Yoga Heals: Arthritis
Yoga practice can be a useful aid to relieving the discomfort of arthritis. Beginner and gentle yoga classes in particular, with their focus on gentle postures and movements to build strength and improve balance and flexibility, may be especially beneficial to those who have arthritis. In addition to providing a safe and effective way to remain physically active, yoga practice includes meditation and reflective activities which provide psychological benefits.
Arthritis is an umbrella terms that indicates a symptom: inflammation of a joint. Joint inflammation can have various causes--many of these are considered different types of arthritis, and some are complications of other diseases. It is estimated that one in three American adults are affected by arthritis. Arthritis is the leading cause of disability in the United States.
The most common type of arthritis, osteoarthritis is the "wear and tear" variety of joint inflammation often experienced by adults after the age of 65. Although injury can lead to earlier onset of arthritis in the affected joint, generally the particular cause of arthritis is often difficult to pinpoint. Recent studies show that some people may be genetically predisposed to arthritis (as in Ehlers-Danlos and Marfan syndromes).
In osteoarthritis, poor circulation of synovial fluid (which is responsible for nourishing and aiding the repair of cartilage) leads to wear of the cartilage, and results in an inflammatory response. Inflammation leads to further destruction of the cartilage, which in turn causes more inflammation. As part of the inflammatory response (and in response to stress), bones often form spurs or osteophytes which can further interfere with joint function.
As cartilage is worn away, bones begin to rub on the adjacent bone, and bone tissue begins to be malformed or splinters off. Especially in active or weight-bearing joints, this can be very painful. Osteoarthritis can be localized to a single joint or can be experienced in several at once--the most common joints affected are those in the cervical and lumbar spine, knees, hips, fingers and the base of the thumb and big toe.
In addition to joint and mobility related complications of arthritis, the osteophytes which form on stressed bones may interfere with nerve function, reducing oxygen to the nerve and resulting in neurological symptoms such as pain, heat, tingling, lack of sensation or weakness.
Rheumatoid arthritis is considered an autoimmune disease in which white blood cells produce an abnormal antibody (rheumatoid factor, or RF) which targets the cells of the joint's synovial lining and causes an inflammatory response in the joint. As the synovial lining is destroyed, the inflammation proceeds to the cartilage, bone tissue and other connective tissue nearby, leading to deformity and disability in the joint.
These are a group of diseases that affect the joints of the spine, the sacro-iliac joint and the elements which connect ligaments and tendons to bones. These diseases also affect other joints, and sometimes other connective tissues throughout the body.
Ankylosing spondylitis typically begins with inflammation in the sacro-iliac joint which moves up the spine, often ossifying the ligaments and tendons that run along the vertebral column. In advanced stages, the spine may become fused in a stooped position, restricting mobility in the thoracic region and making it difficult to breathe. For those with ankylosing spondylitis, it is important to maintain mobility and strengthen the muscles which support the spine in a healthy posture.
Reactive arthritis, also called Reiter's sydrome, occurs as a reaction to an infection somewhere else in the body (such as the intestines or kidneys). It usually affects the joints of the legs and feet, but can be found in other joints, and it presents as an inflammation of the joints as well as the surrounding ligaments, tendons and muscles. For some, the joint inflammation is temporary--it may eventually fade completely--and for others, the inflammation may fade and return.
Psoriatic arthritis is a common complication of the skin disease psoriasis. Recent studies suggest it may be related to genetic mutation that affects the reproduction of epithelial cells, causing them to reproduce too quickly and not detach to be shed quickly enough. This type of arthritis typically affects the spine, but it also occurs in finger, toes, knees and ankles. The symptoms of psoriatic arthritis are generally milder than rheumatoid arthritis.
Gout can also cause arthritis. Excess uric acid is deposited in joints and begins to break down the synovial membrane. This form of arthritis typically begins as frequent "attacks" in the big toe, a condition called podagra, and causes an great deal of swelling and pain in the joint of the toe. Without treatment for gout, the condition will worsen--attacks will become more frequent and will progress to other joints. Proper diet, exercise and weight loss have been the most effective treatments for gout.
Most yoga classes include movement through a full (and safe) range of motion, which helps to circulate synovial fluid and to nourish and repair the synovial membrane and joint cartilage. Yoga also gives students an opportunity to increase their body awareness--they learn tools to notice which movements cause pain or feel good, and they have opportunities to assess and improve their postural habits, which can lessen imbalanced stress on joints.
While doing yoga, the student's focus on alignment, the breath, and the non-attached awareness of gripping, tension or discomfort in the body provides additional psychological benefit. Since inflammation is exacerbated by stress, all forms of arthritis can benefit from the stress-relieving aspects of yoga.
Five Techniques for Arthritis
As with any condition, it is important that the student move gently and with attention to sensation of pain to avoid injury. If a student has arthritis of the hands, for instance, he would need to take care of poses like downward dog, cat/cow, or plank to avoid stressing the wrists and hands. If a student has arthritis of the hip, he will need to move carefully into postures which place the hip in extreme rotation, extension or flexion.
The following poses all move the spine through its healthy range of motion with variations for the new student. A student experiencing arthritis in a specific joint should work with a qualified yoga teacher to find posture and modifications which support healthy range of motion and strengthening for that particular joint. An excellent resource for more information on using yoga to relieve arthritis in specific joints is Loren Fishman's book Yoga for Arthritis.
Students with discomfort or limited mobility due to arthritis are encouraged to seek out a gentle style of yoga--something like a Restore or Gentle Flow class would be most suitable to students with discomfort in joints. An Intro to Yoga class is also typically gentler than more advanced classes.
This seated twist is gentle enough for most students with arthritis, although students with difficulty bringing knees and/or hips into full flexion may need to modify with a simple seated twist. Make sure the spine is vertical while twisting--leaning away from the bent leg could compromise the safety of the low spine.
On hands and knees, using a blanket under the knees for cushion as needed. Focus is on gentle, coordinated motion with the breath, not as much on degree of flexion and extension in the spine. For students who are uncomfortable placing weight on the hands, cat/cow can also be done standing in a slight squat with hands on the knees.
Using a wall or chair for downward-facing dog allows the student to experience most of the benefits of the forward bend and upper back lengthening without stressing the wrists. Students can place hands on the wall about shoulder height (or on the back of a chair) and allow their chest to drop toward the floor as they step back.
For students with arthritis, especially if it is in the hips or knees, it would be best to have a prop higher than a block (such as a chair or bench) so that they can ease into triangle pose with more support and less strain. The student would stand with feet separated about 2-3 feet apart, front toes pointing forward and back toes angled in, and front hand on the chair or bench behind him.
Ujjayi Pranayama (also called Victorious Breath) helps balance and deepen the breath as well as settle the mind. In seated or supported reclined position, hands relaxed where comfortable, the student will be breathing in and out through the nose with a gentle constriction or lift at the back of the throat. There is typically a smooth, steady sound associated with ujjayi breath, and the student can listen to the sound to hear whether the breath is even and unbroken.
Tips, Contraindications and Considerations
Appropriate alignment is especially important for students who already have inflammation happening in their joints. Care must be taken to bring the elements of a pose to the student, to keep the body supported and joints in their safe range of motion. Students with arthritis, along with many others, need to be reminded that if it hurts, they should stop.
A fast-paced vinyasa-style class is not recommended for the student with arthritis, especially if he is new to yoga and inexperienced with yoga postures. Moving quickly to keep up with the group and trying to match the posture of another student can increase risk of joint injury during yoga. Hot yoga is also not recommended, especially during a flare-up, as heat can increase inflammation. However, generating enough body heat to soften the connective tissues before doing bigger stretches is always a good idea, and gentle variations of sun salutations and other movements are an effective way to begin practice.
Yoga is a holistic practice involving movement as well as deep breathing, relaxation, meditation and concentration. There will be days when a physical practice is neither possible nor appropriate for students with arthritis, but they can still benefit from stress management techniques practiced in the more contemplative aspects of yoga.
In a review of current literature, yoga was shown to improve tenderness and swelling of joints for those with rheumatoid arthritis, to reduce pain, and improve self-efficacy. It also has been shown to improve mental health and energy.
Yoga for Arthritis - Johns Hopkins Arthritis Center
Yoga Exercise Videos - Arthritis Foundation