title: Yoga for correction of lymphedema's impairment of gait as an adjunct to lymphatic drainage: A pilot observational study.
abstract: BACKGROUND
  Yoga used as a major component of integrative treatment protocol in 14 Indian village camps improved quality-of-life in 425 lymphatic filariasis patients. They experienced better mobility and reduced disability. This paper documents the gait abnormalities observed in lower limb lymphedema patients and the locomotor changes following integrative treatment.
  
  
  METHODS
  Yoga postures were performed as explained by traditional yoga practice in two sessions: Before ayurvedic oil massage without compression bandages and after the massage with compression bandages. Each yoga posture lasted for 5 min and the whole session ended in 45 min. Throughout each session, we advised patients to do long, diaphragmatic breathing, concentrating on each breath. The flexion of joints was coordinated with exhalation and extension with inhalation. We educated the patients to do longer expiration than inspiration.
  
  
  CONCLUSIONS
  A total of 98 patients (133 limbs) attending the 6(th) month follow-up were evaluated. The most common gait abnormality was antalgic gait. Structural and functional abnormalities were observed in hip, knee and ankle joints. We found that yoga as an adjunct to other components in integrative treatment improved the gait problems. Long standing lymphedema caused altered gait and joint deformities. This was mostly due to inactivity causing muscle weakness and edema within and around the muscles. Both large and small limbs have shown significant volume reduction (P < 0.01) during follow-up after 6 months.
  
  
  CONCLUSIONS
  There can be a mixed etiology for gait related problems in lymphedema patients. Further studies are recommended to understand the causes of deformities in lymphedema patients and an exact role of yoga.
authors.affiliation: Institute of Applied Dermatology, IAD Junction, Uliyathadka, Kasaragod, Kerala, India.
authors.forename: Madhur Guruprasad
authors.initials: MG
authors.lastname: Aggithaya
authors.affiliation: Institute of Applied Dermatology, IAD Junction, Uliyathadka, Kasaragod, Kerala, India.
authors.forename: Saravu R
authors.initials: SR
authors.lastname: Narahari
authors.affiliation: Department of Dermatology, Churchill Hospital, Oxford, UK.
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Ryan
keywords: Gait; integrative medicine; lower limb lymphedema; muscle weakness; range of motion; yoga