Fiona Anderson was in her early 30s and working 12-hour days in a stressful job when her first episode of arthritis flared up. Diagnosed with spondyloarthritis, the disease affected Fiona’s feet, hands and knees. Medication and acupuncture helped, but Fiona also decided to make some positive long-term changes to her lifestyle. She left her job and started attending a yoga class at the local gym each week.

“I looked on yoga as not only being something that would help me with the arthritis but also something that I hoped I could do for the rest of my life, in whatever form,” she explains. “There were some poses that were difficult to start with. But I learned to work within my limits and the difference between what was an acceptable level of discomfort and what was pain. I also used props wherever I could.

“As well as increasing circulation to the joints, one of the great benefits was building up muscle strength that would better support the joint—something I found very helpful.”

A few years later, Fiona’s practice and interest in yoga deepened when she followed her teacher to her own yoga studio. Now, 15 years on, Fiona is herself a teacher at Hawthorn Malvern Yoga Centre in Melbourne—and a dedicated practitioner.

She continues to manage arthritis flare-ups with medication when necessary, but finds yoga is a wonderful preventative. She recommends standing poses including Vrksasana (Tree Pose), Utthita Trikonasana (Extended Triangle Pose) and Prasarita Padottanasana (Wide-Legged Forward Bend) as helpful, as well as some of the more sedentary poses such as Sukhasana (Easy Pose), Virasana (Hero Pose) and Vajrasana (Thunderbolt Pose).

Fiona has also found yoga breathing techniques useful in managing the anxiety that often accompanies the daily pain, stress and fatigue of arthritis. “There have been times, with different stresses, where I don’t feel like doing a physical practice but take half an hour of pranayama and restorative poses—and that’s wonderfully helpful,” she explains.

The Epidemic

Arthritis, a general term referring to disorder of one or more joints, is considered the major cause of disability and chronic pain in Australia. One in five Australians suffer from arthritis, or 3.85 million people and it is estimated that this number will increase to 7 million by 2050.

According to the report Painful Realities: The Economic Impact of Arthritis in Australia, the allocated health system expenditure associated with arthritis is $4.2 billion or $1100 per person with arthritis. The cost to the economy is $23.9 billion a year in medical care and indirect costs such as loss of earnings and lost production.

There are more than 100 known types of arthritis, with the three most significant—osteoarthritis, rheumatoid arthritis and gout—accounting for more than 95 per cent of cases in Australia.

There are more than 100 known types of arthritis, with the three most significant—osteoarthritis, rheumatoid arthritis and gout—accounting for more than 95 per cent of cases in Australia.

Dr David Hunter, Professor of Medicine at The University of Sydney, is a rheumatologist epidemiologist specialising in osteoarthritis. He says that to every one person who has rheumatoid arthritis, 20 have osteoarthritis. “Many people consider osteoarthritis an inevitable part of ageing,” he says. “But some 70 per cent of cases are eminently preventable. When you look at knee osteoarthritis for example, 50 per cent of cases are brought on by overweight and obesity. The other common risk factor is knee injury, or tearing of the meniscus.”

Rheumatoid arthritis, on the other hand, is an autoimmune disease. Its cause is not known, though it is thought to be a product of genetic make-up or exposure to an organism in the community. (Learn more about the different types of arthritis below.)

The Role Of Yoga

Dr Hunter, who practises yoga, says that regular, moderate exercise is critical for people with arthritis, particularly those with osteoarthritis. Exercise improves the integrity and function of the muscles around the joints, ultimately reducing stiffness, pain and swelling.

While he stops short of prescribing yoga for everyone, as arthritis is a very individualistic disease, Dr Hunter does endorse yoga for those willing to embrace it. “Simply by virtue of the activity involved in yoga, it can help with the performance and function of the musculoskeletal system,” he says. “In addition, yoga can help with breathing performance and increased mental energy. Anxiety and depression are common problems for people who have arthritis.”

He adds that Bikram or heated yoga could benefit some people with arthritis in the same way Scandinavian doctors recommend saunas or spas for providing heat to the joints for improved movement.

Supplements and Diet

Diet comes into play with arthritis and Dr Hunter says there is evidence to suggest that supplementing the diet with omega-3 fatty acids (fish oil), vitamin D and vitamin K can improve the function of arthritic joints.

A Doctor’s Home Cure for Arthritis (Thorsons, 2002) by American osteopath Giraud W Campbell, recommends gentle exercise and a dietary approach. Campbell suggests the elimination of gluten, while supplementing the diet with omega-6 and omega-3 fatty acids, vitamin E and C.

Some people experience arthritis flare-ups from citrus fruit and nightshade vegetables (such as potatoes, tomatoes, eggplant and capsicum).

He says that while the effects of foods on arthritis symptoms vary greatly, some people experience arthritis flare-ups from citrus fruit and nightshade vegetables (such as potatoes, tomatoes, eggplant and capsicum).

Osteopath and acupuncturist Tim Hulbert recommends Campbell’s book to his clients and says he has seen dramatic results. Hulbert is also a partner and yoga teacher at Power Living in Sydney, and has seen first hand the benefits of yoga on arthritis—particularly from the people who come regularly and often to class.

Like Dr Hunter, Hulbert advocates a heated yoga room for arthritis patients (Power Living heats the room to 30°C).

“Yoga will release a whole lot of hormones and chemicals and this reduces general inflammation of the body,” he explains. “The main thing I see with osteoarthritis is joint malalignment. Osteoarthritis is an uneven wearing away of the cartilage, caused by uneven alignment of the joints. If you’ve got a hip joint that’s not lined up properly or you’re putting a lot more weight through one side of your body constantly, it’s going to wear away.

“So if you can align the joints, which yoga and osteopathy do, Feldenkrais or Alexander Technique, or whatever you choose, you can either prevent, slow down or cure the symptoms of osteoarthritis.”

Yoga Therapy

Yoga therapist Leigh Blashki, a director of the Australian Institute of Yoga Therapy, also recommends a more individualised approach. “It’s not formulaic. In yoga therapy we do not treat conditions. There is no such thing as yoga therapy for the condition, there is yoga therapy for the person. We must treat everybody individually. There is no ‘one size fits all’.”

He highlights the importance of a yoga teacher understanding what type of arthritis a student has, and that each type can present differently in each person. “In yoga therapy, we believe that a person with osteoarthritis generally has a cold disorder, while rheumatoid is a hot disorder,” he explains.

“We must treat everybody individually. There is no ‘one size fits all’.”

“With osteoarthritis, that means we are trying to warm them up. It’s like we have a stiff hinge on the door and very gently move the door a little bit, a few centimetres at a time, small movements just gradually increasing the range of motion, but lots and lots of little movements to get the door moving again. If you just came and got the door and wrenched it into its full range of motion you’d brake the hinge.”

Blashki doesn’t advocate hot yoga for most rheumatoid arthritis patients, and he likes to use less movement in order to keep the system cool. “Restorative yoga, generally, is a good approach for the inflammatory stage of rheumatoid arthritis. We don’t force the body into anything that it’s not ready for at the time and we tend to support the body a lot more because the body is inflamed or overheated.” He says that for many arthritis sufferers, the gentle “wind-releasing” poses of Satyananda Yoga’s Pawanmuktasana series are very helpful.

For new students, it’s all about finding a style and a teacher they connect with. Blashki says a gentle all-round hatha yoga class is a good starting point if the student has not progressed to an aggressive stage with their arthritis. “But if their arthritis is advanced then they should certainly be seeing a yoga therapist,” he advises.

Finding Acceptance

As for Fiona Anderson, she recalls a recent “Savasana aha moment”, when she realised her arthritis wasn’t all bad news. “Fighting and resisting a chronic disease isn’t the way to go,” she reflects. “It’s going to be there for the rest of your life so you actually need to work with it, then it stops affecting the way you think.

“If I hadn’t had the arthritis I may have never found yoga, which has been one of the most positive things I’ve done in my life so far. Strangely enough, I feel I have a lot to be thankful for.”

Poses for Relief

Just as each person’s experience of arthritis is different, so are the suggested yoga practices to assist them in easing pain. A yoga therapist or yoga teacher knowledgeable in arthritis will be able to devise a routine for your needs. BKS Iyengar, in his book Yoga: The Path to Holistic Health, offers the following poses for arthritis. Depending on your condition, modify the postures or use props such as blocks, blankets and bolsters, and with practice over time, the full poses may be accessible to you.

Supta Virasana (Reclining Hero Pose), for the ankles

Adho Mukha Svanasana (Downward-Facing Dog Pose), for the shoulders, wrists and fingers

Viparita Karani (Legs-Up-the-Wall Pose), for the whole body

Ustrasana (Camel Pose), for the spine and back

Upavistha Konasana (Wide-Angle Seated Forward Bend), for the hips

Bharadvajasana I (Bharadvaja’s Twist), on a chair, for the lower back

Tadasana Urdhva Baddha Hastasana (Mountain Pose), with fingers locked, for the whole body, arms, shoulders and fingers

Types of Arthritis

Osteoarthritis

By far the most common form of arthritis, this develops when articular cartilage, the smooth covering over bones in the joints, starts to break down. It is usually as a result of trauma, ageing or failure of joint repair and maintenance mechanisms. Symptoms include stiffness, pain and tenderness in joints, surrounding muscles and ligaments, possibly with fatigue; reduction in motor skills; and deformities. It usually affects the hips, knees, lower spine, neck and hands.

Rheumatoid arthritis

This is a progressive disease with onset most likely between the age of 25 to 50, and more prevalent in women. The synovial membrane that lines joints is thickened and an over-production of synovial (joint) fluid occurs. Joints become painful, swollen, stiff and, as the process continues, deformed from damage to the cartilage and other soft tissue. Other symptoms can include fatigue, interrupted sleep, weight loss, anaemia, nodules, ulcers, atrophic skin, muscle weakness, impaired joint function and inflammation of the heart, lungs, eyes, nerves, blood vessels and lymph glands.

Gout

Caused by the reaction of defense cells in joints to the presence of uric acid crystals. Gout is characterised by severe acute attacks of joint pain and swelling of joints such as the big toe, the ankle, knee and elbow. An excess of urates (formed by uric acid) can also cause kidney damage, including the formation of stones.

Systemic Lupus Erythematosus (SLE or lupus)

SLE is a chronic inflammatory autoimmune disease of the connective tissues. It affects the skin, especially in sun-exposed areas such as the cheeks, which become red and scaly, and various internal organs (kidneys, heart, lungs and brain can all be affected by inflammation and the subsequent scar tissue). SLE often causes general fatigue, tiredness, loss of concentration and memory.

Ross River Virus

This mosquito-transmitted virus causes epidemic polyarthritis, which is an acute arthritis in many joints causing severe aches and pain. It does not usually damage the joints like rheumatoid arthritis, but the arthritis and fatigue can sometimes last for years before the joint returns to normal. Symptoms include chronic fatigue, rashes, severe headaches, impaired concentration and memory as well as depression.

Katie Sutherland is a freelance writer and yoga practitioner.

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