Last Saturday, I took a wonderful workshop at the Berkeley Yoga Room on Yoga for Bone Health, with Bonnie Maeda and Shari Ser. We covered yoga for osteoporosis, osteoarthritis, and joint replacements. Because I know that many of you are concerned about osteoarthritis (and I have it myself), I asked Shari if I could do another interview with her, this time about yoga for osteoarthritis.
Nina: Why is yoga so beneficial for people with osteoarthritis?
Shari: Yoga is beneficial for people with osteoarthritis because it is something proactive that they can do for themselves to cope this chronic disease. Arthritis is due to imbalances on the ends of bones in the joints with uneven wearing down of the cartilage that covers the bone ends, which allows the bones to move smoothly on one and other. Arthritis is a wear and tear syndrome, an alignment syndrome, or a result of inactivity as well as obesity.
People stop moving with arthritis because it hurts, but when you stop the joint motion you decrease the nutrition to the joint structures. The body tries to repair the area by laying down more bone to protect the area and the result is spurring, which then cause more irritation from the “bones rubbing.”
When the cartilage has deteriorated and there is no movement, the synovial fluid that bathes the inside of all synovial joints decreases, which then decreases nutrition to the joint and the cycle reinforces itself with pain=no movement=more pain with swelling and inflammation=even less movement.
Yoga is so perfect for arthritis because it can stop that cycle by providing infinite variations in joint mobility and ways to maintain the joint alignment to improve joint weight bearing. You need to keep the joint moving in its full range of motion to keep the joint healthy, and yoga allows you to do that.
Nina: Should you do yoga if it hurts?
Shari: Judicious usage of pain meds to allow movement but not to obliterate the
feedback mechanisms that pain provides us with is important. Medication that decreases inflammatory response will allow people to move more, but pain medications that mask pain so people overdo activities are dangerous. Pain keeps our expectations and engagement focused. You don't want to be stoned and do something dangerous!! So a healthy respect for pain is important. You can start out with a small movement and then as fluid in the joint increases you can increase the range of motion slowly till you are at your limit. Deep knee flexion (bending) is very difficult with knee arthritis so modifications to the yoga poses are important are important for people with knee arthritis.
Nina: Is there anything that people with osteoarthritis should watch out for?
Shari: You need to study with a teacher who can observe your alignment when you are doing poses to help you correct your imbalances. Co-contraction of muscles is extremely important. I would not do a lot of jumping into poses but stepping into them instead. Playing with joint position is really key because you may need to change things considerable to minimize your pain. Also being gentle with yourself is important because it took years for the arthritis to develop and will take years to manage and prevent it from progressing. It is true that you CAN remodel cartilage but how long it takes is unknown (at least I haven’t seen any studies).
Nina: What are some of your favorite poses for osteoarthritis and why?
Shari: Favorite poses—hmm, this is a hard one because you have to think about what joint you are focusing on. If I am dealing with osteoarthritis in the spine, I would focus on accessible twists and gentle back bends. If it was hips, balance is the key of co-contracting to keep the joint in good congruency and neutral alignment—maybe Ardha Chandrasana (Half Moon pose) would fit. For knees Warrior 2, but not too deep and starting with a chair if it is problematic bear weight in a knee flexed position. Warm-ups are very important to try to get the fluid circulating first, and then adding non weight-bearing isometrics before starting weight bearing activities. Also cool down poses shouldn’t be missed!