There’s long been debate about whether yoga is manageable for people with rheumatoid arthritis (RA). HealthCentral reached out to Anne, a yoga instructor who has RA, about her modified approach to yoga, to provide perspective for people who may have questions about their ability to do yoga.
HealthCentral (HC): Have you had students with physical limitations, particularly students with RA, who have had to make modifications?
Anne: My class members have included those with MS (multiple sclerosis) , RA, OA (osteoarthritis), Parkinson’s Disease (PD), polymyalgia, osteoporosis, Lyme disease, fibromyalgia, ankylosing spondylitis, scoliosis, various cancers, COPD (chronic obstructive pulmonary disease), heart disease, and more. Basically, it is a "Come as you are, with the body you woke up in today" type of class.
HC: There are so many different kinds of yoga. Is there a certain kind you think is more conducive to people who must make modifications for their bodies?
Anne: Restorative yoga is most likely to include enough modifications. "Gentle yoga" or "chair yoga" would be names of classes also likely to provide significant modifications. Some people think chair yoga will be a "cheat," but using a chair as an alternative floor for support in standing poses actually allows a participant to work with correct alignment and to work with the essence of a pose.
HC: Are there any warm-ups or practices you recommend to make the experience easier on impacted joints?
Anne: I start with a 15-minute warm-up that moves each joint into a gradually increasing range of motion (or not, depending on what's going on with that joint that day). I start from the head down with head tips side-to-side, neck rotations, small chin lifts, and chin drops. These evolve into side reaches, gentle twists, and a seated modification of cat/cow (all include modification for those with osteoporosis and spinal concerns). A thorough series of hamstring, calf, ankle, and foot warm-ups happen before standing poses occur.
HC: What poses cause the most need for modification, and what are some adjustments or modifications you’ve made?
Anne: Using the wall, a chair back, a barre, etc., is great for those with unstable swollen joints during standing poses. Those with swollen feet, ankles, and/or knees may wish to wear supportive shoes for standing poses — also for those where the toes are being flexed. There are also chair-seated versions for all standing poses. Many poses are possible if broken down into one or two essences to be practiced instead of the full expression of the pose. So I might teach these break-downs first and then add optional extensions into the fuller pose. That allows participants to feel comfortable staying in the first phases, knowing they are doing the practice as much as those doing the "full" pose.
HC: Do you see people with physical limitations still experience the rewards of yoga? What rewards are there?
Anne: I have had the "advantage" of having RA and the need to experiment with modifications for poses. I have also seen what my class members need, so create from their needs as well. I don't find their needs to be an impediment to teaching yoga, but an enhancement to the practice.
It turns out taking care of the body's needs creates a better yoga practice for everyone. I’ve seen individuals who began in pain and left moving with less to no pain — individuals with tears in their eyes so relieved that they could move more than they thought they could. The breathing and meditation is particularly helpful for those of us who live with chronic pain and the anxiety of what is next for our bodies. Yoga is a practice, not a product, and that means if we can breathe we can do it, benefit from it, and rejoice in it.
HC: Do you have any other resources for people who might be interested in more information?
Anne: At one time I studied with Peggy Cappy, who wrote "Yoga for the Rest of Us" and teaches/certifies yoga instructors to teach modified yoga. She has many DVD's of yoga for various needs.
Thank you, Anne, for this helpful breakdown of modified Yoga! As always, before trying something new for your body, we recommend you consult with your rheumatologist.