Many times doctors refer patients to us yoga teachers because, other than prescribing painkillers, they have nothing left in their little black bags for folks living with chronic-pain conditions.
Osteoarthritis is one of those conditions.
Osteoarthritis a joint disease in which the healthy cartilage that normally cushions bones at the joints breaks down through wear and tear. It’s the most common form of arthritis.
The usual course of treatment recommended for this population that lives with sometimes disabling chronic pain is:
- manage the symptoms, such as pain, stiffness and swelling (mostly through medication)
- improve joint mobility and flexibility
- maintain a healthy weight
- get enough exercise (vague, for sure…what’s enough? More on that later.)
There is no cure per se for osteoarthritis, but yoga can help manage symptoms in a number of different ways. (I’m also a huge believer in the importance of food as medicine for this population, but this is a discussion best left for another time.)
One study published in the Journal of Rheumatology compared patients with OA in their hands and who tried yoga techniques for six weeks, with patients who did no yoga. The group who did yoga experienced significant relief in joint tenderness, pain during activity and finger range of motion. (Big surprised, right?)
Let’s talk about some generalities first and then get into a program that could potentially give these students some relief, should you find yourself called on to work with someone with OA.
BTW, these recommendations will also work for those with fibromyalgia, chronic fatigue, Epstein-Barr and a variety of other autoimmune conditions.
Move the body
One of the most beneficial ways to manage OA is to get moving. Having lived with chronic pain myself for years in the past, I can tell you this is no enjoyable feat—moving is usually the LAST thing you want to do when you’re in pain.
But this is where yoga can provide infinite benefit. Slow, gentle, sustained movements are excellent to warm the joints and ease the stiffness caused by swelling—as well as alleviate the desire to NOT move.
Using yoga as an incentive to move provides other benefits, such as:
- generating an endorphin release
- stimulating the relaxation response
- burning calories
- creating a sense of connection with the body
- regaining trust and safety in the abilities of the body
Since the tendency for people with OA is to NOT move, oftentimes this population ends up overweight and subsequently depressed.
Think about it, most of us do yoga because IT FEELS GOOD.
But for this population, it doesn’t.
Imagine doing yoga while every joint in your body hurts.
And yet, yoga is still one of the recommended courses of treatment because the alternative (i.e., not doing yoga) equally sucks. In fact, the not-doing-yoga alternative will suck a lot more down the road when things have stiffened up so much that any amount of movement is unbearable.
So that’s the scenario that you as the yoga teacher are coming into when you serve this population.
Some things to remember
Osteoarthritis affects people differently
Some will be severely affected in every joint, similar to fibromyalgia. Others will have only hands or knees affected while other joints will be fine. In other words, there are many variations so be sure to find out what intensity of disease process your student is experiencing.
Those who are affected will have good days and bad days
The level to which the condition is hindering someone on any given day will vary based on their mood, the weather, their weight, stress levels and many other factors. Be prepared to adjust your practice plan based on where the student is that day.
Your intention as the teacher can be focused on different things each session
Such as getting prana moving through the joints one day, and then the elevating of mood another day. On “bad” days, you can think more along the lines of calming the nervous system, bringing the student back into a relaxation response. It’s important to remind the student that operating from the parasympathetic side of the nervous system is the only place that healing can occur.
A positive outlook is important
Many studies have shown how critical a person’s outlook is on how intensely he or she experiences pain. You’ve probably noticed this yourself…on days that you feel good, your pain threshold is high; on days you don’t, the littlest thing can bother you.
Building a yoga program
Personally, I feel that the best type of yoga for a student with OA is a gentle individualized program, along the lines of Kripalu or Viniyoga (now being called ‘adaptive yoga’).
If a student doesn’t have the ability to hire you for private sessions but is highly self-motivated, you could prepare a program for him or her and they could do it on their own.
A student in a general-level class, however, will need special attention and modifications AND to be reminded to not overdo. I would suggest they work at about 60% effort (or less!) until the body is stronger and more limber and the student has learned to work the body comfortably and safely.
Here are some things to focus on for building the program:
- get joints moving – light repetitive movements that build a little energy without stressing joints
- 80% of the session should be warmup-type activities, 20% relaxation
- use shorter holds in strong poses – at 60% (or less) effort
- use longer holds in supported poses (restorative; getting down to the level of fascia is important)
- gradually build up the muscles that support the joints
- utilize twists – these work the core of the body, clear out ama (stale energy) in the digestive tract and are calming to the nervous system
- include lots of deeply relaxing poses – (i.e., legs up the wall, supine supported baddha konasana)
- pranayama should be slow – ujjayi and nadi shodhana
Suggested types of movements for osteoarthritis
To suggest some poses over others is very difficult because just about every pose can be modified for any student—depending on how severe a student is being affected, whether the student is in fairly good shape or has any yoga experience.
But, with that in mind…here are some movements that might feel good to most students experiencing pain in their joints.
NOTE: For the sake of brevity, this video is meant to show the types of movements and postures but is done faster than you would actually teach it. Pause and take rest between movements.
Things to avoid
Since OA affects the cartilage of the joints, special attention needs to be directed to modifying movements or poses that put the joints in a compromised position.
- anything that jars the joints
- intense weight-bearing poses on unsupported joints
- working too hard or too long
- over-heating the body
Any of the conditions that include the letters “itis” at the end, such as arthritis, are typically inflammatory conditions. Inflammation is an aggravation of pitta (the fiery dosha) and, therefore, practices that CALM and SOOTHE the nervous system are good ones for this population.
As a yoga teacher you have a lot to offer people with osteoarthritis. Don’t shy away because it seems like everything hurts them. That’s why they need YOU! Just reassure them, use slow gentle movements and focus your attention on the value of what you have to offer.
Please add your thoughts and comments below…I’d love to hear them.