The private reformer Pilates design of springs, ropes, pulleys and sliding carriage allows both assistance and resistance to the exercises. Forty years ago, when I first became interested in yoga and therapeutic exercise, I was assisting an older woman who was immobilized in her wheelchair by arthritis. Long before I understood the degree to which yoga can rehabilitate the body, I was helping people who were unable to dress, bathe or feed themselves independently due to the pain and stiffness in their joints. This has helped me understand the extreme suffering that can be inflicted by arthritis.
Back then, people
with joint pain and swelling were advised by doctors not to move! The
thinking was “If it hurts, don’t move it.” We now know that inactivity
is one of the worst responses for someone with arthritis.
As Loren Fishman, MD, points out in his book, Yoga for Arthritis, “Arthritis restricts movement, yoga increases range of motion-these two were made for each other.”
is the leading cause of disability in this country, limiting everyday
activities for millions of people. Drugs, surgeries, and steroids can
alleviate some of the discomforts, but study after study has shown that
exercise is most beneficial to most forms of arthritis, specifically
low-impact, flexibility-enhancing exercises such as yoga.
a painful and often debilitating condition caused by decades of wear
and tear on the joints, is considered to be one the side effects of
living longer. By the time we reach age sixty-five, X-rays for at last a
third of us will show some signs of osteoarthritis, the most common of a
group of diseases collectively referred to as arthritis.
in its many forms affects more than seventy million (or one in three)
American adults, according to estimates by the Center for Disease
Control and Prevention.
Arthritis is so common in our culture that
most people consider the pain and discomfort it brings to be a normal
part of aging. Arthritis makes normal activities increasingly painful
and difficult and diminishes or destroys the quality of life.
An Overview of Arthritis
word arthritis means “joint inflammation.” Modern medicine recognizes
more than a hundred varieties of conditions that produce deterioration
in joint structures. The common thread among these conditions is that
they all affect the joints-those nearly 150 ingeniously designed
structures located where two or more bones come together.
joint problems may include pain, stiffness, inflammation and damage to
joints. Joint weakness, instability and visible deformities may occur,
depending on the location of the joint involved.
classified into two main types. Rheumatoid arthritis is a chronic
inflammatory disorder, resulting in stiffness in the joints and muscles,
joint erosion and pain. Osteoarthritis is a degenerative disorder that
erodes the cartilage in joints, which leads to bones rubbing together.
Osteoarthritis frequently occurs in people who are overweight or whose
joints are painful from extreme overuse.
In spite of the
prevalence of arthritis, be careful not to jump to the conclusion that
your achy joints are necessarily due to it. Overuse and injuries can
also result in tendonitis, bursitis, carpal tunnel syndrome and other
fairly common conditions that are unrelated to arthritis.
Arthritis and Exercise
remain healthy, muscles and joints must move and bear weight or they
will lose strength. This weakness, coupled with joint swelling, will
make the joints unstable. Joints in this condition are vulnerable to
dislocation, increased injury and pain. Thus, regular gentle movement
helps to reduce pain and to maintain mobility.
promotes health in many systems of the body. It increases circulation,
which in turn reduces swelling and promotes delivery of oxygen and
nutrients to the tissues. With immobilization, a cycle of deterioration
Because movement is crucial to so many physiological
processes, the arthritic person’s overall health tends to deteriorate
without it. The normal functioning of the immune system declines,
infections and illnesses occur, and the person often becomes frustrated
and depressed. This cycle is self-perpetuating.
When someone comes
to me with arthritis, I teach them how to practice yoga safely with the
support of yoga props. For those who are new to yoga, the term “yoga
props,” simply refers to any object, such as a wall, a sturdy table or a
chair, a folded blanket, a firm pillow, a strap or other item that
makes practicing yoga safer and easier. Yoga props are especially
helpful for older beginners who may have balance problems and are coping
with common health issues such as arthritis and osteoporosis. In
addition to common household objects that can be used as yoga props,
there are professional yoga props such as a sturdy wooden bar known as
the “yoga horse,” yoga wall ropes, yoga bolsters in many shapes and
sizes, yoga straps, special yoga chairs, yoga blocks, firm yoga blankets
and more elaborate props like yoga backbenders that give people with
arthritis and other common health conditions new hope and confidence.
are increasingly advising regular gentle exercise for people with
arthritis because it tones muscles and reduces stiffness in joints. Yoga
is an ideal form of exercise for this because its movements are fluid
and adaptable. Yoga loosens muscles that have been tightened by
inactivity, stress and tension. In yoga we progress gradually, beginning
with simple stretches and strengthening poses and advancing to more
difficult postures only as we become stronger and more flexible.
necessary, you can begin with gentle movements while sitting in a chair
or lying on the floor. You can gradually add weight-bearing standing
postures, with the support of a wall, counter or table, wall ropes,
chairs, blocks, and other props.
The weight-bearing yoga standing
poses are among the key poses for safely increasing range of motion in
all the joints as well as increasing strength and flexibility.
important to note that weak muscles are considered a risk factor for
osteoarthritis. Be especially aware of weakness in the quadriceps, the
large frontal thigh muscles: The weaker the quadriceps, the higher the
risk of developing osteoarthritis in the knee. Yoga standing poses are
valuable for strengthening the quadriceps without wear and tear on the
hip and knee joints.
Practicing yoga can help improve respiration
throughout the day. Calm, slow, rhythmic breathing helps to release both
physical and emotional tension by flooding the body and brain with
oxygen. The regular, daily practice of deep relaxation is restorative to
every cell of the body.
I encourage those of you with arthritis
to seek the help of an experienced teacher who can help you learn to
distinguish between good pain and bad pain and to make yoga part of your
The positive effects yoga can have on mood and
overall outlook are especially important to someone with arthritis. A
yoga class offers positive support and the opportunity to connect with
people who are health-minded and have experienced the benefits of yoga.
Numerous studies emphasize the value of group support in coping with
health challenges such as arthritis.
With arthritis, as with any
injury or disease, listen to your body with focused attention to avoid
injury and determine which movements are most healing. Take classes with
a teacher who is knowledgeable about arthritis. If you are new to yoga,
I recommend a few private lessons, if possible, or start in a small
group class with individualized instruction, where you can practice at
your own pace.
Guidelines for Practicing Yoga in Class and at Home
1. Respect pain.
All yoga students, but especially those with arthritis, must learn the
difference between the beneficial feeling of muscles stretching and the
pain that signals harm. Learn to distinguish between the normal
discomfort of moving stiff joints through range of motion, and the pain
caused by a destructive movement or an excessive demand on a joint.
Sudden or severe pain is a warning. Continuing an activity after such a
warning may cause joint damage.
In general, if pain and discomfort
persists more than two hours after a yoga session, ask a knowledgeable
teacher to check your alignment and help you modify the pose. Try moving
more slowly, practicing more regularly and experiment with how long to
stay in a pose. There is no set answer to the perennial question “How
long should I stay in the pose?” Stay long enough so that a healthy
change has been made but not so long that your body stiffens from
staying in a position too long.
2. Balance work and rest.
Balancing activity and rest applies to yoga as well as to other daily
activities. Do not exercise to the point of fatigue. Stop before you are
exhausted! Weakened, fatigued muscles set the stage for joint
instability and injury. Balance your active yoga session with yoga’s
deeply relaxing restorative poses. Restorative poses are passive poses
that help your internal healing processes to work. If you are fatigued,
practice restorative poses first. You will benefit more from active,
more challenging poses, if you are well rested.
3. Practice with focus and awareness (pay attention to how you feel) and breathe properly.
Avoid mechanical repetitions and counting while exercising. Watch the
flow of your breath and your body’s response to a particular pose or
exercise. Without fully expanding your lungs, the muscles you are
exercising cannot be adequately supplied with oxygen. Holding your
breath while stretching inhibits relaxation. Smooth, peaceful, rhythmic
breathing through the nose reduces pain and tension and increases the
feeling of deep relaxation that follows a yoga session. Learn to tune
into what your body is telling you.
4. Learn to use yoga props.
People with arthritis may already be quite stiff by the time they start
yoga. The use of props helps improve blood circulation and breathing
capacity. By supporting the body in a yoga posture, props allow the
muscles to lengthen in a passive, non-strenuous way. Props help conserve
energy and allow people to practice more strenuous poses without
hurting or over exerting themselves.
Yoga for Arthritic Hips and Knees
areas most commonly affected by arthritis are the hips, knees and
hands. With decreased movement, the muscles and soft tissues around the
hip shorten, putting additional wear and tear on the gliding surfaces.
If a person becomes more sedentary in an effort to minimize pain, bones
and cartilage receive less weight-bearing stimulation. Bone spurs may
even develop to further limit movement.
Lack of exercise also
weakens the thigh and calf muscles. Their strength provides stability
and support for the knee. When the soft tissues of the joint swell, this
causes compression and reduces space in the joint even further.
poses are crucial for stretching and building supportive strength in
the hips, buttocks and thighs. Moving the head of the femur in the hip
socket helps distribute synovial fluid, thus lubricating the joint and
all points of contact.
The same standing poses recommended for
hips are also critical for knee rehabilitation. They create more space
in the knee joint for synovial fluid circulation and develop the
strength of the thigh and calf muscles for better support.
Sit on the Floor Every Day!
encourage all my students, especially those with osteoarthritis of the
knees, to sit on the floor every day, in various cross-legged and other
bent knee positions, as part of their daily life routine. This helps
assure that you do not lose the ability to sit comfortably on the floor.
Sitting with the legs crossed loosely is a simple, natural position
that helps remove stiffness in the hips and knees. To help you sit
comfortably on the floor with your back straight, sit on one or more
folded blankets, a firm bolster, large dictionary or other height.
Avoiding sitting on the floor will only make your hips and knees stiffer
with the passage of time.
Hint: If there is pain in the knees, try increasing the height under the buttock so that your pelvis is higher than the knees, and place folded blankets or yoga blocks under the knees. A knowledgeable yoga teacher can help you adjust your props so that sitting on the floor becomes easy and comfortable. Increase the length of time you sit gradually, and be sure to cross your legs the opposite way (opposite leg in front).
Do not strain your knees by attempting to sit prematurely in more
advanced, bent-knee positions such as the classic Lotus Pose. Forcing
your body into any position can result in serious injury. STOP if you
feel pain, and consult a knowledgeable teacher.
SUZA FRANCINA, the former mayor of Ojai, California, is a writer, animal advocate and Certified Iyengar Yoga Instructor. She has taught yoga since 1972 and is a pioneer in the field of teaching yoga to seniors. Her first book, Yoga for People Over 50, was published in 1977. She is author of The New Yoga for People Over 50 (Health Communications, Inc., 1997); Yoga and the Wisdom of Menopause (HCI, 2003); and The New Yoga for Healthy Aging (HCI 2007). She is currently completing a spiritual memoir, Autobiography of a Yogini. Her writing has appeared in numerous other books, magazines and publications worldwide. Born in Holland in 1949, she emigrated with her family to Ojai, California at the age of seven and has made the Ojai Valley her home ever since. To learn more visit http://www.Suzafrancina.com.
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