Yoga and RA

Although many people with arthritis are interested in yoga, many of them (and their rheumatologists) are still unfamiliar with the practice and wary about the possibility of injury. You may see pictures of people standing with one leg above their heads and think “yoga and my arthritis simply won’t mix.” But one of the advantages of yoga is that it can be modified to suit a person’s specific needs and abilities. And research has shown that regular, tailored yoga comes with little risk of harm for people with RA. In fact, studies have shown that the potential benefits of yoga include increased flexibility, increased strength, and diminished stress.

Getting started

Yoga for Arthritis is a form of advanced specialty training for yoga teachers to learn more about arthritis and related conditions and to better serve their students. The program was created several years ago based on research conducted at the Johns Hopkins Arthritis Center, and the number of certified Yoga for Arthritis teachers is growing. You can find some of them at Yoga4Arthritis. If there isn’t a listing for an instructor near you, you can post an inquiry on the Facebook page.

Even if you can’t find a certified Yoga for Arthritis instructor in your area, however, it’s a good idea to start with live instruction. Only a live teacher can watch your form and provide feedback about how to execute poses safely. But it’s important to choose both the instructor and the style of yoga carefully.

Yoga Alliance is an organization for yoga instructors worldwide. Being registered with Yoga Alliance requires a minimum level of training in yoga techniques, anatomy and physiology, teaching methodology, yoga philosophy, and ethics for yoga teachers, as well as a minimum level of practical teaching experience. You can find a registered yoga teacher by visiting yogaalliance.org and clicking on the organization’s “Directory.” You can also call the Yoga Alliance at (888) 921-9642.

When selecting a class, consider the following questions:

What style of yoga is taught in the class?

The combination of asanas (poses) and pranayama (breathing practices) is generically called hatha yoga. Because yoga has been passed down through many teachers to many students, many schools or styles have emerged with different methods. Some of these styles are fairly gentle and safe for students with arthritis, while others may be too vigorous or intense. See “Yoga Styles to Consider” (below) for more information about various styles of hatha yoga.

In addition to differences in style, classes may differ in level of difficulty. Some classes, however, combine students with different amounts of experience, and provide some modifications for those who need them. But it can be helpful to be in a class geared toward beginning students, especially when first starting to practice yoga.

How long has the instructor been teaching?

While this is not always the case, teachers with more experience are often more adept at modifying poses for each individual and are more likely to have additional training for teaching students with special needs.

Does the instructor have experience working with people with arthritis?

Learning yoga from an instructor who is familiar with your condition and can guide you in making the proper adjustments for your body would be ideal. Classes offered through hospitals or other medical settings may also be a good option since they are often supervised or overseen by medical staff.

When starting any new physical activity, including yoga, you should speak with your rheumatologist about whether it is appropriate for you, given your unique situation. However, many rheumatologists may have some misconceptions about yoga and concerns about its safety. On the Yoga for Arthritis website, you can find an information page for clinicians under “Resources” that may be a helpful way to clarify the potential risks and benefits of yoga and start the conversation. If you or your rheumatologist has additional questions or concerns, you can also e-mail Yoga for Arthritis at mailto:[email protected].

Making yoga work for you

When you start a new yoga class, try to arrive early. If you haven’t already had a discussion with the teacher about your RA, do so now. Explain that you have RA and how your condition affects you. The teacher might know how RA differs from OA, but be prepared for the possibility that he is not familiar with various rheumatic conditions. Even if he doesn’t know much about RA, you can still probably work together to find appropriate modifications. Tell the teacher which joints are involved, how your movement might be limited, and about any movements that you know cause you pain. If the teacher isn’t willing or able to work with you to find different ways to execute poses when needed, find another teacher.

While some yoga studios have yoga mats you can borrow, you will probably want to invest in your own mat. Sharing mats can mean sharing germs, and having your own yoga mat can also help to ensure that you have the right mat for you.

Yoga mats come in many varieties. Although most yoga mats are made of vinyl, there are also mats made of natural materials, such as rubber or cotton. Some mats are thinner and lighter for easier transport. Some are thicker and provide more cushioning. Some yoga mats are longer for taller students. Think about your individual needs and what type of mat will best suit you. Also, make sure the mat you select is a yoga mat and not a mat for general exercise. Exercise mats are not always “sticky” enough to avoid slipping, and a general exercise mat may be less stable in standing or balancing poses, depending on the type of padding it has.

In addition to yoga mats, most yoga studios have yoga props available, and some yoga teachers rely heavily on props during their classes. Yoga props can be incredibly useful for students with RA. Common yoga props include foam blocks and fabric straps.

Some people use a yoga wedge (a less common prop consisting of a wedge-shaped piece of foam or cork) for any pose that requires weight bearing in the hands. If used correctly, a yoga wedge can reduce the degree to which a person has to bend his wrists, which is where some people have the most discomfort.

But props aren’t always necessary. There are other adjustments that you can make with your hands and wrists if a wedge (for example) is not available, such as staying on your fingertips, keeping your hands clenched in fists, or using a chair or the wall instead of the floor.

Your yoga teacher can help you learn more about using props, and as you practice and work with your teacher, you will find the adjustments and props that work best for you and your body.

Yoga at home

If you are intimidated by a group setting or aren’t feeling up to a full class, which usually lasts between 60 and 90 minutes, you may want to work with a yoga therapist. Yoga therapists generally work one-to-one with individuals, or with small groups that share a particular condition or concern. Yoga therapists often have more training than most yoga teachers, and they specialize in working with people who have specific needs or limitations.

The International Association of Yoga Therapists recently established standards for training yoga therapists. Since this development is still fairly new, however, you may want to ask any yoga therapists you are considering what their training includes, and how much experience they have working with people with RA.

A session with a yoga therapist is typically more expensive than a yoga class, but it can allow you to learn safe ways to practice yoga at home, and a yoga therapist can also work with you in shorter practice sessions if that’s more comfortable for you. A yoga therapist can also follow up with you to find out how well your yoga training is working and make adjustments as needed. With some practice, you may start to feel stronger and more comfortable moving into a gentle or beginner class.

Many people who want to do yoga at home also do so by following along with a book or DVD. I developed a DVD with the Arthritis Foundation called Arthritis-Friendly Yoga. This DVD (available at afstore.org) is intended for people who are fairly mobile and have mild-to-moderate arthritis. It offers a variety of options for each pose, and discusses ways to work around pain and stiffness in commonly affected joints.

Yoga safety

During yoga practice, avoid anything that causes you additional pain. If you feel any sensation that is sharp or shooting, back off and ask for an alternative version of the pose. One of the reasons yoga works well for conditions such as RA is that it can be adapted to work for each person. Don’t ever go further into a pose that hurts.

During yoga you will often feel the sensation of gently stretching or engaging your muscles, but the sensation should occur in the thickest part of the muscle, not at the joint. As with any physical activity, you may also experience some soreness after yoga practice. This comes from using muscles in a new way and is completely normal.

Be sure to drink plenty of water during and after practice. You may also want to gently stretch any sore muscles, or take a warm bath. If you experience discomfort that is severe or persists for more than two days, contact your rheumatologist. You may want to plan for a less active day after your first few yoga sessions, until you get acclimated to this new activity.

During a flare

If you are having a flare or if your body needs a break, you can still practice yoga. Speak with your rheumatologist about whether some slow, gentle movement is advised during a flare. Some simple yoga poses can even be practiced in bed.

It’s especially important during a flare to remember that yoga is not just a physical activity. Yoga is a holistic mindfulness practice that can include a variety of components, such as deep breathing, relaxation, meditation, visualization, and concentration. These aspects of yoga practice can also help you to maintain a positive outlook and change your perspective. The benefits of yoga as a holistic practice may also include stress management, which is important for anyone with RA, especially during a flare.

Your yoga journey

Yoga can be an enjoyable way to stay active and a great tool in managing your RA. It is important, however, to take this journey safely. This includes finding a qualified instructor, speaking to your rheumatologist, and listening to your body.

As you practice yoga over time, you may notice that it changes the way you stand, the way you breathe, and even the way you see the world. This is all part of the journey of growth and discovery that has attracted people to yoga for centuries. Enjoy it. Yoga is yours to explore!

Yoga Styles to Consider

There are many styles of hatha yoga to choose from, and some are more intense than others. Here are some general recommendations about various kinds of yoga. Firsthand experience, however, is often the best way to know what’s best for you. When choosing a style of yoga and a yoga class, talk to the instructor about the class first, and see if you can take a sample class before enrolling in a series of classes.

Styles

Anusara, Integral, Iyengar, Sivananda, Viniyoga

Description: These styles of yoga tend to be gentle. Viniyoga emphasizes one-to-one instruction and is recommended for most people with arthritis in private sessions. Iyengar yoga features the extensive use of props to individualize poses.

Recommendation: These styles are recommended for most people with arthritis.

Styles

Ananda, Kripalu, Kundalini

Description: Aspects of these yoga styles may be more difficult for people with arthritis. Ananda yoga, for example, has longer meditation sessions, which could pose a problem for people with arthritis. Kripalu yoga is taught at three intensity levels, and the first level is recommended for most people with arthritis. Kundalini practice may put particular stress on a person’s knees.

Recommendation: These styles are generally recommended for people with arthritis, though they can be more difficult.

Styles

Vinyasa Ashtanga (sometimes just called Ashtanga), Bikram (sometimes called “hot” yoga)

Description: These styles of yoga may be more strenuous. Bikram yoga, for example, is performed in a room heated to 105°F.

Recommendation: These styles are not recommended for people with arthritis.

Want to learn more about rheumatoid arthritis? Read “Steps to Manage Rheumatoid Arthritis Flare-Ups” and “Managing Sleep Problems in RA.”

Steffany Moonaz is a yoga therapist, registered yoga teacher, and a creator of Yoga for Arthritis. She is also a professor at Maryland University of Integrative Health.

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