Yoga in the heart of the city

Yoga For Osteoarthritis

By Jodie Xie (YA 500 Teacher Training Course Case Study 2008)

What is osteoarthritis?
Osteoarthritis is the most common type of arthritis, especially among older people. Sometimes it is called degenerative joint disease or osteoarthritis.
Osteoarthritis is a joint disease that mostly affects the cartilage. Cartilage is the slippery tissue that covers the ends of bones in a joint. Healthy cartilage allows bones to glide over one another. It also absorbs energy from the shock of physical movement. In osteoarthritis, the surface layer of cartilage breaks down and wears away. This allows bones under the cartilage to rub together, causing pain, swelling, and loss of motion of the joint. Over time, the joint may lose its normal shape. Also, bone spurs--small growths called entophytes--may grow on the edges of the joint. Bits of bone or cartilage can break off and float inside the joint space. This causes more pain and damage.
People with osteoarthritis usually have joint pain and limited movement. Unlike some other forms of arthritis, osteoarthritis affects only joints and not internal organs. For example, rheumatoid arthritis--the second most common form of arthritis--affects other parts of the body besides the joints. It begins at a younger age than osteoarthritis, causes swelling and redness in joints, and may make people feel sick, tired, and (uncommonly) feverish.

How Does Osteoarthritis Affect People?
Osteoarthritis affects each person differently. In some people, it progresses quickly; in others, the symptoms are more serious. Scientists do not know yet what causes the disease, but they suspect a combination of factors, including being overweight, the aging process, joint injury, and stresses on the joints from certain jobs and sports activities.
Osteoarthritis hurts people in more than their joints; it can lead people to experience a spiraling cycle of pain.
The ongoing pain can cause stress, which causes tight, tense muscles-leading to more pain and limiting a person's activities. When people can no longer do the things they love or even take care of themselves, they experience depression, which exacerbates whatever pain the person is experiencing. And the cycle goes on.
Despite these challenges, most people with osteoarthritis can lead active and productive lives. They succeed by using osteoarthritis treatment strategies, see below for more details.

What Areas Does Osteoarthritis Affect?
Osteoarthritis most often occurs at the ends of the fingers, thumbs, neck, lower back, knees, and hips.

Treatment Options for Osteoarthritis:
There are multiple ways of approaching the management of patients with moderate to severe osteoarthritis. As a first principle, strengthening the muscles across the joint will help to diminish direct forces of compression and, effectively, "unload" the joint. Needless to say, weight reduction will augment muscle strengthening, again leading to diminished load bearing, with consequent decreases of pain in the compromised joint.
Anti-inflammatory medications are available in over-the-counter strength as well as by prescription. Local injection has also proven beneficial in many cases.
Finally, joint replacement arthroplasty is a proven modality for surgical correction of the cartilage deficient joint.

How yoga can help osteoarthritis?
I chose some specific yoga poses for each case study's arthritis. Some postures focus on flexibility that will help open up the joints and increase range of motion and as well as nourishing it via increased circulation of blood, energy and oxygen. Other postures focus on strengthening and building muscles around the joint, stabilizing it.

Example Case Study:
Na Pan with Shoulder Arthritis
Cause and Treatment History:
Na studies very hard, reading and writing (right handed) for hours and hours everyday since she attended primary school. From July to Oct 2006, she worked as data entry 5 hours a day on the computer, at the end of the year 2006 Na had pain in the right shoulder, especially on wet days. When she feels tired or picks up something heavy using her right shoulder or carries a heavy bag, she has increased pain.
In the end of 2006, just after Na noticed something wrong in her right shoulder, she had a very professional massage in China, and was told by the doctor that she has shoulder arthritis.
Symptoms include:
Pain and stiffness in the right shoulder, feels heavy.
The stiffness is usually worse in the morning, and can slowly improve with "warm up" activities.
Rounded right shoulder, chest is forward.
Has Asthma, and breathing problem.
Home Practice Program Assessment:
The first three exercises are warm ups to move the shoulders in different directions, and to stretch and flex -
Interlocking fingers with arms behind back and gently lifting.
Garudasana arms both sides gently lifting.
Interlocking fingers with arms vertical.
Downward Facing Dog - Adho Mukha Svanasana.
Warrior I - Virabhadrasana I
Extended Triangle Pose - Utthita Trikonasana
Bridge Pose - Setu Bandha Sarvangasana
Evaluation 1:
Na did her home practice and regular Ashtanga yoga practices two to three times per week consistently. The result of her persistence shows clearly in the Home Practice Program Assessment Sheet Summary of Findings for Na Pan. The images of her Dog Down, Warrior 1, and Bridge Pose specifically show her shoulders are more flexible and open than last time.
She reported less pain in her right shoulder than before, especially in wet weather and that a previous problems with constipation had lessened and her sleep has been improved.
Evaluation 2:
Na continued her yoga practice twice a week and practiced the first three warm ups almost every day, as they increased her comfort.
She said she now only felt pain very occasionally, when she was tired. She also reported an increase in energy levels and less tiredness.
Evaluation 3:
As Na was preparing for school examinations, she didn't keep her yoga practice as conscientiously as before. Her practice reduced to just the first three warm up exercises when she felt stiffness in her shoulders after sitting for long time. She noticed that with no yoga practice her shoulder got tighter and was painful more frequently. She said she would try to increase her practice, back to twice a week again after the examinations.
The illustrated improvements in Na's condition when she was able to maintain a steady practice clearly indicate that yoga is a very useful tool for increasing her joint health and effectively managing her arthritis.

Conclusion:
We must acknowledge that there is no cure for arthritic disease, and the goal of any treatment modality is a decrease in pain and tenderness and an improved range of motion.
This study has shown, in all three cases, that a consistent yoga program did bring varying levels of relief from arthritis symptoms. The three subjects all stated that when they kept to their practice, their arthritic joints were less painful, but when they stopped doing yoga, they felt stiff and uncomfortable again.
In addition, one of the case studies reported a significant change to the quality of her sleep by doing her program, illustrating another great benefit from yoga practice.
Unfortunately, lifestyle and work commitments present a large barrier to achieving the full therapeutic benefits that yoga offers and all three subjects practiced only when time allowed, rather than making the practice a priority in their busy lives. A greater focus on the importance of personal health and an increased commitment to spend some time each day to that end is recommended, for the full benefits of yoga as an effective tool in managing the pain and dysfunction of osteoarthritis to be illustrated.