Using guided imagery to improve knee health post-knee replacement.

The goal is to improve knee strength and range of motion through yoga therapy with an emphasis on a daily guided imagery practice. We will measure progress using a journal; knee pain will be tracked daily while range of motion and strength will be tested weekly. The aim is to have bilateral improvements in strength and ROM within 30 days.

Client is a 70 year old male. Client has had bilateral knee replacements - left knee replaced in 2006, right knee replaced at the end of 2022.

I was quite impressed with the guided imagery exercises that we learned in the Healing Relationships module and felt excited to implement the practice. I envisioned going through a regular yoga therapy session with an emphasis on imagining healing and nutritive fluid, light, and/or energy moving in and out of the knee. These practices would be designed to build up to a guided imagery practice in which we sat still and imagined going deeper into the knee joint and guiding the innate healing energies of the body in and through it. I envisioned that we would make this practice a daily habit, even on the days in which there would be no movement-based yoga therapy. I planned for the client to use a journal in order to bring more focus and awareness into the day-to-day healing process of the knee joint.

I implemented hatha yoga in the sense that we used physical movement in order to balance the energies of the body, which would allow for increases in the energy of the body and assist healing. Hatha yoga, applied appropriately, can be a great foundation for the healing that comes about through more subtle practices like guided imagery and mediation. I incorporated asana and pranayama, which are branches of Raja Yoga. Raja Yoga also provided a foundation for more subtle healing energies to awaken within the body.
I used Jnana Yoga in our discussions of the Energy within that has all power, including the power to heal the body. We practiced deidentifying with the pain of the physical body in favor of identifying with the Healing Power within.
We utilized Bhakti Yoga by cultivating an attitude of faith and awe towards the natural and miraculous healing capacity within the body.

The client seemed to me to have a more conservative constitution and therefore they were a bit skeptical of the idea that our thoughts can help the body to heal. I was happy to get into the science behind the placebo effect, which we discussed as including 'belief' and 'mindset' effects. We talked about Dr. Joe Dispenza, who was able to help his spine to heal after a catastrophic accident. Other doctors thought he would never walk again; he was able to get back to his very active lifestyle with the help of a healing guided imagery practice that was very similar to the one that we were implementing. This intellectual convincing was quite effective with this client. I also believe the journal was very useful as it helps to bring accountability to the daily practice and further awareness of the healing process. I can see myself using a journal with many of my clients.

I'd suggest that the client continue to work with their physical therapist and their orthopedic doctor for continued care of the replaced knee. I'd also advise that the client continue to do the asanas and movements we were doing together as well as the exercises offered by their physical therapist. I would reiterate the importance of staying mentally positive and continuing to do the healing guided imagery that we were working on. I'd also ask if they would be willing to keep the journal and check in with me from time to time if they aren't willing to continue yoga therapy. I would recommend that they continue with their meditation practice and offer resources for different guided meditations like Headspace if they would be unwilling or unable to continue yoga therapy with me. Lastly, I would encourage them to check with their doctor to see what other exercise activities they can do.

I do feel that we achieved our goals, which were to decrease pain and improve knee strength and ROM. In reviewing the daily pain journal that the client kept, both he and I noticed a significant reduction in pain. His average pain score of '7' became a '4'. Because he had previously had a knee replacement, he was experienced with the normal healing process and felt that the healing process was hastened by the yoga and imagery practices. We measured his ROM on a weekly basis and found that his ROM improved by 10 degrees in the recently-reconstructed knee over the course of 30 days as measured by a Goniometer - he went from 97 degrees of flexion to 107 degrees of flexion. In the knee that was reconstructed 20 years ago, he went from 101 degrees of flexion to 112. Because of the client's advanced age, we tested strength using a chair-supported lunge; the client reported feeling stronger.

Yes, this was my first time working with a truly mobility-restricted senior citizen. He was not able to comfortably get up and down from the floor, so we wound up spending a lot of time practicing that, which is time that I did not allot for in our session plans. While it felt good to help him feel more comfortable in that, that was something that just came up in conversation that he immediately really wanted to work on. I felt compelled to work on that with him despite the fact that it was not part of our plan. We wound up using blankets to make the floor comfortable enough for him to kneel upon while he got up and down. He also engaged me in conversation a lot.
I am continually learning the lesson that these sessions will not go perfectly as is planned every time, and I will need to be able to adapt on the fly as things come up. I still need to learn how to time everything better.

The client and I were both blown away by how effective and enjoyable the guided healing imagery practices were. It seems as if the client truly started to believe that he could support the healing process with his mind; the result was a measurable decrease in pain. Overall, the results that the client saw were satisfactory, which makes me feel good about my work, although I did realize that there will come times I will have to really focus on moving the session forward. This client, in particular, liked to talk a lot, and could be quite obstinate in his decisions - for example, when he wanted to learn how to get up and down from the floor, it's as if the entire world was reduced to only that task and the steps it would take for the task to be accomplished. In the moment - and even in hindsight - I don't feel terrible about this, since it was something productive that is within our scope of practice, but the experience made me realize there will be times I will have to firmly guide clients away from doing certain things even if they insist otherwise. I do feel this client was capable of getting up from the floor, but I need to be able to say 'no' to clients sometimes.