Article, Pain
Physical activity is recommended for arthritis management but many activities are not suitable for people living with joint pain and limitations.Yoga, when practiced with a qualified instructor/therapist, can be easily modified to accommodate limitations, and can be practiced through all stages of disease. In addition, yoga’s breathing practices and mindfulness are useful for stress management, which might reduce frequency or severity of flares. Additionally, yoga philosophy can offer perspective that may foster greater acceptance, contentment, and gratitude in the face of challenges.

Arthritis and rheumatic conditions is an umbrella category that consists of over 100 different disease diagnoses. Some of these include rheumatoid arthritis, lupus, ankylosing spondylitis, gout and fibromyalgia. What these diseases have in common is that they are often accompanied by pain, can interfere with activities of daily living, and can result in reduced quality of life. In addition, many people living with these conditions experience fatigue, trouble sleeping, depressive symptoms, and even social isolation. Some of these conditions are autoimmune in nature, some are more mechanical, and some are closely associated with central nervous system dysregulation.

Regardless of which rheumatic disease is involved, the tools of yoga can help individuals to balance activity and rest, improve mood, find social connection, and reframe life with chronic disease.

Physical activity is recommended for general health, and certainly that applies to people with rheumatic conditions also. Unfortunately, it is more challenging to exercise in the face of pain, fatigue, stiffness and swelling. While people with arthritis should exercise for all of the same reasons as the general public (cardiovascular health, weight maintenance, improved energy and mood, bone density, etc), there are some unique considerations for this population. Physical activity can help to maintain joint mobility, which can decrease over time. Some diseases can involve rheumatoid cachexia, or muscle wasting, which can be reduced with strengthening exercises. Strong skeletal muscles can help keep joints stable with the loss of connective tissue. Therefore, it is imperative to find safe, accessible, and sustainable ways for this population to balance physical activity and rest.

Unlike physical activities such as running or swimming, yoga is infinitely modifiable. The physical poses of yoga can be adapted with props, such as blocks, straps, and blankets. Poses can also be moved to a chair or a wall, and can be flipped around to change the impact of gravity. What must be maintained is the essence of the pose, and the intention of the pose, but this can take many forms.

Adaptation of a yoga practice for someone with joint limitations is best done with the guidance of a yoga teacher or yoga therapist with specialized training and experience. Yoga professionals who have worked with limitations have an extensive set of tools at their fingertips, and a creativity about how to find new modifications on the spot.

This is best done while working one-on-one in a private session, or in a small group where the professional can provide individualized attention. A fast-paced class is not ideal for the process of learning and creating individually tailored poses, but a more fluid practice might be available after the individual gets comfortable with how to adapt a practice for the fluctuations that come with disease flares and/or disease progression.

When many Westerners think of yoga, the focus is on the physical practice of static poses and moving pose sequences. However, these are relatively new compared to the more ancient practices of meditation, mindfulness, attention, and breathwork. In fact, the physical postures were initially used as a tool to bring the body into balance for greater comfort, balance and attention in seated meditation. While the physical practice of yoga offers potential for many benefits to those living with arthritis, it is perhaps the other practices that help yoga to stand out from other activities in addressing both mind and body simultaneously.

Alteration of the breath can be used to engage parasympathetic nervous system engagement, which counters the stress response. Since stress can trigger flares and exacerbate symptoms, tools for stress management are important for stable disease.

Mindfulness and meditation have long been associated with better mental health, and even measurable changes in brain activity and pain response. Many people initially pursue yoga for the physical practice, which can be an introduction to the other practices that can confer an important impact. Furthermore, tools such as deep breathing and mindfulness can be easily practiced without an instructor and can be seamlessly incorporated into daily life.

A skilled yoga teacher or therapist uses not only the practices of yoga, but also incorporates the underlying philosophy. The yogic philosophy can provide perspective that can support ways to think differently about life with chronic disease. The yamas and niyamas, or ethical principles, can also help to guide individuals in safe execution of the physical practice. For example, the first principle is “ahimsa” or “non-harming.” This is, of course, aligned with the medical profession’s aim to “first, do no harm.” While this applies to the yoga professional, it also applies to the individual student. It is important to do no harm to others, but also to do no harm to self. This may mean a more gentle physical practice on some days, or a reminder to not judge oneself on days that are physically more limited. Other principles encourage practitioners to avoid envy of their previous ability or the abilities of others, to be honest with themselves and their instructor about limitations and pain, to listen and honor bodily cues, and to foster contentment and equanimity in any situation. While it cannot be suggested that these are easy concepts to understand or master, these concepts are where the practice of yoga can become transformative, not just physically, but mentally, emotionally, socially, and even spiritually. While yoga is not a religion, it may encourage an inner quiet that could foster connection to an individual’s sense of spirituality, whatever form that may take.

In working with hundreds of students and clients who live with arthritis or other rheumatic conditions, I have seen the potential for many types of benefits and growth. For some people, finding a way to become physically fit and to feel capable in a body that has provided challenges is euphoric. For others, yoga provides a way to become quiet and pay more attention to the need for balance in one’s life. And in a few rare cases, I have seen individuals come to find gratitude for the very disease that brings them pain, limitations, and daily uncertainty. In a process of true transformation, it is possible to find gratitude in the most unlikely places. Yoga practice is unique in its ability to meet anyone where they are on their journey- physically, mentally, emotionally, socially, or spiritually. It is universally accessible when modified appropriately, and can be practiced for a lifetime with no limit to the lessons and skills that can continue to be utilized, both on the mat and out in the world.