspecting the force vector which are superior to the other two yoga manoeuvres, to emitted from the force plate and position of the virtual improve lower limb joint angle and decrease lower extremity marker. Each motion cycle trial was time normalised on a injury risk. The findings of the current study can contribute time basis of 100% to mitigate the effect of the varying speed of each individual using a custom algorithm (MATLAB, in determining the potential mechanisms of injury in yoga exercise and help participants improve their skills to prevent MathWorks, Natick, USA) [20]. The angles in the sagittal injuries. and frontal planes were obtained by calculations derived from the Plug-in-Gait model, which predicted the joint cen- tres of the hip, knee, and ankle in Vicon Nexus (v1.8) to find 2. Method the maximum and minimum angles during each trial, and 2.1. Participants. Thirteen experienced female yoga practi- then, the ROM range was calculated. Raw kinetic data of the GRF from the force plates was filtered with a 6 Hz 2nd- tioners were recruited in the current study (aged 33:1± 5:40 years, body height 161:3± 5:6cm, body mass 63:3± order Butterworth low-pass filter. The kinematic data were 10:4kg, and practice experience 5:5±1:05 years). These modeled to compute the required variables with Vicon Nexus; the inverse dynamic model was utilised to calculate practitioners were all certified with a Yoga Alliance- accredited 200-hour Hatha yoga teacher-training course with the kinetic parameters. The angular impulse was obtained by calculating the integral of the joint moment of each joint a minimum of 5 years of teaching experience [15]. Partici- pants would be excluded if they had musculoskeletal and/or in the sagittal and frontal planes. It is expressed as the sum other medical conditions in the previous 6 months before of the total angular impulse (Nm/kg) of one movement cycle. The profiles of the five successful normalised trials were aver- the study. The experiment was approved by the University Ethical Committee, and all participants signed an informed aged to obtain an ensemble average for each participant. consent before the experiments. 2.4. Statistical Analysis. All data were presented as mean and 2.2. Data Acquisition. All participants were asked to change standard deviation. Shapiro–Wilk’s test was used to test the normal distribution. One-way repeated ANOVA was used into a skin-tight suit, and then, body height and body mass were measured. Forty-five reflective markers (14 mm diame- in exploring the differences amongst the three yoga move- ter) were placed on anatomical landmarks of the participant ments. Bonferroni post hoc tests were conducted to compare specificdifferences. All variables were analysed using SPSS 22 in accordance to the Plug-in-Gait set [16]. The participants were given 10 min to warm up as they choose [17] (i.e., prac- software (SPSS Inc., Chicago, IL, USA). Statistical signifi- cance was set at alpha < 0:05. tice Sun Salutations or other yoga postures) and familiarise themselves with the data collection environment and proto- cols to ensure that participants move at a comfortable level 3. Results of mobility. A three-dimensional motion capture system with 10 3.1. Lower Limb Joint Angle. The three yoga movements cameras (Vicon MX-13, Oxford Metrics, Oxford, UK) was began in the same initial yoga posture, and all three joints used to obtain marker trajectory with a sampling rate of in the frontal and sagittal planes began at the same joint angle 100 Hz. We synchronised four force platforms (Kistler 9287 (Table 1). C, Winterthur, Switzerland) embedded in the middle of the The ROM of the yoga movements was 90.5 for the hip, ° ° testing area in accordance to previous studies; the frequency 83.3 for the knee, and 48.7 for the ankle in the sagittal plane ° ° ° of force plates was set at 1000 Hz [5, 18]. and 54.8 for the hip, 44.9 for the knee, and 4.8 for the ankle Applied Bionics and Biomechanics 3 Crescent lunge pose Warrior II pose Triangle pose Figure 1: Three typical yoga manoeuvres. Table 1: Mean and standard deviation for peak joint angles and range of motion ( ) in the sagittal and frontal planes. Flex/ext Abd/add Max Min ROM Max Min ROM 121:3±0:552:8±27:2 −3:7±3:2 −41:3±28:7 Hip 90.5 54.8 66:9±7:317:1±23:1 41:8±1:313:3±13:6 Yoga averages Knee 83.3 44.9 9:2±1:2 −17:0±18:4 5:8±0:92:1±0:3 Ankle 48.7 4.8 121:3±10:483:3±14:738:0± 13:1 −0:1±5:1 −8:3±5:38:2±3:8 Hip 73:8±17:631:0±18:042:7± 15:342:9±15:017:6±8:925:3±12:7 Lunge Knee 9:1±7:3 −6:6±8:415:7± 7:24:8±2:92:1±2:52:8±1:3 Ankle 120:8±12:643:8±23:977:0± 24:3 −5:5±6:0 −55:3±6:449:7±7:5 Hip 67:7±19:929:9±15:737:8± 14:342:0±8:924:2±9:217:8±9:9 Warrior II Knee 10:4±5:4 −6:3±7:716:7± 6:56:0±3:22:4±2:63:6±1:5 Ankle ∗ ∗ Hip 121:8±11:831:3±22:8 90:5 ± 22:9 −5:5±5:5 −60:3±6:1 54:8 ± 6:5 ∗ ∗ 59:2±23:5 −9:5±6:1 68:8 ± 23:1 40:4±12:2 −1:9±5:4 42:4 ± 12:8 Triangle Knee ∗ ∗ 8:1±9:2 −38:3±7:5 46:4 ± 11:3 6:6±3:01:8±2:4 4:8 ± 1:7 Ankle Note: positive values indicate flexion and abduction and negative values indicate extension and adduction; significant differences ( P <0:05) are highlighted in bold. in the frontal plane. When analysing the individual yoga largest knee joint adduction moments (0.30 Nm/kg) com- movement, we observed that the triangle pose performed a pared with the lunge (0.06 Nm/kg) and warrior II significant and the largest ROM of the hip (90.5 ), knee (0.07 Nm/kg) poses. Notably, the triangle pose was the only ° ° (68.8 ), and ankle (46.4 ) in the sagittal plane (P <0:05) and posture that could generate remarkable knee adduction ° ° ° hip (54.8 ), knee (42.4 ), and ankle (4.8 ) in the frontal plane moment after the initiation of the movement at approxi- (P <0:05) amongst the three yoga manoeuvres. Therefore, mately 40% of the movement cycle. For ankle adductor moving into the triangle pose required the most ROM for moments and eversion moment, the peak value was similar amongst the three manoeuvres (P >0:05), 0.06 Nm/kg for all three joints in both planes. the warrior II pose and 0.07 Nm/kg for the lunge and triangle poses (Table 2). 3.2. Lower Limb Joint Moment 3.2.1. Sagittal Plane. No significant difference was found for 3.3. Lower Limb Angular Impulses. Upon visual inspection the hip flexor moment throughout the entire movement cycle distribution of the lower limb angular impulse, we found that (P >0:05): lunge (1.90 Nm/kg), warrior II (1.45 Nm/kg), and the hip joint contributed significantly the most amongst the triangle (1.38 Nm/kg). Although the extensor moments were three studied yoga manoeuvres in the sagittal and frontal present in the knee joint, knee extension angles could only be planes (P <0:05), ranging from 51.67% to 70.56% of the total achieved when practising the triangle pose, with 9.5 of exten- angular impulse. No significant difference was found for the sion. Furthermore, no plantar flexor moment was generated ankle joint total angular impulse in the sagittal and frontal in any of the yoga movements (P >0:05, Table 2). planes (P >0:05). However, the knee shared the load differ- ently in each individual posture (Table 3). 3.2.2. Frontal Plane. The hip joint adduction moments indi- cated that no significant difference was observed in the trian- 4. Discussion gle (0.85 Nm/kg), lunge (0.69 Nm/kg), and warrior II (0.62 Nm/kg) (P >0:05) poses. The knee joint in the triangle This study is the first to quantitatively investigate three fun- pose travelled into slight adduction of 1.94 , expressing the damental yoga manoeuvres by characterising the kinetics 4 Applied Bionics and Biomechanics Table 2: Mean and standard deviation of bodyweight-normalised peak joint moments (Nm/kg) in the sagittal and frontal planes. Flex/ext Abd/add Max Min Max Min 1:58 ± 0:28 0:08 ± 0:02 0:07 ± 0:03 −0:72 ± 0:12 Hip Yoga averages Knee 0:24 ± 0:14 −0:50 ± 0:38 0:37 ± 0:04 −0:14 ± 0:13 0:67 ± 0:11 0:03 ± 0:01 0:03 ± 0:00 −0:07 ± 0:00 Ankle Hip 1:90 ± 0:34 0:07 ± 0:20 0:08 ± 0:09 −0:69 ± 0:46 0:16 ± 0:20 −0:31 ± 0:15 0:33 ± 0:10 −0:06 ± 0:04 Lunge Knee 0:80 ± 0:11 0:04 ± 0:04 0:03 ± 0:32 −0:07 ± 0:02 Ankle 1:45 ± 0:56 0:06 ± 0:19 0:09 ± 0:11 −0:62 ± 0:41 Hip Knee 0:40 ± 0:34 −0:25 ± 0:12 0:37 ± 0:17 −0:07 ± 0:06 Warrior II 0:61 ± 0:25 0:02 ± 0:03 0:03 ± 0:04 −0:06 ± 0:03 Ankle 1:38 ± 0:38 0:10 ± 0:10 0:03 ± 0:12 −0:85 ± 0:26 Hip 0:16 ± 0:27 −0:94 ± 0:22 0:40 ± 0:21 −0:30 ± 0:22 Triangle Knee Ankle 0:61 ± 0:15 0:04 ± 0:04 0:02 ± 0:03 −0:07 ± 0:03 Note: positive values indicate flexion and abduction and negative values indicate extension and adduction. Table 3: Mean and standard deviation of the total angular impulses (Nm) in the sagittal and frontal planes. Movement Hip Percent Knee Percent Ankle Percent Flex/ext 99.54 61.02% 20.74 12.71% 42.86 26.27% Yoga averages Abd/add 40.21 64.64% 20.18 32.44% 1.82 2.93% Flex/ext 132.35 68.35% 8.51 4.39% 52.78 27.26% Lunge Abd/add 34.41 61.36% 20.01 35.68% 1.66 2.96% Flex/ext 83.64 61.56% 12.69 9.34% 39.53 29.10% Warrior II Abd/add 34.83 60.35% 21.42 37.12% 1.46 2.53% 51.67% Flex/ext 82.61 41.02 25.66% 36.26 22.68% Triangle 70.56% Abd/add 51.4 19.12 26.25% 2.33 3.20% Note: positive values indicate flexion and abduction and negative values indicate extension and adduction; significant differences ( P <0:05) are highlighted in bold. and kinematics associated with the hip, knee, and ankle joints three joints in the sagittal and frontal planes. Practising the amongst yoga practitioners. The findings demonstrated that triangle pose caused the knee to extend over its baseline by the lunge and warrior II poses followed similar joint angle, 9.5 on average, and the increased extension has been shown joint moment, and angular impulse patterns, whereas the tri- to be significantly correlated to anterior cruciate ligament angle pose obtained the largest ROM in all joints in the sag- impingement in uninjured knees [21]. On the contrary, the ittal and frontal planes. hyperextension of the knee also contributed to the excessive strain on the oblique popliteal ligament and posterior cruci- 4.1. Lower Limb Joint Angle. When examining the yoga ate ligament [22]. Therefore, even for yoga experts, it is movement with regard to the joint angle pattern, limited important to avoid hyperextension and associated knee inju- ROM was observed in the knee and ankle joint angles ries during bending the knees in the triangle pose [9, 23]. between the lunge and warrior II poses. Notably, the knee Knee adduction angle could cause reduction in the patella ° ° joint reached a maximal flexion angle of 73.8 and 67.7 in cartilage volume in valgus knees amongst patients with OA [24]. We found that the knee joint in the triangle pose prac- the lunge and warrior II poses, respectively. These manoeu- vres were typically described in yoga training manuals as tice travelled into slight adduction of 1.9 , which was the only having a 90 bend; therefore, the present study found that manoeuvre that showed knee adduction. Therefore, those 16.2% to 22.3% was less than what was classically instructed who suffered from medial compartment knee OA should be in a yoga class. This result partially supported our hypothesis, cautioned during pursuing triangle yoga poses [25]. No which indicated that even experts did not perform the move- increase in joint angles or moments was apparent for the ment as it was ideally described and instructed. ankle joint, indicating that the studied yoga postures did Triangle pose practice was found to be distinct from the not improve the dynamic stability amongst the healthy par- other selected poses as it expressed the largest ROM for all ticipants who utilised ankle strategies for balance [26]. Applied Bionics and Biomechanics 5 The present study has several limitations. Firstly, the 4.2. Lower Limb Joint Moment. Practising the triangle pose may also bring a concern to vulnerable populations, such as motion pattern obtained from this study is only applicable those who suffer from knee OA. Lower knee abductor for the lower extremity of healthy female yoga teachers. Sec- ondly, when using eternal makers for the collection of moments could reduce knee pain, and the progression of knee OA increased 6.46 times with 1% increase in adduction motion capture, skin, clothing, and adipose tissue may cause moment [25]. Individuals with knee OA have significantly artifact movement, thereby creating errors in the calculation reduced isokinetic hip abductor strength. Those who suffered of joint centres. Despite the above-mentioned possible limi- from knee OA increased hip abductor moment to protect tations of this study, motion patterns of yoga movements could serve as a foundation for future applied research and against degeneration of the joint capsule [27]. However, no yoga manoeuvres, which were examined in the present study, clinical applications for people with disease. showed hip abductor moments [28]. Therefore, examining manoeuvres with hip abductor moments or exploring various 5. Conclusion instructional words to encourage hip abductor strength in the The present study proposed that the lunge and warrior II triangle pose, reduce knee adduction moment, and protect those with knee OA is recommended in future studies. poses shared similar motion patterns with regard to joint Reduced lower limb abductor and adductor joint moments angles, joint moments, and angular impulse. The triangle pose may be superior to the other two manoeuvres, which were also found to be prevalent in elderly people [29], and this reduced strength was associated with higher risks of falls [30]. improves hip joint ROM, strength, and dynamic stability. However, knee injuries such as OA should be paid attention The great hip adduction moments present in the yoga move- ments may suggest that the practice of yoga can be considered to because of the large knee extensor and adductor moments. for future studies regarding training mechanisms that reduce These findings will help practitioners when practising yoga by using scientifically based evidence. falls, thereby improving dynamic stability [31]. On average, yoga expressed greater total hip ROM and hip flexor moments compared with activities of daily life (ADL) Data Availability [3, 32], suggesting that yoga should be studied further as a potential training modality to improve daily gait [28, 33, 34]. The datasets used and/or analysed during the current study are available from the corresponding authors upon reason- In addition, the knee abduction angle and abductor moments were greater in yoga than in ADL [30]. Thus, this point should able request. be kept in mind when considering yoga as a therapeutic or rehabilitation approach for knee joint disorders [35, 36]. Conflicts of Interest Yoga solicits the hip joint moment in the frontal plane, No potential conflict of interest was reported by the authors. which is associated with knee health and dynamic stability [37]. Future studies should focus on soliciting more abduc- tion moments to promote overall knee health. Authors’ Contributions Elizabeth Whissell and Lin Wang are co-first authors. 4.3. Lower Limb Angular Impulses. The hip contributed 51.67%–70.56% of the angular impulse in the lower limb in all three yoga movements compared with the knee and ankle, Acknowledgments suggesting that yoga may have a strong training effect on the This work was supported by the National Natural Science hip and may improve hip strength and ROM. 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Journal

Applied Bionics and BiomechanicsHindawi Publishing Corporation

Published: Aug 13, 2021

References