If you have arthritis, practicing yoga may offer a therapeutic two-for-one deal. Not only can this ancient discipline make you more limber and strong, but its emphasis on breathing exercises and meditation can help lighten the psychological burden of coping with chronic pain from all forms of arthritis, including osteoarthritis (OA) and rheumatoid arthritis (RA).
Yoga was long misunderstood in the United States, where it used to be viewed as an exotic practice that required pretzel-like contortions, but it has now achieved mass popularity. According to a 2016 survey, about 36 million Americans have tried yoga at some point in their lives—up from 20.4 million in 2012—with men and people over 50 making up the fastest-growing groups of converts. The main goals of those who express interest in yoga are flexibility, fitness, and stress relief.
While the amount of research that has been conducted on yoga as medical therapy is modest, several studies suggest that yoga can have important benefits for individuals with arthritis.
The basics of yoga
The word “yoga,” derived from the ancient Sanskrit language, means “union,” reflecting the discipline’s goal of benefiting and uniting the mind and body. Contrary to what some people believe, yoga isn’t a religion. It’s a philosophy or system for achieving better overall health and peace of mind.
Historians say that yoga was first practiced in India thousands of years ago. Over time, many different forms have evolved. One style known as hatha yoga is commonly offered at local studios or community centers. In this type, you learn to bend and stretch your body into different poses or postures. You may hold certain poses for a period of time, but other poses are more fluid and involve gentle movement.
Learning to control your breathing and to focus on the present moment (the meditative practice known as mindfulness) are important aspects of all forms of yoga.
Practitioners of yoga, known as yogis, have long insisted that the discipline is good for the mind and body, and a slowly growing body of research suggests that yoga can play a valuable role in managing the physical and psychological symptoms of many different medical conditions, including arthritis.
For a study published in The Journal of Rheumatology in 2015, researchers recruited 75 arthritis patients (mostly women) to participate; about half had RA and the rest had knee OA. The average subject was 52 years old and had been living with arthritis for nine years. All were sedentary—that is, they weren’t involved in any type of exercise program at the time.
Half of the participants were randomly assigned to start a hatha yoga program that included two one-hour-long classes per week, plus take-home exercises. The other half, who served as the control group, were put on a wait list to join the yoga program. After two months, subjects in the yoga group experienced a 20 percent improvement in pain symptoms, while pain levels were unchanged in the control group. Members of the yoga group increased the distance they could walk in a timed test, too.
Importantly, participants who practiced yoga also reported having more energy, as well as a better mood and a more positive perception of their health. Most of these improvements persisted when measured again nine months later.
The results of another small study, published in the Clinical Journal of Pain in 2013, underscore the potential psychological benefits that people with arthritis may gain from practicing yoga. Researchers invited a group of young women with RA to learn Iyengar yoga, a style that emphasizes precise alignment of the body in poses that are held for long periods, often involving props, such as foam blocks, for support. After attending several Iyengar yoga classes per week for a month and a half, the women had similar pain levels as those in the control group, who didn’t learn yoga.
However, the study found that the women who practiced yoga reported less fatigue, brighter moods, and greater acceptance of their RA, as well as more confidence in their ability to manage the condition, when compared with women in the control group.
Is yoga safe for you?
If you have arthritis, it’s natural to wonder whether all the bending, twisting, and balancing that yoga entails is safe for your joints, which may have some damaged cartilage, as well as other tissue damage. Yoga is generally thought to be safe for people with arthritis, but care must be taken.
In the two studies previously mentioned, as in most other studies, none of the participants experienced any worsening of joint symptoms or joint injuries. But a study published in 2018 in the Journal of Bodywork and Movement Therapies suggests that musculoskeletal pain can result from recreational yoga, especially if participants overexert themselves or take a class that is too advanced. So check with your doctor before performing yoga (or starting any new exercise regimen), and keep a few things in mind before you roll out your yoga mat.
For one, be sure you know what type of yoga the instructor is offering before you sign up for a class. Hatha yoga and Iyengar yoga, described earlier, are both good options for people with OA, RA, and other rheumatic diseases. (Iyengar yoga, in particular, may provide added support for joints damaged byRA.) Chair yoga—in which all poses and moves are performed while seated or while standing and using a chair for support—is another alternative that is well suited to older adults who haven’t been active recently.
A small 2017 study published in the Journal of the American Geriatrics Society found that adults 65 and older with OA of the knee, hip, foot, or ankle reduced their levels of pain and fatigue while they were enrolled in a chair yoga program. They were able to walk faster, too. These benefits diminished after the program ended. But even a month later, OA patients who learned yoga reported that pain caused less interference and disruption in their daily lives.
Note that you may feel less comfortable with some other forms of yoga, which could put you at risk for injury or other medical problems. Ashtanga yoga (often called power yoga) is quite strenuous and involves constant movement. Likewise, Kundalini yoga may be too taxing for some people with arthritis, as may vinyasa yoga, which is known for its fluid movements that are synchronized with the breath. Bikram, or “hot,” yoga—taught in rooms with the thermostat dialed up past 100°F—could be dangerousfor someone with heart disease or other medical conditions.
Moreover, you may need to modify some movements and avoid others altogether to accommodate joints that are damaged or flaring. For example, if your wrists ache, assuming the downward dog pose, in which your body is bent over into a reverse V, could be modified by placing a foam yoga wedge under your palms. If any pose causes pain that can’t be alleviated with modification, don’t do it.
Learning how to perform yoga safely from a properly trained instructor is essential. Look for an instructor who is registered with Yoga Alliance, which requires training and education in not only yoga philosophy and techniques, but also anatomy and physiology.
Some major hospitals now have yoga therapists who are specially trained to work with people who have specific medical conditions, such as OA and RA.
This article first appeared in the 2019 UC Berkeley Arthritis White Paper.
Also see Arthritis and Exercise.