Yoga for Arthritis - Can Yoga Help Preserve Freedom of Movement? An Interview with Yoga Therapists Dr. Loren Fishman and Ellen Saltonstall

“Osteoarthritis is a heart attack of the joint,” which some are calling a ‘joint death.’ Considering there were 600,000 ‘joint deaths’ in the U.S. in 2002 (94 percent because of osteoarthritis), compared with 451,326 coronary heart deaths in 2004, the focus has to be on how we identify the onset of osteoarthristic compared with how the onset of other diseases are identified.”  ~ U.S. Bone and Joint Decade – Global Network Conference, 2009.

We hear a lot about heart health and the prevention of heart disease, but here’s a little known fact that may give you pause: Musculoskeletal diseases, including back pain and osteoarthritis, are now the second greatest cause of disability in all regions of the world, according to the Global Burden of Disease 2010 Study.

Everyone loses range of motion as they get older. And while that may seem like an insignificant shift, loss of range of motion is to musculoskeletal disorders what high blood pressure is to heart disease. Joint health is the first step in a causal relationship towards disease and disability. If it hurts to move, we move less, and thus go from limiting joint pain, to painful mobility, inactivity, obesity, comorbidity and finally disability.

Maintaining joint health is key to preserving freedom of movement and preventing this vicious cycle of growing fragility and disability. In this interview, yoga therapists Dr. Loren Fishman and Ellen Saltonstall discuss keys to maintaining joint health and how yoga can help keeps our joints mobile and fluid throughout life.

Q: We take it for granted that we will lose range of motion (ROM) as we get older, and most people don’t even think twice about it. But there are some serious health implications associated with loss of ROM?

Dr. Loren Fishman: People with limited ROM can’t bend down, they’re not able to move around the way other people are. That’s the most fundamental aspect of losing range of motion: Once you lose it, there are things you can’t do. You can’t reach for things, there are cars you can’t get into, there is even clothes you can’t get into.

And then, there are the more serious medical aspects of it. The loss of range of motion is also accompanied by loss of coordination and a loss of strength. When you lose range of motion, your muscles get flaccid and stiff because they’re not being utilized fully. With muscles, the slogan is really quite true: You use it or you lose it. Muscles atrophy. That’s what can happen with the joints and the consequences of it.

Other consequences include reduced ability to right yourself when you’re about to fall. No matter who you are and no matter where you happen to walk, there are times when your balance is less stable. If you have a good range of motion, you can slide your hip out. You can thrust your body to the other side. You can twist and do all kinds of things to avoid falling.

Ellen Saltonstall: There’s also a lack of motivation because if you have less range of motion and have pain when you move, you don’t want to move. So it could lead to total immobility and other health issues that come from that – loss of vitality altogether.

Dr. Loren Fishman: When you talk about loss of vitality, you bring something that is really very poorly recognized in the medical or the yoga literature: that moving your joints is one of the strongest stimuli to breathing properly and deeply. There are little movement receptors inside all of our joints, and they send signals that go directly and indirectly to the apneustic center, one of the centers in the brain that regulate breathing.

Ellen Saltonstall: Better breath leads to more mental alertness, a better attitude, and more ability to manage stress. All kinds of things come from better breathing, of course.

Q: Which are the factors that predispose us for losing range of motion as we get older? I mean, it’s remarkably universal. Is it both the joints and the muscles or is it like a chicken and egg kind of thing?

Dr. Loren Fishman: Inactivity is a really good way of losing range of motion.

Ellen Saltonstall: You also get adhesions in the soft tissue, the fascia that surrounds every muscle gets tighter and thicker, gets tight without movement.

Dr. Loren Fishman: That is certainly true. Inactivity leads to loss of range of motion; if you do too little, you’re going to get adhesions. But if you do too much, you’re going to get overuse syndrome.

In the case of the joints, that often means something like running too much. And of course, you could be doing too much yoga of a certain kind as well, and taxing your joints beyond their natural limits.

Q: How does yoga affect joint health? Can it both increase range of motion and prevent arthritis, as well?

Ellen Saltonstall: As we age, we’re going to lose some range of motion. It’s kind of inevitable. But yoga gives us the perfect way to maintain as much as we can and maintain it safely and maintain it in a way that suits our particular needs and maintain it in a way that’s varied and enjoyable. We feel empowered because we know what to do and how to start. Most people start to feel greater range of motion immediately.

Hatha yoga, the physical exercise branch of yoga, gets the body moving to stretch all those soft tissues and move the joints through their normal range of motion. The fascia needs to be stretched which goes along with muscle stretching, and yoga does an excellent job at that too.

To get the best results, however, you do need to cater the practice to your age, to your level of fitness, to your body type, to your previous history of injuries or other body difficulties, and to really know your body. This is a key thing for safety in developing range of motion.

Dr. Loren Fishman: A good teacher will emphasize that you should only go as far as Mother Nature will permit you. Mother Nature has provided you with a wonderful alarm bell, a monitoring system known as pain! You don’t have to be a sadomasochist to find a little pain rather interesting. But there is a point beyond which the pain is overwhelming the gain. That’s when the ratio of risk versus benefit is too high, and you have to stop. So that’s one wonderful thing about yoga: it’s self-administered, so you know when to stop.

Dr. Loren Fishman: If you have loss of range of motion from whatever cause, yoga is likely to be able to help you get back to a normal range. And in that respect, it conquers whatever’s wrong with you to a certain extent, sometimes completely, sometimes very partially, but in my experience, usually quite a bit.

Q: There has been a recent debate in the media about whether or not yoga can sometimes hurt the joints. What are your thoughts on that?

Dr. Loren Fishman: Well, of course, yoga can hurt you. Wonderbread can hurt you. Anything can hurt you if you do it wrong, if you use it wrong. But that doesn’t mean that yoga is a particularly risky activity. In the overall picture, it is extremely helpful for the joints.

Ellen Saltonstall: Yoga can be tremendously beneficial as long as you work within your limits. Teachers need to help students learn to listen to their own signals and learn the language of their particular body. There are different kinds of soreness. It’s like the Eskimos have all the words for snow. I think we, as yogis, should have lots of different words for pain and discomfort.

Sometimes pain and discomfort is the body calling you to move and calling you to do something specifically for that part of your body, because it’s become immobilized. Either because you’re sitting at your desk too long or doing something strenuous that’s out of balance with the rest of your activities.

So, the body calls for movement with certain sensations, and those sensations might not be comfortable ones. They might not be, “Oh, whoopee! Let me go do some yoga!” They might be, “Oh, wow. My ankle is really stiff,” or, “Oh, wow. When I bend my knees, it feels weird,” or, “My lower back is stiff after sitting by my desk.” But those are the times when a careful, intelligent moderate yoga practice that is well suited to what you are able to do can make a big difference.

Dr. Loren Fishman: It’s a valuable distinction to be made, I think. You don’t want to say “There’s a really good place beyond that pain, so get past the pain.” That’s a real formula for hurting yourself.

Q: You two have a course on Yoga U about “Yoga for Joint Health – Keys to Staying Mobile and Agile All Life Long.” Tell us about the course and what you will be covering.

Ellen Saltonstall: We will look at what happens in the joints when we do the different yoga poses, and how coming in to certain end ranges of motion is healthy for the joints, because it circulates the fluids and keeps the cartilage healthy.

We’ll also cover the importance of alignment, because how you do your yoga is just as important as what you do and how much you do. Correct alignment will keep the joints healthy by making the pressures more even around the joint in any given pose and by using all the different components of the joint in your whole practice. We’ll talk about how the teacher can help prevent risks in the student by watching closely and knowing your students well enough to know how to spot when they’re working too hard or forcing themselves into poses that they’re not ready for.

Dr. Loren Fishman: We’ll talk about recognizing and avoiding the risks for other people and for yourself, too, and setting realistic goals. We’ll discuss the different inner aspects of yoga and its effect on joints – the fluids, what’s in the fluids, the circulation of the fluids, the cartilage. We’ll also talk about how to protect yourself, your joints, your muscles, your nerves, your sinews, your ligaments, and how to use them to make yourself happy.

Dr. Loren Fishman is a medical doctor and lifelong student of yoga, including extensive studies with B.K.S. Iyengar in India. As a practicing MD, Dr. Fishman has become known as a leading pioneer in the integration of yoga in rehabilitative medicine. Dr. Fishman is the author of several books in addition to the books co-authored with Ellen Saltonstall.

Ellen Saltonstall is a certified yoga instructor at the ERYT 500 level. She is a movement educator, author and yoga therapist based in New York City with over thirty years of teaching experience.
 

For more information on Loren and Ellen's course on joint health see here:

Yoga for Joint Health – Keys to Staying Mobile and Agile All Life Long