Yoga, a practice of exercises, breathing techniques and meditation that started in ancient India, has been touted as a way to boost physical and mental health for 5,000 years. But does yoga really work to improve physical arthritis symptoms like pain and stiffness, or psychological issues like stress and anxiety? YES.
In fact, yoga is proven to help people with arthritis improve many physical and psychological symptoms. Recent scientific studies of people with various types of arthritis show that regular yoga practice can help reduce joint pain, improve joint flexibility and function and lower stress and tension to promote better sleep. Yoga comes in many different forms, but generally involves positioning the body in various poses along with coordinated breathing and meditation exercises.
Sharon Kolasinski, MD, a professor of clinical medicine and a rheumatologist at the University of Pennsylvania in Philadelphia studied the effects of yoga on people with knee osteoarthritis (OA). She found that subjects taking 90-minute, modified Iyengar yoga classes once a week for eight weeks reported significant reductions in pain and improvements in physical function, as well as noticeable improvements in joint stiffness. Yoga poses were modified to accommodate the fact that people with knee OA may not be able to bend their joints as far as others, and Iyengar yoga allows participants to use chairs, blocks or other aids to help them balance during poses.
“Yoga is definitely one option for people with arthritis. Not only for the exercise benefits, but it’s also beneficial in the mind/body area, promoting relaxation and stress reduction,” says Dr. Kolasinksi.
Subhadra Evans, PhD, a researcher at the University of California at Los Angeles Medical Center, agrees. After conducting a small study of the effects of six weeks of Iyengar yoga on a group of women with rheumatoid arthritis (RA), Evans was impressed by yoga’s immediate, positive impact on people with a serious chronic disease. “I was surprised by how strong those results were,” she says.
Participants filled out questionnaires to measure pain, disability, mood, function and other symptoms, and also sat down for personal interviews with the researchers to gauge their feelings about the yoga program and its effects on their RA.
“They all said that day-to-day levels of pain hadn’t changed, but their relationship to the pain had changed. They were able to get through daily activities much more effectively, and had much more energy,” Evans says. “I think if we had had them do yoga longer, we may have seen more significant changes in pain and other symptoms.”
Still, Dr. Kolasinki warns: “You need to be taught by an instructor who understands your limitations.” Postures should be modified to suit your needs, and props should be used to help you balance during poses. Because it allows the use of aids, Iyengar yoga, in particular, is often recommended for people with arthritis.
Yoga’s Many Benefits
Many people turn to yoga as a way to exercise gently, as well as to reduce tension and improve joint flexibility.
Dr. Kolasinski adds that yoga also can help a person with arthritis build muscle strength and improve balance. In addition, yoga offers people with arthritis a form of exercise that is enjoyable enough to do regularly.
“There is no question that people are not exercising enough. Yoga provides an exercise option. It’s not the only thing you do, but it is a component” of an overall healthy regimen that may also include cardiovascular exercises like walking, or a low-fat diet.
According to Dr. Kolasinski’s research, people with arthritis who practice yoga regularly will eventually see improved physical function. “Admittedly, these are small studies, but I think yoga can enhance pain management, thereby improving function,” she says.
Yoga has other benefits for people with stiff joints due to arthritis. “Stretching exercises in general help improve range of motion, so the fact that you’re stretching in yoga will help flexibility.”
On days when you’re experiencing a painful arthritis flare, continuing to do some type of physical activity like yoga, if possible, can help you maintain joint flexibility. “To the extent that you can continue to exercise, you should," she says. "However, don’t overtax your joint that’s flaring.”
Some yoga poses may need to be modified for people with arthritis, Dr. Kolasinski adds. Downward facing dog, for example, involves kneeling on the floor and raising your body with your arms. People with arthritis may also need to use a chair, a block, a strap or other aids to help maintain balance during some poses, she says.
Before starting a yoga regimen, speak to your rheumatologist or primary-care physician to ensure that yoga is right for you. In addition, discuss what type of modifications might be appropriate for your unique condition, Dr. Kolasinski says.
Yoga’s emphasis on introspective thought – pinpointing the sources of pain or anxiety and learning to relax them – is useful for people with arthritis, adds Linda Howard, a yoga instructor in Baltimore, Md., and the creator of Easing Into Yoga, an instructional DVD with gentle yoga poses.
In yoga, “you develop a communication with your own body,” Howard says. Most of us don’t really think that way.”
Can Yoga Fight Inflammation?
Many forms of arthritis, especially autoimmune diseases like rheumatoid arthritis, involve inflammation, a process that causes joint swelling, redness, and pain and eventually destroys the joint components. Yoga may be a gentle, soothing form of physical activity for someone with RA or a similar disease, but can regular yoga practice actually help reduce inflammation?
While Dr. Kolasinski says that yoga practice does not reduce inflammation, a 2010 study led by researcher Janice Kiecolt-Glaser, PhD, at Ohio State University in Columbus, may prove differently. Kiecolt-Glaser measured key blood markers for inflammation in a study of 50 healthy women practicing basic Hatha yoga postures and found promising results.
The women were divided between yoga novices and experts, and the more experienced yoga practitioners showed lower levels of inflammation-causing proteins like interleukin-6 in their blood. Catheters were inserted into each woman’s arm to measure various substances during the yoga sessions, Kiecolt-Glaser explains. These included C-reactive protein, tumor necrosis alpha and interleukin-6, all proteins that may play a role in inflammation in many forms of arthritis, including RA. The women who were new to yoga had higher amounts of these markers in their blood than those who practiced yoga regularly.
"We didn’t see an actual difference during the yoga session. But we found that the experienced yoga practitioners had less reaction to stressors, perhaps less physiological reactions to stressors,” says Kiecolt-Glaser, a professor of psychiatry and psychology who wanted to explore the benefits of exercise on people with various medical conditions. “We chose yoga to study because it’s low impact. It’s a whole lot easier to start yoga than to start jogging. Yoga has a lot of potential benefits.”
Other than the length of time the women in Kiecolt-Glaser’s study had practiced yoga, all were quite similar, she notes. Age, weight, physical function and other health behaviors were very similar among the participants. All reported improved mood after yoga, she says. “People all reported lower levels of anxiety and tension, of stress. By reducing negative mood, you can also reduce pain,” she says.
Other recent studies do show that yoga can help people with RA improve symptoms. A 2009 study conducted at the Dubai Bone and Joint Center in Dubai, United Arab Emirates, looked at the effects of a biweekly yoga program for people with RA. Twenty-six out of 47 study subjects participated in 12 yoga sessions and reported significant improvements in measurements of disease activity.
In addition, an Indian study published this year looked at a week-long, intensive yoga program’s effects on people with RA. Sixty-four men and women with the disease were given tests for hand grip strength, rheumatoid factor (a blood marker often associated with inflammation) and C-reactive protein. All the participants showed reduced disability scores on the standardized Health Assessment Questionnaire measuring function, and reduced rheumatoid factor levels. In addition, some participants showed improved hand grip strength following a week of yoga.
An older study conducted at the University of Pennsylvania in 1994 also showed that yoga could provide relief for people with hand osteoarthritis, a common condition that can impair daily activities like dressing, driving a car or cooking. An eight-week yoga regimen improved hand pain, tenderness and finger range of motion in the participants.
Do Yoga Regularly – Even Daily
Yoga is gentle enough for most people to do every day, says Dr. Kolasinski. Yoga classes or private instruction can be expensive, but you can practice a yoga routine on your own at home, using a DVD or printed yoga instructions, once you’ve learned the moves from an instructor.
Finding the right instructor is key, says Howard. A good instructor not only understands that you have arthritis and shows you how to modify the moves, but should help create an overall program that fits with your goals. If you are less interested in the mind-body connection or meditation aspects of yoga than the physical poses and flexibility benefits, find an instructor or class that focuses on what you need. “That’s why it can be difficult for people to the find the right yoga practice for them,” says Howard.
Once considered an obscure, even esoteric practice, yoga is gaining in popularity among a wide variety of people with various health conditions. Dr. Kolasinski says more of her patients are asking if yoga is appropriate for them. “I think yoga is in a renaissance,” Dr. Kolasinksi says. “It’s becoming more of a mainstream option.” She believes it’s a good choice of physical activity for people with arthritis. Just be careful not to overdo it, and be mindful if you experience any pain or discomfort. “Don’t overtax a joint that’s flaring,” she says
Most Americans do not get enough physical activity, a factor that contributes to higher rates of obesity and health problems like arthritis. “Getting people moving is key,” Dr. Kolasinksi says.