Podcast: How Yoga Benefits Arthritis

Full Transcript:
Released 1/30/2024

PODCAST OPEN:            
You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts. 

MUSIC BRIDGE 

Dan Hill: 
Hello. And welcome to the Live Yes! With Arthritis podcast. I'm Dan Hill. And I'll be your guest host for this episode. Today, we're talking about yoga for arthritis. I am an exercise physiologist, and I am a veteran. Because of my service, I had developed osteoarthritis. I found yoga in 2010. I moved to Maryland from Arizona. And I started a hot yoga class. And I fell in love with the practice, I fell in love with the community. And eventually, I became a teacher myself. And now I work through the Arthritis Foundation to teach fitness classes and services in my area. 

I have Instagram: dtm.fitness. And YouTube at DTMfit. And I am doing a lot of arthritis-friendly movement practice videos. Yoga is a wonderful way to increase flexibility, range of motion, balance and strength to support arthritic joints. and just overall health. But benefits go well beyond the physical. The mindfulness of yoga has been scientifically proven to also improve mental health for people with arthritis, reducing anxiety, depression and improving quality of life. 

One of my mantras is: Movement is medicine. Because depression cannot hit a moving target. But when it hurts to move, it's hard to do that thing that makes you feel better. In this episode, I'd like to explore that, along with the other benefits of yoga and similar practices for arthritis. And to help us today, we welcome to the podcast our guest expert, Dr. Steffany Moonaz, the founder of Yoga for Arthritis. Dr. Moonaz, welcome to the podcast. Can you tell us about yourself? 

Steffany Moonaz, PhD, C-IAYT: 
Thank you so much, Dan. I love what the Arthritis Foundation is doing and how they make information and resources available to people with all different kinds of arthritis and in all of its stages. 

I was a professional dancer and a movement analyst. And I had an epiphany when I was pretty young. I was in a foul mood in junior high. And I went into the dance studio where I went every day after school. And I realized about halfway through my first dance class of the evening that the foul mood I was in was completely gone. And I had this epiphany that this was like a secret ingredient. That this was incredibly powerful, and that it could transform the lives of people who are suffering far more than I was. I decided that I was going to be a neuroscientist; because I figured whatever was happening there must be happening in my brain. 

Along the way, I found public health. And I realized: Actually, what I really want to do is understand how to help people use these tools in order to transform their own lives. And to really change the way that we think about the challenges that people are living with. Both from a physical health perspective and from a mental health perspective. 

It was later that I found yoga and became a yoga teacher and then a yoga therapist. And in my doctoral studies at Johns Hopkins University, I worked in the rheumatology department. And I studied the effects of yoga for people living with osteoarthritis of the knee and rheumatoid arthritis. 

I now serve as the research director at Southern California University of Health Sciences — entirely focused on how do we take the tools of yoga that are physical, mental, emotional, spiritual in nature, and make them accessible and appropriate and useful for people living with arthritis in all of its forms. 

Dan Hill: 
Can we jump in and talk about how yoga is so beneficial for people with arthritis? 

Steffany Moonaz, PhD, C-IAYT: 
We'll sort of go through the different aspects of self, right? What most people think of, especially in the West, when they think about yoga, is they think about the physical postures. Oftentimes, the imagery of those poses makes it look like you have to twist yourself up into a pretzel in order to practice yoga. 

The purpose of putting the body in a particular position originally was in order to be able to focus the mind, to steady the body, to quiet the body, to calm the body, so that you could do things like meditate or engage in deep breathing practices, right? And this list of a whole bunch of different postures of the body evolved more recently than the original practices of yoga, which were mostly mental. But it turns out that the physical postures in and of themselves are also incredibly beneficial. 

While the postures themselves can have particular benefit, they can strengthen this part of the body, stretch that part of the body, improve flexibility, improve balance. There is nothing magical about a particular shape. Like if we call out something like “downward dog,” there could be benefits from doing downward dog. But there are lots of different ways to do downward dog. And even in different yoga traditions, a certain pose could be practiced in several different ways. Is this done with the hands together? With the hands apart? With the elbows bent or them straight? There's not a consensus that there is only one right way to do a particular pose. 

It's highly modifiable. Whatever's going on with your shoulder or your knee or your wrist, we can just make a little adjustment and do the pose in a way that's going to suit you as an individual. Not every yoga teacher knows how to do that. So, it's really important to have a teacher like you or like me or, you know, someone who has the training and the experience to be able to make it safe and appropriate. 

Dan Hill: 
How do props and tools come into play? Such as yoga blocks and bolsters and straps? 

Steffany Moonaz, PhD, C-IAYT: 
The props are used in a few different ways. One way is to sort of fill the spatial gap, OK? So, for example, if you're reaching down to touch the floor, and the floor is too far away for whatever reason, then props can be used to sort of bridge that space, right? So, I could put my hands down on a block if I don't reach the floor or a chair, right? Something higher up. 

Another way that props are used is to create cushioning or support. And so, then you might have something like a yoga blanket, or a bolster, or a pillow, or those sorts of things. And then the last one is to assist with sort of like the activities of daily living aspect of yoga. If I can't grip onto something, then I might use a prop to be able to assist me in the way that people living with arthritis might use a tool to be able to do a button, right? 

But it doesn't have to be a fancy, expensive, commercial yoga prop; we can use household items. If the studio you're going to, or the community center, wherever you're practicing yoga, doesn't have a lot of yoga props available, you can bring a towel from home; a scarf or whatever it is that you may have that could provide that bit of support or assistance that you might need. Or find a studio that does have props, because you also are going to need a teacher who is able to guide you in how to use them. 

Dan Hill: 
Right. I have arthritis in my wrists and fingers, among several other places. There's several poses in yoga that don't get along well with me. But I've recently discovered these Wrist Buddy Yoga blocks. Have you heard of those? 

Steffany Moonaz, PhD, C-IAYT: 
Yep. 

Dan Hill: 
What do you think about those? 

Steffany Moonaz, PhD, C-IAYT: 
I think it's different for every person. There are actually way more tools available now than there were when I got started, which is really wonderful. Behind me, I have some props on the wall. And one of them is a wedge. And so, what that does is, it just gives your wrists a little bit of support. It changes the angle. Because I actually also happen to have the same issue: that I'm not able to put my wrist at a 90-degree angle. And so that just sort of reduces the angle of the wrist. 

Dan Hill: 
Yeah. 

Steffany Moonaz, PhD, C-IAYT: 
Some people just roll up the edge of their mat and use that for a little bit of support. And there's also chair yoga. And in chair yoga, you're not going to be down on the floor on your hands at all because the practice is going to be sitting in a chair, and maybe standing with the support of the chair. So, you can also engage in a gentler yoga practice that doesn't have that kind of demand on the joints. 

PROMO: 
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Dan Hill: 
What scares a lot of people away is: A lot of the yoga classes that I've seen advertised don't really specify exactly what kind of yoga it is. It's just like Yoga. Or Yoga 2 or Yoga 3. I want to know: Am I going to be sitting down for an hour? Or am I going to be moving my body for an hour? 

Steffany Moonaz, PhD, C-IAYT: 
Dan, there's kind of a movement in yoga for greater accessibility. And not just for people with arthritis. But there are all sorts of ways that people might want more information about what's going to happen in a yoga class. 

Is there going to be loud music? Is it going to be fast paced, for example? Is it going to be in a heated room? And so, we really should be doing a better job of describing the yoga. In lieu of that, you can call the location and say, "I have arthritis in my hands and knees. I'm looking for a yoga practice. What's going to be an appropriate fit for me?" Or: "I have an autoimmune condition. I don't want to be in a hot room." Or, you know: "I have vertigo. So, I don't want to be upside down." You can call and get a little bit more information and try to find a class that's going to be a good fit. 

Dan Hill: 
What does the research say about yoga, specifically for arthritis? 

Steffany Moonaz, PhD, C-IAYT: 
It helps. (laughs) 

Dan Hill:  
That's exactly what I tell people. 

Steffany Moonaz, PhD, C-IAYT: 
There’s a lot of diversity in the yoga practices that are studied and in the way that outcomes are measured. What we can say definitively is that when people with arthritis do a yoga practice that is designed for arthritis — that’s an important caveat — when we're doing a randomized control trial for people with arthritis, whether it's RA or lupus or OA or low back pain, whatever it is — the yoga practice that we are delivering is designed for that population. 

When people are doing a yoga practice that is designed for their condition, they tend to experience improvements in a whole bunch of outcomes, physical and psychological. Reduced pain, improved physical function — including balance, flexibility, strains, and then also psychologically — improved depressive symptoms, stress, self-efficacy and overall quality of life in a whole bunch of areas. 

Now, what we can't say is whether you're going to experience those same effects if you go to the hot flow yoga studio on the corner and go to the all-levels yoga class, right? In fact, there's a little bit of research that suggests that you're more likely to get injured in a community yoga setting than you are in a yoga research study, where it's highly regulated. You really have to be careful to find an appropriate class and really reap those benefits. 

Dan Hill: 
There's so many people that say, "Oh, I went to yoga once and I don't like yoga." 

Steffany Moonaz, PhD, C-IAYT: 
Yeah. The recommendations that are coming out now from the American College of Rheumatology, for example, include yoga as one of the options for how people can stay physically active and help with the self-care aspect of arthritis management. There's nothing in the recommendations about what that yoga looks like. And so, if a family medicine doctor or a rheumatologist says you might want to try yoga, that's not necessarily enough guidance for somebody to find a safe and appropriate class. 

Also, in the research, we tend to have sort of a whole-person practice that includes physical postures, as well as breath regulation and mindfulness, meditation, relaxation. And so, we can't say necessarily what the most potent ingredients are. We can say that a comprehensive yoga practice has these effects. But if you're doing a practice that is just a bunch of poses, and it doesn't have that mental component to it — that breath regulation, the relaxation — we don't know whether the benefits will be the same. 

Dan Hill: 
I am a big advocate of breathwork. And I think that could be a starting point to yoga. Because, like you said, yoga doesn't have to be a series of postures. Yoga can be just sitting down and breathing, lying down and breathing. How does breath play a role in yoga? 

Steffany Moonaz, PhD, C-IAYT: 
The breath is sort of where we think about energy regulation, right? And if we're thinking from a Western scientific perspective, that makes sense. Because if we're not breathing fully and deeply, then we're not getting enough oxygenation for our tissues in order to sustain us and fuel the activity that we want to do. If you're having shallow breath, you might find that you're more fatigued. And if we don't have healthy postural alignment, it may be difficult to take deep breaths. 

The breath is connected to our nervous system function. So, when we breathe, it affects what's called the autonomic nervous system, which has two components: the sympathetic and the parasympathetic. Sympathetic is our fight or flight. And parasympathetic we can call rest and digest or relaxation response. When we're feeling stressed, and oftentimes we're feeling stressed because life with arthritis is challenging or because we're living with pain, and that gets stressful and overwhelming, it can affect the way that we breathe. But the reverse is also true: that the way that we breathe can affect our stress. 

If we take full deep breaths, especially if we elongate the exhale — take a deep breath in and then let it out nice and slow — we tend to shift from being in that stress response, that fight or flight response, to being in a more relaxed state. And when we are in that relaxation response, it affects the signaling between the body and the brain about the pain we're experiencing, especially in a circumstance of chronic pain. 

Dan Hill: 
People always ask me, you know, what does anxiety feel like? And the best example I can give them is to take a deep breath, let all of your breath out of your lungs, and then hold your lungs empty, knowing that you can breathe at any second. Have you ever tried that empty breath hold meditation? 

Steffany Moonaz, PhD, C-IAYT: 
Yeah. And I think that that's a great example, Dan, about how a yoga practice can give us an opportunity to train for everyday life; in that we're in a controlled environment and we have complete autonomy over our own body/mind, and we get to decide where our edge is. Being able to have the discernment to decide what's OK and what's not OK, which is a tool for arthritis management. Because, for example, if you're gardening and your knees are starting to bother you, where is that line where this is no longer a good idea? 

The benefits that I'm getting from gardening for my mental health and well-being are outweighed by the exacerbation of my joint pain that's going to set me back tomorrow. But that requires that we're paying attention to our own sensation. That we're noticing how we feel in the physical body. Or we're noticing, "Oh, this is making me feel overwhelmed or stressed that I am staying in this position for this long. " Or, "It's making me feel uncomfortable that it's so quiet in this room, and everybody is sitting still for this meditation practice." What am I going to do with that sensation? Am I going to decide to stay here in the discomfort? Or am I going to decide that the wise choice is to come out of it? 

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Dan Hill:  
I think my biggest accomplishment, the thing I tell most people about this one, I stayed in shavasana for 90 minutes, in a hot yoga class, because that's what my body needed. And my ego let me stay for 90 minutes. It started with ego. I just fell in love with how I felt, and who I became, and the people that I met. The community. 

Steffany Moonaz, PhD, C-IAYT: 
Before you even get to the breath regulation and the physical postures, the philosophy of yoga foundationally: First, do no harm. In order to practice yoga, we have to consider what is going to do the least harm for me as the person practicing and for the world beyond me. And it's not just in my yoga practice, but it's in every action that I take in the world. How can I do the least harm? 

Dan Hill: 
I agree wholeheartedly. If someone has never done yoga before, how would you suggest that they get started? 

Steffany Moonaz, PhD, C-IAYT: 
When someone has not practiced yoga before, I strongly recommend that you find a teacher. That may be somebody that you work with one on one. And there are yoga therapists who have additional training in how to work with people who have mobility challenges or chronic conditions that you may want to consult first. Or an experienced yoga teacher who understands how to work with people living with arthritis and chronic pain conditions. 

If you can find a teacher who is a good fit for you — and a sangha, a community, a class of people who are supportive, who are welcoming… Every yoga space, every yoga studio, has a different culture to it and a different feel. And you want to feel like you are welcome, safe, accepted. 

Dan Hill: 
I found VETOGA, a nonprofit that I work for now. Have you heard of VETOGA? We train veterans to become yoga teachers. And then send them back to their communities to train more veterans. VETOGOA was a lifesaver for me. 

Steffany Moonaz, PhD, C-IAYT: 
We need more diversity among the yoga profession. We need teachers who are older, who are living in larger bodies, who have physical disabilities, who have different identity structures. Because, like we see in medical encounters, there is a difference when you feel like the person who is providing care understands you, can relate to your experience. We need diversity in the profession so that there isn't this stereotype that yoga is only practiced by young, thin, white women. 

Dan Hill: 
Did you want to talk about your organization? 

Steffany Moonaz, PhD, C-IAYT: 
Yeah, sure. Thank you, Dan. Yoga for Arthritis was founded because, as I was doing the research… I am a researcher first, that's my primary vocation. I started Yoga for Arthritis to train yoga teachers to work more safely with people who are living with arthritis and to help them understand the whole person experience of arthritis. It's not a disease that only affects the joints; it affects all aspects of the life of the person who has that happening in their joints and/or systemically. 

And also to make yoga practices and tools available to people who are living with arthritis. We offer continuing education training for people who are already yoga teachers. We offer training for people who are living with arthritis and chronic pain, who want to become yoga teachers. And then we also offer resources, classes, videos, programs for people living with arthritis who are interested in getting started with a yoga practice. You can find all of that and more at arthritis.yoga. 

PROMO:  
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Dan Hill: 
Before each episode, we post a question on social media. And for this episode, we asked: How has yoga helped improve your arthritis and overall health? One response we got here from Allie Marie Santos is: “I actually found yoga to be painful. A lot of the positions are layout pressure and leaning on your wrists, knees, sitting on your ankles, etc. Stretching in positions that don't put full pressure on your joints has been helpful to me, but everyone is different.” Dr. Moonaz, would you like to respond to that? 

Steffany Moonaz, PhD, C-IAYT: 
You really have to find a practice that's appropriate for you and an instructor who's able to offer suggestions for how to modify the practice with props. Maybe a chair class is going to be better. Or there are things that you can use really that can take pressure off of the joints. 

Dan Hill: 
Here's another response we got. He said: “Better balance, flexibility and strength has helped maintain bone density. Mostly makes me feel better physically and mentally. Working with an instructor who understands appropriate modifications is key.” Can yoga help maintain bone density? I thought you really needed a lot more weight for that. 

Steffany Moonaz, PhD, C-IAYT:  
When we strengthen muscle, muscle pulls on bone. And so, bone density isn't uniform; we have greater or lesser bone density in certain parts of the body. If we can target places in the body where the bone density is less and really strengthen the musculature around those bones, we can help to build strength. And actually, there's a whole program, Yoga for Osteoporosis, by a colleague of mine, Dr. Loren Fishman, who has seen in the research that bone density can improve with a yoga practice, again, that is designed for that population. You have to be careful, though, because if the bones are weak, yoga could also cause harm. 

Dan Hill: 
I want to talk about this one here from Ali Traxler: “I have been doing hot yoga for about a year now, and I absolutely love it. I love the fact that I am able to stay active while doing an activity that has low impact on my joints and body. If I'm having a flare-up or in pain, I can still participate in the activity just by taking it slower. I can easily modify poses as I go, or simply sit down if I am experiencing pain. I have noticed a big difference in my stiffness, as well as my pain, since starting hot yoga.” What's your opinion on hot yoga over regular yoga? 

Steffany Moonaz, PhD, C-IAYT: 
Yoga in a warm room can be beneficial for people who find that the cold exacerbates their joint symptoms. The warmth can be alleviating. The warmth also can help to sort of loosen our tissue so that we are able to move a little bit more freely. There's a difference between warm and hot. And I would be cautious about being in a very hot room. 

One, if you're an older person who may have other comorbidities, like risk of any kind of a heart condition, I would be careful about a hot room for balance reasons. Because it can be slippery, there's a lot of sweating. I would also be cautious about the heat for anyone who has systemic arthritis, who is on immune-suppressing medication where there may be risk of infection; because a hot room can also breed pathogens that may result in some sort of an infection or illness. 

So, there can be some benefit to the warmth. And also, you'll probably talk with your doctor and find out if being in a hot room is appropriate for you. 

A lot of people with arthritis also have hypermobility, where there's a lot of laxity in the joints, either because of an injury or because of a genetic tendency toward hypermobility overall. Being in a hot room where the tissues are elongated even further, you might have a tendency to reduce the integrity in the joints, when really what might be needed in that situation is more stability, more structure, more strengthening. And so again, talking to your doctor, working one on one with somebody who can tailor practice to you and give you some tips for how to engage, is really helpful. 

Dan Hill: 
The entire practice of yoga: It’s mental fitness, it’s physical fitness, it’s spiritual fitness, it’s family fitness. It's all encompassing. Just fitness in all aspects of your life, from your breath, to the way you treat yourself, to the way you treat others. To returning your shopping cart, to using your turn signal. That's yoga. 

Steffany Moonaz, PhD, C-IAYT: 
And I think that's part of why yoga is such a great fit for arthritis management. Because arthritis affects all of those things. It affects our physical fitness, our mental fitness, our family fitness, etc. Having a set of tools that is that comprehensive, that can help to improve whole-person well-being, is beyond what you might find in another type of just physical activity. 

Dan Hill: 
Dr. Moonaz, what are your top three takeaways from today's discussion? 

Steffany Moonaz, PhD, C-IAYT: 
One is that yoga starts with the breath. That's something that anyone and everyone can do. If you are breathing, then you can practice yoga. Another is that: If you're going to engage in a yoga practice, it's really important to find an appropriate yoga practice and appropriate yoga instructor. And that is for physical safety, but also for psychological, emotional, social safety. You want to feel comfortable in a yoga space. You want to feel like you can trust the instructor and the community that you're practicing with to support you appropriately. 

And along the same lines, I'm going to add that everybody should talk to their doctor first. Whoever is helping you to manage your arthritis and other health conditions, tell them that you're interested in starting a yoga practice, find out what recommendations they have, things that you should be careful about, things that you might want to avoid. So that you have that information before you enter into a yoga practice. 

And then, lastly, I would underscore the concept of ahimsa, the concept of non-harming: that yoga helps us to train ourselves to take care of ourselves in all aspects of life. Where we're paying attention and thinking about what is going to be the most beneficial and the least harmful for me and the world around me in this moment. 

Dan Hill: 
Great. You took my first one: the breath. That was my number one, too. So, I had to think of another one. I want to plug my buddy's company, Wrist Buddy blocks, because he's a veteran like myself. They're fantastic. 

My second takeaway is: Depression has a hard time with a moving target. As long as you keep your body moving, not only is it going to help your arthritic joints, but it's also going to help your mental health. But when your arthritic joints make it hard for you to move, what can you do? Just breathing on its own is physical exercise. Breathing on its own is mental exercise. Learn how to breathe the right way. 

Number three is: Don't wait to get started. Start yoga or start going to the gym. I hope you have already. If you haven’t, don’t wait until the next new year. Find something on YouTube and just follow along. It's not hard. It’s free. And you won't regret it. 

So, thank you again, Dr. Moonaz, for joining us. 

Steffany Moonaz, PhD, C-IAYT: 
Thank you. 

PODCAST CLOSE: 
The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. This podcast aims to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to arthritis.org/ podcast. Subscribe and rate us wherever you get your podcasts. And stay in touch!