CHAPTER 9
ARTHRITIS
MARIAN GARFINKEL first met her teacher, B. K. S. Iyengar, in 1974, and has been traveling to India annually to study with him ever since. She was so impressed with the master’s work with people suffering from a variety of health conditions that she was inspired to conduct scientific studies of his approach. Marian is best known for her randomized controlled trial, published in the Journal of the American Medical Association ( JAMA) in 1998, which showed the benefits of the specifically adapted program of Iyengar yoga that she created for people with carpal tunnel syndrome (see Chapter 13). Eight years before that, for her doctoral thesis in health education at Temple University, she conducted a study demonstrating the effectiveness of Iyengar yoga for arthritis of the hands and finger joints, which was later published in the Journal of Rheumatology. She continues to teach, research, lecture, and perform and publish clinical trials at the University of Pennsylvania Medical School and at Temple University. She is also the founder and director of, and teaches at, the B. K. S. Iyengar Yoga Studio of Philadelphia.
Liz McDonough (not her real name) came to see Marian Garfinkel because of problems she was having with her knees. She’d been taking yoga classes for several years, but the pain in her knees, which had been worsening even after she had surgery to correct it, led her to seek treatment in private session with Marian. Liz had been a competitive runner for most of her life and now, in her early fifties, it appeared to be catching up with her. Three years earlier she’d been diagnosed with degenerative arthritis (osteoarthritis) of both knees. A year earlier, she’d undergone arthroscopic surgery on her right knee, which had reduced her pain, but only for a while. Most of the time, even everyday activities such as walking pained her. Liz had particular trouble going up and down steps.
Overview of Arthritis
There are many varieties of arthritis. By far the most common form is osteoarthritis (OA), the wear-and-tear kind that often affects the joints in the back, neck, hips, fingers, or, as in Liz’s case, the knees. In a healthy joint, a well-lubricated lining of cartilage covers the ends of bones, allowing them to slide smoothly over one another. In a joint affected by osteoarthritis, the protective cartilage is damaged and worn down, allowing bone to rub painfully on bone. Genetic factors, old sports injuries, bad postural habits, the kind of work you do—all can play a role in damaging the cartilage. Among the elderly, OA of the knee leads to more chronic disability than any other medical condition.
Less common but potentially more serious is rheumatoid arthritis (RA), an autoimmune inflammatory disease that leads to redness and swelling of joints, and if left unchecked can result in major joint deformities. Whereas degenerative arthritis affects men and women more or less equally, women are far more likely to develop RA, and it often comes on at a far earlier age. There are several other inflammatory forms of arthritis, such as those associated with lupus and with the skin disease psoriasis, in which the joint damage more closely resembles that in RA than OA.
How Yoga Fits In
Yoga is particularly well suited to help prevent or minimize the erosion of cartilage that causes the joint pain of osteoarthritis, and to create greater ease of movement and decrease pain within joints that have already sustained such damage. From a yogic perspective, most of the factors that are responsible for the damage to cartilage are related to how the body sits, stands, and moves through space. Misalignment of bones, dysfunctional movement patterns, lack of body awareness, poor posture—all of these overlapping and interconnected factors can cause wear and tear on the cartilage, and all of them are problems that yoga can help correct. Yoga is also ideally suited to deal with stress, which is believed to be a factor in the worsening of symptoms in both OA and RA. And for those people whose arthritis is severe, yoga can teach them how to cope better with pain that they cannot eliminate entirely. Experienced meditators, for example, appear to be able to modulate their reaction to pain. They may still have the discomfort, but are less bothered by it.
The painful rubbing of bone on bone that occurs when cartilage wears down is often the result of misalignment that the average doctor has little idea how to correct. Such misalignments can be the result of unconsciously holding in some muscles, the failure to engage other muscles, dysfunctional patterns of use, and unusually shaped bones. (Two of these misalignments are so well known, and so obvious, that the names for them are part of colloquial speech: bowlegged and knock-kneed.) An experienced yoga teacher can help deal with misalignments, first by being knowledgeable and observant enough to identify them, and then by being skillful enough to help the student readjust so that there is less stress on the joints. In therapeutic yoga you learn to actively engage the muscles that can help realign the bony parts of the joints. Marian Garfinkel describes what she does to help students with arthritis as “trying to create space in the joint, so the bones can move more readily.”
Yogis like to say that everything is connected, and nowhere is this more obvious than in the case of anatomy. The hip bone really is connected to the thigh bone, which is in turn connected to the knee joint, so it’s no surprise that how you move your hips will ultimately affect what happens in your knee. A skilled yoga therapist sees these connections and understands how movement in one joint might affect movement in another. If you have a knee problem, a yoga therapist might focus on increasing the range of motion in your hips. And because even seemingly distant areas of the body are linked, you might also be taught to open up the spaces between your toes and ground the feet more fully during standing poses, as a way of helping not just with knee pain but with back and neck problems, too.
Yoga can also help you become aware of habitual misalignments and patterns of movement that may contribute to problems in the future, or worsen problems you already have. Unless you have a background in dance or some other discipline that builds body awareness, you probably have little sense of what your knees are doing when you walk, sit, or stand—how, for example, the kneecaps track when you bend and straighten your knee joint along a certain axis of movement. If you don’t realize you are moving in a potentially injurious way, you could continue to do so for many years, digging deeper behavioral grooves, samskaras, which manifest on the cartilage and ultimately on the bones themselves. A good asana practice can help you become aware of maladaptive patterns and start to change them. Yoga can get you out of an unhealthy groove, literally and figuratively.
While it may not seem obvious, poor posture is another samskara that can contribute greatly to knee problems like Liz’s, to degeneration of the vertebral joints in the lower back and neck, and to many other problems from the head to the toes, quite literally. Yoga is, of course, one of the most effective ways to improve posture ever invented. If, for example, you normally stand with your shoulders slumped and your head held several inches in front of your spine—a postural habit common to most people who sit at a desk all day—you are putting excessive pressure on the joints in the lower body (see Chapter 2). Postural changes and chest-opening poses like backbends can slowly correct the problem.
Yoga exercises its effects on posture partly through bringing awareness to formerly unconscious postural habits and to their consequences. Yoga practitioners may notice, for example, that even standing with the phone cradled to their neck puts pressure on the knee joint. (If this seems far-fetched, try it out and see if you notice any sensation of compression on the outside surface of the knee on the side you’re leaning toward.) Such awareness allows you to make corrections before more significant damage is done.
Another way yoga can help arthritis is by keeping people moving. Although people with arthritis tend to avoid using sore joints because of the pain involved, evidence suggests that inactivity weakens muscles and further reduces movement in the joints (causing what doctors refer to as “decreased range of motion”), so that a vicious cycle is set in motion: pain leads to restricted movement; lack of movement causes the muscles to become both weak and tight, leading to further misalignment of the joint surfaces and more pain. Gentle movement under the supervision of a skilled yoga therapist can put a stop to this cycle.
Asana is also great preventive medicine. Most people who aren’t actively working to maintain flexibility in their muscles and other tissues, and range of motion in their joints, become more restricted in their movements as they age. Asana takes your joints through a wide range of motion, inscribing new and healthier movement “grooves” in your body. Movement distributes lubricating synovial fluid, continually secreted into the joint by its synovial lining, over the surface of the cartilage that caps the bones. When the cartilage is well lubricated, the joint surfaces glide more easily across each other, reducing wear and tear. Joint movement also helps bring nutrients into cartilage, which lacks its own blood supply. You can think of cartilage as a sponge that gets squeezed by movement. Stale synovial fluid, depleted of nutrients, leaves, allowing a fresh supply to soak in from the joint when the compression is released. Areas of the joint surface that rarely get used because they are outside the normal grooves of movement fail to get the nutrients they need and over time tend to degenerate—an example of “use it or lose it.”
Yogis believe that stress may play a role in worsening symptoms of OA, and contribute to flare-ups of inflammation in RA. This belief is now being confirmed by pain experts who increasingly recognize that tight muscles (characteristic of people under stress) are often a major cause of pain in arthritis. Another cycle may ensue, as constant pain can itself be very stressful, causing further tightening and tension of the muscles. With measures that both reduce stress and relax muscles, yoga can interrupt this feedback loop.
The Scientific Evidence
When I visited various yoga therapy clinics in India, I heard several dramatic stories of the relief people with arthritis had obtained from practicing yoga. These stories are just anecdotes, of course, but they suggest what may be possible, and yoga’s efficacy is beginning to be borne out by studies (though much more research is needed).
Marian Garfinkel’s doctoral dissertation, later published in the Journal of Rheumatology, was a randomized controlled study of twenty-five patients with degenerative arthritis (OA) of the hands. She found that a program of adapted Iyengar yoga and relaxation resulted in significant reductions in pain and an increase in range of motion. Beyond these objective measures, Marian believes the students also experienced improvements in their mood and energy levels.
More recently, Marian and several colleagues from the Division of Rheumatology at the University of Pennsylvania School of Medicine published a small pilot study evaluating an eight-week program of adapted Iyengar yoga for OA of the knee. Marian designed and taught the yoga intervention. Seven women, all obese and over fifty, none of whom had done yoga before, completed the protocol by attending at least five of eight weekly, one-to one-and-a-half-hour sessions. No home practice between lessons was required. After eight weeks, the women averaged a 47 percent reduction in pain, a 39 percent improvement in physical function, and a 39 percent reduction in stiffness. The women also experienced a statistically significant improvement in their mood compared to before the trial began. There were no injuries or other adverse reactions to the yoga protocol.
A small controlled trial, published in the British Journal of Rheumatology, found that a three-month program of gentle asana and breathing techniques resulted in improved grip strength in patients with rheumatoid arthritis. The study’s authors included Robin Monro, PhD, of the London-based Yoga Biomedical Trust, along with researchers from the Swami Vivekananda Yoga Research Foundation near Bangalore. While the effect was small, it is noteworthy that all the patients who tried yoga wished to continue it after the study was completed. Another study at Vivekananda found that a more intense fifteen-day program resulted in large increases in grip strength in twenty patients with rheumatoid arthritis, especially among the women (who on average were quite weak prior to starting the program).
Dr. Jon Kabat-Zinn, founder of the Stress Reduction Clinic at the University of Massachusetts Medical Center, evaluated a ten-week program teaching mindfulness meditation and hatha yoga to fifty-one people with chronic pain who had failed to improve with conventional medical care. The most common types of pain in the group included low back, neck, and shoulder pain. Half of the patients experienced a 50 percent reduction in pain and 65 percent had a one-third reduction in pain scores. There were large improvements in mood and other symptoms. The response was similar for all types of pain. The majority of patients in mindfulness-based stress-reduction programs appear to continue their practice when the program is over, demonstrating long-term improvements in function.
Marian Garfinkel’s Approach
Marian made the following observations about Liz when she walked in for her first appointment. “She appeared to be carrying all the weight in her knees, and was hunched over and had very little body awareness. Her head was going forward and her knees were more prominent than normal.” Marian deduced that Liz probably had some calcification in the joints. Liz was also bowlegged, her knees angling out to the sides.
On the right side, where Liz had had her knee surgery, Marian says, “the shin bone was totally different. It was projecting toward me, and it was not aligned with the femur” (the thigh bone). Marian suspected that some of this abnormality may have been the result of the operation. The right foot looked contracted. The toes were bunched together, particularly toward the outside of the foot. Standing, Liz couldn’t lift her toes at all, a reflection of tightness in the muscles of the sole of the foot, which should be soft. She also found that Liz had a great deal of tightness in some of the muscles in her arms and back, and she believed this tension was causing a chain effect that was adversely affecting Liz’s knees.
When Marian asked Liz to show her the asana she had been doing, she saw that Liz was doing the postures incorrectly. “She had almost no awareness of her alignment. What she was doing was really not helping her. If you have OA of the knee, you need to modify the pose to work the leg differently so that you place less weight on the knee. If poses are done incorrectly, it could cause other injuries.” Marian also believes that there are specific modifications that need to be made for bowlegs.
Here are the poses and instructions that Marian provided for Liz in each of their three lessons together:
LESSON 1
Marian began their first lesson with a restorative pose, a passive chest opener, due to her suspicion that Liz was both tired and mildly depressed. When people are in pain, Marian stresses, it is necessary to proceed slowly. “The first thing I have to do is manage their pain to give them the confidence to want to continue. You need to be certain not to make their condition worse.”
EXERCISE #1. RECLINING COBBLER’S POSE (Supta Baddha Konasana), on a platform or table, five to ten minutes. Start by sitting on a platform or strong table in Cobbler’s pose, approximately six inches in front of a cylindrical bolster. Place folded or rolled blankets or yoga blocks under your thighs and calves so that your legs are supported and you feel no tension in your groin. Next, loosely fasten a yoga strap around your buttocks and the tops of your feet. Then, lie back over the bolster and tighten the strap (no more than is comfortable). If your chin is higher than your forehead, place a folded blanket under your head (figure 9.1). Stay in the pose for several minutes, breathing gently in and out through your nose.
Marian Garfinkel has a platform in her yoga studio, about the height of a high table, on which students with arthritis and other problems that restrict mobility can practice their poses. Not having to get up and down from the floor makes practicing easier, less painful, and safer. If you don’t have a platform, she suggests that you use a strong rectangular table, which you can make even more secure by pushing it against a wall. Start by standing with your back to the table, move your pelvis back onto the table (left), and then swing your legs up (right).
EXERCISE #2. HALF STANDING FORWARD BEND (Ardha Uttanasana), with hands on the wall, one minute. Start by facing a bare wall, standing approximately two feet from it, with your feet parallel to each other. Place both your hands on the wall, a bit lower than shoulder height. Step back one foot at a time until you are far enough away from the wall to bend at your hips and stretch your arms straight in front of you (figure 9.2). Keep your feet directly under your hips and elongate your legs. Try not to round your lower back. Rather, allow your lower back to retain its natural inward curve.
Marian used this pose both as a diagnostic tool and to teach Liz proper alignment of the legs, with the ankles, knees, and hips stacked evenly. Normally in this pose, the hips should be even, but Liz’s left hip was higher than the right, in part due to all the muscular tightness in her right leg. As is common in runners, Liz was putting most of her weight on the ball of the foot and less on the heel, especially on the right side. An additional benefit of this pose is that it gives traction to the spine, which helps take the pressure off the knees.
Because Marian felt that Liz had not yet learned to use her legs properly in asana, she asked her not to do any other yoga until their next lesson, out of concern she’d end up doing more harm than good. Marian says that getting alignment right is vital for a condition like arthritis, so the only homework she gave Liz was to be aware of how she walked and how she sat, observing precisely what she was doing with her knees and legs. Marian’s goal with these self-study exercises was to help put Liz more in touch with her body, to begin to cultivate awareness in her everyday life. To avoid further knee damage, Marian asked Liz not to cross her legs when she sat.
LESSON 2
Liz returned the following week for her second lesson. She’d had some improvement in knee pain, and Marian felt she was now ready to begin more difficult standing poses.
EXERCISE #3. WARRIOR II POSE (Virabhadrasana II), with back to a platform, fifteen seconds. (At home Marian suggested that Liz use a high table, kitchen counter, or any other sturdy surface about that height.) Start by standing with your back to the platform, and place your hands on the surface behind you. Separate your feet three or three-and-a-half feet apart. Turn your right foot out ninety degrees and your back foot in fifteen to thirty degrees. Next, keeping your hands on the surface behind you, bend your front knee so that it is directly over your ankle (figure 9.3) and your thigh is as close to parallel to the floor as possible. Stay briefly in the pose and then come out by reversing your steps. Repeat on the other side.
The purpose of putting your hands on a platform is to give you stability and to take some of the weight off your legs.
EXERCISE #4. TRIANGLE POSE (Trikonasana), against a platform, with right foot propped on a slant board, thirty seconds. Start by standing on a yoga mat with your back against a platform (or high table, kitchen counter, etc.). The yoga mat will help keep the prop under the ball of your front foot from slipping. Place your hands on the surface behind you. Separate your feet to three or three-and-a-half feet apart (wider, if you have longer legs). Turn your right foot out to ninety degrees and place a slant board (a wedge-shaped yoga prop) under the ball of your front foot (figure 9.4b). If you don’t have a slant board, you can use a piece of two-by-four, a book, or any other object that lifts the ball of your foot. Sliding your right arm along the platform, lengthen the sides of your body and move your torso to the right to come into the pose (figure 9.4a). To come out of the pose, reverse your steps. Repeat the pose on your left side, propping the left foot. Do twice on each side for thirty seconds.
Because Liz’s adductor muscles (in her inner thighs) were tight, probably from all the running she had done, using the prop under her foot gave her more opening in the hip and greater freedom to move into the pose without risking compression of her knee.
Marian stresses that in Triangle pose the most important part of the pose is having a straight back leg. In other words, if you are doing the pose to the left, be sure to fully straighten the right leg. To straighten the leg, press strongly into your back heel while keeping the knee soft (so it does not lock or hyperextend). The work of the back leg is the element of the pose that Marian believes is most beneficial for knee osteoarthritis.
Although Liz had made good progress, Marian did not assign her these poses as homework because she wasn’t yet convinced that Liz could do them well enough to gain benefit and not risk harm. Instead, Marian asked her to continue her awareness training as before. She also asked her to simply sit in a chair and align her knees and ankles. From this position, she asked Liz to raise and lower her hands a few times, to try to release some of the tightness in her arms and back (figure 9.5).
LESSON 3
Three weeks later, Liz returned for her third lesson, already noticing an improvement in her symptoms. Marian says that she was able to do the poses with better alignment, more flexibility in the foot, and no compression in the knee joint. Marian therefore modified the way she had Liz do Triangle pose, removing the prop under her foot, and instead, having her turn her front foot out slightly more than the standard ninety degrees. Increasing the angle of the foot reduces compression of the knee, though not to the same degree as the slant board does. Eventually, as Liz gained flexibility and strength, Marian would have her do the pose in the usual way: without a prop and with her foot turned out just to ninety degrees.
EXERCISE #5: TRIANGLE POSE (Trikonasana), against a platform, with front foot turned out, thirty seconds, twice on each side. Follow the instructions for Triangle pose in exercise #4, placing your front foot directly on the floor (rather than on a prop) and turning it out to slightly more than ninety degrees (figure 9.6). Stay in the pose for thirty seconds, then repeat on the other side.
Because of the progress Liz had made in alignment and flexibility, Marian felt it was appropriate to add the hamstring stretches described below. They wouldn’t have been good for Liz when she first came in, because she was in pain then and Marian felt these stretches would have increased her pain, to the point where she wouldn’t have been able to walk the next day.
EXERCISE #6. SUPINE HAND TO FOOT POSE, TO THE SIDE (Supta Padangusthasana II), using a strap, fifteen to twenty seconds, two times on each side. Start by lying on your back, with your knees bent and the soles of your feet on the floor. Next, bring your right leg into your chest, wrap a cotton yoga strap around the arch of the foot, straighten your leg until it is perpendicular to the floor, and then transfer both ends of the strap to your right hand. Hold the strap with a light grip. Straighten your left leg along the ground, then allow your right leg to drop out to the side and pull it up toward your shoulder (figure 9.7). Keep your shoulders dropped and your hips level. Breathe through your nose, keeping your breath soft, and relax your temples and your throat. Hold the pose for approximately fifteen to twenty seconds. Repeat on the other side.
EXERCISE #7. SUPINE HAND TO FOOT POSE (Supta Padangusthasana I), using a strap, fifteen to twenty seconds, two times on each side. Start by lying on your back, with your knees bent and the soles of your feet on the floor. Next, bring your right leg into your chest, wrap a cotton yoga strap around the ball of your right foot, and hold the ends of the straps in both hands. Straighten your right leg and lift it up toward the ceiling and straighten your left leg along the ground. Press the ball of your right foot into the strap while creating resistance with your hands. The more you press your foot into the strap, the more you pull the belt toward you. Pull the outside of the belt a little more strongly than the inside (this helps open up the little toe side of the foot). Do twice on each side (figure 9.8).
EXERCISE #8. SUPPORTED RELAXATION POSE (Savasana), with chest elevated and support for the legs (figure 9.9), ten minutes. Marian suggests using blankets under the head and neck, and under the back from the waist up, both for elevation and the softness they provide. Set up for the pose by folding a blanket and placing it lengthwise on your mat to support your entire torso and head. Then sit in front of the folded blanket (but not on it) and lean back so the bottom of the folded blanket hits you at the waist. Place a second folded blanket on top of the first blanket under your head to support your head and neck. Place a rolled blanket with a diameter of three to four inches under the top of the thighs to support them, which takes the pressure off the knees.
Yogic Tool: VISUALIZATION. One of the common postural problems that teacher Joan Arnold, trained in both Anusara yoga and the Alexander Technique, sees in people with knee pain is the habit of pushing the pelvis down into the legs, which puts pressure on the knees. “When we think about the pelvis going up, it creates more space in the hip joints and frees the action of the legs,” she says. “The most efficient, effortless way to achieve this is to use our capacity to visualize.” To do the exercise, stand in Mountain pose (Tadasana) with your feet hips’ width apart. Once you settle into the pose, imagine a pure, central core of energy flowing evenly from the middle of the pelvis, midway between the pubic bone and the tailbone, up toward the head. Think of lightness in the pelvis and spaciousness in the hip joints. This helps you tap into the torso’s internal suspension system, which includes the pelvis. Try not to do anything muscularly to lift or push yourself up, though your muscles will probably make subtle adjustments in response to the visualization. Then return to your normal posture, and see whether you notice a difference between what you are used to and what you’ve just achieved. Your feet may feel heavier and more grounded.
Contraindications, Special Considerations, and Modifications
If you have arthritis, it’s generally better to move in and out of poses rather than hold them. The transitions should be slow and smooth, always coordinated with the breath. Don’t jump into poses, even if you’re in a class and that’s what everyone else is doing. If there is evidence of muscle fatigue, such as shakiness or increasing discomfort, it’s best to come out of the pose, as tired muscles may not be able to hold good alignment and the result can be further damage to the joint. If necessary, rest in Savasana between poses until you’ve regained your strength.
Squatting poses like Chair pose (Utkatasana, figure 9.10a) and Garland pose (Malasana) may be inappropriate for those with arthritis of the hips, knees, or ankles. One-legged balancing poses like Tree pose (Vrksasana) may put too much pressure on the joints of the standing leg (figure 9.10b).
In deciding whether a pose or series of poses is appropriate, it is important to evaluate both how you feel while doing the pose and how you feel afterward. More than your usual level of stiffness a couple of hours after practice, or the next morning, may be a sign that you need to scale back your practice, build up more slowly, or eliminate some poses entirely.
If you use pain medication for arthritis, try to take it long enough in advance of your practice to allow it to be absorbed into your system. This may require a couple of hours. Some “time-release” drugs should be taken several hours ahead of time. Check with your doctor or pharmacist. Over time, as you gain internal awareness from your practice, you’ll be able to fine-tune when to take your medication for optimal results.
The yogic approach for rheumatoid arthritis and other inflammatory types of arthritis needs to be different from that used in osteoarthritis, because there tends to be much more swelling of joints. “I would not ever start with standing poses with rheumatoid arthritis,” Marian says. She uses lots of props to provide support, suggests doing the poses briefly two or three times on each side, and builds up the duration of the practice very slowly to avoid a flare-up. When a joint is acutely inflamed—marked by warmth, redness, swelling, and/or increased pain—it may be necessary to rest the joint and concentrate on other yogic practices until the inflammation settles down. Practices such as breath work, chanting, and meditation are almost always appropriate. Simple restorative yoga poses which work the joints more passively may also be appropriate until you get to the stage where you can cautiously increase the activity.
Students who have had hip-or knee-replacement surgery need to take special precautions when doing yoga in the first several months after the operation. Even after the tissue is well healed, some yoga poses risk causing a dislocation or other injury. In general, you don’t want to push the joint that’s been operated on through its most extreme range of motion. Instead, focus on building functional strength in the surrounding muscles, and consciously limit the range of motion. Since there are a number of possible surgical approaches to hip replacement, and the movement contraindications vary depending on what exactly was done, it’s best to consult with the surgeon who performed the operation and the physical therapist involved in your postoperative rehabilitation before embarking on or resuming a yoga program. Twisting poses, forward bends, backbends, or asanas, which require extreme external or internal rotation of the hips (see appendix 1, “Avoiding Common Yoga Injuries”) may be off limits to you. If you’ve had knee replacements you should avoid one-legged balancing poses and asanas in which you squat, as this places the joint in a vulnerable position.
A Holistic Approach to Arthritis
Walking, swimming, or another form of aerobic exercise is advisable.
Topical medications like capsaicin, derived from red peppers, appear to be effective for arthritic joints near the surface of the body, such as the knees, but are less useful for joints like the hips.
Directly applying either heat to reduce stiffness or cold to cut pain can be surprisingly helpful.
Nonsteroidal anti-inflammatory drugs (NSAIDs, pronounced EN-seds) like ibuprofen, commonly prescribed for arthritis, have pain-relieving and—if used consistently in high-enough doses—anti-inflammatory properties, but may also cause serious side effects. Check with your doctor or pharmacist.
Some patients with osteoarthritis get good pain relief from the drug acetaminophen (Tylenol), which is a cheaper and generally safer option than NSAIDs.
Acupuncture is safe and can relieve pain.
Cognitive/behavioral therapy to learn coping strategies and to change self-defeating attitudes can be useful.
Even a few pounds of weight loss can lessen symptoms, especially for arthritis involving the legs or lower back.
High heels put most of the body’s weight on the ball of the foot, reducing its ability to absorb shock and putting strain on the knees.
Working with someone who understands functional anatomy, such as a good physical therapist or a teacher of the Alexander Technique or the Feldenkrais Method, can be very useful.
Two dietary supplements often combined in one pill, glucosamine and chondroitin, appear to be safe and effective in treatment of OA. More recently they have been combined in a topical salve.
S-Adenosylmethionine, or SAMe, appears to be safe and effective though is quite expensive. MSM (methylsulfonylmethane) may also be useful.
Vitamin D, which you can get from either a few minutes of sunlight a day (without wearing sunscreen) or via supplements, may lessen the progression of arthritic symptoms.
Oils rich in arachidonic acid, such as peanut and corn oil, may promote inflammation while omega-3 fatty acids, found in flaxseeds, flaxseed oil, and such fish as herring, mackerel, salmon, tuna, and sardines, tend to reduce it. Canola oil is a better choice for cooking. Fried foods, red meat, refined sugars, and trans fats can fuel inflammation.
A diet low in harmful fats and rich in whole foods such as grains, beans, fruit, nuts, and vegetables of a variety of colors, contains lots of vitamins and natural antioxidants, and can reduce arthritic symptoms. Bioflavonoids, found in berries and other fruit, appear to reduce inflammation in joints. Healthy nuts include almonds and walnuts.
Some alternative healers believe that nightshade vegetables, such as eggplants, peppers, tomatoes, and potatoes, may exacerbate arthritic symptoms and contribute to flare-ups of rheumatoid arthritis. Most conventional doctors disagree. The yogic approach would be to let your own experience guide you. If you suspect nightshades could be contributing to your symptoms, cut them out of your diet for a couple of weeks, and then see what happens when you add them back.
Ginger, a traditional Ayurvedic arthritis remedy, can be used in cooking or made into tea. Turmeric also has anti-inflammatory properties.
Dehydration can dry out the fluid in the joints, so drink plenty of water and other liquids.
For some with marked symptoms of pain and loss of motion, joint-replacement surgery is the best alternative.
Over the time Marian worked with her, Liz’s strength, flexibility, and alignment all improved. She was able to do more asana, and gradually reduced her need for props. More important, she experienced much less knee pain in the course of her everyday activities. The right knee never improved as much as the other, however, which Marian thinks was probably due to complications from the surgery. Liz was still doing well three years later when Marian bumped into her.
Marian had stressed to Liz the importance of consistent and mindful practice. “Even if you do ten minutes a day, that’s an hour a week,” she had told her. “What’s important is the regularity of it, not that you do an hour one day and nothing the next.” Liz got the message and has been good about keeping up a daily practice, however brief the practice often is.
Beyond giving her more mobility and less pain, the regular practice appears to have helped Liz reap psychological benefits. Marian says Liz seems more hopeful than she had been when they first met, even though she never did get back to running. Much of her improvement is likely a consequence of having found in her yoga practice concrete steps she could take to improve her condition. When you feel you’ve accomplished something, says Marian, it gives you a sense of empowerment, which can have a big impact on mood. Marian sees herself only as “a messenger.” The yoga practice does the rest.