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Specialize and Thrive: Working with Individuals with Osteoarthritis and Joint Replacements

Arthritis is the most common cause of disability in the world.3 Osteoarthritis, the most common form of arthritis, has led to a dramatic increase in the incidence of hip and knee replacements in recent years. The rate of total hip replacements has almost doubled between the years 2000-20101 and approximately 7.2 million Americans are now living with hip and/or knee replacements. 6 While these rates have nearly doubled in recent years, the number of younger individuals (ages 45-54) having these replacement surgeries is increasing.5

The rapid and dramatic increase in individuals living with osteoarthritis and/or joint replacements has created a massive void between the number of people living with these issues and the number of qualified individuals to help them safely and effectively accomplish their functional goals. This void, however, has created an incredible opportunity for fitness professionals to align themselves with allied health professionals to become part of the solution. This article will discuss some recent changes in the thought process about how osteoarthritis develops, how fitness professionals are an important part of the solution, and why this is the most opportune time for fitness professionals to specialize and align themselves with health professionals.

Why do so many individuals experience osteoarthritis and what can be done about it?

While injury, overuse, age, obesity, genetics, and race have been given as possible causes, there has been a lack of solid evidence to explain why the incidence rate of osteoarthritis continues to skyrocket. 2,3,5 However, recently there have been suggestions that osteoarthritis is not as previously suggested, due only to old age or genetics. Dr. Ian Wallace, a postdoctoral researcher who has studied more than 2,000 skeletons, believes the recent dramatic increase in osteoarthritis isn’t an inevitable consequence of living longer. He believes it is more attributable to the modern decline of physical activity and is quoted as follows: “Dr. Wallace thinks the most obvious candidate to explain the increase in knee osteoarthritis is the modern decline in physical activity.” 8

Nevertheless, it is not just about people needing more quantity of activity; it’s also about the quality of the exercise.10,11 If exercise is performed without optimal joint alignment and control, the individual is at risk for developing degenerative joint changes.10,11 Therefore, it’s imperative that fitness professionals specializing in working with individuals that have osteoarthritis or joint replacements are able to properly assess for non-optimal and inefficient posture and movement habits and from these results, develop an appropriate exercise program. Additionally, fitness professions specializing in this niche must also be able to instruct proper exercise form and understand what exercises or activities are contraindicated with these populations. 10,11

A well-designed exercise program that includes flexibility, strength, and cardiovascular exercise is required to appropriately address the postural and movement habits that contributed to the development of osteoarthritis. Likewise, many individuals will have developed compensatory patterns as a result of joint pain or loss of mobility and subsequently developed non-optimal posture and movement habits that need to be addressed.

Several organizations including the Arthritis Foundation, Center for Disease Control, and American College of Sports Medicine have created guidelines for working with individuals that present with arthritis. General recommendations include improving joint mobility/flexibility, aerobic conditioning, resistance training, maintaining a healthy weight, and consulting with a medical doctor.2,3,13

Helping individuals develop a more optimal and efficient posture and movement strategy is one of the most effective strategies for safely working with individuals with osteoarthritis and joint replacements.9,10,11 An approach that includes using the most appropriate soft tissue release, mobilization, stretching, neuromuscular activation strategies, and appropriately progressing the individual through the fundamental movement patterns has been shown to improve joint mobility and strength in individuals with osteoarthritis as well as joint replacements. 9,10,11 Additional strategies that have been shown to be helpful in improving strength and mobility and managing the symptoms of osteoarthritis include three-dimensional breathing7,9,10,11, proper nutrition featuring a whole-foods, plant-based diet4, and meditation.14

The future

The great news is that there is a growing need for qualified fitness professionals to work with the increasing numbers of individuals that have osteoarthritis and/or joint replacements. However, this requires that the fitness professional have both the right education and the appropriate skillset as many of these individuals will require a thorough approach to address their specific needs and to provide them with the best functional outcomes. Organizations such as the MedFit Network, The Institute for Integrative Health and Fitness Education, and the Functional Aging Institute are helping to create the education necessary for health and fitness professionals to develop specializations in working with special populations including the older adult populations experiencing osteoarthritis and joint replacements. Additionally, through their educational platforms and live course work, they provide fitness professionals with strategies for aligning and working with allied health professionals.

For many individuals experiencing pain or loss of function secondary to osteoarthritic changes, seamless integration between medical procedures, rehabilitation, and functional fitness is becoming a viable and necessary alternative to narcotics and surgery. Hence, the birth of the medical fitness space where fitness professionals work either in collaboration with or in the actual physical location of medical doctors, physical therapists, chiropractic physicians, and massage therapists. Clinics such as Rejuv Medical have provided a model for how to improve patient outcomes by combining the benefits of regenerative medicine procedures (Plasma Rich Protein and Stem Cell Therapy), physical therapy, and personal/group training.

Specialization in working with individuals that have osteoarthritis and/or joint replacements and working in the medical fitness space is the future. The fitness professional that acquires the appropriate education and develops a working relationship with allied health professionals will be able to attract more individuals that need, want, and will pay for their expertise. By providing a more integrated and effective approach to helping individuals accomplish their health and fitness goals, these fitness professionals will continue to thrive in the coming years.

This article was featured in MedFit Professional Magazine summer 2019 issue.

Subscribe to MedFit Professional Magazine to read more great content like this!


Dr. Evan Osar is an internationally recognized speaker, author, and expert on assessment, corrective exercise, and functional movement. Dr. Osar is committed to educating and empowering fitness professionals while helping them develop relationships with allied health professionals. He is author of the Corrective Exercise Solutions to Common Hip and Shoulder Dysfunction and has developed the industry’s most complete training certification, the Integrative Movement Specialist™. With his wife Jenice Mattek, he created the on-line educational resource www.IIHFE.com

 

References:

  1. American Association of Hip and Knee Surgeons. NCHS Releases Hip Replacement Data. Retrieved from http://www.aahks.org/nchs-releases-hip-replacement-data/
  2. Arthritis Foundation. Osteoarthritis Treatment. Retrieved from http://www.arthritis.org/about-arthritis/types/osteoarthritis/
  3. Centers for Disease Control and Prevention. Osteoarthritis. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm
  4. Clinton, C., O’Brien, S., Law, J., Reiner, C., Wendt, M.R. (2015). Whole-Foods, Plant-Based Diet Alleviates the Symptoms of Osteoarthritis. Arthritis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359818/
  5. Dotinga, R. (2015). Number of Hip Replacements Has Skyrocketed, U.S. Report Shows. Retrieved from https://consumer.healthday.com/senior-citizen-information-31/demographic-arthritis-news-37/number-of-hip-replacements-has-skyrocketed-u-s-report-shows-696419.html
  6. Mayo Clinic. First nationwide prevalence study of hip and knee arthroplasty shows 7.2 million Americans living with implants. Retrieved from http://www.mayoclinic.org/medical-professionals/clinical-updates/orthopedic-surgery/study-hip-knee-arthroplasty-shows-7-2-million-americans-living-with-implants
  7. Mattek, J. and Fisher, S. (2017). What Lies Beneath: The under-realized effects of breast, abdominal, and pelvic surgeries. St. Bernardino, CA: Niche Pressworks.
  8. McDonald, B. (2017). Skeletons say arthritis isn’t about aging – it’s about activity. Retrieved from http://www.cbc.ca/radio/quirks/august-19-2017-1.4252722/skeletons-say-arthritis-isn-t-about-aging-it-s-about-activity-1.4252755
  9. Osar, E. (2012). Corrective Exercise Solutions for Common Hip and Shoulder Dysfunction. Chinchester, UK: Lotus Publishing.
  10. Osar, E. (2017). Integrative Corrective Exercise Instructor Certification Program: Training the Older Client. Chicago, IL: Institute for Integrative Health and Fitness Education course handouts.
  11. Osar, E. (2018). The Fundamentals for Training the Older Client with Osteoarthritis. Retrieved from https://www.ptonthenet.com/remote-learning
  12. Pagnano, M., Wolfort, M., Berovitz, A. 2015. U.S. National Center for Health Statistics. Data brief; National Center for Health Statistics.
  13. Riebe, D., Ehrman, J., Liguori, G., Magal, M. ACSM’s Guidelines for Exercise Testing and Prescription. 10th Philadelphia, PA: Wolters Kluwer.
  14. Selfe, TK., Innes, KE. 2013. Effects of Meditation on Symptoms of Knee Osteoarthritis. Alternative Complementary Therapies; 19(3): 139-146.

 

ORTHOPEDICS CONSULTATION WOMAN

If You Can’t Beat It, Use It: An Exercise Guide to Post-Joint Replacement Wellness

It all started over 40 years ago, when I chose as my sport – some would say, my life – the Korean martial art of Tae Kwon Do. I was young, fit, pretty strong and, unbeknownst to me, very flexible – perfect for the art of kicking high and hard. Once I got hooked on it, I was in the gym a few hours a day, 6-7 days a week…for the next almost 20 years. That did not include the running I did to get my cardiovascular conditioning primed for the art and sport I was practicing at high levels of both skill and competition. I knew then, at age 19, that I was going to pay for the training and abuse I was putting my body through, but not until I was older, say, 40 or so.

Instructor And Elderly Patient Undergoing Water Therapy

5 Simple Exercises To Help Symptoms Of Rheumatoid Arthritis

When left unchecked, rheumatoid arthritis can be majorly debilitating and cause real and continued pain. However, if you’re willing to do the research and put in the work, you can do certain exercises which can majorly reduce the symptoms, improve your overall mood and actually make you that much physically healthier, generally speaking, which can only be a good thing. The real question then is, what sort of exercises ought you be doing to try and achieve this. Well, let’s take a look at five ways to help improve those symptoms.

Start Stretching

Stretching is actually something which we all ought to do and can be a great way to start anyone’s day. Daily stretching reinforces a healthy sense in which the muscles are able to become increasingly limber and flexible across time. Stretching is a personal thing, and it will depend a bit on where most of your arthritis pain is concentrated. When you stretch you want to go slowly and thoroughly. Warm up for a few minutes and then stretch each of the muscles you want slowly, pushing yourself further in tiny intervals. To guarantee success, track down a physical therapist with an understanding of rheumatoid arthritis.

A Focus On The Hands

“It’s all too common that rheumatoid arthritis has an adverse and painful effect on the hands, meaning this is an area which ought to be focused on in terms of exercises that can be done”, advises Charles Tevesham, health writer at LastMinuteWriting and Writinity. There are only a limited number of ways in which one can move one’s hands, so you ought to do your best to try and explore the full range of stretches available. Using a stress ball and a small roller can help to achieve this as well.

Go For Walks

Sometimes when you are in pain, having to get up and go on a walk can be the last thing that you want to do. But, it’s hugely beneficial. The act of walking involves so many of the different muscle groups and makes it so easy to do something that will be beneficial for your arthritis. It is also a great way to boost your mood, since it is exercise and involves being outdoors. Make sure you drink water and try to slowly increase your speed across the duration of your walk.

Water-Based Exercises

Completing exercises, stretches and other forms of aerobics in a pool is a wonderfully forgiving way of going about your pain reduction routine. Being in water helps to reduce the impact of your body weight so it makes it very easy to do exercises without fearing that you are going to injure yourself. Furthermore, the act of swimming is actually a really good exercise that involves using all o the muscle types in your body in a way which is actually deeply therapeutic and relaxing. If the water is warm, that’s an even better way to soothe pain.

Get On Your Bike

Cycling is another good exercise option. “Cycling is definitely one of the more strenuous options available to you, but it’s one that will really help ensure that the increase in the risk of cardiovascular problems that rheumatoid arthritis involves, doesn’t get the better of you”, says Mary Simmons, health blogger at DraftBeyond and ResearchPapersUK. You ought to make sure that you have stretched thoroughly before you get onto a bike as the intense locational nature of the workout, in other words the amount of pressure it puts your leg muscles under, can cause you an injury. That said, it’s an incredibly good way to exercise the muscles in the lower half of your body and has long term benefits to flexibility and pain reduction.

Conclusion

Overall, stretching and various other exercises are actually vitally important to giving yourself the best chance of avoiding unnecessary and difficult to deal with pain. Rheumatoid arthritis is never going to be pleasant, but if you really commit to a routine of exercise you can be sure that the way you feel, physically and mentally, is going to improve and that steps towards managing the symptoms will be moved through quickly.


Harry Conley is a content editor at LuckyAssignments and GumEssays. He develops training procedures and manages the workflow to give writers supplemental support instruction. A man of many interests, Harry also works in providing supplementary materials and instructional support for contributors.

 

References

Charles Tevesham, health writer, LastMinuteWriting and Writinity.
Mary Simmons, health blogger,  DraftBeyond and ResearchPapersUK

Health, fitness, wellness

Living Well with Arthritis

Although arthritis today is considered one of the leaders of the pack in the epidemic of chronic illness, millions of those affected are living fulfilling lives and living them well.

According to The Institute of Medicine’s New Report on Living Well With Chronic Illness, 8.6 million Americans are living with disabilities related to arthritis. The Arthritis Foundation reports it as “striking one in every five adults, 300,000 children and as the leading cause of disability in the United States.” Arthritis is a chronic illness that impacts many.

Depositphotos_39763765_xs(1)Those living with arthritis can live well and have a good quality of life by employing lifestyle interventions as medicine, in conjunction with, prevention, joint protection, weight management, physical activity, wise food choices, stress management and a good medical regimen. By combining all these necessary recommendations into a personalized Wellness Strategy and Plan, a coach can assist an arthritis patient in organizing what is important for them to live life well. The Wellness Plan then becomes a map by which to navigate toward managing and maximizing the patient’s best life possible.

A common factor also influencing quality of life for those challenged by arthritis or any chronic illness is what is called “adherence” or “medical compliance”. Lack of adherence to medical and lifestyle improvements is a large piece of the cost of healthcare today and contributes to the epidemic of chronic illness. Average patient adherence rates for prescribed medications are about 50 percent, and for lifestyle changes they are below 10 percent.

The World Health Organization reports “improving adherence also enhances patients’ safety because most of the care needed for chronic conditions is based on patient self-management, use of medical technology for monitoring, and changes in the patient’s lifestyle.” A coach assists in supporting patient compliance and self-accountability and works with the patient to forward the action toward their goals.

The same report goes on to say “patient-tailored interventions are required and must be customized to the particular illness-related demands experienced by the patient. There is no single intervention strategy that has been shown to be effective across all patients.” Therefore, working with individuals one on one is of primary importance for enhancing their quality of life. Coaches work with clients on a one on one basis assisting them in creating a wellness plan that is personalized to them.

Dr. Bennett and team’s article Health Coaching for Patients with Chronic Illness states “it is critical that those with arthritis understand, agree with and participate in the management of their chronic condition. Health coaching is one way to accomplish this function.”

A long-term study done at Stanford University indicates that interactions with a coach can significantly increase the health of people with chronic illness. Stanford’s Chronic Disease Self-Management Program brought patients (including those with arthritis) together with a coach. “Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatient visits and hospitalizations.”

Young Couple Jogging in Park

It was found “This type of self-management, through coaching, is so effective it has been endorsed by the Surgeon General of the United States.”

“Give a man a fish, and he eats for a day. Teach a man to fish, and he eats for a lifetime.” Health & Wellness coaches work with a client to tailor-make a wellness plan that includes self-management, coordinating their medical regimen, and forwarding lasting lifestyle changes. Working together with a coach, a patient can successfully manage their condition and create a strategy to living life well with arthritis.

What Can Health & Wellness Coaches Do for You?

► Work with you to take an inventory of your current wellness status

► Guide and facilitate your personal well-life vision toward the life you would like to live

► Work with you to develop a personalized Wellness Plan that is tailored to your needs. The wellness plan becomes the map that integrates your important areas of focus including: self-management support, the medical regimen, and lifestyle improvements.

  • Self-management support:
    • Promote healthy behaviors
    • Impart problem-solving skills
    • Assist with the emotional impact of chronic illness
    • Provide regular follow-up and accountability
    • Encourage people to be active participants in their care
    • Assist in patient self-advocacy
  • The medical regimen – facilitation of a patient-directed approach
    • Scheduling and attending medical appointments
    • Asking your medical team the right questions
    • Following through on daily prescribed medications
    • Tracking your regimen to support success
  • Lifestyle improvements
    • Physical activity
    • Healthy eating
    • Eliminating risk factors
    • Promoting healthy behaviors

► Bridging the gap between clinician and patient.

  • Health coaches can bridge wellness-coachthese gaps between the medical team and patient by following up with patients and guiding a patient-centered approach, asking about needs and addressing obstacles, addressing health literacy, cultural issues and social-class barriers.
  • Health Coaches help patients become self-directed in navigating the health care system. Coaches can help with patient self-advocacy and coordination of care

► Provide accountability & support for you to be successful

  • Offer emotional support
  • Coping with illness is emotionally challenging. Coaches can offer emotional support and help patients cope with their illnesses. They also assist patients in seeking out additional emotional support that will help them achieve and maintain success.

► Provide ongoing evaluation of progress toward your goals

  • Re-evaluating success
  • Resetting goals & action steps as necessary
  • Provide acknowledgement & support of successes
  • Assist in maintaining forward momentum toward goals

► Serve as a continuity figure

  • Coaches travel with the patient as an ally and assist them with staying the course while implementing their wellness plan.

► Assist in patient-directed achievement of successful lifestyle behavioral change

  • Be your ally and walk shoulder to shoulder with you

Dr. Linda Gogl is a Doctor of Physical Therapy with Board Certification in Orthopaedic’s with over 20 years in healthcare. She currently serves as Director of Development and Team Member for Real Balance Global Wellness Services. Her professional experience includes outpatient Clinical Director, Developer/Director of an APTA Credentialed Orthopaedic Residency Program, Director of Quality Assurance for the largest physical therapy private practice in California, Credentialed Clinical Instructor, Adjunct Professor of Anatomy & Physiology, Research mentor and Clinical Coordinator for University affiliations. More recently she also served as National Director of Training and Implementation for OptimisPT, a physical therapy software system.

References

  • Arthritis Foundation. Arthritistoday.org
  • Bennett et al, Health Coaching for Patients With Chronic Illness. Fam Pract Manag. 2010 Sep-Oct;17(5):24-29.
  • Harris et al. The Institute of Medicines’s New Report on Living Well With Chronic Illness. Centers for Disease Control and Prevention. Volume 9 – September 20, 2012.
  • Lorig et al. Chronic Disease Self-Management Program, 2-year Health Status and Health Care Utilization Outcomes. Medical Care. Volume 39, Number 11, pp 1217-1223.2001
  • National Prevention Strategy, Clinical and Community Preventive Services, National Prevention Council 2010. www.surgeongeneral.gov/initiatives/prevention/strategy/preventive-services.pdf
  • National Prevention Council Action Plan: Implementing the National Prevention Strategy www.surgeongeneral.gov/initiatives/prevention/2012-npc-action-plan.pdf
  • World Health Organization. Adherence to Long-Term Therapies. Evidence for Action. 2003.
dr-nick-rx

The Pharmacologics of Exercise: Yes, Exercise Is Medicine!

It’s been said: “If all the benefits of exercise could be placed in a single pill, it would be the most widely prescribed medication in the world.” Scientific evidence continues to mount supporting the numerous medicinal benefits of exercise. In fact, there’s hardly a disease that I can think of that exercise won’t help in one way or another, be it prevention, treatment, or even cure in some instances.

Arthritis

Stress and Arthritis

Many people believe that arthritis can only come from physical activity in your body, and it certainly does, but what others tend to forget, or simply don’t know, is that an individual’s mental health is a huge factor in arthritis as well. A study in 2009 by researchers at the Centers for Disease Control and Prevention claimed that people who experienced traumatic events during their childhood, which included physical or emotional abuse, had a much higher risk for developing rheumatoid arthritis compared to individuals who did not experience trauma.

Can Stress and Anxiety Actually Worsen Symptoms of Arthritis?

Some researchers claim that there is a direct relationship between a person’s stress response and inflammation in their body. Author Andrea W.M. Evers, PhD, took blood samples from 80 rheumatoid arthritis patients once every month for six months to measure the correlation between the stress hormone and inflammatory cytokines, and found that it played a main role in the amount of arthritis severity. Releasing cytokines in your body are the cause of inflammation, and exhibiting various levels of stress can also cause these specific molecules to be released, which eventually will promote inflammation and pain. Evers concluded that “patients who have a tendency for more worrying reported slightly more disease activity, more swollen joints, and more pain.”

Identifying the Root of Your Stress

As an individual becomes diagnosed with arthritis, their emotions can become extremely overwhelming. They may grow frustrated, uncomfortable, or in some cases, become very depressed. It becomes harder to perform normal daily tasks like putting on socks, cooking food, climbing stairs, and even just walking for some people. Their daily routine has become altered, and while some people can handle the change in lifestyle, others find it harder to cope and their stress can actually make the physical pain worse. Being able to identify where the arthritis is coming from in the body and developing a plan to improve it is the first step to reducing the stress associated with this disorder.

Tips for Handling Stress with Arthritis

Learning how to cope and finding ways to relieve tension can improve an individual’s quality of life physically and emotionally. One tip to handling stress would be to stay as active as you can throughout the day. Many people who have arthritis are often fearful of performing exercises simply because they worry it might make the pain worse or damage the joints, however, physical activity can actually improve the symptoms of rheumatoid and osteoarthritis. Daily activities like swimming and walking can reduce stiffness and stress on the joints while releasing endorphin hormones, (the hormones that make you feel good), ultimately improving the pain associated with arthritis and putting you in a better mood altogether.

Another tip would be to eat right so your body can fight inflammation. This tip seems like common sense, however many people don’t know which foods to eat and which ones to avoid. Some foods to start including in your every day diet are salmon, berries, and leafy green vegetables. Foods to avoid are red meats and vegetable oils, mainly because they contain omega-6 fatty acids which actually cause inflammation instead of reducing it.

Becoming more aware of your arthritis and coping with it appropriately will relieve pain in the body, resulting in an all-around happier and healthier you.


Lauren Adkins is a senior at Rowan University studying Health Promotion and Wellness Management. She is currently an intern at The Stress Management Institute and has a passion for helping people live a healthier lifestyle and improving their well-being. Lauren has also volunteered for a program at Rowan called “Get-FIT,” where she worked with individuals with developmental disabilities and promoted a happy, healthy, and fit lifestyle for them. Other than working towards a degree, Lauren enjoys spending time with family and friends, painting, and listening to music in her free time.

References

https://www.arthritis.org/living-with-arthritis/comorbidities/depression-and-arthritis/stress-rheumatoid-arthritis.php

https://www.everydayhealth.com/rheumatoid-arthritis/living-with/rheumatoid-arthritis-stress/

yoga-woman

Beyond Modifications: Bringing all of Yoga’s Tools to People with Arthritis

For over a decade, I have been researching the effects of yoga for people with arthritis. As many people envision, this includes a lot of modifications, adjustments, and extensive use of props. We work with students to find versions of each asana that remain true to the essence of the pose, working within any movement limitations without creating pain or joint discomfort.

But when we teach yoga to people who have arthritis, we don’t strive for a magical asana sequence that will address arthritis in a particular body part.

Yoga is a holistic process. When we make the mistake of thinking about yoga as if it were physical therapy, we lose what makes yoga a unique therapeutic process. Instead, yoga can go hand-in-hand with modalities like PT, as complementary processes.

Researchers lose something when looking only at an asana sequence and its effect on the joints.

Instead, our job is to get the joint issues out of the way, through support, use of props, compassion and awareness, so that yoga can work its magic on the whole person- body, mind, and soul.

Just as yoga can improve overall physical fitness for healthy individuals, it can improve fitness for people with arthritis. But with this population, the stakes are even higher. Yoga can improve balance, which prevents dangerous falls. Yoga practice can enhance flexibility, which allows individuals to maintain mobility over time. Improved strength means greater joint stability. Improved strength means a reduction in the muscle loss that accompanies some forms of arthritis. Improved strength means an increased ability to participate in everyday activities that can be challenging as joints deteriorate.

But a yoga practice has the potential to bring much more to the lives of people with arthritis. Yoga allows those with a chronic, disabling disease to realize what their bodies CAN do. It fosters a connection to their bodies which may have been lost during years of disease progression and reduced activity. Yoga can teach students to be present in the moment, and to adjust to their bodies needs on a particular day, without judgment. Arthritis changes every day, and this skill serves our students every day, even if they don’t get on the mat.

Yoga also helps our students to relax and to be mindful. Having a chronic disease is stressful, and stress can exacerbate that disease. The relaxation and meditation practices of yoga can break the cycle of stress reactivity.

Yoga classes connect people with arthritis to others who are striving and thriving… people who are living a full and active life, whatever journey they have taken to arrive at that place.

And yoga changes other behaviors. When people start to feel connected, they want to do other things in the name of self-care. They eat healthier foods, go for a walk outside, make time for themselves, and some even make an effort to be more adherent with their medical care.

When we think about bringing the tools of yoga to the arthritis community, let’s be sure to look beyond the modification of asana as a goal. Our goal is to make the asanas possible, so the totality of yoga can come through to our students, safely and effectively.

Reprinted with permission from Dr. Steffany Moonaz.


Dr. Steffany Moonaz is a yoga therapist and researcher and serves as Assistant Director of Academic Research at the Maryland University of Integrative Health. Dr. Moonaz is working to bring yoga to people with arthritis in communities around the country, as well as educating yoga teachers and yoga therapists about the unique needs of this population. She currently leads Yoga for Arthritis teacher training programs nationwide and serves as a mentor for several emerging researchers who are working to study the effects of yoga for various health conditions.

senior-yoga-water

Don’t Let Arthritis Stop You: Move On

Arthritis comes in many forms and has many manifestations, affecting almost every joint in the body. We generally speak in terms of the two most-known if not popular forms of arthritis: rheumatoid (RA) and osteo-arthritis (OA.) The essential difference is in the root cause. RA is an auto-immune disease whereby the body, for unknown reasons, attacks itself, particularly in the joints. OA, on the other hand, is often considered the downstream effect of wear and tear, over-use, prior injury, or, as we’re seeing more of as society gets more sedentary, from lack of use. In OA, typically, some insult to the joint disrupts the natural repair processes and further deterioration occurs subsequently.

treatmentDue to their differing causes, there are obviously differing treatments; but the basics of medical management are essentially the same. I am not qualified to address the specifics of the treatments available but, in lay terms, treatment usually entails some version of anti-inflammation and pain-reduction drugs, precautionary movement or positional guidance (don’t do’s, for example), physical therapy to manage pain and inflammation, and therapeutic exercises to support the structures affected as the disease itself causes not just inflammation and pain but damage to the structures that support the joints. Typically we identify arthritis as something that damages cartilage and, in truth, that is often what the standard ‘films’ – X-ray, possibly MRI (magnetic resonance imaging) – show. We now know that the synovial sacs around the joint are also affected and that these and other chemical disturbances affect the muscles and tendons that move and support the joint. In almost all cases of arthritis, pain, inflammation, reduced strength and range of motion (ROM) ensue, diminishing quality of life in many ways and, because some of the drugs used to treat it, potentially reducing quantity of life. (Gastrointestinal bleeding from non-steroidal anti-inflammatories (NSAIDs) or bone loss (osteoporosis) from corticosteroids can lead to fatal outcomes (such as spontaneous fractures leading to falls from osteoporosis) if not treated with other medications.)

When someone is potentially afflicted or actually diagnosed with a form of arthritis, the medical community goes into hyper-drive, encouraging changing one’s habits, be they the types of activities one engages in recreational, competitively, or professionally; or the types of non-activities one currently does, in particular, being inactive. In some cases, dietary advice is offered as we are learning more about foods that are pro-inflammatory and others that have anti-inflammatory benefits. In the former category, we are learning that excessive sugar or simple carbohydrates, including processed wheat products, may exacerbate inflammation while others, such as salmon, dark, green veggies, and certain oils (e.g., olive oil) are capable of reducing the inflammatory elements circulating throughout our bodies and our joints. Furthermore, in more extreme cases, when arthritis becomes very painful and debilitating, over-the-counter and/or prescription-fitted braces may be offered to defer some of the more end-line procedures such as surgery to fuse the joint or replace it with a prosthetic device.

The most common non-pharmaceutical and non-surgical treatment for arthritis of any sort: exercise.

Note that there are several legitimate ways to integrate exercise through resistance training programs that have proven quite effective in arthritis management. Yoga, Pilates (floor or machine based), Tai Chi, Qigong and water-based, or aqua, exercise are all beneficial to many aspects of the overall arthritis program of strength, ROM, proprioception and ultimately function. Since many of these are quite technical and are often done in class formats, one should ask the instructor(s) as to their experience working with arthritis clients.

nonsurgicalAs with any form of exercise, by whatever professional instruction, you should be totally aware of your pain levels as going “through” the pain is not recommended; thus, you must assert control over the exercise sessions. There will be some exercises, however, that are not destructive and may be somewhat painful but must be done in order to maintain reasonable levels of function and independence. So long as the pain subsides within a couple of hours – preferably as soon as you stop – and there is no exacerbation of inflammation the next day, you can assume that the exercise was just enough. If symptoms flare up over the next 24 hours, however, assume you did more than you should have and alert your trainer or instructor so that he/she can avoid doing the aggravating exercise(s) as much or as hard next time. For these reasons, along with all the other recommendations so far as exercise interventions are concerned, it is best to seek the counsel and assistance of a fitness professional with a background in medical fitness. This could be someone with a more advanced academic degree, someone with a license to practice rehabilitation exercise (physical therapist, athletic trainer, etc.), or someone who’s taken several educational programs to have a greater understanding of the variety of disorders and diseases that may benefit from exercise interventions.


Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”.