1 2333 96 TWELVE-MINUTE DAILY YOGA REGIMEN REVERSES OSTEOPOROTIC BONE LOSS. OBJECTIVE: ASSESS THE EFFECTIVENESS OF SELECTED YOGA POSTURES IN RAISING BONE MINERAL DENSITY (BMD). METHODS: TEN-YEAR STUDY OF 741 INTERNET-RECRUITED VOLUNTEERS COMPARING PREYOGA BMD CHANGES WITH POSTYOGA BMD CHANGES. OUTCOME MEASURES: DUAL-ENERGY X-RAY ABSORPTIOMETRIC SCANS. OPTIONAL RADIOGRAPHS OF HIPS AND SPINE AND BONE QUALITY STUDY (7 TESLA). RESULTS: BONE MINERAL DENSITY IMPROVED IN SPINE, HIPS, AND FEMUR OF THE 227 MODERATELY AND FULLY COMPLIANT PATIENTS. MONTHLY GAIN IN BMD WAS SIGNIFICANT IN SPINE (0.0029 G/CM(2), P = .005) AND FEMUR (0.00022 G/CM(2), P = .053), BUT IN 1 COHORT, ALTHOUGH MEAN GAIN IN HIP BMD WAS 50%, LARGE INDIVIDUAL DIFFERENCES RAISED THE CONFIDENCE INTERVAL AND THE GAIN WAS NOT SIGNIFICANT FOR TOTAL HIP (0.000357 G/CM(2)). NO YOGA-RELATED SERIOUS INJURIES WERE IMAGED OR REPORTED. BONE QUALITY APPEARED QUALITATIVELY IMPROVED IN YOGA PRACTITIONERS. CONCLUSION: YOGA APPEARS TO RAISE BMD IN THE SPINE AND THE FEMUR SAFELY.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
2 2777 26 YOGA SPINAL FLEXION POSITIONS AND VERTEBRAL COMPRESSION FRACTURE IN OSTEOPENIA OR OSTEOPOROSIS OF SPINE: CASE SERIES. OBJECTIVE: THE OBJECTIVE OF THIS REPORT IS TO RAISE AWARENESS OF THE EFFECT OF STRENUOUS YOGA FLEXION EXERCISES ON OSTEOPENIC OR OSTEOPOROTIC SPINES. WE PREVIOUSLY DESCRIBED SUBJECTS WITH KNOWN OSTEOPOROSIS IN WHOM VERTEBRAL COMPRESSION FRACTURES (VCFS) DEVELOPED AFTER SPINAL FLEXION EXERCISE (SFE) AND RECOMMENDED THAT SFES NOT BE PRESCRIBED IN PATIENTS WITH SPINAL OSTEOPOROSIS. METHODS: THIS REPORT DESCRIBES 3 HEALTHY PERSONS WITH LOW BONE MASS AND YOGA-INDUCED PAIN OR FRACTURE. RESULTS: ALL 3 PATIENTS HAD OSTEOPENIA, WERE IN GOOD HEALTH AND PAIN-FREE, AND HAD STARTED YOGA EXERCISES TO IMPROVE THEIR MUSCULOSKELETAL HEALTH. NEW PAIN AND FRACTURE AREAS OCCURRED AFTER PARTICIPATION IN YOGA FLEXION EXERCISES. CONCLUSIONS: THE DEVELOPMENT OF PAIN AND COMPLICATIONS WITH SOME FLEXION YOGA POSITIONS IN THE PATIENTS WITH OSTEOPENIA LEADS TO CONCERN THAT FRACTURE RISK WOULD INCREASE EVEN FURTHER IN OSTEOPOROSIS. ALTHOUGH EXERCISE HAS BEEN SHOWN TO BE EFFECTIVE FOR IMPROVING BONE MINERAL DENSITY AND DECREASING FRACTURE RISK, OUR SUBJECTS HAD DEVELOPMENT OF VCFS AND NECK AND BACK PAIN WITH YOGA EXERCISES. THIS FINDING SUGGESTS THAT FACTORS OTHER THAN BONE MASS SHOULD BE CONSIDERED FOR EXERCISE COUNSELING IN PATIENTS WITH BONE LOSS. THE INCREASED TORQUE PRESSURE APPLIED TO VERTEBRAL BODIES DURING SFES MAY BE A RISK. EXERCISE IS EFFECTIVE AND IMPORTANT FOR TREATMENT OF OSTEOPENIA AND OSTEOPOROSIS AND SHOULD BE PRESCRIBED FOR PATIENTS WITH VERTEBRAL BONE LOSS. SOME YOGA POSITIONS CAN CONTRIBUTE TO EXTREME STRAIN ON SPINES WITH BONE LOSS. ASSESSMENT OF FRACTURE RISK IN OLDER PERSONS PERFORMING SFES AND OTHER HIGH-IMPACT EXERCISES IS AN IMPORTANT CLINICAL CONSIDERATION.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
3 1990 20 SPINAL CURVATURES OF YOGA PRACTITIONERS COMPARED TO CONTROL PARTICIPANTS-A CROSS-SECTIONAL STUDY. PURPOSE: THE ANGLES OF THORACIC KYPHOSIS AND LUMBAR LORDOSIS DETERMINE THE SPINAL ALIGNMENT IN THE SAGITTAL PLANE. THE AIM OF THIS STUDY WAS TO COMPARE THE THORACIC KYPHOSIS AND LUMBAR LORDOSIS OF MALE AND FEMALE YOGA PRACTITIONERS WITH NON-PRACTICING PARTICIPANTS AND TO DETERMINE THE POSSIBLE DEPENDENCIES BETWEEN SAGITTAL SPINAL CURVATURES AND SOMATIC PARAMETERS, TIME SPENT ON YOGA EXERCISE, AND UNDERTAKING OTHER PHYSICAL ACTIVITIES IN YOGA PRACTITIONERS. METHODS: THE STUDY INVOLVED 576 WOMEN AND 91 MEN AGES 18-68 YEARS (MEAN = 38.5 +/- 9) WHO WERE PRACTICING YOGA, AND 402 WOMEN AND 176 MEN AGES 18-30 YEARS (MEAN = 20.2 +/- 1.3) AS A CONTROL GROUP. THE ANGLES OF THORACIC KYPHOSIS AND LUMBAR LORDOSIS WERE MEASURED USING A PLURIMETER-V GRAVITY INCLINOMETER. RESULTS: THE TWO-WAY ANOVA DEMONSTRATED THE INFLUENCE OF GROUP (P < .0001) AND SEX (P = .03) ON THE ANGLE OF THORACIC KYPHOSIS, AS WELL AS THE INFLUENCE OF GROUP (P < .0001) AND SEX (P < .0001) ON THE ANGLE OF LUMBAR LORDOSIS. IT WAS NOTED THAT YOGA PRACTITIONERS HAD LESS PRONOUNCED THORACIC KYPHOSIS AND LUMBAR LORDOSIS AND WERE MORE OFTEN CHARACTERIZED BY NORMAL OR SMALLER THORACIC KYPHOSIS AND LUMBAR LORDOSIS THAN STUDENTS FROM THE CONTROL GROUP. IN YOGA PRACTITIONERS, THE ANGLE OF THORACIC KYPHOSIS WAS POSITIVELY CORRELATED WITH AGE, BODY MASS, BMI, AND UNDERTAKING OTHER FORMS OF PHYSICAL ACTIVITY. THE ANGLE OF LUMBAR LORDOSIS WAS NEGATIVELY CORRELATED WITH BODY HEIGHT AND BODY MASS. CONCLUSIONS: THE RESULTS SUGGEST THAT YOGA EXERCISES CAN AFFECT THE SHAPE OF THE ANTERIOR-POSTERIOR CURVES OF THE SPINE AND MAY BE AN EFFICIENT TRAINING METHOD FOR SHAPING PROPER POSTURE IN ADULTS.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
4 2359 19 VERTEBRAL COMPRESSION FRACTURES ASSOCIATED WITH YOGA: A CASE SERIES. BACKGROUND: THE IMPORTANCE OF EXERCISE IN SKELETAL HEALTH IS INCREASINGLY RECOGNIZED BY BOTH PATIENTS AND PROVIDERS. HOWEVER, THE SAFETY OF PRESCRIBED OR RECREATIONAL EXERCISE IN AT-RISK POPULATIONS REMAINS UNDER-REPORTED AND UNDER-PUBLICIZED. YOGA HAS GAINED WIDESPREAD POPULARITY DUE TO ITS PHYSICAL AND PSYCHOLOGICAL BENEFITS. WHEN PRACTICED IN A POPULATION AT INCREASED FRACTURE RISK, HOWEVER, SOME YOGA POSES MAY INCREASE FRACTURE RISK, PARTICULARLY AT THE SPINE, RATHER THAN INCREASING BMD AS NOTED IN RECENT POPULAR PRESS REPORTS. CASE REPORT: NINE SUBJECTS (8 WOMEN) WITH A MEDIAN AGE OF 66 YEARS (RANGE 53-87), DEVELOPED VERTEBRAL COMPRESSION FRACTURE (VCF) ONE MONTH TO SIX YEARS AFTER INITIATING YOGA-ASSOCIATED SPINAL FLEXION EXERCISES (SFE). VCF PRESENTED WITH BACK PAIN AND OCCURRED IN THE THORACICSPINE (N.=6), LUMBAR-SPINE (N.=4) AND CERVICAL-SPINE (N.=1). FOUR PATIENTS HAD OSTEOPOROSIS BY BMD CRITERIA PRIOR TO VCF AND 2 HAD OSTEOPENIA (MEDIAN T-SCORE -2.35; RANGE -3.3 TO +2.0). INTERESTINGLY, ALL PATIENTS HAD THEIR LOWEST T-SCORES AT THE SPINE. THREE PATIENTS HAD A HISTORY OF FRAGILITY FRACTURE PRIOR TO THE INDEX VCF. WHILE ONE PATIENT HAD PRIMARY HYPERPARATHYROIDISM AND ANOTHER WAS TREATED WITH HIGH DOSE PREDNISONE, NO OTHER RISK FACTORS FOR BONE LOSS INCLUDING MEDICATIONS OR SECONDARY OSTEOPOROSIS CAUSES WERE IDENTIFIED IN THE OTHER PATIENTS. CLINICAL REHABILITATION IMPACT: THIS STUDY IDENTIFIED PATIENTS IN WHOM INCREASED TORSIONAL AND COMPRESSIVE MECHANICAL LOADING PRESSURES OCCURRING DURING YOGA SFE RESULTED IN DE NOVO VCF. DESPITE THE NEED FOR SELECTIVITY IN YOGA POSES IN POPULATIONS AT INCREASED FRACTURE RISK, BOTH SCIENTIFIC AND MEDIA REPORTS CONTINUE TO ADVERTISE YOGA AS A BONE PROTECTIVE ACTIVITY. ACCORDINGLY, YOGA IS MISCONCEIVED AS A 'ONESIZE-FITS-ALL' PRESCRIPTION. INSTEAD, THE APPROPRIATE SELECTION OF PATIENTS LIKELY TO BENEFIT FROM YOGA MUST BE A CORNERSTONE OF FRACTURE PREVENTION.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
5 2209 12 THE GEOMETRIC CURVATURE OF THE SPINE DURING THE SIRSHASANA, THE YOGA'S HEADSTAND. THIS STUDY ANALYSED THE BEHAVIOUR OF THE GEOMETRIC CURVATURE OF THE SPINE DURING SIRSHASANA. THE POSITION OF DORSAL RETROREFLECTIVE MARKERS WAS COMPUTED VIA STEREOPHOTOGRAMMETRIC ANALYSIS IN SIX MALES AND FIVE FEMALES (29.4 +/- 8.8 YEARS, 63.0 +/- 11.4 KG, 1.66 +/- 0.08 M [AVERAGE +/- STANDARD DEVIATION]). THE SPINAL POINTS WERE PROJECTED ONTO THE SAGITTAL AND FRONTAL PLANES OF THE TRUNK, A POLYNOMIAL WAS FITTED TO THE DATA AND THE TWO-DIMENSIONAL GEOMETRIC CURVATURE WAS QUANTIFIED. THE INFERIOR LUMBAR LORDOSIS DECREASED COMPARED TO THE ORTHOSTATIC POSITION AND GAIT, WHICH MAY FAVOUR THE POSTERIOR PROTRUSION OF THE LUMBAR SPINAL NUCLEUS PULPOSUS IN PEOPLE WITH POSTERIOR HERNIATION. THE LATERAL DEVIATION AT THE MIDDLE OF THE THORACIC SPINE INCREASES DURING SIRSHASANA, WHICH MAY REFLECT INCREASED DIFFICULTIES FOR POSTURAL CONTROL AND SPINAL LOADS. IT COULD BE USEFUL FOR PROMOTING POSITIVE SPINAL STRUCTURAL AND FUNCTIONAL CHRONIC ADAPTATIONS FOR HEALTHY PARTICIPANTS, IF THE YOGA PROGRAMME IS CAREFULLY PLANNED AND THE SPINAL ALIGNMENT IS CAREFULLY MONITORED DURING A HEADSTAND. HOWEVER, IT MAY AGGRAVATE SOME SPINAL DISEASES, ESPECIALLY SCOLIOSIS.	2017	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
6 1111 27 EFFECTS OF YOGASANAS ON OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN. BACKGROUND: OSTEOPOROSIS IS COMMONLY ENCOUNTERED BY POSTMENOPAUSAL WOMEN. THERE IS AN INCREASED NEED FOR A LOW COST AND EFFICIENT TREATMENT ALTERNATIVE TO ADDRESS THIS POPULATION. AIMS: TO STUDY THE EFFECTS OF INTEGRATED YOGA ON BONE MINERAL DENSITY (BMD) IN POSTMENOPAUSAL WOMEN WITH OSTEOPOROSIS. SETTINGS AND DESIGNS: EXPERIMENTAL PRE-POST STUDY CONDUCTED IN A COMMUNITY SETTING. MATERIALS AND METHODS: 30 FEMALES IN THE AGE GROUP OF 45-62 YEARS SUFFERING FROM POSTMENOPAUSAL OSTEOPOROSIS WITH A DUAL-ENERGY X-RAY ABSORPTIOMETRY (DEXA) SCORE OF </=-2.5 UNDERWENT A 6 MONTHS FULLY SUPERVISED YOGA SESSION. ALL THE PARTICIPANTS COMPLETED THE STUDY. PRETRAINING AND POSTTRAINING BMD WAS CALCULATED. OUTCOME MEASURE: DEXA SCORE AT THE LUMBAR SPINE. STATISTICAL ANALYSIS: THE STUDY WAS STATISTICALLY ANALYZED USING PAIRED T-TEST TO SEE THE SIGNIFICANCE OF PRETRAINING AND POSTTRAINING EFFECTS OF A YOGA SESSION. RESULTS: IMPROVEMENT IN T-SCORE OF DEXA SCAN OF -2.55 +/- 0.25 AT POSTTRAINING AS COMPARED TO A PRETRAINING SCORE OF -2.69 +/- 0.17. CONCLUSIONS: INTEGRATED YOGA IS A SAFE MODE OF PHYSICAL ACTIVITY WHICH INCLUDES WEIGHT BEARING AS WELL AS NOT WEIGHT BEARING ASANAS, PRANAYAMA, AND SURYANAMASKAR, ALL OF WHICH HELPS INDUCE IMPROVEMENT IN BMD IN POSTMENOPAUSAL OSTEOPOROTIC FEMALES.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
7 2853 23 YOGA, VERTEBRAL FRACTURES, AND OSTEOPOROSIS: RESEARCH AND RECOMMENDATIONS. BACKGROUND: OSTEOPOROSIS IS CHARACTERIZED BY DECREASED BONE DENSITY THAT LEAVES BONES FRAGILE AND HIGHLY SUSCEPTIBLE TO FRACTURE. GLOBALLY, 1 IN 3 WOMEN AND 1 IN 5 MEN OLDER THAN 50 WILL SUFFER FROM AN OSTEOPOROTIC FRACTURE, AND THOSE INDIVIDUALS WILL EXPERIENCE A CONSIDERABLY HIGHER RISK OF POSTFRACTURE MORTALITY THAN WILL THE GENERAL POPULATION. GENTLE, WEIGHT-BEARING EXERCISES SUCH AS YOGA CAN HELP PREVENT OR CEASE THE PROGRESSION OF OSTEOPOROSIS; HOWEVER, THERE IS INSUFFICIENT DATA REGARDING WHICH YOGA POSES PRESENT THE LEAST RISK AND ARE MOST BENEFICIAL TO INDIVIDUALS WITH REDUCED BONE DENSITY. OBJECTIVES: REVIEW THE EXTANT LITERATURE ABOUT THE RISKS AND BENEFITS TO THE SPINE OF PARTICULAR FORMS OF MOVEMENT AND CONSIDER RECOMMENDATIONS RELATIVE TO THE PRACTICE OF YOGA. METHODS: A REVIEW OF THE PUBMED, MEDLINE, AND COCHRANE DATABASES WAS CONDUCTED THAT IDENTIFIED MANUSCRIPTS PUBLISHED BETWEEN 1966 AND 2011 ABOUT TOPICS RELATED TO OSTEOPOROSIS AND SPINAL MOVEMENT. CONCLUSIONS: MOVEMENTS INVOLVING SPINAL FLEXION CAN INCREASE RISK FOR VERTEBRAL COMPRESSION FRACTURES; HOWEVER, A COMBINATION OF MILD SPINAL FLEXION AND EXTENSION MAY PROVE BENEFICIAL. MODERATE, WEIGHT-BEARING ACTIVITIES THAT STRENGTHEN THE MUSCLES SUPPORTING THE SPINAL COLUMN, PROMOTE BALANCE, IMPROVE POSTURE, AND ENHANCE QUALITY OF LIFE APPEAR TO BE OF GREATEST BENEFIT. AMPLE EVIDENCE SUPPORTS THE IMPORTANCE OF VARIED SPINAL MOVEMENT FOR PRESERVING THE HEALTH AND STRENGTH OF THE VERTEBRAL BODIES. EXERCISE MODIFICATIONS SUITABLE FOR HIGH-RISK INDIVIDUALS MAY BE COUNTERPRODUCTIVE FOR THOSE AT LOW RISK FOR VERTEBRAL FRACTURES. YOGA THERAPISTS ARE CAUTIONED TO NOT APPLY A ONE-SIZE-FITS-ALL APPROACH WHEN WORKING WITH THIS POPULATION. WELL-DESIGNED EMPIRICAL STUDIES ARE NEEDED TO FURTHER OUR UNDERSTANDING OF WHICH YOGA POSES PRESENT THE LEAST RISK AND ARE OF GREATEST BENEFIT TO INDIVIDUALS WITH OSTEOPOROSIS.	2013	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
8  987 19 EFFECTS OF HATHA YOGA EXERCISES ON SPINE FLEXIBILITY IN WOMEN OVER 50 YEARS OLD. [PURPOSE] THE AIM OF THIS STUDY WAS TO ACCESS THE FLEXIBILITY OF THE SPINE IN WOMEN PRACTICING YOGA AS A PART OF THE "UNIVERSITY FOR HEALTH" PROJECT. [SUBJECTS AND METHODS] THE STUDY INCLUDED 56 WOMEN RANGING IN AGE BETWEEN 50-79 AND ATTENDING 90 MINUTES HATHA YOGA SESSIONS ONCE A WEEK. THE MEASUREMENTS WERE PERFORMED TWICE-AT THE BEGINNING OF THE PROJECT AND AFTER ITS COMPLETION, I.E., AFTER 20 WEEKS OF CLASSES. THE RANGE OF SPINE MOBILITY IN THREE PLANES WAS MEASURED USING A RIPPSTEIN PLURIMETER. THE RANGE OF MOTION IN THE SAGITTAL AND FRONTAL PLANES WAS MEASURED IN A STANDING POSITION WITH THE FEET HIP-WIDTH APART. THE TORSIONAL RANGE OF MOTION OF THE SUBJECTS WAS MEASURED WITH THE TRUNK BENT AT A RIGHT ANGLE AND THE LEGS APART. THE FLEXIBILITY RANGES OF THE SPINE AND HAMSTRINGS WERE ALSO MEASURED BY THE TOE-TOUCH TEST IN A STANDING POSITION. [RESULTS] THIS STUDY SHOWED THAT THE APPLIED YOGA EXERCISES INCREASED SPINAL MOBILITY AND FLEXIBILITY OF THE HAMSTRING MUSCLES REGARDLESS OF AGE. [CONCLUSION] YOGA EXERCISES SHOULD BE RECOMMENDED TO THE ELDERLY TO MAKE THEIR MUSCLES MORE FLEXIBLE AND TO INCREASE THE RANGE OF MOTION IN THE JOINTS, WHICH IS PARTICULARLY IMPORTANT FOR IMPROVING THEIR LIFE QUALITY.	2015	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
9 2400 22 YOGA AND DISC DEGENERATIVE DISEASE IN CERVICAL AND LUMBAR SPINE: AN MR IMAGING-BASED CASE CONTROL STUDY. THE OBJECTIVE OF THE CURRENT STUDY WAS TO FIND OUT WHETHER YOGA PRACTICE WAS BENEFICIAL TO THE SPINE BY COMPARING DEGENERATIVE DISC DISEASE IN THE SPINES OF LONG-TIME YOGA PRACTITIONERS AND NON-YOGA PRACTICING CONTROLS, USING AN OBJECTIVE MEASUREMENT TOOL, MAGNETIC RESONANCE IMAGING. THIS MATCHED CASE-CONTROL STUDY COMPRISED 18 YOGA INSTRUCTORS WITH TEACHING EXPERIENCE OF MORE THAN 10 YEARS AND 18 NON-YOGA PRACTICING ASYMPTOMATIC INDIVIDUALS RANDOMLY SELECTED FROM A HEALTH CHECKUP DATABASE. A VALIDATED GRADING SCALE WAS USED TO GRADE THE CONDITION OF CERVICAL AND LUMBAR DISCS SEEN IN MAGNETIC RESONANCE IMAGING OF THE SPINE, AND THE RESULTING DATA ANALYZED STATISTICALLY. THE MEAN NUMBER OF YEARS OF YOGA PRACTICE FOR THE YOGA GROUP WAS 12.9 +/- 7.5. THE OVERALL (CERVICAL + LUMBAR) DISC SCORES OF THE YOGA GROUP WERE SIGNIFICANTLY LOWER (INDICATING LESS DEGENERATIVE DISC DISEASE) THAN THOSE OF THE CONTROL GROUP (P < 0.001). THE SCORES FOR THE CERVICAL VERTEBRAL DISCS OF THE YOGA GROUP WERE ALSO SIGNIFICANTLY LOWER THAN THOSE OF THE CONTROL GROUP (P < 0.001), WHILE THE LOWER SCORES FOR THE YOGA GROUP IN THE LUMBAR GROUP APPROACHED, BUT DID NOT REACH, STATISTICAL SIGNIFICANCE (P = 0.055). THE SCORES FOR INDIVIDUAL DISCS OF YOGA PRACTITIONERS SHOWED SIGNIFICANTLY LESS DEGENERATIVE DISEASE AT THREE DISC LEVELS, C3/C4, L2/L3 AND L3/L4 (P < 0.05). MAGNETIC RESONANCE IMAGING SHOWED THAT THE GROUP OF LONG-TERM PRACTITIONERS OF YOGA STUDIED HAD SIGNIFICANTLY LESS DEGENERATIVE DISC DISEASE THAN A MATCHED CONTROL GROUP.	2011	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
10 2779  8 YOGA TECHNIQUES AS A MEANS OF CORE STABILITY TRAINING. CORE STABILITY IN GENERAL INVOLVES THE MUSCULAR CONTROL REQUIRED AROUND THE LUMBAR SPINE TO MAINTAIN FUNCTIONAL STABILITY. STABILITY AND MOVEMENT ARE CRITICALLY DEPENDENT ON THE COORDINATION OF ALL THE MUSCLES SURROUNDING THE LUMBAR SPINE. THIS PAPER AIMS TO SHOW THAT AN AGE-OLD YOGA PRACTICE, CALLED UDDHYANA BHANDA AND NOULI, IS AN EFFECTIVE MEANS OF CORE STABILITY.	2009	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
11 1984 22 SOFT TISSUE AND BONY INJURIES ATTRIBUTED TO THE PRACTICE OF YOGA: A BIOMECHANICAL ANALYSIS AND IMPLICATIONS FOR MANAGEMENT. OBJECTIVE: TO ANALYZE INJURIES THAT WERE DIRECTLY ASSOCIATED WITH YOGA PRACTICE AND IDENTIFY SPECIFIC POSES THAT SHOULD BE AVOIDED IN PATIENTS WITH OSTEOPENIA OR OSTEOPOROSIS. PATIENTS AND METHODS: WE RETROSPECTIVELY REVIEWED THE MEDICAL RECORDS OF PATIENTS WITH INJURIES THAT WERE PRIMARILY CAUSED BY YOGA. PATIENTS WERE SEEN FROM JANUARY 1, 2006, THROUGH DECEMBER 31, 2018. INJURIES WERE CATEGORIZED INTO 3 GROUPS: (1) SOFT TISSUE INJURY, (2) AXIAL NONBONY INJURY, AND (3) BONY INJURY. PATIENTS UNDERWENT EVALUATION AND WERE COUNSELED TO MODIFY EXERCISE ACTIVITY. RESULTS: WE IDENTIFIED 89 PATIENTS FOR INCLUSION IN THE STUDY. WITHIN THE SOFT TISSUE GROUP, 66 PATIENTS (74.2%) HAD MECHANICAL MYOFASCIAL PAIN DUE TO OVERUSE. ROTATOR CUFF INJURY WAS SEEN IN 6 (6.7%), AND TROCHANTERIC BURSOPATHY WAS OBSERVED IN 1 (1.1%). IN THE AXIAL GROUP, EXACERBATION OF PAIN IN DEGENERATIVE JOINT DISEASE (46 PATIENTS [51.7%]) AND FACET ARTHROPATHY (N=34 [38.2%]) WERE OBSERVED. RADICULOPATHY WAS SEEN IN 5 PATIENTS (5.6%). WITHIN THE BONY INJURY CATEGORY, KYPHOSCOLIOSIS WAS SEEN ON IMAGING IN 15 PATIENTS (16.9%). SPONDYLOLISTHESIS WAS PRESENT IN 15 PATIENTS (16.9%). ANTERIOR WEDGING WAS SEEN IN 16 (18.0%), AND COMPRESSION FRACTURES WERE PRESENT IN 13 (14.6%). THE POSES THAT WERE MOST COMMONLY IDENTIFIED AS CAUSING THE INJURIES INVOLVED HYPERFLEXION AND HYPEREXTENSION OF THE SPINE. WE CORRELATED THE KINESIOLOGIC EFFECT OF SUCH EXERCISES ON SPECIFIC MUSCULOSKELETAL STRUCTURES. CONCLUSION: YOGA POTENTIALLY HAS MANY BENEFITS, BUT CARE MUST BE TAKEN WHEN PERFORMING POSITIONS WITH EXTREME SPINAL FLEXION AND EXTENSION. PATIENTS WITH OSTEOPENIA OR OSTEOPOROSIS MAY HAVE HIGHER RISK OF COMPRESSION FRACTURES OR DEFORMITIES AND WOULD BENEFIT FROM AVOIDING EXTREME SPINAL FLEXION. PHYSICIANS SHOULD CONSIDER THIS RISK WHEN DISCUSSING YOGA AS EXERCISE.	2019	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
12 1965 26 SERIAL CASE REPORTING YOGA FOR IDIOPATHIC AND DEGENERATIVE SCOLIOSIS. BACKGROUND: NON-SURGICAL TECHNIQUES FOR TREATING SCOLIOSIS FREQUENTLY FOCUS ON REALIGNING THE SPINE, TYPICALLY BY MUSCULAR RELAXATION OR MUSCULAR OR LIGAMENTOUS STRETCHING. HOWEVER, SUCH TREATMENTS, WHICH INCLUDE PHYSICAL THERAPEUTIC, CHIROPRACTIC, AND BRACING TECHNIQUES, ARE INCONSISTENTLY SUPPORTED BY CURRENT EVIDENCE. IN THIS STUDY, WE ASSESS THE POSSIBLE BENEFITS OF ASYMMETRICAL STRENGTHENING OF TRUNCAL MUSCLES ON THE CONVEX SIDE OF THE SCOLIOTIC CURVE THROUGH A SINGLE YOGA POSE, THE SIDE PLANK POSE, IN IDIOPATHIC AND DEGENERATIVE SCOLIOSIS. METHODS: TWENTY-FIVE PATIENTS WITH IDIOPATHIC OR DEGENERATIVE SCOLIOSIS AND PRIMARY CURVES MEASURING 6 TO 120 DEGREES BY THE COBB METHOD HAD SPINAL RADIOGRAPHS AND WERE THEN TAUGHT THE SIDE PLANK POSE. AFTER 1 WEEK PERFORMING THE POSE WITH CONVEXITY DOWNWARD FOR 10 TO 20 SECONDS, THEY WERE INSTRUCTED TO MAINTAIN THE POSTURE ONCE DAILY FOR AS LONG AS POSSIBLE ON THAT ONE SIDE ONLY. A SECOND SERIES OF SPINAL RADIOGRAPHS WAS TAKEN 3 TO 22 MONTHS LATER. PRE- AND POST-YOGA COBB MEASUREMENTS WERE COMPARED. RESULTS: THE MEAN SELF-REPORTED PRACTICE OF THE YOGA POSE WAS 1.5 MINUTES PER DAY, 6.1 DAYS PER WEEK, FOR A MEAN FOLLOW-UP PERIOD OF 6.8 MONTHS. AMONG ALL PATIENTS, A SIGNIFICANT IMPROVEMENT IN THE COBB ANGLE OF THE PRIMARY SCOLIOTIC CURVE OF 32.0% WAS FOUND. AMONG 19 COMPLIANT PATIENTS, THE MEAN IMPROVEMENT ROSE TO 40.9%. IMPROVEMENTS DID NOT DIFFER SIGNIFICANTLY AMONG ADOLESCENT IDIOPATHIC AND DEGENERATIVE SUBTYPES (49.6% AND 38.4%, RESPECTIVELY). CONCLUSIONS: ASYMMETRICALLY STRENGTHENING THE CONVEX SIDE OF THE PRIMARY CURVE WITH DAILY PRACTICE OF THE SIDE PLANK POSE HELD FOR AS LONG AS POSSIBLE FOR AN AVERAGE OF 6.8 MONTHS SIGNIFICANTLY REDUCED THE ANGLE OF PRIMARY SCOLIOTIC CURVES. THESE RESULTS WARRANT FURTHER TESTING.	2014	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 
13 2015 16 SUGGESTIONS FOR ADAPTING YOGA TO THE NEEDS OF OLDER ADULTS WITH OSTEOPOROSIS. BACKGROUND: EXERCISE SUCH AS YOGA MAY HAVE HEALTH BENEFITS FOR OLDER ADULTS WITH OSTEOPOROSIS, BUT WITHOUT ATTENTION TO SAFE MOVEMENT YOGA CAN ALSO INCREASE THE RISK FOR INJURY. OBJECTIVE: THE CURRENT ARTICLE PROVIDES SUGGESTIONS FOR HOW TO ADAPT YOGA TO THE NEEDS OF OLDER ADULTS WITH OSTEOPOROSIS. SUGGESTIONS: A GENERAL GUIDELINES FOR EXERCISE IS THAT OLDER ADULTS WITH OSTEOPOROSIS SHOULD PARTICIPATE IN A MULTICOMPONENT EXERCISE PROGRAM, INCLUDING RESISTANCE AND BALANCE TRAINING. CONTRAINDICATED MOVEMENTS INCLUDE END-RANGE FLEXION/EXTENSION/ROTATION OF THE SPINE AND INTERNAL/EXTERNAL ROTATION OF THE HIP. YOGA POSTURES THAT SHOULD BE ENCOURAGED INCLUDE POSTURES EMPHASIZING SPINAL ALIGNMENT AND EXTENSION TO MID-RANGE IN STANDING AND ON THE FLOOR. OVERARCHING CONSIDERATIONS FOR PARTICIPATION IN YOGA ARE THAT CLASSES SHOULD BE DESIGNED FOR HIGHER-RISK OLDER ADULTS, LED BY AN INSTRUCTOR WHO HAS HAD PROPER TRAINING WITH INDIVIDUALS WITH OSTEOPOROSIS, SHOULD BE A NONCOMPETITIVE ENVIRONMENT, AND SHOULD GIVE ATTENTION TO WHICH POSTURES ARE SAFE AND HOW TO TRANSITION SAFELY.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
14  968 34 EFFECTS OF AN 8-MONTH ASHTANGA-BASED YOGA INTERVENTION ON BONE METABOLISM IN MIDDLE-AGED PREMENOPAUSAL WOMEN: A RANDOMIZED CONTROLLED STUDY. ALTHOUGH YOGA HAS THE POTENTIAL TO BE AN ALTERNATIVE PHYSICAL ACTIVITY TO ENHANCE BONE HEALTH, THERE IS A LACK OF HIGH QUALITY EVIDENCE FOR THIS TYPE OF INTERVENTION. THE PURPOSE OF THIS RANDOMIZED CONTROLLED TRIAL WAS TO EXAMINE THE EFFECTS OF A PROGRESSIVE 8-MONTH ASHTANGA-BASED YOGA PROGRAM ON BONE TURNOVER MARKERS (BTM), AREAL BONE MINERAL DENSITY (ABMD) AND VOLUMETRIC BONE CHARACTERISTICS IN PREMENOPAUSAL WOMEN. THIRTY-FOUR PREMENOPAUSAL WOMEN (35-50 YEARS) WERE RANDOMLY ASSIGNED EITHER TO A YOGA GROUP (YE, N = 16) OR A CONTROL GROUP (CON, N = 18). PARTICIPANTS IN YE GROUP PERFORMED 60 MINUTES OF AN ASHTANGA-BASED YOGA SERIES 2 TIMES/WEEK WITH ONE DAY BETWEEN SESSIONS FOR 8 MONTHS, AND THE SESSION INTENSITY WAS PROGRESSIVELY INCREASED BY ADDING THE NUMBER OF SUN SALUTATIONS (SS). PARTICIPANTS IN CON WERE ENCOURAGED TO MAINTAIN THEIR NORMAL DAILY LIFESTYLES MONITORED BY THE BONE SPECIFIC PHYSICAL ACTIVITY QUESTIONNAIRE (BPAQ) AT 2 MONTH INTERVALS FOR 8 MONTHS. BODY COMPOSITION WAS MEASURED BY DUAL ENERGY X-RAY ABSORPTIOMETRY (DXA). BONE FORMATION (BONE ALKALINE PHOSPHATASE, BONE ALP) AND BONE RESORPTION (TARTRATE-RESISTANT ACID PHOSPHATASE-5B, TRAP5B) MARKERS WERE ASSESSED AT BASELINE AND AFTER 8 MONTHS. ABMD OF TOTAL BODY, LUMBAR SPINE AND DUAL PROXIMAL FEMUR AND TIBIA BONE CHARACTERISTICS WERE MEASURED USING DXA AND PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY (PQCT), RESPECTIVELY. WE FOUND THAT THE SERUM BONE ALP CONCENTRATIONS WERE MAINTAINED IN YE, BUT SIGNIFICANTLY (P = 0.005) DECREASED IN CON AFTER THE 8 MONTH INTERVENTION, AND THERE WERE SIGNIFICANT (P = 0.002) GROUP DIFFERENCES IN BONE ALP PERCENT CHANGES (YE 9.1 +/- 4.0% VS. CON -7.1 +/- 2.3%). NO CHANGES IN TRAP5B WERE FOUND IN EITHER GROUP. THE 8-MONTH YOGA PROGRAM DID NOT INCREASE ABMD OR TIBIA BONE STRENGTH VARIABLES. BODY COMPOSITION RESULTS SHOWED NO CHANGES IN WEIGHT, FAT MASS, OR % FAT, BUT SMALL SIGNIFICANT INCREASES IN BONE FREE LEAN BODY MASS OCCURRED IN BOTH GROUPS. THE FINDINGS OF THIS STUDY SUGGEST THAT REGULAR LONG-TERM ASHTANGA YOGA HAD A SMALL POSITIVE EFFECT ON BONE FORMATION BUT DID NOT ALTER ABMD OR TIBIA BONE CHARACTERISTICS IN PREMENOPAUSAL WOMEN. KEY POINTSREGULAR LONG-TERM ASHTANGA-BASED YOGA PROGRAM HAD A SMALL POSITIVE EFFECT ON BONE FORMATION, BUT NO EFFECTS WERE FOUND ON BONE RESORPTION.NONE OF THE BONE DENSITY OR GEOMETRY VARIABLES WERE CHANGED BY THE 8-MONTH ASHTANGA-BASED YOGA INTERVENTION.FUTURE YOGA INTERVENTIONS SHOULD FOCUS ON LONGER DURATION AND GREATER FREQUENCY TO ELICIT IMPROVEMENTS IN BONE MINERAL DENSITY.	2015	

15  184 30 A RANDOMIZED CONTROLLED TRIAL TO ASSESS PAIN AND MAGNETIC RESONANCE IMAGING-BASED (MRI-BASED) STRUCTURAL SPINE CHANGES IN LOW BACK PAIN PATIENTS AFTER YOGA PRACTICE. BACKGROUND THE PRESENT STUDY AIMED AT DETERMINING WHETHER 12 WEEKS OF YOGA PRACTICE IN PATIENTS WITH CHRONIC LBP AND MRI-BASED DEGENERATIVE CHANGES WOULD RESULT IN DIFFERENCES IN: (I) SELF-REPORTED PAIN, ANXIETY, AND SPINAL FLEXIBILITY; AND (II) THE STRUCTURE OF THE DISCS OR VERTEBRAE. MATERIAL AND METHODS SIXTY-TWO PERSONS WITH MRI-PROVEN DEGENERATIVE INTERVERTEBRAL DISCS (GROUP MEAN +/-S.D., 36.2+/-6.4 YEARS; 30 FEMALES) WERE RANDOMLY ASSIGNED TO YOGA AND CONTROL GROUPS. HOWEVER, TESTING WAS CONDUCTED ON ONLY 40 SUBJECTS, SO ONLY THEIR DATA ARE INCLUDED IN THIS STUDY. THE ASSESSMENTS WERE: SELF-REPORTED PAIN, STATE ANXIETY, SPINAL FLEXIBILITY, AND MRI OF THE LUMBOSACRAL SPINE, PERFORMED USING A 1.5 TESLA SYSTEM WITH A SPINAL SURFACE COLUMN. THE YOGA GROUP WAS TAUGHT LIGHT EXERCISES, PHYSICAL POSTURES, BREATHING TECHNIQUES, AND YOGA RELAXATION TECHNIQUES FOR 1 HOUR DAILY FOR 3 MONTHS. NO INTERVENTION WAS GIVEN TO THE CONTROL GROUP EXCEPT FOR ROUTINE MEDICAL CARE. A REPEATED-MEASURES ANALYSIS OF VARIANCE (ANOVA) WITH POST HOC ANALYSES (WHICH WAS BONFERRONI-ADJUSTED) WAS USED. THE ETHICS COMMITTEE OF PATANJALI RESEARCH FOUNDATION HAD APPROVED THE STUDY WHICH HAD BEEN REGISTERED IN THE CLINICAL TRIALS REGISTRY OF INDIA (CTRI/2012/11/003094). RESULTS THE YOGA GROUP SHOWED A SIGNIFICANT REDUCTION IN SELF-REPORTED PAIN AND STATE ANXIETY IN A BEFORE/AFTER COMPARISON AT 12 WEEKS. A FEW PATIENTS IN BOTH GROUPS SHOWED CHANGES IN THE DISCS AND VERTEBRAE AT POST-INTERVENTION ASSESSMENT. CONCLUSIONS WITHIN 12 WEEKS, YOGA PRACTICE REDUCED PAIN AND STATE ANXIETY BUT DID NOT ALTER MRI-PROVEN CHANGES IN THE INTERVERTEBRAL DISCS AND IN THE VERTEBRAE.	2016	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   
16 1655 14 MUSCULOSKELETAL INJURIES IN YOGA. WHILE YOGA HAS BEEN WIDELY STUDIED FOR ITS BENEFITS TO MANY HEALTH CONDITIONS, LITTLE RESEARCH HAS BEEN PERFORMED ON THE NATURE OF MUSCULOSKELETAL INJURIES OCCURRING DURING YOGA PRACTICE. YOGA IS CONSIDERED TO BE GENERALLY SAFE, HOWEVER, INJURY CAN OCCUR IN NEARLY ANY PART OF THE BODY-ESPECIALLY THE NECK, SHOULDERS, LUMBAR SPINE, HAMSTRINGS, AND KNEES. AS BROAD INTEREST IN YOGA GROWS, SO WILL THE NUMBER OF PATIENTS PRESENTING WITH YOGA-RELATED INJURIES. IN THIS LITERATURE REVIEW, THE PREVALENCE, TYPES OF INJURIES, FORMS OF YOGA RELATED WITH INJURY, SPECIFIC POSES (ASANAS) ASSOCIATED WITH INJURY, AND PREVENTIVE MEASURES ARE DISCUSSED IN ORDER TO FAMILIARIZE PRACTITIONERS WITH YOGA-RELATED INJURIES.	2018	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
17 2722 20 YOGA MIGHT BE AN ALTERNATIVE TRAINING FOR THE QUALITY OF LIFE AND BALANCE IN POSTMENOPAUSAL OSTEOPOROSIS. AIM: OSTEOPOROTIC VERTEBRA AND HIP FRACTURES ARE MAJOR CAUSES OF DYSFUNCTION, DISABILITY, MORTALITY AND IMPAIRED LIFE QUALITY IN THE AGEING POPULATION. IN THE POSTMENOPAUSAL PERIOD, EXERCISES PREVENT RAPID BONE LOSS AND INCREASE MUSCLE STRENGTH, MOBILITY AND FLEXIBILITY THEREBY DECREASING THE RISK OF FALLS AND FRACTURES. YOGA EXERCISES, WHICH HAVE BEEN AN INSEPARABLE PART OF EASTERN CULTURE FOR HUNDREDS OF YEARS, ARE NOW BEING USED IN THE FIELD OF OSTEOPOROSIS REHABILITATION. YOGA HAS A POSITIVE EFFECT ON BALANCE, POSTURE, FLEXIBILITY, AND LIFE QUALITY RESULTING FROM ITS EFFECTS ON BALANCE, STRETCHING, RELAXATION AND STRENGTHENING. THE AIM OF THIS STUDY WAS TO EVALUATE THE EFFECT OF YOGA EXERCISES IN POSTMENOPAUSAL OSTEOPOROTIC WOMEN ON BALANCE AND LIFE QUALITY AND TO COMPARE THE RESULTS WITH A CLASSIC OSTEOPOROSIS EXERCISE PROGRAM. METHODS: TWENTY-SIX POSTMENOPAUSAL OSTEOPOROTIC WOMEN OVER 55 YEARS OF AGE WERE INCLUDED IN THE STUDY. A NEUROMUSCULAR TEST BATTERY AND THE QUALEFFO AS A LIFE QUALITY INDEX WERE USED FOR THE ASSESSMENT OF BALANCE AND LIFE QUALITY, RESPECTIVELY. RESULTS: THE RESULTS SHOWED THAT YOGA EDUCATION HAS A POSITIVE EFFECT ON PAIN, PHYSICAL FUNCTIONS, SOCIAL FUNCTIONS, GENERAL CONCLUSION: IN CONCLUSION, YOGA APPEARS TO BE AN ALTERNATIVE PHYSICAL ACTIVITY FOR THE REHABILITATION OF OSTEOPOROTIC SUBJECTS.	2010	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
18 2393 12 YOGA AND BONE HEALTH. OSTEOPOROSIS IS A PUBLIC HEALTH PROBLEM AFFECTING INDIVIDUALS GLOBALLY. YOGA HAS BEEN FOUND TO PREVENT AND REVERSE BONE LOSS. YOGA MAY RESULT IN BETTER BALANCE, IMPROVED POSTURE, AND GREATER RANGE OF MOTION, STRENGTH, AND COORDINATION, ALL FACTORS THAT ALSO MITIGATE THE RISK OF FALLS AND FRACTURES. A 12-MINUTE, 12-POSE YOGA REGIMEN IS DISCUSSED IN DETAIL. ONCE LEARNED, THE ONGOING USE OF YOGA IS SAFE, WITHOUT COST, AND MAY BE DONE LIFELONG.	2021	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
19  322 16 ANKLE MOTION IN COMMON YOGA POSES. BACKGROUND: MOTION OF THE ANKLE IS ESSENTIAL FOR MANY YOGA POSES. AN UNDERSTANDING OF RANGE OF ANKLE MOTION DURING TYPICAL YOGA POSES MAY HELP THE CLINICIAN TO UNDERSTAND EXPECTED OUTCOMES OF PATIENTS WHEN RETURNING FROM ANKLE SURGERY OR INJURY TO YOGA. METHODS: THE BIOMECHANICS OF TWENTY HEALTHY ACTIVE YOGIS WERE COLLECTED DURING SEVEN YOGA POSES THAT ARE COMMON WITHIN THEIR PRACTICES. MOTION CAPTURE AND FORCE PLATES WERE USED TO ASSESS THE RANGE OF MOTION AND JOINT MOMENTS OF THE ANKLE FOR EACH POSE. RESULTS: ALL POSES RESULTED IN PLANTARFLEXION AND EXTERNAL ROTATION MOMENTS AT THE ANKLE JOINTS. JOINT LOADING WAS HIGHEST IN SINGLE LEG POSES. THE ARC OF MOTION USED BY THE STUDY PARTICIPANTS IN THE POSES WAS 29 DEGREES OF SAGITTAL MOTION, 20 DEGREES OF FRONTAL MOTION AND 35 DEGREES OF TRANSVERSE MOTION. DISCUSSION: ANKLE MOTION WAS EVALUATED WHEN HEALTHY YOGIS PERFORM STANDARD POSES. THESE RESULTS MAY HELP IN DISCUSSION WITH PATIENTS REGARDING EXPECTED OUTCOMES AFTER ANKLE INJURY OR SURGERY.	2019	
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     
20 1991 16 SPINE FUSIONS, YOGA INSTRUCTORS, AND HIP FRACTURES: THE ROLE OF DUAL MOBILITY IN PRIMARY TOTAL HIP ARTHROPLASTY. BACKGROUND: DESPITE THE INCREASED USE OF DUAL MOBILITY (DM) IN PRIMARY TOTAL HIP ARTHROPLASTY (THA), DEBATE EXISTS REGARDING THE INDICATIONS FOR ITS USE. NO SPECIFIC ALGORITHM EXISTS TO GUIDE THIS DECISION-MAKING PROCESS. THEREFORE, THE PURPOSE OF THIS ARTICLE IS TO SUMMARIZE THE CURRENTLY AVAILABLE LITERATURE REGARDING THE USE OF DM IN PRIMARY THA AND PROVIDE EVIDENCE-BASED GUIDELINES BASED ON SPECIFIC PATIENT POPULATIONS AND RISK FACTORS FOR INSTABILITY. METHODS: WE REVIEWED THE CURRENT LITERATURE FOR STUDIES EVALUATING RISK FACTORS FOR DISLOCATION IN PRIMARY THA, AS WELL AS THE CLINICAL USE AND RESULTS OF DM IN PRIMARY THA. BASED ON THE STRENGTH OF THE LITERATURE, WE DISCUSS THE USE OF DM IN SPECIFIC PATIENT POPULATIONS. WE PROVIDE A DECISION-MAKING ALGORITHM TO DETERMINE WHETHER A PATIENT MAY BE INDICATED FOR DM IN PRIMARY THA. RESULTS: SURGEONS SHOULD CONSIDER PREOPERATIVE PATIENT DEMOGRAPHICS, RISK FACTORS FOR INSTABILITY (EG, SIGNIFICANT HIP-SPINE ISSUES), TYPE OF PROCEDURE TO BE PERFORMED (EG, CONVERSION ARTHROPLASTY), AND INDICATIONS FOR SURGERY (EG, THA FOR FEMORAL NECK FRACTURE). BASED ON THIS ALGORITHMIC ASSESSMENT, DM MAY BE WARRANTED IN THE PRIMARY THA SETTING IF A PATIENT'S COMBINED RISK REACHES AN ESTABLISHED THRESHOLD BASED ON THE LITERATURE. CONCLUSION: THIS EVIDENCE-BASED ALGORITHM MAY HELP GUIDE CURRENT PRACTICE IN THE USE OF DM IN PRIMARY THA. WE ADVOCATE THE CONTINUED JUDICIOUS USE OF DM IN HIP ARTHROPLASTY. LONGER TERM STUDIES ARE NEEDED IN ORDER TO EVALUATE THE DURABILITY OF DM, AS WELL AS ANY COMPLICATIONS RELATED TO THE DM ARTICULATION.	2021