The fear of pain often stops people in pain from exercising — a barrier that needs to be worked through to bust the myth that exercise adds to chronic pain. The more you exercise, the more flexible your joints become, and the stronger the muscles and ligaments surrounding the affected joints will be, offering additional support. This isn’t to say that all exercise is good for people with arthritis and other pain or that some types don’t exacerbate pain. However, one kind of physical activity that is particularly beneficial for pain is yoga. Not only has yoga for arthritis been found to reduce levels of pain, but it can also enable people with arthritis and other pain conditions to better manage their pain.
In fact, doctors from the Boston Medical Center reported recently that yoga is as effective as physical therapy in reducing chronic low back pain. And it’s often more cost effective: Insurance doesn’t always cover physical therapy, but yoga classes may cost only $10 to $15 per week. Plus, yoga can be done at home by following a DVD or online instructions.
Different Types of Yoga
Yoga isn’t just a series of movements. It also involves meditation and techniques for breathing that increase oxygen in all parts of the body. Hatha yoga is the “original yoga,” and various adaptations such as Bikram, Iyengar, and Vinyasa have specific poses that help relieve chronic pain. Vinyasa is used by people who need to remain supple and increase lung capacity, like free-divers. It’s also widely used as a way to increase strength and endurance. Iyengar and Bikram yoga are regarded as the most helpful for arthritis, although all forms of yoga can be beneficial.
The late B. K. S. Iyengar, founder of Iyengar yoga, began focusing on the practice at age 16. This type of yoga is particularly beneficial for people with compromised mobility because it allows for using props to achieve the poses.
“It is important to modify yoga poses according to your condition,” says Rajvi Mehta, Ph.D., a yoga teacher based in Mumbai, India, and editor of Yoga Rahasya, the quarterly journal of the Iyengar Institute. “Gently identify your range of movement and then work on how to enhance that using different poses. Props might be needed so that you have support, giving you the confidence to do the poses while also preventing injury.”
Indeed, correct alignment is an important component of any type of yoga because it opens the body to healing. One of Iyengar’s many well-known quotes is, “Focus on keeping your spine straight. It is the job of the spine to keep the brain alert.” If you are living with osteoarthritis (OA) or rheumatoid arthritis (RA), and whether it affects your hips, knees, fingers, toes, or spine, Iyengar yoga could offer you some relief.
Bikram yoga is another type of yoga that can relieve pain. It’s a form of “hot yoga,” meaning it is performed in rooms at about 104° F. Participants learn 26 poses (asanas) and two breathing exercises aimed at stretching, detoxifying, and relieving stress. Bikram yoga is advocated particularly for chronic pain such as that experienced with arthritis. For example, to relieve inflammation in finger joints, a participant will interlace her fingers, encouraging compression and release.
“One of the keys to asanas is to deny blood to a joint by holding the pose,” says Kim Mazabow, who runs a yoga studio in South Africa. “Then once the compression of holding the pose is released, it allows fresh blood to flow around the joint, thus flushing out microscopic buildups, which may have occurred over time within the synovial fluid.”
Yoga Eases Spinal Inflammation
Ankylosing spondylitis (AS), an inflammatory type of arthritis affecting the spine and large joints, leads to pain and stiffness in the spine as well as the sacroiliac joints — the spot where the spine joins the pelvis. The sacroiliac joints act like shock absorbers on a car, diffusing the forces transmitted from your upper body to the legs. Sacroiliac-joint dysfunction can have various causes, one of which is an abnormal way of walking. For example, some people feel they are too tall and therefore hunch, others lean forward when they walk, and some place their feet unnaturally, leading to strain on the joints.
A good yoga teacher will work on correct posture to bring the body into alignment. Indeed, expert yoga teachers will adapt poses to suit a person’s abilities until he or she increases his or her range of motion, flexibility, and strength sufficiently to build up to more demanding poses. There is no cure for AS, but yoga helps with pain management. However, it is important to take other factors into consideration as well, including stress and diet, because all the good work done in yoga can be undone by eating a high-sugar diet. Equally, stress can lead to further inflammation.
Stress related to work, finances, and relationships all contribute to inflammation. In fact, Janice Kiecolt Glaser, Ph.D., director of the Ohio State Institute for Behavioral Medicine Research, found that even the chronic stress of caregiving for a spouse or parent can greatly enhance inflammation.
Yoga for Pain Management
“According to Iyengar, ‘The body is the bow, the asana is the arrow, and the soul is the target,’” says Mazabow. “If we feel that our lives are becoming unmanageable, the practice of yoga helps us to pause and drop into peace — giving us a chance to self-correct.” In India, she notes, yoga isn’t usually practiced simply for fitness as it is in western countries. Instead, a person with a particular ailment will go to a yoga master to be given specific asanas to help with his or her problem.
“The Zen masters teach that pain is unavoidable but suffering is optional,” says Mazabow. “In other words, at some point in our lives we will have pain, whether physical or emotional. It is how we deal with pain that matters; we can choose to hang on to it or we can let it go.” By choosing to practice yoga, you can work on the physical aspects of pain through poses, as well as the mental aspects through breathing techniques, bringing you into a space of quiet meditation.
Pain is, in fact, relative. A person with an X-ray showing fairly extensive osteoarthritic damage might not be in pain, whereas someone with a far lesser degree of damage may experience more severe pain. Yoga helps change your relationship with pain, increases your ability to get through daily activities, and improves your energy levels. Indeed, Mehta says, “There are research studies published in peer-reviewed science journals clearly showing how when pain decreases, there is a decrease in the consumption of pain medication and improved mobility.”
No Pain to Ourselves or Others
Don’t let fear of damaged joints stop you from giving yoga a try. Ian Cariaga, a strength and conditioning coach and yoga teacher from Australia, says, “Our bodies adapt to conditioning, so the less you move, the less you will be able to move. If you think you are doing your joints a favor by nursing the injury, the truth is you are only compromising your own mobility.”
Cariaga draws an analogy between our joints and the ball joints in a car, because both need to be kept active; otherwise, they seize up. “Joints themselves have no veins, arteries or capillaries. They rely on synovial fluid to keep them ‘greased.’ Yoga builds strong ligaments to support joints and through the poses, synovial fluid and capsules within the joints are shifted to encourage joint mobilization. But during the poses, we don’t overextend the joint and cause discomfort as this can put extra pressure on an already damaged joint.”
“Yoga does a wonderful job of circulating fluids in the body,” says instructor Lesley Fightmaster, who provides free yoga classes via YouTube videos. “However, if a joint is inflamed, I would encourage gentle work with that area. Some movement is good for healing, but in yoga we practice ‘ahimsa,’ which means no pain or harm to ourselves or others.”
Fightmaster teaches people who have both RA and OA. “The mind and body are connected, so when dealing with pain, it’s most effective to address both,” she says. “I’m not a doctor, but the way I understand it, pain can be lessened in the body but there’s still a neuropathway associated with that pain that can make the perception of pain continue. Practicing yoga mindfully can address both the physical and the mental.”
“Yoga encourages mental strength,” adds Cariaga. “Often, we have a small injury but don’t notice it until someone else points out that we are bleeding or have a bruise. As soon as the mind is aware of it, then it brings the injury into focus and we usually ‘feel’ pain because we fear pain. Yoga teaches us to focus on the present and put aside the emotions of fear, allowing us to overcome pain.”
To illustrate his point, Cariaga mentions a woman who had two operations on her knees. He coached her in yoga as well as strength and conditioning. “She is a yoga teacher herself and was aware that the poses would help her knees. Through yoga, we were able to release tension and stress, which take their toll on the physical body, as well as get her knees back into condition.”
“The wonderful thing about yoga,” says Mazabow, “is that it is a fair relationship — the longer you practice, the stronger and better you will become. There is no reason for age to be a factor — a 90-year-old can be better than a 30-year-old.” Indeed, Iyengar was doing headstands into his 90s. It was the lifestyle associated with yoga that contributed to a healthy fulfilled life. Iyengar summed it up when he said, “Words cannot convey the value of yoga — it has to be experienced.”
A version of this article was published in the December 2016/January 2017 issue of Pain-Free Living. Subscribe.