This article is an excerpt from Yoga Therapy for Arthritis: A Whole-Person Approach to Movement and Lifestyleby Steffany Moonaz and Erin Byron.
It is up to the person with arthritis to decide how the yoga will begin. Whether you have rheumatoid arthritis (RA) or osteoarthritis (OA), or some other form of systemic or inflammatory condition, it is ideal to start with live instruction by a qualified and experienced professional, in a setting where individual guidance and feedback is available. Only a live teacher can observe and provide feedback about how to safely execute the poses. After some training (or in between classes), you may want to start practicing yoga at home. As with any physical activity, speak with your rheumatologist, orthopedist, or other medical provider(s) about whether it is appropriate for you, given your unique situation.
Many of my clients and students admit that they wanted to take yoga for many years before actually attending a class. A number of concerns stood in their way: thoughts about safety; looking stupid, incapable, or different; fear of injury or making the condition worse; or seeing contortionist postures in the media and thinking that was how to practice yoga. These are valid concerns, as some forms of yoga do pressure students to perform postures in a regimented way, which is not appropriate for arthritis. Yoga classes for arthritis require modification and a non-judgmental approach. Some yoga classes incorporate extreme positions and not all teachers are aware of why or how to modify the asanas. I understand why you might have concerns about practicing yoga.
People do get hurt practicing yoga. The typical ways people get hurt are through extreme class environments (such as excess heat, regimented technique, or a competitive philosophy), not being given options/modifications for postures, moving quickly between postures so there is little time for awareness and adaptation, or pushing too hard. That is not the kind of yoga I recommend. The good news is that with a few simple questions, you can screen out the unsuitable classes and find a class and teacher that meets the needs of a person with arthritis.
The steps to finding a suitable yoga class are:
1. Speak with your healthcare team and receive clearance from your doctor(s) to participate in yoga.
2. Research the classes available in your area.
3. Have a phone conversation with the people at the studio and ask the questions listed below.
4. Arrive early to a class and talk to the teacher before it starts.
5. Be the authority of your body during class. Listen to yourself and do not overextend.
6. Observe the effect of class on your whole self for the next few days.
Step 1: Checking With Your Doctor
Before beginning any fitness regime or marked lifestyle change, it is important that your healthcare team is involved in the process. In general, people looking after your well-being will be pleased about the incorporation of a fitness and stress reduction program. Often they will make you aware of any specific concerns or movements to avoid.
Sometimes doctors will recommend avoiding yoga and this could be for one of two reasons: 1) The doctor does not know much about yoga and fears you will be asked to perform physical feats that will strain the joints or 2) Your arthritis or physical functioning are not in a place where beginning an activity program is advisable.
To address the first issue, offer to provide the doctor with literature about the research behind the program and examples of the gentle poses involved in the practice. You can even suggest that the doctor call the yoga center to discuss it in more detail. However, if the second issue is involved, it is not advisable for you to participate until your health or functioning recover. In the meantime, you may begin interacting with yoga by performing some personal reflections, relaxations, and gentle breathing practices. Do whatever physical activity the doctor recommends, such as a short daily walk, and hopefully yoga will be an option when the disease stabilizes.
Step 2: Researching the Classes in Your Area
There are numerous types of yoga classes that may be suitable for a person with arthritis. If you live in a small town with limited options, seek out a “gentle,” “restorative,” “beginner,” or “therapeutic” class. If you have significant limitations or trouble getting to the floor, consider starting with a “chair yoga” class. “Yoga for seniors” is a good option even if you are a young person because of the humor, compassion, and accepting approach evident in those classes. These teachers tend to have greater experience in modifying postures and may be better able to support you in finding a safe and more comfortable position. Additionally, they will support your beginning needs and a slower pace. Even a “hatha,” “classical,” or “Integral” yoga class with a teacher who supports modifications could be a good fit. In the best of circumstances, you may find a Yoga for Arthritis class.
Just a few years ago, it may have been hard to find a yoga teacher specializing in arthritis. Today, there are several approaches to find a good fit for yourself or your clients/patients. I have trained over a hundred teachers in Yoga for Arthritis and offer continuing education for yoga teachers specifically about arthritis. You can find some of those teachers featured on our website or contact us for a recommendation in your area. Some yoga teachers also have a healthcare background that provides useful context about life with these conditions. In fact, you might even find a yoga teacher who has been living with arthritis or a related condition for many years themselves.
If you are struggling with where to begin, please contact the Yoga for Arthritis organization for additional guidance. We are happy to support you as you explore available group classes. It is important to start slowly and mindfully, with a teacher who can offer skillful guidance for safety and optimal outcomes.
Step 3: Looking Into a Yoga Center
Once you have researched your options for yoga classes, it is best to call each facility and ask questions about their teachers, standards, and approach. The following is a sample list of questions. Your doctor, rheumatologist, and other healthcare providers may also alert you to specific concerns—unique to you—that you might want to ask about. Be sure to identify up front that you are interested in yoga due to your arthritis so that the person answering your questions can best describe how their offerings might support you.
Are you a registered yoga teacher or certified yoga therapist? Please tell me about your training.
Yoga Alliance is the recognition body for yoga instructors worldwide. Being registered with Yoga Alliance requires a minimum level of training in techniques, anatomy/physiology, teaching methodology, philosophy/ethics, and practical experience. While there are still many differences between training programs, due to the diversity of yoga traditions and approaches, there is a core industry standard. Most yoga teachers working today are trained at least at the 200-hour level and many receive the additional 300 hours to be a 500-hour yoga teacher.
In the emerging field of yoga therapy, the International Association of Yoga Therapists (IAYT) requires a minimum of 1000 hours of training and experience working with clinical populations such as those with arthritis or other pain conditions. The IAYT accredits training programs and certifies yoga therapists as C-IAYTs.
How long have you been teaching?
While this is not always the case, teachers with more experience are often more adept at modifying poses for each individual. They have had years to work with a variety of students and have likely made many discoveries about individual differences and potential adaptations during that time. Additionally, they might have continued training for students with special needs, conditions, or health concerns.
Do you have a medical/healthcare background or experience teaching students with arthritis?
This is an ideal scenario. Many yoga instructors decided to teach because they discovered the healing properties of yoga through their own journeys. It is not unusual for someone in the healthcare field to teach yoga because of the range of benefits it provides. Even if they do not come from a medical background, try to find a teacher who is familiar with your condition and can guide you in making the proper adjustments for your body. Short of this, classes offered through hospitals or medical settings are often supervised or overseen by medical staff and may be a good option for you.
How do you teach your classes?
Based on your research, you are calling places that offer some form of yoga that seems like it might benefit your arthritis symptoms. Confirm at the beginning of the call that they do offer that style (gentle, restorative, beginner, hatha, chair, senior, etc.). Each may do the practices with slightly different form or in a different order, emphasizing different aspects. Many modern classes draw from a variety of styles to best suit the general population or people who tend to go to classes in that space. If you have taken yoga classes before, you may encounter some things that are familiar and some that are quite different. Ultimately, this is your journey and for safety and comfort, you will make the poses your own.
I have numerous movement limitations. Will I be the only one in class changing how I perform the postures?
It is actually okay if you are the only one. Some people feel nervous or singled out by being the only person who modifies poses and sequences; however, soon enough they realize that no one else in the class is bothered by it (it may even inspire some people!) and the class itself, not just the teacher, becomes a source of support. This question elicits a general tone about how much you will be encouraged to adapt your practice. As the instructor answers, listen for the ways they will accept your limitations and help you adapt the class to suit your specific needs. Gain a sense of how much diversity happens within the class and the level of encouragement the teacher transmits. The ideal is “a lot”!
What kinds of props do you have available and how much do you use them?
There is a range in the amount and kinds of props available and how much teachers utilize them. Yoga props are incredibly useful for students with arthritis. For example, I use a yoga wedge (a less common prop) for any postures that require weight bearing in the hands. I also put a folded blanket under my knees for cushioning during floor poses. If props aren’t available, there are other adjustments to make with the position of various body parts for greater ease or comfort. As you practice and work with your teacher, you will find the adjustments and props that work best for your body. Once you figure out what works for you, you can take that knowledge into any yoga class! The next couple of questions address adjustments and modifications.
I can’t sit on the floor. Are there other ways I can do the postures?
Some students may have a difficult time getting up from and down to from the floor. One big reason for this is that putting weight on their knees is painful, even for the moment of transition from standing to sitting. You also may not be very strong, flexible, or physically fit (yet!) which can impede the ability to sit on the floor. Hopefully your yoga teacher will work with you to find a tolerable method. Putting a folded blanket or bolster below your knees can help, or even offering hands for assistance. Leaning on a chair or the wall can help you feel more stable. However, when we focus on the intention underlying a pose, we can also adapt any asana for a different orientation such as sitting on a chair or lying on the floor. Hopefully your new yoga teacher will be helpful and encouraging so that after a period of time using the wall or chair to reorient a pose, you become comfortable with moving up and down from the floor. This skill can also benefit you in other areas of life.
My ankle (or knee, back, etc.) doesn’t bend like that. Do I have any options?
Especially if you have been living with arthritis for many years, you may have fused joints or had joint replacement surgery. These naturally impose limitations. Sometimes moving joints in a particular way can be very painful. It is more important to minimize pain and remain comfortable than it is to do the pose in a traditional way. Your yoga teacher should work with you to find a position that suits you better but still honors the essence of the pose and challenges you in some way.
It hurts to put weight on my hands. Are there other things I can do?
This is a common complaint for people with arthritis in their hands or wrists. In fact, some people are unable to put their hands on the ground due to deformities or bone fusion. It can be especially challenging for postures like table, downward facing dog, or plank. You may want to use a wedge to change the wrist angle, use blocks that the fingers can hang over, make fists, or do the pose on a chair or against the wall so you can reduce weight in the hands. Similarly, you might try cobra with hands hovering above the floor or without any pressure in the hands, even if they are still on the floor.
How many people attend your classes?
Most class sizes range from five to 25 people. You decide how many people you are comfortable practicing with. A smaller group means more individual attention. If there are a large number of people in the class you are considering, you may ask the follow-up question, how do you ensure the safety of such a big class?
Be sure to check in with your healthcare team about any other questions you should be asking and if curiosities arise during the conversation, ask those questions, too. Ensure you have asked all of your questions before attending the class, even if it means calling back again. That said, do not procrastinate going to yoga. If you get there and you feel that it is not a good fit, you can decide to leave and look elsewhere.
Step 4: Attending a New Class
It can be scary to start anything new, especially as an adult. You may have been living with the pain of arthritis for a long time and feel apprehensive about physical activity that could further injure you. Remember that you are the expert of your own body and you will not perform anything that causes you pain. That being said, starting a new physical activity can be a challenge, so be prepared for working some muscles you may have forgotten about. Give yourself the freedom to experiment with attending a few different classes to get a sense of what your local options are for studios, styles, and teachers.
When you start a new class, try to arrive early so that you have enough time for a conversation with the teacher. Explain that you have arthritis, which type it is, and how it affects you symptomatically. Tell the teacher which joints are involved, how your movement might be limited, and any movements that cause joint pain. Even if they don’t know much about arthritis, you can probably work together to find appropriate modifications. Ask if there is a posture you should return to in case you can’t figure out how to modify the one being taught or you need a break (and make sure it’s something that doesn’t hurt!). If the teacher isn’t willing/able to help you find different ways to execute a pose, which they should be after the telephone conversation, find another teacher.
Step 5: Participating Within Your Limits
During yoga practice, avoid anything that causes additional pain to the joints. If you feel any sensation that is sharp or shooting, back off and ask for an alternative variation to the pose. Remember the resting alternative the teacher provided from your conversation in class. Perform it when in doubt.
One of the reasons yoga works well for rheumatoid conditions is that it can be adapted to work for each person. Do not go further into a pose that increases your pain. You will feel the sensation of gently stretching and toning muscles, but that should be in the thickest part of the muscle, not at the joint. Be sure to keep the recommendations of your healthcare team in mind, perhaps even bringing notes from your medical provider to the first few yoga classes. You are the authority of your body during class. Respect the teacher but choose for yourself. Listen to obvious and subtle messages from your body and do not overextend.
Step 6: Observing the Effects of Class
The effects of a yoga class may be evident for days after the practice. Remember that yoga is not just a physical activity. It is a holistic mindfulness practice that includes a variety of components (deep breathing, relaxation, meditation, visualization, concentration, etc.). As with any physical activity, you may also experience some soreness after yoga practice. This comes from using muscles in a new way. Following the guidelines of your healthcare team and listening to your body during class can help limit this, but it will also diminish in time as your fitness improves. 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 discomfort is severe or if it persists for more than two days, contact your rheumatologist. You may want to plan for a less active day after your first few yoga practices, until you get acclimated to this new activity. Other effects are also evident right away. Anecdotally, people sometimes report improved sleep after just one class, a greater capacity for breath or increased sense of optimism. You might consider starting a journal to track the benefits that you notice over time, physically, energetically, emotionally, mentally, and spiritually. You can also use this to document any questions that arise about yoga for your yoga teacher or for your doctor.
(c) 2018 Singing Dragon. Reprinted with permission. This article may not be reproduced for any other use without permission.