5 Tips for Practicing Yoga With Arthritis

When she was a teenager, a doctor told Marina Nellius her rheumatoid arthritis would eventually force her into a wheelchair. "He said I'd be crippled by the age of 25," she says. "I remember his exact words. It utterly broke me."

A few years later, Nellius needed to lean on walls or railings for support to walk when her arthritis flared, and her weight had ballooned to 200 pounds, so she joined a study on the effects of yoga on arthritis patients at Johns Hopkins Arthritis Center in Baltimore. There, she learned how to practice gentle yoga -- a slower, less physically challenging form of the discipline often used by people with movement limitations, such as those with chronic conditions like arthritis and back pain or who are recovering from surgery. Nellius was desperate to find an approach that would help her manage her arthritis -- and the yoga poses and meditative practices she acquired during the study provided one. "[Yoga] changed my life," she says. "I was convinced my body hated me. I began to see what [it] could do with support, patience and tenderness."

[See: Osteoarthritis and Activity: Walking It Out.]

What it Is

Nellius, now 34, is one of the 52.5 million U.S. adults who suffer from arthritis, which is characterized by pain and stiffness in joints throughout the body. The most common form is osteoarthritis, caused by wear and tear on the joints; rheumatoid arthritis, meanwhile, is an autoimmune disorder in which the body's own immune system attacks joints. Physical activity is one of the best ways to manage arthritis -- and gentle yoga helps people with the condition move more freely, yoga therapists and rheumatologists say.

By alleviating pain and stiffness, gentle yoga helps people with arthritis exercise more, which in turns make it easier for them to manage their symptoms. "Physical activity is universally recommended as an essential part of arthritis management. Unfortunately, many people with arthritis tend to be sedentary or to reduce activity levels due to the interference of arthritis symptoms, including pain, stiffness, swelling and fatigue," says Steffany Moonaz, a certified yoga therapist and co-author of the Johns Hopkins study. Because arthritis symptoms can change from one day to the next, people with the condition need to be able to adapt their physical activities, Moonaz says. Gentle yoga is good for people with arthritis and other kinds of chronic pain because they can modify their poses, including how long they hold them, according to how much pain and stiffness they're experiencing on a given day, she explains.

Gentle yoga is not a specific type of yoga, like Kundalini, Ashtanga, power and Bikram yoga, each of which are physically vigorous and would probably not be appropriate for many people suffering from arthritis pain and stiffness, Moonaz says. Gentle yoga resembles a slower-paced beginner's or intermediate class, says Robin Rothenberg, a certified yoga therapist based in Fall City, Washington. "Gentle yoga moves at a slower pace; there is extra time for moving in and out of poses," Moonaz says. "The poses are generally not held as long." In an arthritis-friendly yoga video she made for the Arthritis Foundation, Moonaz and yoga students demonstrate how people with arthritis can use foam wedges, which typically cost less than $25, to support their wrists or ankles during certain poses. They can also do their practice from a chair if sitting on the floor is too difficult, and they can use straps to execute poses that require them to grasp a body part -- such as a foot -- that they can't reach due to pain and stiffness.

Considering its potential health benefits, the cost of yoga classes is also relatively gentle on your pocketbook. Prices vary depending on geographic region, but most areas have affordable options, Moonaz says. In Kansas City, Missouri, one yoga studio offers a package of 10 classes for $105. In the District of Columbia, you can sign on for 10 classes for $150. Prices for one-on-one instruction are higher; typically, a one-on-one yoga session is around $80 for an initial visit and $75 for a follow-up, according to a survey by the Maryland University of Integrative Health.

Benefits

Gentle yoga is not a cure for arthritis, but it can help people manage their pain, lead more active lives and boost their mood, research shows. And it makes sense for those with pain and limited mobility because it's safe and poses little risk of injury.

There's evidence gentle yoga can alleviate lower back pain; build muscle strength; improve function, balance and posture; and mitigate mental health problems such as anxiety, stress, depression and insomnia. One study presented at the American Academy of Pain Management in 2016, for example, showed yoga was as effective as physical therapy in alleviating lower back pain.

Another study, published in the BMC Complementary and Alternative Medicine journal in 2014, found that weekly yoga could help mitigate the symptoms of osteoarthritis in older women.

The study Nellius participated in, which was published in 2015 in The Journal of Rheumatology, involved 75 sedentary adults ages 18 and up with rheumatoid arthritis or knee osteoarthritis. After eight weeks, the researchers concluded yoga can help sedentary people with arthritis safely increase their level of exercise and improve their physical and psychological health. By the end of the study, Nellius' joint pain had diminished dramatically. She began walking long distances without support and participating in low-impact dance classes, and she dropped 70 pounds. "I consider my rheumatoid arthritis a blessing now," Nellius says. "I'm aware of the importance of taking care of my body, and though I have a serious condition, I'm pretty healthy."

"We think yoga is great. It can help with strength [and] flexibility, which helps improve your ability to function day to day," says Marcy O'Koon Moss, senior director of consumer health for the Arthritis Foundation, which helped fund the study. "On top of that, it's relaxing [and] helps alleviate stress and improve focus. When you're dealing with chronic pain, that can be helpful."

[See: 8 Lesser-Known Ways to Ruin Your Joints.]

How to Get Started

If you're living with arthritis and would like to try gentle yoga to help manage your symptoms and improve your physical and mental health, experts recommend these strategies:

1. Talk to your doctor first. Ask your primary care physician or rheumatologist if there are any positions or movements you should avoid or limit, Moonaz says. Also seek your physician's advice regarding what type of movements you should do or avoid when your arthritis flares, she says. Your rheumatologist can "help you delineate whether the soreness you feel a day or two after yoga is natural, or whether you're causing pain" to joints, which could be counterproductive, says Dr. Ali Ajam, a rheumatologist at The Ohio State University Wexner Medical Center.

2. Find an instructor experienced in teaching gentle yoga. Not all yoga instructors are experienced in teaching gentle yoga or working with people with arthritis. To find one who is, check with the International Association of Yoga Therapists, which lists more than 700 certified yoga therapists, most of whom can teach gentle yoga, says John Kepner, the organization's executive director. Another good option, he says, is calling yoga studios in your area and asking which instructors are experienced in gentle yoga and teaching yoga to people with arthritis.

3. Discuss your condition with your instructor. Before you start your yoga regimen, discuss your condition and physical limitations with your instructor. Explain which of your joints are affected and how much they can hurt when your arthritis flares, Moonaz says. A good instructor will help you devise modifications for specific poses that will protect your joints, will keep an eye on you in class to make sure you're not in physical distress and won't push you beyond your physical limitations, she says.

4. Know and heed your limits. Some sports trainers live by the adage "no pain, no gain." Dismiss that slogan, says Carole Dodge, an occupational therapist and certified hand therapist at the University of Michigan Medical Center who works with many patients with arthritis. If you feel pain while practicing yoga, stop, Dodge advises. Stretching or exercising through it could increase joint inflammation, which exacerbates the discomfort. People exercise less when they feel pain, she notes, so "you don't really move forward, you move backward." People with milder forms of arthritis and other chronic pain conditions may be able to execute more challenging yoga poses and hold them for longer than people with severe discomfort and stiffness, Moonaz says.

[See: 10 Ways to Avoid Winter Joint Pain.]

5. Don't neglect the meditative aspect of yoga. People with arthritis often feel stressed out about their condition, wondering when it will flare and how bad it may become, says Dr. Orrin Troum, a rheumatologist at Providence Saint John's Health Center in Santa Monica, California. "The mental aspect of yoga and its relaxation techniques can be particularly helpful," he says. "Stress induces inflammatory proteins in the body, which make you vulnerable to joint pain and swelling. If you reduce stress, you feel better." Meditation, deep breathing and relaxation techniques are central to yoga and "can have profound effects on the brain and nervous system, [plus] change the way people live with and experience arthritis," Moonaz says. Deep-breathing techniques can help you deepen certain poses and help invigorate or calm the body and the mind, Moonaz says. Plus, some yoga instructors and therapists use chanting as part of the meditative aspect of their practice. When she's teaching a class, Moonaz, for example, uses chanting at the beginning of a session to boost the energy level of her students; at the end, she sometimes initiates a peace chant to express gratitude and disseminate positive energy.

Ruben Castaneda is a Health & Wellness reporter at U.S. News. He previously covered the crime beat in Washington, D.C. and state and federal courts in suburban Maryland, and he's the author of the book "S Street Rising: Crack, Murder and Redemption in D.C." You can follow him on Twitter, connect with him at LinkedIn or email him at rcastaneda@usnews.com.

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