Reprinted with permission from the Caring of the New York City Chapter of The Transition Network (TTN).
The Transition Network is an inclusive community of professional women, 50 and forward, whose changing life situations lead them to seek new connections, resources and opportunities. Through small group interactions, programs and workshops, members inspire and support eachother to continue a life of learning, engagement and leadership in the world. As a national organization, The Transition Network is a voice for women who continue to change the rules. For more information, go to www.ttn-nyc.org.
As women reach the age of 60 and beyond, our sense of ourselves as strong, independent and capable women can be shaken by the onset of Arthritis It is useful to know this possibility -- and to be prepared with at least a rudimentary plan of action – should anything happen to ourselves, or to our friends. So, what do we actually know about Arthritis? And why would Yoga be relevant?
Arthritis is the Number One cause of disability in the United States. Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are the most common of the over 100 forms of Arthritis, and both can affect every aspect of our lives -- from our mobility to our ability to be with those we love, or even to simply be by ourselves – in peace. Yoga is relatively well known to most of us, but less well known as an effective therapy to address the symptoms of Arthritis. In the past two decades American Yoga has developed a strong, and research-based therapeutic branch, and Arthritis was one of the first conditions to benefit from that research.
The ethical, spiritual and energetic components of classical Yoga provide relief for the pain and stress Arthritis patients undergo. The physical poses, or asana, are very gentle movements that lubricate the joints, strengthen and stretch muscles and increase balance. They lead the body to relaxation. Another Yoga practice, meditation, meditation contributes to the stress relief and relaxation that arthritis patients need to be able to cope with their challenges. It’s not “just exercise.” Further, classical Yoga philosophy is based on non-harming of self and others and is focused on seeking contentment, peace of mind and compassion for oneself and well as for others. A Yoga for Arthritis class contribute to a fundamental nervous system shift -- from the stressed out “fight or flight” sympathetic nervous system of a body tensed up by inflammation and anxiety, to the tranquility offered by the “rest and digest,” para-sympathetic nervous system. It is this repeated transition – and education in how to make the transition -- to a relaxed body with peace of mind that allows for hope among the students, as well as acceptance of what is.
This is so important, because there is no cure for Arthritis. Osteoarthritis (OA) develops with life; an athletic lifestyle, a traumatic injury or excess weight might contribute more to the wear and tear of the cartilage in the joints, than might a different lifestyle, but osteoarthritis seems to be a part of the life of all vertebrates, from fish to humans. Among us the joints affected by OA are the weight-bearing and working joints, such as hips, knees, shoulders and hands. The cartilage in the joints weakens, the joints become inflamed and lead to pain, limited mobility and psychic distress.
Rheumatoid Arthritis (RA) also affects the joints, but RA has a different source: it is an autoimmune disease, in which the patient’s own immune system attacks and inflames her joints. In general, women are more prone than men to suffer from all immune diseases, including RA. The joints affected are usually hands and wrists, feet and ankles and elbows and knees, but RA can also affect other body systems, such as the respiratory and cardiac systems. RA tends to strike at a younger age, sometimes even in early childhood. RA can be especially disabling, not only because of multiple joint inflammation, but also because it starts so much earlier and gets worse with age. Notably, by the time women are over 50, both OA and RA have become women’s diseases, because after menopause, when women lose the cushioning effects of estrogen, they start to account for the majority (60%) of OA cases. While there may be a genetic component to both OA and RA, the genetic mechanisms are not known.
Since all forms of arthritis are chronic, “management” is the only recourse for arthritis patients. They experience more depression than the general population, and in general, depressed people experience more pain along with more anxiety, sleeplessness and stress. Medical management of arthritis includes medications, and gentle exercise is usually recommended for its physical and psychological benefits. The exercises mentioned on the Arthritis Foundation website include two-minute workouts, walking, bicycle riding, Tai Chi and yoga.
Clearly, everyone should be as active as they can and as long as they can, with the activities of their choice. But Yoga offers an array of strategies to manage Arthritis that is simply unmatched.
In the past 15 years or so the yoga landscape changed dramatically for older adults, as Yoga teacher training shifted to Yoga therapy teacher training. Now, Yoga therapists who would teach Yoga classes to the elderly learned not how to teach their students to achieve classical Yoga asana, or poses, but to adapt the poses, or even pieces of the poses, to the capacities of the students. Also, Yoga therapists were required to understand the health challenges facing older populations, among them Arthritis, osteoporosis, heart disease, chronic pain and stroke, and to adjust their teaching accordingly.
As a result of this new, therapeutic ‘branch’ of American yoga, Yoga for Arthritis is the first program to specifically address the needs of arthritis and to offer complete yoga practice specifically designed for the individual needs of people with OA and RA.
The Yoga for Arthritis program is available in New York City as Yoga for Arthritis and Chronic Pain the Integral Yoga Institute of New York (IYINY) on West 13th Street. The teachers are a team of graduates from the program, well versed in the physical aspects of the disease, skilled in adapting poses to individual needs and in helping students learn how to shift their own nervous systems from the stressed sympathetic to the relaxed parasympathetic nervous system. Books that would be useful to arthritis patients include: Yoga Therapy for Arthritis, A Whole Person Approach to Movement and Lifestyle, by Steffany Moonaz; Yoga for Arthritis by Loren Fishman and Ellen Saltonstall, and Relax into Yoga for Chronic Pain, by Jim Carson, Kimberly Carson and Carol Krucoff.
But how significant – or scientific -- are positive self-reports by Yoga practitioners, students and teachers alike? For many years positive Yoga therapy research results were acknowledged, but were followed by “howevers,” referring to small sample size, lack of objective outcome measures (as opposed to participant self-reports) and specification of the biological mechanism at work. Nonetheless, the shift to Yoga therapy for the elderly attracted the interest and support of the National Center for Complementary and Integrative Health (NCCIH). Now, the scientific bar has been raised, and yoga research is hot and sophisticated!
Thus, for example, at the 2019 NCCIH-supported Symposium on Yoga Research (SYR), there were three projects that studied the effects of Yoga on RA patients. All three trials had over 100 participants, randomized into Yoga and control groups; and each trial cited different but specific physiological markers in the immune and neuroendocrine systems that showed statistically significant reduction of inflammation in the Yoga groups -- the “neuro-biological mechanism of effectiveness.” The rigor and sophistication of trials and results like these validate all those self-reports by students whose pain, stress and anxiety were relieved by their yoga for Arthritis practice.
Commenting on the value of Yoga in the face of improvements in the medical care for Arthritis, Dr. Loren Fishman, the New York City physiatrist with a specialty in Yoga, observes, “Even so, medications do have side effects and surgery, well, it’s always good to avoid surgery if possible. Yoga offers a pleasurable alternative – and at the very least it can minimize the use of medications and delay consideration of surgery.” My own thought is that if you are lucky enough not to have Arthritis, tell your friends who do about this article. They will love you more!
Elizabeth de G. R. Hansen, Ph.D., C-IAYT.
Yoga teacher and Yoga Therapist in New York City with focus on yoga for the elderly. Yoga research on arthritis and diabetes. Publications in Journal of International Association of Yoga Therapists. Current interests, yoga and the disabilities of age.