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Yoga for Arthritis : Modifying Yoga Poses for those with Arthritis

(peaceful music) – Hi, I’m Dr. Steffany Moonaz, Director of Clinical and Academic Research at the Maryland University of Integrative Health. For 15 years now, I have been studying the effects of mind body practices for people with rheumatic diseases. In fact, my research in that area began right here at Johns Hopkins University in this very room, conducting yoga classes for people with osteoarthritis and rheumatoid arthritis. What we found in that study, which became the largest and most rigorous randomized controlled trial studying the effects of yoga for people with arthritis was that it can improve the symptoms of arthritis. Practicing yoga just two or three times a week for about eight weeks resulted in improvements in pain, in physical function, in physical fitness, and in mood.

Sometimes people living with arthritis can feel intimidated from approaching a yoga practice especially when yoga classes are often geared toward people who are physically fit and more mobile than the arthritis population. I’m gonna show you a few ways that you can modify a yoga practice to make it more accessible, safer, and more comfortable for people living with arthritis. That includes safe ways to get up and down from the floor, ways to modify the poses for both wrists and knees, and yoga poses that you can do seated in a chair.

To get down to the floor safely and comfortably, we’re going to use a chair, some cushioning on the mat, so something like a folded up blanket or pillow, and then the mat you wanna make sure that your chair is on the mat all four legs, so that it’s not likely to move when you put your weight into the chair. So we’re gonna start standing facing the chair and then we bend the hips and knees just slightly keeping a nice long spine so that we can bring the hands down to the chair, you can hold onto the chair arms, bring the hands to the chair seat, or you could have the chair turned around the other way and hold onto the back.

Either way, we’re gonna bring the weight of our hands into the chair and then lower one knee down, and you’re gonna put the knee on that cushion so that it’s a little bit of support for that knee. Lower the knee down, you bring a hand to the floor and take a hip down and then you’re seated for yoga poses that happen on the floor. So of course to come up to standing, you can do the reverse. Bring yourself onto that cushion for the knees, the hands go on the chair, step one foot up and plant it, put weight into the hands, and then come to standing, take a nice long spine and walk yourself up to stand.

A lot of yoga poses require putting weight into the hands which can be uncomfortable for people who have arthritis in the wrists, in the hands, or in the fingers. So there are a few modifications that can be used in order to make the poses more comfortable. I actually have wrist pain and use these modifications myself. So one of the options instead of bringing the wrists right underneath the shoulders, is just to take the hands a little bit forward which reduces the angle at the wrist. Another is to fold the front of the mat so that it provides a little bit of cushioning and put the wrists on the mat while the fingers come over the front. Additionally, you can tent the fingers so that the fingertips are on the mat but the palms are not. You can also use fists so that the wrists are straight, if that’s comfortable for the hands. Lastly, these are yoga blocks and yoga blocks have three different heights.

So they can be at the lowest height, at the medium height, or at the highest height and in any of these positions you can bring the forearms to the block and have the hands on the outside. It’s most stable if they’re at the lowest setting, forearms resting here, and then the hands can be in whatever position is comfortable for you. Sitting cross legged on the floor is common in yoga practice and it’s not necessarily comfortable for people who have arthritis or knee pain which is the most common joint to be affected by arthritis. There are a few ways that we can adjust a seated position in order to make it more comfortable. One is to take some yoga blocks and place them underneath the knees to lift up the knees a little bit and as I showed you earlier, there are several different orientations for the block so that you can raise them up a little bit higher if that feels better.

This might be uncomfortable for some people’s hips so you wanna find that place that feels good for both your knees and your hips. Another is that your feet don’t necessarily need to be so close to the body, so one way to make it more comfortable for the knees is just to take the feet a little bit further away and it’s not important that they’re tight into the body, you can even have the legs extended more and have the soles of the feet together. It’s also fine if you’re sitting in this position for a long time, to extend one leg. So if you notice that one of your knees is getting uncomfortable, it’s fine to extend the leg out to the side for a little bit, even give the knee a little bit of a massage, and then bring it back into position when you feel comfortable. Another option is to come into an entirely different seated position. So you can come onto the knees and while it may seem like putting weight on the knees wouldn’t be comfortable for knee arthritis, you can put down a blanket or a pillow underneath the knees for support and then sit up on something and that can actually also feel a little bit better for the hips because it’s not so much external rotation in the hips, so this is another option and then of course lastly you can do all of the yoga poses seated in a chair.

So if none of these positions are comfortable for the knees, everything can be adapted to sitting in a chair, which might feel better for your joints. I’m going to demonstrate three different yoga poses that can be done seated in a chair. You can think of these as a nice break from your workday if you’re sitting at a chair, at a desk, for a long period of time. You can use these when you stop at a rest stop and you need a little break or a stretch, or any time you find that you’re sitting for long periods and you could use a little bit more movement. When we’re seated in the chair, we wanna be mindful of the angle of the joints. So you wanna make sure that your knees and hips are aligned. And for some people you might wanna sit up on a little pillow or cushion so that it’s more comfortable for the hips. And then take a look at the ankles, make sure that the ankles are lined up right underneath the knee so the ankles are not the inside or to the outside of the knees.

And that has a more even distribution of weight for all of the joints. This is what we might call Seated Tadasana or Seated Mountain Pose. We’re tipping to the front of the pelvis, drawing the shoulders back and down, letting the shoulder blade slide in and down the back as opposed to the position that we might often find ourselves in, we wanna reverse that so that the chest and heart is open, chins parallel to the floor, not forward, not back, not up or down, eyes straight ahead, full deep even breath and as you breathe, you should notice that the abdomen expands as you inhale, and then retreats as you exhale so that you are getting the full benefit of deep breathing which we know is associated with a lot of health affects as well. So in this position, we’re gonna start mobilizing the spine in what we call Cat/Cow Sequence and this is oftentimes done on the hands and knees but it can also be done seated.

So we start moving into Cat by drawing the bellybutton in toward the spine, rounding the back, letting the head curl, chin lowers toward the chest, rolling back onto the back of the pelvis, and then reversing that, bringing the abdomen forward, arching the back, you might draw the elbows back in, and feel an expansiveness in the lungs, fullness in the breath, and you can move through that sequence, exhale as you round into Cat, inhale as you arch into Cow. You might find that it feels good to have the arms sliding forward and back on the thighs as you execute that sequence. And then after a few rounds, bring yourself back to center, maybe roll the shoulders, feel the length in the spine, and notice the effects of that sequence.

Another pose that can be done seated is a side stretch, so we’re gonna start by creating length in the spine and you can bring your hand either to your shoulder, to your hip, into what we call Cactus Pose or right alongside the ear. If this doesn’t feel comfortable for your shoulder, then be sure to choose one of the other options. From here, we’re gonna take a side stretch and you can put your other hand on the seat of the chair or the arm of the chair or in your lap, whatever feels stable, and you’re gonna feel the pelvis really grounding into the chair as you lengthen through the spine, and take a little side bend and feel that side stretch all the way through the whole spine, from the cervical spine down to the lumbar spine.

And you’ll feel an opening in this whole side body here, really reaching out through the fingertips and it doesn’t matter how far the arm reaches, just that you’re feeling a nice stretch in the side body. And that you continue to breathe fully and deeply in this position. And then come up, lower the arm down, and then you’ll repeat the same thing on the other side. Arm up into whatever position feels comfortable, lengthen through the spine, take a nice side stretch over, full deep breath, and then as you’re ready come back up, lower the arm down and find that Seated Tadasana that Seated Mountain Pose again. Lastly, we’ll move into a spinal twist. So for the spinal twist, you’re gonna take one leg and cross it over the opposite leg only if that feels comfortable. So you could cross the ankle over if that’s available to you, you can cross the legs here or you can keep the feet flat on the floor.

In any of those orientations, again you’re gonna find the length in the spine and starting at the base of the spine, very slowly start to twist one vertebrae at a time so that the head is the last thing to go as you look over your shoulder. You can bring the hands to wherever they feel comfortable, so perhaps a hand on the opposite knee, and you wanna make sure that you’re not holding on and really pulling into that pose because you want this to be gentle and you wanna be sure that you’re able to breathe fully and deeply here without any exacerbation of pain in the spine so if you’re feeling any discomfort you wanna just back off a little bit, find the length, and breathe into the pose. And then to go the other way, you come back to center, you can choose to cross the leg if you’d like, sit up nice and tall and then again very slowly begin to twist over to the other side, gazing over the shoulder, breathing fully and deeply, soft easy gaze, relaxed muscles of the face, and then as you’re ready come back to center.

Release the leg, and find that Seated Mountain again..

As found on Youtube

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