The chance is big that you have students with arthritis in your yoga classes. What to do with them? Have you ever wished you could support them more, guide them better during class and let them experience the benefits of gentle movement?
Having worked in general practice as an Advanced Nurse Practitioner for many years and previously as a Health Visitor, I have come in contact with many people suffering from arthritis in varying degrees of severity. And as a qualified yoga teacher, I noted quite a lot of my client group also had issues related to arthritis. I recognized a need to look into this further.
Historically, yoga was practiced alongside ayurvedic medicine, nutritional remedies and various religious means to cure illness. Nowadays we have many scientific and healing modalities to call upon. Yoga still has a place within that context.
Prevalence of arthritis conditions
The condition is more prevalent than diabetes, heart disease, and cancer and has wide-ranging socio-economic effects as many children and work age people have the condition.
• >10 million UK
• >40 million Europe
• >54million US
• >108 million in India (15% of the population)
By working in conjunction with health professionals in this area, arthritis can be affected by primary prevention (trying to prevent a disease), secondary prevention (early detection of disease and prevention of worsening symptoms) and tertiary prevention (improving quality of life and reducing symptoms of the disease).
What is Arthritis?
Classifications of arthritis
Arthritis is very common but not well understood. It is a term used to describe any disorder that affects joints. Symptoms generally include swelling pain and stiffness. There are over 100 types. The spine, hips knees hands and feet are often affected restricting movement. In America, it is the leading cause of disability.
This is the commonest form of arthritis. Osteoarthritis (OA) is the result of the breakdown and gradual loss of joint cartilage. As the cartilage wears down, heat pain and swelling occur. It is often referred to as wear-and-tear arthritis.
This is a form of arthritis caused by excess uric acid in the bloodstream. The symptoms are due to the formation of uric acid crystals in the joints and the body’s response to them. Small joints in the feet and hands are usually affected, though it can occur in other joints.
• Rheumatoid arthritis
This form of arthritis is an autoimmune disease, in which the body’s immune system turns against and destroys healthy tissue. In Rheumatoid arthritis (RA) attacks are made on the synovial linings of the joints and sometimes linings of blood vessels, heart, and lungs. Unless the immune system attack is stopped RA can damage not only the synovium but also the joint cartilage, bone, ligaments, and tendons causing deformity and disability.
This is a group of diseases that affect the spine, sacroiliac joints and structures that join ligaments and tendons to bone. These diseases occur in children and adults. They include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and joint problems linked to inflammatory bowel disease.
Arthritis Treatment and Prevention
Treating arthritis in medical forms
There have been many advances in medical forms of treatment for arthritis over recent years, mostly in the form of analgesia and non-steroidal anti-inflammatory drugs. There are also strong immune-suppressive drugs and newer biological agents for RA and spondyloarthropathies. When joints are irreparably damaged and symptoms limit daily activities, surgically replacing the joint with a prosthesis can help restore some function and better quality of life. These treatments while helpful are not without their problems in the form of side effects and complications including weight gain, risk of infection and brittle bones.
Managing arthritis with exercise, lifestyle, and yoga
There are many studies to show the benefits of exercise for many forms of arthritis. Exercise can improve strength and increase range of motion in affected joints. Exercise raises endorphins giving a feel-good factor that has a knock-on effect on improving other lifestyle factors such as diet and alcohol use.
Combining medication with yoga can give ease. It is important to use everything available that is helpful with no over-reliance on one particular therapy.
Why yoga can help to deal with arthritis?
When considering the person with arthritis it is important to consider the impacts of the disease on overall physical, mental and spiritual health. Yoga is in an ideal position to address these issues. As well as the physical symptoms, depression, anxiety anger and frustration commonly occur. With the yoga focus on breath work that works on the parasympathetic nervous system (the rest and digest response) and meditation as well as the physical movement, they can help to address a lot of the issues associated with the disease.
Pranayama exercises and yogic breath help improve breath function by increasing lung capacity. Breathing and meditation have also been shown to lower anxiety and help with pain or when undergoing difficult medical procedures. Asana or yoga exercises increase joint mobility, improve balance and bone density and reduce pain. Yoga often induces an overall feeling of well-being.
As well as preventing arthritis, yoga can slow down the progress and help people come to terms with the disease and its effects. By working with interception, which is a sense of the internal state of the body, and with proprioception, which is the awareness of one’s body, its position in space and its movements, we can work towards improving the overall life experience.
Types of yoga for arthritis conditions
There are many types of yoga and some may not always be suitable for certain types of arthritis. In general, Hatha Yoga with held poses and stretches, Restorative Yoga including Yoga Nidra and slow mindful styles of Vinyasa Yoga as well as some of the gentle Yin Yoga poses held for shorter periods are favored. Intense Vinyasa- or Power Yoga and Bikram Yoga are not considered suitable.
Managing chronic pain with Yoga
Pain or expectation of pain is one of the biggest challenges when working with clients. Chronic or persistent pain is pain that lasts longer than three to six months chronic pain is often labeled as low back pain, fibromyalgia, and arthritis.
Slow asana practice can help to send accurate messages to the brain. It reduces hyper-focus on brain signals. Yoga increases blood flow, releases endorphins and activates the parasympathetic nervous system.
Six Sample Yoga Poses for Arthritis Patients
Yoga poses are traditionally performed standing, seated and lying down. Clients struggling to get from sitting or lying on the floor to standing, can do a lot of work from a chair and progress to more active poses.
This is not an exhaustive list of starter poses just a snapshot of some of the poses that can be used and adapted.
Chair pose (Utkatasana)
Benefits: Strengthens the lower body, and vertebral column, stretches shoulders and chest increases vitality.
Cues: Stand with feet together hip-distance apart, feet parallel, reach arms towards the sky with an inhale palms facing each other.
Modifications: Feet wider apart, not squatting down as far, can be started sitting and progress to a full position.
Mountain Pose (Tadasana)
Benefits: Improves posture and aligns the spine, calms the nervous system.
Cues: Stand with feet together, allow arms to hand by your sides, feel length in the spine relax shoulders down. Engage your core and thighs and lift kneecaps up.
Modifications: Do the pose with your back against the wall.
This is a very versatile asana, which can be done in a high or low position holding onto a chair or table.
Benefits: Stretches the hip, gluteus muscles and quadriceps whilst improving balance, opens the chest improves coordination and core awareness. Reduces fatigue and increases energy.
Cues: Step one foot forward, while engaging the back leg. Bring your torso upright. Hold the pose and take deep breaths, then repeat with the other leg.
Modifications: Keep hands on hips, can be done from a chair. Not to be done post hip surgery. Shorten stance and leave back foot flat on the floor.
Standing Forward Fold (Uttanasana)
Benefits: Stretches and lengthens the spine and hamstrings. This is a resting and rejuvenation pose, which stimulates the liver and kidneys and digestive system and calms the mind.
Cues: Stand with your feet together, feet parallel. Bend forward from the hips and exhale. Reach hands towards the floor on either side of your feet.
Modifications: Bend the knees, hold onto shins to lessen the stretch. It can be done seated on a chair, feet comfortably apart with the head hanging loosely down.
Half spinal twist (Ardha Matsyendrasana)
Benefits: Activates the parasympathetic nervous system, increases hip flexion, opens the shoulders, relieves fatigue, and stretches the neck.
Cues: Sit with your legs stretched out. Bend your left leg and place the left foot foot flat on the floor near the right knee, bend your right leg and bring the heel near the left buttocks. Bring left fingertips to the floor, gently push and extend spine. Bend right arm press the elbow against the left knee and twist to the left. Gaze over your left shoulder. Untwist and change sides.
Modifications: A twist performed in a chair is a good variation when mobility is limited.
Corpse pose (Savasana)
Benefits: Relaxes the entire body and consolidates gains from previous poses. Lowers blood pressure releases lactic acid build-up, relieves stress and fatigue and refreshes the mind. Improves sleep.
Cues: Lie on back, bring feet wide and let them flop open. Bring arms several inches away from the torso, palms up. Close eyes and find stillness. Focus on the breath.
Pranayama and meditation
Breath control or pranayama is an integral part of yoga. The practice of rhythmic, deep and slow respiration stimulates and is stimulated by calm content states of mind which aid acceptance of chronic and severe pain states.
Meditation and mindfulness practices can also help and are encouraged, they take time and practice to cultivate. By starting with a guided meditation in a group practice, being consistent with adjusting focus and doing what feels right the practice can help the client learn to cope with the pain and symptoms of arthritis.
There is a plethora of research to show that relaxation practices, yoga postures, breathing practices, and meditation could reduce the need for medical care when dealing with arthritis. There is an obvious benefit for this deeper modality that affects mind and body enabling resilience, stress reduction/management, balance as well as affecting strength and mobility in the joints.
Yoga instructors need to be knowledgeable in order to serve this group of people and liaise with health care providers to set up specific groups. This information is also useful when working with open yoga classes as these will be attendees who will benefit from extra advice on modifications and signposting to other professionals or groups.