Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional. Yoga teachers should remain within their : This means not attempting to diagnose, treat, or offer medical advice to students.
A priority when working with arthritic joints in yoga is to lessen the strain placed on those joints. As discussed at greater length in “Working with Arthritis in Yoga Class,” the answer is more complicated than simply deciding to move less.
According to physical therapist Bill Reif, author of The Back Pain Secret: The Real Cause of Women’s Back Pain and How to Treat It, the less you move your joints, the less range of motion you’ll maintain. “Over time,” he explains, “the muscles surrounding your joints will shorten, limiting motion.”
Many of those with rheumatoid arthritis (RA) and osteoarthritis (OA) can benefit from stretching and strengthening affected joints in order to maintain range of motion and reduce pain. “OA generally affects the hips and knees, whereas RA tends to impact the smaller joints of the hands and feet,” Reif says, adding that arthritis can affect the back as well, especially the lower back.
The gentle sequence below is arthritis-friendly in its minimization of ups and downs from the floor (which may be impossible or uncomfortable for those with arthritis in the knees), in its exclusion of weight-bearing in the hands (because the hands and wrists are often affected by arthritis), and in its use of support for balancing (as balancing can be challenging for those with arthritis in the knees and hips). Walls and props are suggested for reducing the load, and thus the stress, on the feet, knees, and hips.
Reif recommends that those with arthritis practice this sequence a few times a week, make note of which poses most effectively target your affected joints, and practice those every day.
“All poses should decrease discomfort, not increase it,” he says. “Stretch to the point of mild tension, not pain. If practice increases your discomfort, ease up on your routine.”
Those with arthritis should also see their physician for a thorough examination, a definitive diagnosis, and personalized treatment recommendations, which may include splints for the joints to help limit compression in a yoga practice.
Before you begin, consider warming up by taking a hot bath or shower, spending time in a steam room or sauna, using hot compresses, taking a walk, or riding a stationary bike. Doing so before this (or any) sequence will make the movements more accessible. You will need a wall, a yoga strap, and four or five blankets (or large towels).
If standing or sitting on a stack of blankets is uncomfortable, you may want a chair as well. You also can practice the first five poses seated upright. Note that for chair pose (number 5), lean your upper body forward and reach your arms up, lifting your hips off the edge of the chair briefly. For meditation (number 11), you can also sit in the chair if you’d like.
1. Mountain Pose (Tadasana) With a Twist
According to Reif, this gentle twist “will loosen shoulders, elbows, hips, and knees and open up the space between these joints.” He adds that, to make the movement fluid, you can “initiate the movement with your eyes, then let your torso follow, then the rest of your body.”
Stand in mountain pose with your feet hip distance apart and roughly parallel, your ears stacked above your shoulders, shoulders over your hips, and hips over your heels. Have your arms alongside you with palms facing in. Keeping your toes and knees aligned, twist to the right using your torso, then to the left, slowly, allowing your arms to swing freely. Repeat this movement for several deep, easy breaths.
2. Shoulder Circles
This motion helps to mobilize the shoulder joints by stretching the deltoids and pectorals.
Still standing in mountain pose, lift your arms out to your sides, about shoulder height. Make loose fists with your hands, thumb side facing up, with thumbs relaxed (or, if you have the flexibility to do so comfortably, turn your thumbs back behind you to increase the external rotation of your shoulders).
Keeping the rest of your body steady, make big circles with your arms, moving slowly in one direction for a few deep breaths, then the other for a few more breaths before releasing your arms at your sides.
3. Wrist Circles
These movements help to mobilize the wrists by strengthening muscles, including the wrist flexors and extensors.
Still in mountain pose, with your arms down alongside you, once again make loose fists with your hands, thumbs facing forward in a relaxed manner. Keeping your arms still, circle both wrists slowly in one direction for two or three breaths, then in the other for another few breaths.
4. Opening and Closing Fists
This exercise will help to stretch and strengthen the joints of the hands.
While your arms could be in a number of different positions with the hands making fists, holding your arms out in front of you, shoulder height and parallel, has the benefit of gently strengthening your arms.
From mountain pose, lift your arms to shoulder height out in front of you, making loose fists, with the thumb side of the hands directed toward the ceiling (thumbs relaxed and resting on top); wrists are in their neutral position (i.e., there should be a straight line from your forearms to the back of your hands). On an inhale, keeping neutral wrists, open your hands, spreading your fingers wide. On an exhale, keeping your wrists neutral, close your hands slowly, making fists. Repeat this movement several times, moving with the breath, and then relax your arms at your sides.
5. Chair Pose (Utkatasana) and Heel Lifts at the Wall
This pose strengthens the hamstrings, quadriceps, glutes, and calves, aiding in hip, knee, and ankle mobility. The wall is used to minimize the weight through the hips, knees, and feet, and to assist with balance during the heel lifts.
Stand about a foot or two away from the wall, and then press your back and buttocks against it. (Ideally, the back of your head should also be against the wall. But if doing so makes you lift your chin uncomfortably high, simply move your head as far back toward the wall as you comfortably can while keeping your chin parallel to the earth and the back of your neck long.) Place your hands on your hips. Slide your hips down the wall, bending your knees, stepping your feet forward, and pausing when your knees are bent to a challenging yet sustainable degree. Reif says, “You can bend just a few inches at first, then over time, as you gain quadriceps strength, you might bend your knees up to but probably not exceeding 90 degrees.”
For more intensity, lift your arms overhead (or as high as you comfortably can). Hold for a few breaths.
Then come upright, resting for a breath or two with your back against the wall.
Return to chair pose with the help of the wall. Now, to strengthen your calves, experiment with lifting both heels while keeping your knees bent.
Start by lifting both heels for one breath cycle, then gradually work up to lifting them for several breaths.
Release your heels and come back to upright, sliding your back upward along the wall to keep some of the load off the legs.
6. Runner’s Stretch at the Wall
This one is for your calf muscles (gastrocnemius and soleus) and Achilles’ tendon and will aid in ankle mobility. The variation with the back knee bent will channel the stretch to the soleus muscle.
Turn around so that you’re facing the wall. Stand about a foot away, placing your hands on the wall at about chest height. Step your left foot two or three feet back behind you. Both feet should be pointing toward the wall. Lean forward on a diagonal, keeping your spine long (i.e., hinge from your hips and don’t round your back) and keep your back heel grounded as you bend your elbows until you feel a stretch in your left calf muscles. (If you don’t feel a stretch, try stepping your left foot farther back.) Hold here for several breaths.
Now, bend your left knee, keeping it directly in line with the center of your left foot. Root down with the ball of your left foot and reach back through your left heel. Hold here for several breaths.
Release the pose, and then repeat on the other side.
7. Knees to Chest (Apanasana) and Knee Circles
This pose gently stretches the lower back and mobilizes the hips.
Lying on your back, draw both knees into your chest for several breaths.
Then place a hand on each knee and use your hands to circle your knees away from each other for a few breaths, and then toward each other for a few more breaths.
8. Hamstring Stretch (Supta Padangusthasana) and Leg Circles With Yoga Strap
This pose targets not only the hamstrings and calves, but also the hip abductors and adductors, increasing ankle, knee, and hip flexibility.
Note that if straightening one leg on the floor bothers your lower back, you can keep that leg bent, with the foot flat on the floor.
Still lying on your back, stretch both legs out in front of you. Draw your right knee in toward your chest, placing your strap around the sole of your right foot (at the upper part of the arch, near the ball of the foot). Take one side of the strap in each hand and lengthen your right leg toward the ceiling, reaching through your heel and aiming your toes toward your right shoulder. Bend and straighten your right leg a few times, and then straighten it as much as you comfortably can for a few breaths.
Then take the strap in your right hand and circle your right leg in one direction, then the other for several breaths, before switching sides.
9. Bridge Pose (Setu Bandha Sarvangasana)
Bridge, which works the hamstrings and gluteal muscles while stretching the quadriceps, will increase hip and knee mobility. It also strengthens the spinal extensors, which support upright posture. Unlike standing poses, in which all of the body’s weight travels through the hips and knees into the feet, in bridge pose, the shoulders are tasked with supporting some of your weight.
Lie on your back with your knees bent and feet on the ground, heels under your knees or slightly forward of them. Bend your elbows at right angles alongside your rib cage, so that your forearms are perpendicular to the floor and your fingers point toward the ceiling with palms facing each other. On an inhale, push down with your feet (keeping them grounded), your upper arms, and the backs of your shoulders in order to lift your hips and heart upward. On an exhale, relax back down to the floor. Repeat bridge once or twice more.
10. Windshield Wipering the Knees and Moving Bound Angle (Supta Baddha Konasana).
These poses help to free the lower back and mobilize the hips in preparation for the seated meditation that follows.
Lying on your back, with your arms out to the sides, bend your knees and place your feet about shoulder distance apart, flat on the floor. Inhale here, and then, on an exhale, lower your knees to the right, rolling to the outside edge of your right foot and the inside edge of your left foot.
On an inhale, lift your knees back up to center. On an exhale, lower your knees to the left. Inhale back to center and then repeat these movements a few more times.
Then bring your feet close together. On an inhale, widen your knees away from each other as far as is comfortable, bringing the soles of your feet to touch. On your exhale, bring your knees back together, replanting the soles of your feet on the mat. Repeat this movement a few more times. Then linger for a few breaths with your knees wide, bringing the soles of your feet together.
11. Seated Meditation
Mindfulness meditation seems to enhance coping skills and can improve symptoms of depression that sometimes accompany rheumatoid arthritis. Easy seat can be made more comfortable with the modification shown here, though sitting in a chair (or even lying down) may work best for some.
To offload weight from the ankles, knees, and hips, sit on several folded blankets (or a bolster) placed horizontally against the wall. Stack the blankets high enough that your knees are below your frontal hip bones, and scoot back far enough that the wall supports you—the back of your pelvis, your mid and upper back, and the back of your head all relaxing comfortably against the wall. (If you cannot bring your head to the wall, move it back only as far as you comfortably can.) Rest your hands on your thighs, palms up or down (or in the mudra of your choice).
With your eyes closed or your gaze softly lowered, come to an awareness of the present moment, first noticing the external components of the present moment: the sounds around you, the time of day, the temperature. Then draw your attention to the internal components of the present moment: the movements of your breath and the fluctuations of your thoughts and feelings. Notice where you feel discomfort, but also the many areas of your body that feel good. Continue this relaxed mindfulness for a few minutes. In successive practices, experiment with gradually extending the time you spend in meditation.
12. “Snow Angels”
This movement, which may feel good after the stillness of meditation, strengthens the muscles that abduct and adduct the shoulders and hips. While you could practice this pose by sliding your hands and feet along the floor, this version uses four blankets to reduce friction. If, when you bring your head to the floor for this pose and the supine poses that follow, the back of your neck shortens uncomfortably and your chin tips up toward the ceiling, place a folded blanket under your head as well.
Come down to the mat, lying on your back with your legs close together, a folded blanket under each heel, and arms at your sides with your palms up (a folded blanket under the back of each hand).
Inhale and, as if making a snow angel, spread your legs wide on the floor, keeping your toes pointing up, and raise your arms out to the sides then up alongside your ears, keeping your palms facing up. Exhale and bring your legs together and your arms back to your sides. Repeat these movements slowly for several breath cycles, moving with the breath.
Relax into savasana with your hands and heels still supported by blankets, breathing deeply and easily for several uninterrupted minutes. While you relax, imagine warmth and ease suffusing your entire body.
See if you can stay present to the traces of these sensations that remain, even as you return to awareness and activity.
Photography: Andrea Killam