Forty years ago, when I first became interested in yoga and therapeutic exercise, I was assisting an older woman who was immobilized in her wheelchair by arthritis. Long before I understood the degree to which yoga can rehabilitate the body, I was helping people who were unable to dress, bathe or feed themselves independently due to the pain and stiffness in their joints. This has helped me understand the extreme suffering that can be inflicted by arthritis.
Back then, people with joint pain and swelling were advised by doctors not to move! The thinking was "If it hurts, don't move it." We now know that inactivity is one of the worst responses for someone with arthritis.
As Loren Fishman, MD, points out in his book, Yoga for Arthritis, "Arthritis restricts movement, yoga increases range of motion-these two were made for each other."
Arthritis is the leading cause of disability in this country, limiting everyday activities for millions of people. Drugs, surgeries, and steroids can alleviate some of the discomforts, but study after study has shown that exercise is most beneficial to most forms of arthritis, specifically low-impact, flexibility-enhancing exercises such as yoga.
Osteoarthritis, a painful and often debilitating condition caused by decades of wear and tear on the joints, is considered to be one the side effects of living longer. By the time we reach age sixty-five, X-rays for at last a third of us will show some signs of osteoarthritis, the most common of a group of diseases collectively referred to as arthritis.
Arthritis in its many forms affects more than seventy million (or one in three) American adults, according to estimates by the Center for Disease Control and Prevention.
Arthritis is so common in our culture that most people consider the pain and discomfort it brings to be a normal part of aging. Arthritis makes normal activities increasingly painful and difficult and diminishes or destroys the quality of life.
An Overview of Arthritis
The word arthritis means "joint inflammation." Modern medicine recognizes more than a hundred varieties of conditions that produce deterioration in joint structures. The common thread among these conditions is that they all affect the joints-those nearly 150 ingeniously designed structures located where two or more bones come together.
Arthritis-related joint problems may include pain, stiffness, inflammation and damage to joints. Joint weakness, instability and visible deformities may occur, depending on the location of the joint involved.
Arthritis is classified into two main types. Rheumatoid arthritis is a chronic inflammatory disorder, resulting in stiffness in the joints and muscles, joint erosion and pain. Osteoarthritis is a degenerative disorder that erodes the cartilage in joints, which leads to bones rubbing together. Osteoarthritis frequently occurs in people who are overweight or whose joints are painful from extreme overuse.
In spite of the prevalence of arthritis, be careful not to jump to the conclusion that your achy joints are necessarily due to it. Overuse and injuries can also result in tendonitis, bursitis, carpal tunnel syndrome and other fairly common conditions that are unrelated to arthritis.
Arthritis and Exercise
To remain healthy, muscles and joints must move and bear weight or they will lose strength. This weakness, coupled with joint swelling, will make the joints unstable. Joints in this condition are vulnerable to dislocation, increased injury and pain. Thus, regular gentle movement helps to reduce pain and to maintain mobility.
Physical movement promotes health in many systems of the body. It increases circulation, which in turn reduces swelling and promotes delivery of oxygen and nutrients to the tissues. With immobilization, a cycle of deterioration begins.
Because movement is crucial to so many physiological processes, the arthritic person's overall health tends to deteriorate without it. The normal functioning of the immune system declines, infections and illnesses occur, and the person often becomes frustrated and depressed. This cycle is self-perpetuating.
When someone comes to me with arthritis, I teach them how to practice yoga safely with the support of yoga props. For those who are new to yoga, the term "yoga props," simply refers to any object, such as a wall, a sturdy table or a chair, a folded blanket, a firm pillow, a strap or other item that makes practicing yoga safer and easier. Yoga props are especially helpful for older beginners who may have balance problems and are coping with common health issues such as arthritis and osteoporosis. In addition to common household objects that can be used as yoga props, there are professional yoga props such as a sturdy wooden bar known as the "yoga horse," yoga wall ropes, yoga bolsters in many shapes and sizes, yoga straps, special yoga chairs, yoga blocks, firm yoga blankets and more elaborate props like yoga backbenders that give people with arthritis and other common health conditions new hope and confidence.
Physicians are increasingly advising regular gentle exercise for people with arthritis because it tones muscles and reduces stiffness in joints. Yoga is an ideal form of exercise for this because its movements are fluid and adaptable. Yoga loosens muscles that have been tightened by inactivity, stress and tension. In yoga we progress gradually, beginning with simple stretches and strengthening poses and advancing to more difficult postures only as we become stronger and more flexible.
If necessary, you can begin with gentle movements while sitting in a chair or lying on the floor. You can gradually add weight-bearing standing postures, with the support of a wall, counter or table, wall ropes, chairs, blocks, and other props.
The weight-bearing yoga standing poses are among the key poses for safely increasing range of motion in all the joints as well as increasing strength and flexibility.
It's important to note that weak muscles are considered a risk factor for osteoarthritis. Be especially aware of weakness in the quadriceps, the large frontal thigh muscles: The weaker the quadriceps, the higher the risk of developing osteoarthritis in the knee. Yoga standing poses are valuable for strengthening the quadriceps without wear and tear on the hip and knee joints.
Practicing yoga can help improve respiration throughout the day. Calm, slow, rhythmic breathing helps to release both physical and emotional tension by flooding the body and brain with oxygen. The regular, daily practice of deep relaxation is restorative to every cell of the body.
I encourage those of you with arthritis to seek the help of an experienced teacher who can help you learn to distinguish between good pain and bad pain and to make yoga part of your daily life.
The positive effects yoga can have on mood and overall outlook are especially important to someone with arthritis. A yoga class offers positive support and the opportunity to connect with people who are health-minded and have experienced the benefits of yoga. Numerous studies emphasize the value of group support in coping with health challenges such as arthritis.
With arthritis, as with any injury or disease, listen to your body with focused attention to avoid injury and determine which movements are most healing. Take classes with a teacher who is knowledgeable about arthritis. If you are new to yoga, I recommend a few private lessons, if possible, or start in a small group class with individualized instruction, where you can practice at your own pace.
Guidelines for Practicing Yoga in Class and at Home
1. Respect pain. All yoga students, but especially those with arthritis, must learn the difference between the beneficial feeling of muscles stretching and the pain that signals harm. Learn to distinguish between the normal discomfort of moving stiff joints through range of motion, and the pain caused by a destructive movement or an excessive demand on a joint. Sudden or severe pain is a warning. Continuing an activity after such a warning may cause joint damage.
In general, if pain and discomfort persists more than two hours after a yoga session, ask a knowledgeable teacher to check your alignment and help you modify the pose. Try moving more slowly, practicing more regularly and experiment with how long to stay in a pose. There is no set answer to the perennial question "How long should I stay in the pose?" Stay long enough so that a healthy change has been made but not so long that your body stiffens from staying in a position too long.
2. Balance work and rest. Balancing activity and rest applies to yoga as well as to other daily activities. Do not exercise to the point of fatigue. Stop before you are exhausted! Weakened, fatigued muscles set the stage for joint instability and injury. Balance your active yoga session with yoga's deeply relaxing restorative poses. Restorative poses are passive poses that help your internal healing processes to work. If you are fatigued, practice restorative poses first. You will benefit more from active, more challenging poses, if you are well rested.
3. Practice with focus and awareness (pay attention to how you feel) and breathe properly. Avoid mechanical repetitions and counting while exercising. Watch the flow of your breath and your body's response to a particular pose or exercise. Without fully expanding your lungs, the muscles you are exercising cannot be adequately supplied with oxygen. Holding your breath while stretching inhibits relaxation. Smooth, peaceful, rhythmic breathing through the nose reduces pain and tension and increases the feeling of deep relaxation that follows a yoga session. Learn to tune into what your body is telling you.
4. Learn to use yoga props. People with arthritis may already be quite stiff by the time they start yoga. The use of props helps improve blood circulation and breathing capacity. By supporting the body in a yoga posture, props allow the muscles to lengthen in a passive, non-strenuous way. Props help conserve energy and allow people to practice more strenuous poses without hurting or over exerting themselves.
Yoga for Arthritic Hips and Knees
The areas most commonly affected by arthritis are the hips, knees and hands. With decreased movement, the muscles and soft tissues around the hip shorten, putting additional wear and tear on the gliding surfaces. If a person becomes more sedentary in an effort to minimize pain, bones and cartilage receive less weight-bearing stimulation. Bone spurs may even develop to further limit movement.
Lack of exercise also weakens the thigh and calf muscles. Their strength provides stability and support for the knee. When the soft tissues of the joint swell, this causes compression and reduces space in the joint even further.
Standing poses are crucial for stretching and building supportive strength in the hips, buttocks and thighs. Moving the head of the femur in the hip socket helps distribute synovial fluid, thus lubricating the joint and all points of contact.
The same standing poses recommended for hips are also critical for knee rehabilitation. They create more space in the knee joint for synovial fluid circulation and develop the strength of the thigh and calf muscles for better support.
Sit on the Floor Every Day!
I encourage all my students, especially those with osteoarthritis of the knees, to sit on the floor every day, in various cross-legged and other bent knee positions, as part of their daily life routine. This helps assure that you do not lose the ability to sit comfortably on the floor. Sitting with the legs crossed loosely is a simple, natural position that helps remove stiffness in the hips and knees. To help you sit comfortably on the floor with your back straight, sit on one or more folded blankets, a firm bolster, large dictionary or other height. Avoiding sitting on the floor will only make your hips and knees stiffer with the passage of time.
Hint: If there is pain in the knees, try increasing the height under the buttock so that your pelvis is higher than the knees, and place folded blankets or yoga blocks under the knees. A knowledgeable yoga teacher can help you adjust your props so that sitting on the floor becomes easy and comfortable. Increase the length of time you sit gradually, and be sure to cross your legs the opposite way (opposite leg in front).
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