Arthritis and Yoga

 by Upasana

My interest in arthritis went up a few notches from purely academic to intensely personal when two years ago I was diagnosed with arthritis in my right hip, after several months of near constant pain in that area. I was not unused to experiencing pain here, having been hit twice by a car, once at the age of 13, when my right femur was badly fractured, and again at age 21. In the second accident my right hip was badly bruised without being broken. Twenty–five years later the chickens came home to roost – arthritis often develops in a site of earlier injury.

The only comforts held out by the doctor were anti-inflammatory tablets and the possibility of a hip replacement down the line. Instead I took apart my daily Yoga practice in an attempt to discover how it might be improved so as to address this specific problem, thereby benefiting not only me, but hopefully many of my students who were also suffering from arthritis, mainly of the hips.

I didn’t confine my explorations to the field of Yoga, but read and experimented as widely as possible. One helpful book was by Dr. Paul Lam, a doctor and practitioner of Tai Chi who was so crippled with arthritis at a relatively young age that he could barely drag himself upstairs. He put together a modified form of Tai Chi, to be preceded by a series of gentle warm ups, which involved putting the joints through as full a range of movements as possible – not unlike Pawanmuktasana, although some of the movements felt quite new to my body. Standing work made use of a chair for support, and I continued to use one myself for many months (and still do, occasionally, when teaching).

If arthritis has arisen out of an earlier injury, there is likely to be a long history of both conscious and unconscious protection of the area. Even now, if I visualise any impact to my right hip, I can feel my heart racing and my breathing become shallow with the anticipation of pain, far more so than if I were to visualise any other area subject to impact, simply because a major part of my anticipation consists of the vivid memory of actual pain. The related issues of anticipation, letting go, and relaxation will be looked at later. First I will describe two of the exercises using chairs, plus a couple of others that have been of great help.

Exercise 1: Face the back of a chair, hands resting lightly on the top of its back, standing with awareness of skeletal alignment. Establish a steady breath rhythm. Taking most of your body weight into your left leg whilst keeping your pelvis aligned, move your right leg backwards, initiating at your hip, feeling how the direction of movement is established by that hip’s ball and socket joint. With your right toes resting lightly on the floor, direct your right heel towards the floor without actually bringing it to the floor. After breathing steadily for 30 seconds or so reverse the movement. Repeat a few times before changing legs.

Exercise 2: Have a chair to your left, so that your left hand can rest on it for balance. Take your body weight into your left leg, whilst keeping your pelvis aligned. Establish a steady breath rhythm. Raise your right leg so that it forms a right angle, thigh parallel to the floor. Let your foot hang down from your ankle. Alternately extend and flex your lower leg a few times, initiating at the hinge joint of your knee, then allow the lower leg to dangle without tension. Be aware of your body weight passing down into the ground through your left leg. Work on the opposite side.

Initially I could take my body weight on my right hip for short periods only, clinging on to the chair for dear life. However, with gentle perseverance, working for a few minutes each day on these exercises, I was eventually able to dispense with the chair. I then began to concentrate on working towards some of the classical weight bearing and balancing asanas, such as Eka Padasana, which I can now practise without pain, if not without sometimes falling over! The enforced ‘go slow’ period highlighted the value of establishing a firm foundation and some understanding of the principles involved in any asana before launching into it. If a movement does not feel easy, smooth and effortless, it is important to return to basics to discover why this is so.

Two other exercises specifically for the hip were introduced to me by Shyama Chandra on one of her excellent Hatha Yoga Intensives held in the Ashram each spring:

Exercise 3: Lie in semi-supine (on your back with knees bent, feet on the floor, parallel and hip-width apart). Let your arms be comfortable, either resting on the floor a little way from your body, or with hands resting on your abdomen or lower ribs. Raise your right foot a few inches from the floor, allowing your lower leg to dangle from the knee. Be aware of an axis running from floor to ceiling through your right thigh, and begin to rotate around that axis in polo mint-size circles, aware of the movement initiating from your hip. Move very slowly. Gradually increase the size (but not the speed) of your circles, until they are side-plate size. Pause then reverse the movement, until you are moving, barely perceptibly, around that central axis. Release your foot to the floor. Work on the left side. Breathe steadily throughout. Slower movement brings about a deeper release.

Exercise 4: From semi-supine position extend your right leg at 70-80 degrees from the floor. Keeping the leg straight, rotate it to the right and then left, turning your whole leg first in the direction of your big toe, then in the direction of your little toe. Your leg remains in the mid-line of your body. Breathe steadily throughout.

Good breathing cannot be over-emphasised. We have a tendency to breathe more shallowly, and even hold our breath, when initiating a new movement or changing position. Holding the breath in this context indicates a conscious or unconscious expectation of pain or danger, and that alone can cause muscles to stiffen. In Yoga we are often told to find/observe the natural rhythm of our breath. Do we have any idea what that is? Is it not likely that we lost touch with it at the same time as we began to lose the ease and grace of a young child’s movements? The defensive armouring of our musculature and conditioning of both body and mind lead us far away from natural rhythms and spontaneous impulses. Breathing is involuntary, and its mechanisms are deep, complex and subtle, far more so than any voluntary controls we might attempt to put upon the process. Bearing this in mind, imagination can be of greater use than sheer willpower. Excessive effort results in physiological stress symptoms which take blood away from the cortex of the brain and inhibit integration of right and left hemispheres, vital for an enjoyable and thus effective learning experience. Thinking of breathing as a passive rather than active process gives us more chance of getting in touch with our involuntary breathing mechanisms. Thus we allow the breath to be released, and, when it’s ready, to be re-filled. We imagine our bodies being breathed, reminiscent of that hymn, “Breathe through me breath of God”. The etymological link between ‘breath’ and ‘spirit’ points to a deeper experience of being. In the practice of Yoga, the feeling of letting go can coexist, paradoxically, with a measure of self-discipline. We can let go in a number of ways. Within the context of a class it can mean not anticipating the teacher’s next instructions, but taking them as they come. This can be very difficult for some people - our culture is forever urging us to get ahead. It means allowing yourself to flow with the teacher’s instructions, an exercise in trust, whilst recognising and honouring your limitations. Letting go can also occur within the context of an exercise, a split second relaxation of an arm in the pause between lowering and lifting, or the gradual identification and melting of tensions which allows us to ease into a position and explore it without rushing. This physical letting go in time translates into an attitude of mind, a ‘manas mudra’ which can have only a positive effect regarding disease and lifestyle.

I have mentioned alignment a few times when describing the exercises. Alignment and economy of movement go hand in hand. However alignment is not so easy either to recognise or establish. Our sensory perception is by and large unreliable (which is why it is necessary to be observed by a teacher until we re-educate the use of our body) and physical conditions such as arthritis can make it near impossible to maintain a steady alignment of the body. Yet that need not thwart us! We can practise awareness of alignment in positions other than standing – in semi-supine, or in a prone position where we can trace the line from forehead to sternum to navel to pubic bone to between our big toes. It’s that development of awareness which is infinitely more valuable than merely looking ‘right’.

Awareness of one’s skeletal structure is a useful exercise which I practise regularly and teach frequently. It involves visualising, from a standing position, the major bones and joints of the body, working from the feet up. You imagine all your joints to be filled with air, your ribcage floating around your spine, your skull floating like a balloon above your spine. The more we can feel into our skeletal structure, the less likely we are to overuse muscles in too great an effort to keep ourselves upright.

To summarise, it is important to realise that movement is as much, if not more of, a cerebral process than a physical one. And our minds can either sabotage or help enormously, depending on the degree to which we are willing to look at ourselves with honesty and compassion.

Finally. The frequency of a cat’s purr is said to be wonderful for knitting bones and soothing arthritic conditions, so if you are lucky enough (as we are at the Ashram) to have a feline companion, try clasping him or her to your affected body part!