(Note: yoga instruction is best on a one-on-one basis with a qualified yoga instructor, particularly if you have not practiced yoga before. Consult your rheumatologist before starting a new exercise program.)
These days, yoga is all over place; celebrities are doing it, schoolteachers are doing it, dogs are apparently doing it. But if you have rheumatoid arthritis, you might be one of the seemingly few not doing it. Luckily, having RA doesn't mean you can't. There are still ways to reap the benefits of a yoga practice even if your range of motion is limited and your joints are misbehaving.
A good place to start if you are returning to your yoga practice is to remember the three P's: Props, Pace and Poses.
In the past, you may have practiced yoga with just you and your mat. That might have worked before, but if you are dealing with RA or any other physical issues, then props are your new best friend. Some props that you will want to have near you are yoga blocks (try to find solid, sturdy blocks as opposed to foam blocks that offer less structure and support), a belt or strap, blankets and a yoga bolster or firm pillow. They will make everything easier and allow you to get the most out of your practice. You can sit on blocks during meditation and you can use them as a stopgap between the floor and your hands in many poses. Blocks will help you keep proper alignment and will bring the floor up to meet you where you are. You don't have to struggle to get your hand all the way down to the floor in a pose like triangle. Remember, practicing yoga isn't about looking a certain way, so let go of any prior expectations of how you are supposed to look (or how you used to look) in each pose. Straps are helpful in many restorative poses, such as legs up the wall. By using a strap to keep your legs from sliding apart, your leg muscles can completely relax, allowing you to get more out of the pose and do less unnecessary work. Straps can also be used to extend your reach in certain poses.
Blankets, bolsters and pillows can be used to make your yoga practice feel more like a spa treatment. You can sit on them during seated poses to ease stress on your hips and hamstrings, and you can use them to support different parts of your body during restorative poses so that you can fully relax.
I was a fan of props before my RA, but now I consider them indispensable.
Many types of yoga, such as vinyasa, ashtanga or flow yoga, keep the body in continuous motion and use the breath as a link between different poses. This way of practicing can be quite vigorous and aerobic. It may still be an appropriate way for you to practice depending on the state of your joints and your stamina, but as many of us know, what used to be invigorating can now be just the opposite with RA.
In coming back to my own practice, one of the key changes I made was to slow down. A lot. Rather than jumping in and going strong for an hour or more, I now begin my practice by meditating for ten minutes. It helps me take my own mental and emotional temperature so that I can assess how I'm feeling that day. Do I already feel tired? Is a part of my body struggling just while I'm sitting down and breathing? Or, do I feel pretty good and ready to move? Taking the time to check in with yourself before you even begin to move is crucial in making sure you practice yoga in a way that makes sense for you that day.
Once you start moving, make sure to keep checking in during and after each pose. Did that sun salutation make you feel more or less energetic? Did warrior 1 make you feel like you were building your strength or eroding it? Remember that creating awareness is at the heart of practicing yoga, so moving blindly through poses or pushing yourself to keep up with a certain momentum misses the point, especially if it ends up backfiring and landing you in bed the next day from exhaustion.
It's also important not to bite off more than you can chew. In the past, maybe your practice included a full range of poses. Now, doing only two or three might be a better choice.
And now we get to the tricky part. If you practiced yoga before your RA, you may find that some of the poses you practiced easily before are no longer accessible to you, or, even if you could do them, the risk for injury and strain outweighs the possible benefits.
In general, it's a good idea to minimize or avoid poses that will place your wrists in extreme positions where they are also bearing weight, such as caturanga, upward-facing dog, arm balances and even downward-facing dog. Similarly, if your feet and ankles are really bothering you, developing a practice that includes mostly seated or prone poses will offer you a more rewarding practice than suffering through standing poses that stress out your vulnerable toes, ankles and knees.
This is where props come in particularly handy. Many standing poses can be flipped over and practiced lying down using straps.
For instance, if practicing a low lunge isn't in the cards one day, flip over onto your back and have a strap or belt handy. Begin with your legs stretched out along the floor, as if you were standing up. Flex the feet and make sure your toes and knees are facing up towards the ceiling, rather than off to the side. Engage your abdominal muscles and make sure your spine, including your neck, is not askew. The backs of your shoulders can relax and rest against the floor as your arms stretch out alongside your body. At this point, you are probably putting in some pretty good effort and you haven't even done anything yet.
Next, keeping both feet flexed, lift your left leg and bend your left knee, bringing the knee up towards your left shoulder. Lift your left foot so that the sole of the foot is facing up towards the ceiling, as if you were standing on the ceiling. Bring the left knee as close to your left shoulder as you can without losing the alignment of your spine and right leg, which should be working this whole time keeping the right toes and knee facing up and the muscles engaged. Next, bring your left hand up to your left foot and grab hold of your foot across the arch, or if your arms aren't long enough to reach your foot, use your strap by looping it around the arch of the foot and holding onto the strap with your left hand. Keep breathing fully and steadily for five breaths, using the strap or your hand to gently encourage your left hip to open up and stretch, then slowly release and do the same on the other side for five breaths.
You've just gotten all the hip-opening benefits of a low lunge but with much less strain than if you had been standing, and practicing this pose while lying down helps your spine relax since it isn't working against gravity.
Yoga can be a great way to add movement back into your routine even with RA. Finding a good instructor who can help you modify poses in person is the best way to practice, but if that isn't available to you, there are many yoga videos and books out there. Particularly if you are just starting out, look for instructional videos that are for gentle or basic yoga. The Iyengar School of Yoga is known for its emphasis on modifying poses with props, and restorative yoga is a great way to get the benefits of yoga without any strain at all.
RA changes many things, including the way you exercise, but one of yoga's greatest attributes is that it can be adapted and modified to support you on your good days or your bad days.
Sara is also the author of the blog, The Single Gal's Guide to Rheumatoid Arthritis.