The Transition Network

New York City Chapter

Yoga for Arthritis? YES!!!

(Posted February 25, 2020)

By Elizabeth de G. R. Hansen, Ph.D., C-IAYT.

As we TTN members reach the age of 60 and beyond, our sense of ourselves as strong, independent and capable women can be shaken by the onset of Arthritis.  It is useful to know this possibility -- and to be prepared with at least a rudimentary plan of action – should anything happen to ourselves or to our friends.  So, what do we actually know about Arthritis? And why would Yoga be relevant?

Osteoarthritis and Rheumatoid Arthritis are the most common of the over 100 forms of Arthritis, and both can affect every aspect of our lives -- from our mobility to our ability to be with those we love, or even to simply be by ourselves – in peace. Yoga is relatively well known to most of us, but less well known as an effective therapy for the management of Arthritis.  In the past two decades, American Yoga has developed a strong and research-based therapeutic branch, and Arthritis was one of the first conditions to benefit from that research.  

Osteoarthritis (OA) develops with life; an athletic lifestyle, a traumatic injury or excess weight might contribute more to the wear and tear of the cartilage in the joints than might a different lifestyle, but osteoarthritis seems to be a part of the life of all vertebrates, from fish to quadrupeds and bipeds like us. Among us, the joints affected by OA are the weight-bearing and working joints, such as hips, knees, shoulders and hands. The cartilage in the joints weakens and the joints become inflamed, leading to pain, limited mobility and psychic distress.  

Rheumatoid Arthritis (RA) also affects the joints, but RA has a different source: it is an autoimmune disease, in which the patient’s own immune system attacks and inflames her joints. In general, women are more prone than men to suffer from all immune diseases, including RA.  The joints affected are usually hands and wrists, feet and ankles and elbows and knees, but RA can also affect other body systems, such as the respiratory and cardiac systems.  RA tends to strike at a younger age, sometimes even in early childhood. RA can be especially disabling, not only because of multiple joint inflammation, but also because it starts so much earlier and gets worse with age.  Notably, by the time women are over 50, both OA and RA have become women’s diseases, because after menopause, when women lose the cushioning effects of estrogen, they start to account for the majority (60%) of OA cases.  There may be a genetic component to both diseases, but if so, the mechanisms remain unknown.

There is no cure for Arthritis; all forms of it are chronic.  People with Arthritis experience more depression than the general population, and in general, depressed people experience more pain along with more anxiety, sleeplessness and stress. The management of the disease often includes medications, and gentle exercise is usually recommended for its physical and psychological benefits. The exercises mentioned on the Arthritis Foundation website include two-minute workouts, walking, bicycle riding, Tai Chi and Yoga.  

Clearly, everyone should be as active as they can for as long as they can – but Yoga offers an exceptional array of strategies to manage Arthritis that is simply unmatched.  In the past 15 years or so the Yoga landscape changed dramatically for older adults, as Yoga teacher training shifted to Yoga therapy teacher training.  Now, Yoga therapists who would teach Yoga classes to the elderly learned not how to teach their students to achieve classical Yoga asana, or poses, but to adapt the poses, or even pieces of the poses, to the capacities of the students. Also, Yoga therapists were required to understand the health challenges facing older populations, among them Arthritis, osteoporosis, heart disease, chronic pain and stroke, and to adjust their teaching accordingly. Based on these changes Yoga for Arthritis was the first research and evidence-based program for Arthritis to emerge from Yoga’s new therapeutic branch.  

The Yoga for Arthritis program offers a complete Yoga practice specifically designed for the individual needs of people with OA and RA.  The ethical, spiritual and energetic components of classical Yoga provide relief for the pain and stress that Arthritis patients undergo.  The physical poses, or asana, are very gentle movements that lubricate the joints, strengthen and stretch muscles and increase balance.  They lead the body to relaxation.  Other Yoga practices such as breathing exercises and meditation contribute to the stress relief and relaxation that Arthritis patients need to be able to cope with their challenges.  It’s not “just exercise.”

Further, classical Yoga philosophy is based on non-harming of self and others and is focused on seeking contentment, peace of mind and compassion for oneself and others. A Yoga for Arthritis class contributes to a fundamental nervous system shift - from the stressed out “fight or flight” sympathetic nervous system of a body tensed up by inflammation and anxiety, to the tranquility offered by the “rest and digest,” para-sympathetic nervous system.  It is this repeated transition – and education in how to make the transition -- to a relaxed body with peace of mind that allows for hope among the students, as well as acceptance of what is.  
But how significant – or scientific -- are positive self-reports by Yoga practitioners, students and teachers alike?  For many years positive Yoga therapy research results were acknowledged, but followed by “howevers,” referring to small sample size, lack of objective outcome measures (as opposed to participant self-reports) and specification of the biological mechanism at work. However, paralleling the shift from Yoga classes for the elderly to Yoga therapy for the elderly – the new therapeutic Yoga attracted the interest and support of the National Center for Complementary and Integrative Health (NCCIH). The scientific bar has been raised, and Yoga research is hot and sophisticated!

Thus, at the 2019 NCCIH-supported Symposium on Yoga Research (SYR), there were three projects that studied the effects of Yoga on RA patients.  All three trials had over 100 participants, randomized into Yoga and control groups; and each trial cited different but specific physiological markers in the immune and neuroendocrine systems that showed statistically significant reduction of inflammation in the Yoga groups -- the “neuro-biological mechanism of effectiveness.”   The rigor and sophistication of trials and results like these validate all those self-reports by students whose pain, stress and anxiety were relieved by their Yoga for arthritis practice.   

Commenting on the value of Yoga in the face of improvements in the medical care for arthritis, Dr. Loren Fishman, the New York City physiatrist with a specialty in Yoga, observes, “Even so, medications do have side effects and surgery, well, it’s always good to avoid surgery if possible. Yoga offers a pleasurable alternative – and at the very least it can minimize the use of medications and delay consideration of surgery.”  My own thought is that if you are lucky enough not to have arthritis, tell your friends who do about this article.  They will love you more!

The Yoga for Arthritis program is available in New York City as Yoga for Arthritis and Chronic Pain at the Integral Yoga Institute of New York (IYINY) on West 13th Street. The teachers are a team of graduates from the program, well versed in the physical aspects of the disease, skilled in adapting poses to individual needs and in helping students learn how to shift their own nervous systems from the stressed sympathetic to the relaxed parasympathetic nervous system. Books that would be useful to TTN members are Yoga Therapy for Arthritis, A Whole Person Approach to Movement and Lifestyle, by Steffany Moonaz; Yoga for Arthritis by Loren Fishman and Ellen Saltonstall, and Relax into Yoga for Chronic Pain, by Jim Carson, Kimberly Carson and Carol Krucoff.  

Material from, 17:07:06 March 5, 2021.
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