Is arthritis getting in the way of your life? Living with chronic pain is never easy; and sore, swollen joints can transform even the simplest of tasks into harrowing labor.
What if there was something you could do to help alleviate your arthritis pain and rediscover the enjoyment you once found in activities you have since felt forced to discard?
Yoga may be the answer you’ve been looking for.
What is Arthritis?
Arthritis is the leading cause of disability in the United States. Over 52 million people are diagnosed with this chronic condition yearly; and by age 65 nearly 50% of people will develop some form of arthritis. (1)
The chronic pain and joint stiffness characteristic of this condition significantly affect our ability to function in our day to day lives. While medications are often successful in dampening symptoms of arthritis, doctors recommend incorporating additional alternative therapies and lifestyle changes for the best results.
It has long been understood that keeping active is beneficial for those suffering from arthritis, and is integral to maintaining mobility and preventing further damage to the body: including muscle or tendon shortening, articular capsule contraction and weakening of ligaments supporting joints. (2)
Unfortunately, 44% of people with arthritis admit they do not exercise at all, while 80% are not active enough. (3) It’s no mystery as to why this is the case: Who feels like hitting the gym when they can barely get out of bed without pain?
Many are also understandably confused as to how they should proceed with exercise while protecting their joints.
Thankfully, Yoga has emerged as one of the top fitness activities recommended by physicians - quickly proving itself a safe and effective way to increase your exercise level while helping to treat your arthritis symptoms; and simultaneously addressing the many psychological factors associated with living with chronic pain. (4)
The American College of Rheumatology (ACR), Osteoarthritis Research Society International (OARSI) and the Ottawa Panel all recommend yoga as a means to increase strength, improve endurance and preserve function. (2)
Why Yoga Works?
The practice of yoga is over 5,000 years old, but it wasn’t until recently that it became popularized in the Western world. Since then, doctors and researchers have been exploring yoga’s ability to help manage arthritis symptoms, as well as an actual treatment for the disease.
A scientific review conducted by Ward et al. confirmed yoga’s benefits for reducing self-reported pain levels in patients suffering from a wide-range of musculoskeletal conditions: including low back pain, fibromyalgia as well as both osteo and rheumatoid arthritis. (5)
A study in the Journal of Alternative and Complementary Medicine looked into yoga’s potential for treating Osteoarthritis of the knee: a common condition in older populations.
They found that following an 8-week program -- during which previously yoga-naive participants attended a weekly 90-minute class -- subjects had a 46.7% decrease in pain and disability as measured by the Western Ontario and McMaster Universities Osteoarthritis Index. (6)
In a second study, published in the Journal of Rheumatology, researchers observed a reduction in finger joint and hand pain in OA patients after completing in a similar 8-week yoga program. (7)
Increase Range of Motion
Second only to pain, loss of mobility is the biggest determinant of disability in arthritis.
Yoga is one of the safest and most effective ways to improve flexibility in older populations and people with disability. According to a study published in the International Journal of Yoga Therapy, yoga outperformed traditional calisthenic exercise when it came to improving flexibility in elderly participants. (8)
In 2008, Takur et al. examined the effects of a 7-day residential intensive yoga treatment program on patients with chronic low back pain. They observed greater improvement in overall spinal flexibility in the yoga group compared with the group performing traditional exercise. (9)
A sedentary lifestyle caused by chronic pain can result in overall loss of muscle tone, which can exacerbate the pain experienced by people with arthritis. Increasing the strength of muscles surrounding joints in order to support and protect them is one of the reasons it is so important to remain active.
Research conducted by Gothe et al. examined the effects of an 8-week yoga program on a group of sedentary adults with an average age of 62.
They concluded that while the improvements in strength due to yoga were similar to those found in the control exercise group, yoga is a better suited for treatment as it requires little equipment and is easily adapted to all levels of function and disability. (10)
Many studies have demonstrated an increase in hand-grip strength as a result of yoga. One, completed by Dash and Telles in the Indian Journal of Physiology and Pharmacology, showed that yoga improved hand-grip strength-as measured by a dynamometer-in both normal subjects and those with rheumatoid arthritis across all age groups. (11)
Both age and lack of physical activity can result in a loss of balance. Performing standing yoga poses helps to improve posture and balance control.
Standing poses fall into the category of “proprioceptive activities” - they work on both your body and your brain by stabilizing the muscles used and training your sense of proprioception: our ability to perceive motion and orientation.
A study investigating the use of proprioceptive exercises to improve balance control in subjects over the age of 60 showed that these exercises have the greatest impact on balance when compared to other forms of fitness. (12)
Research done by the National Strength & Conditioning Association revealed that a short-term yoga program improved balancing time by an impressive 228% in a group of young adults. (13) While this study examined healthy individuals, the results can reasonably be to extrapolate to include other groups.
Stress has been implicated in both the onset of rheumatoid arthritis and the exacerbation of its symptoms. (14) Unfortunately, living with the chronic pain caused by this condition often results in greater feelings of stress; thus setting off an endless feedback loop.
Yoga - unlike other fitness regimens - is multifaceted: incorporating physical exercise, breathing techniques and meditation. These elements work together to maximize stress reduction.
A study looking into the functional and physiological effects of yoga in women with rheumatoid arthritis measured decreased levels in the stress hormone cortisol immediately following a practice. (14)
Furthermore, when compared with a group resting lying down, the group with performed yoga postures along with periods of guided relaxation experienced the greatest reduction in stress when measured by Electro Photonic Imaging. (15)
Living with a chronic condition may lead to feelings of depression and social isolation - which greatly impacts our overall quality of life. (16)
Yoga changes our relationship with our body and our disability: reducing pain and improving mobility go a long way towards improving our mood there is evidence that yoga has an independent impact on depression.
Along with significantly less pain and disability, young adults with arthritis reported lower levels of depression and an increase in positive mood as a result of six weeks of biweekly yoga classes.
The researchers theorized that yoga may help ameliorate a patient’s relationship with their condition: encouraging self-acceptance and improving their overall outlook on life. (17)
A study on mindfulness-based yoga intervention in women with depression found that following a 12-week yoga program participants scored lower on the Beck Depression Index and experienced fewer ruminating thoughts associated with their depression. (18)
Improve Sleep & Energy Levels
By helping alleviate the emotional aspects of living with chronic pain, yoga can improve your quality of sleep. (19)
Halpern et al. examined the effect of yoga on a group of older adults with insomnia, and concluded it to be effective in both improving a range of subjective factors including overall quality of sleep, sleep efficiency, sleep latency and duration. (20)
Another study in the journal of Sleep Medicine examined the effectiveness of yoga in improving the sleep quality of women with osteoarthritis. They found that a gentle evening practice was effective in increasing the total sleep time of their participants. (21)
At the same time, Wood et al. found that a simple 30-minute gentle yoga routine - combining stretching and breathing exercises - had a marked impact on the participants’ perception of both their physical and mental energy. (22) When we are better rested we are better able to deal with all the challenges life throws our way - including pain.
Yoga And Your Immune System
One of the key factors in arthritis is inflammation: This is the underlying cause of red, hot and swollen joints.
What Is Inflammation?
Inflammation is caused by our immune system responding to a threat to our bodies - while often the threat is real, such as an infection or injury, in Rheumatoid Arthritis the inflammation is a result of the immune system attacking our own cells. (23)
The chronic inflammation seen in RA can lead to joint erosion, loss of mobility and damage to associated tissues throughout the body: including tendons, ligaments and bones. This results in increased pain and greater disability. (24)
It’s thus very important to get inflammation under control - and this is the main goal of the many medications prescribed to treat the condition, such as NSAIDs (Nonsteroidal Anti-Inflammatory Drugs). (25)
Evidence Yoga Decreases Inflammation
Various studies have been conducted in order to examine yoga’s potential for treating inflammation.
In 2010, researchers at the Ohio State University in Columbus measured inflammatory blood markers in 50 healthy women. The subjects were divided into groups of novice and experienced yoga practitioners and blood tests revealed significantly lower levels of inflammation-causing proteins - such as interleukin-6 - in the regular practitioners. (26)
In a more recent study from 2015, a group of scientists in India investigated the effect of long term yoga practice on the levels of inflammatory markers following moderate and strenuous exercise.
Not only did they observe lower resting levels of Tumor Necrosing Factor Alpha and Interleukin-6 in the group of regular yoga practitioners, but also documented a reduction in the increase of these markers in response to exercise when compared to the non-yoga group. (27)
They concluded that the regular practice of yoga lowers the body’s production of pro-inflammatory proteins, as well as protects against the rise in these proteins in response to stressful stimuli -- in this instance physical exercise. Additionally, they found that yoga promotes the production of inflammation-fighting cytokines. (27)
Where To Start
Remember to always consult your doctor before starting a new physical activity. Your doctor can advise you on certain things you should avoid, and what activities should be approached with special vigilance in accordance with your personal situation.
It is highly recommended to begin by attending a yoga class at a local studio. This gives you the opportunity to discuss your condition with a certified teacher who has been trained on how to modify a yoga practice to suit your needs.
Yoga classes come in a multitude of flavors: look for one intended for beginners, or described as gentle -- these courses move at a slower pace and are less strenuous than their Hot and Power Yoga cousins.
Most yoga studios offer a Gentle Yoga class as part of their repertoire. These classes are enjoyed by a wide variety of people - from the super fit student looking to relax to pregnant women and seniors.
The majority of the class takes place seated or lying down on a yoga mat - although some gentle standing poses do make an appearance. You will be guided through a sequence of different postures at a slow, steady pace. (28)
There is a greater focus on relaxation throughout the practice than in more vigorous styles, allowing you to maximize on the stress reducing benefits yoga has to offer.
Chair Yoga has been approved by the Arthritis Foundation as a safe way to increase activity for those with very limited mobility; while still providing you all the benefits of a traditional yoga practice. (29)
During the practice will be led through a series of postures while the body remains supported by a chair -- either sitting or standing. While it is frequently recommended for seniors or persons with disability, Chair Yoga can be modified to suit any level of fitness.
Restorative Yoga is often confused with Gentle Yoga: but it is unique unto itself.
Over an hour long course you will be guided through only 5 or 6 positions, which are held for an extended period of time (5 minutes or more). You may at first be taken aback by how little you move throughout the class!
The defining characteristic of Restorative Yoga is the extensive use of props: blocks, bolsters, pillows and blankets all make an appearance. These are used to support the body and enable you to rest fully in pose. (30)
Props are also the key to making this practice accessible to a wide range of people - easily rearranged to complement your level of flexibility and any injury.
Yoga Therapists are highly specialized yoga teachers who have undergone extensive training in how to modify a yoga practice to fit each individual’s unique needs.
The classes are primarily taught in small groups or privately: This allows your Yoga Therapist to provide you personalized support and guidance throughout your practice at a level which is impossible in larger classes. (31)
Your Therapist will work with you to address your personal concerns and to set goals - appropriate to your condition. The International Association of Yoga Therapists website has a directory where you can search for qualified professionals in your area.
Yoga At Home
While it is recommended to begin exploring yoga with the guidance of a certified yoga teacher, attending weekly classes at a studio is not always easily accessible or practical. Thankfully there are many resources available at your fingertips to allow you to practice yoga anywhere.
If you add keywords such as “arthritis” or “knee pain” to your search you can find videos better tailored for your physical condition.
There are also at-home yoga programs developed specifically for people with arthritis. The Arthritis Association has a list of videos linked on their website which give a detailed breakdown of various yoga postures.
Grokker is yet another fantastic resource for those looking to practice yoga at home. Your membership will give you access to thousands of yoga videos, including ones - such as this one with Sherry Zak Morris - that are designed to help relieve the pain associated with arthritis.
Yoga For Arthritis (YFA) - founded by Steffany Moonaz, Phd -- is on a mission to bring yoga to people with arthritis around the globe. You can purchase their “Arthritis-Friendly Yoga” DVD on their website, as well as their specialized meditation video and various yoga props.
Amazon also has some great DVDs if you prefer to shop there.
Just remember to keep your at-home practice safe by following these four helpful guidelines.
What To Avoid
There are some important things to keep in mind to ensure your yoga practice is both enjoyable and safe.
“No Pain, NO PAIN”
One of my yoga teachers used to repeat this statement every class. Unlike in many fitness communities, yogis do not believe in the adage of “no pain, no gain."
Your yoga practice is a time to tune in to the messages your body is sending you - and pain is a very clear message! If at any point during your practice a certain pose is causing painful sensations that is your cue to back away.
Keeping those signs your body is sending you in mind, it is important to increase the intensity of your yoga practice accordingly - this is true for everyone, but particularly important if you have a known condition.
In a yoga class, your teacher (whether in studio or through a video at home) may make suggestions on how to either deepen or lighten a particular pose. In the beginning it is recommended to stick with the most basic version, and with time begin exploring the more advanced options.
Not A Competition
Remember that yoga is foremost a personal practice: you are not trying to compete with the person on the mat beside you; nor should you be pushing yourself to perform at a self-idealized level.
Our bodies are not the same each day - sometimes we feel tired, sometimes energized - and in the case of arthritis, pain is known to fluctuate widely.
Therefore it is just as important not to compare our practice one day with the practice on another.
If yesterday you could reach your toes in a forward bend, but today you can only reach your knees that is not a sign of failure: it is simply a fact of life.
Most importantly, pay special attention to your sensitive areas. If your arthritis strikes your hands and wrists avoid poses that require you to bear weight in these areas (such as downward dog) - if it’s your hips and knees take extra care when moving in and out of poses that require rotation of these joints.
This is where working with a teacher or Yoga Therapist has the most advantage: Let them know which areas of your body need special attention at the beginning of each practice and they can provide guidance as to how you to avoid aggravating your condition.
Start Living Better Today
Living with chronic pain due to arthritis is never easy, but by beginning to explore the world of yoga - and the many benefits this 5,000-year-old practice has to offer - you can take control of your body again and start living better.
Remember to discuss your interest in yoga with your doctor; and always respect your body’s needs.
The benefits of yoga can be further bolstered by incorporating an anti-inflammatory diet - which has been shown to help reduce the chronic pain associated with osteoarthritis and rheumatoid arthritis, as well as other inflammatory conditions. (32)