Friday Q&A: Arthritis and Flow Practice

Forest Road by Melina Meza

Q: I have very painful arthritis in my hands, feet and knees and I have been doing Flow classes twice weekly which involves lots of down dog and strength in my arms poses. Am I doing more harm than good persevering through the pain? I do adapt when I can. I attend these classes at Glasgow University gym and I am 63 years old.
A: My short answer is that yes, you are likely doing more harm than good by persevering through the pain. But lets unpack this a bit more.
There are several aspects of this question I’d like to explore today. The first is to look at osteoarthritis and the use of yoga to maintain or improve function and symptoms for those who have it. Osteoarthritis is a very common condition that is associated with aging, and is the most common cause of disability in adults in the U.S. (and certainly high on the list worldwide), affecting 1 in 5 adults. We have written about yoga and osteoarthritis many times in the past, including a great post by Nina with links to almost all our past posts on arthritis, Yoga for Arthritis: The Big Picture  and a specific look at hand arthritis from guest writer Ann Swanson, 5 Tips for People with Arthritis of the Hand. I recommend anyone interested in learning a lot more about this particular topic to take some time to review these posts.
In addition, there have been many scientific studies looking at the use of yoga for osteoarthritis that have found yoga to be a good adjunct to western approaches to pain management and functional improvement. In the book Principles and Practices of Yoga in Health Care, the authors reviewed 21 studies looking at a mix of osteoarthritis and rheumatoid arthritis and yoga, many of which demonstrated improvement in pain and joint stiffness. The authors noted that “slow, gentle stretching poses can help maintain range of motion necessary for overall mobility and daily activities.” The practices studied, however, did not include flow classes. And from my experience, when symptoms are active, often restorative and non-weight bearing poses are more appropriate. So I can feel pretty confident recommending certain appropriate yoga practices to address arthritis that we have covered in the posts above.
One of the questions I think I am hearing from our reader is “what is the best style of yoga for me to be doing with my arthritis? Is Flow Yoga safe for me?” Unfortunately, I don’t know from what the reader shared with us whether the classes our reader is attending are helping or worsening her arthritis symptoms, but her statement “persevering through the pain” implies it may be aggravating her arthritis to some extent. If she is experiencing a flare of symptoms in her knees, feet, and hands during and after class, then this flow class is not for her. From my time in India in 2005, I was exposed to the concept of “anga bhanga sadhana,” or limb-harmful practices (including yoga ones!). A yoga practitioner is encouraged to identify these sorts of practices and change or avoid them altogether—some good common sense!
It is appropriate and admirable that our reader is attempting to modify poses when possible. However, one of the challenges of trying to insert modifications in a flow class for yourself is that the pace of class often moves too fast. There are some styles of flow practice that I know of, such as those that go by such names as Smart Flow and Slow Flow,  that might provide a bit more time for modifications. But I do not know whether those are available to our reader.
However, I would encourage this reader to explore the options in her area, even if they are less convenient than her class at the university. There’s a good chance she can find classes in other styles of yoga, such as Iyengar- or Krishnamacharya-style (Viniyoga), which are better suited to her particular concerns and are taught by teachers who have some training in adapting yoga poses for those with arthritis. It could be also helpful for our reader to work with a local yoga therapist (check out www.iayt.org) or experienced teacher to gain more skills and options on how to better care for her joints when attending her flow class or any public class, for that matter. Of course, I recommend all the time both here and to those I come into contact with that it is important to take the time to find the teacher, class, or yoga therapist that is right for you and not just take the class that happens to be nearby.
Here are three posts that may give you more to think about along these lines: 

1. Nina’s post Friday Q&A: Finding a Yoga Teacher on finding the right teacher, with key recommendations of finding out what's available in your area, looking into the reputation of the studio and the teachers, and trying out several classes. 
2. Andrea Gilat’s post Finding the Right Yoga Teachers: Tips for Third Agers with specific recommendations for the older practitioner.
3. My own contribution to the discussion on finding a safe class Friday Q&A: Finding a Safe Yoga Class

Another possibility is that if the university class has a focus for younger students and not on older staff and professors, perhaps our reader can advocate for a new class at the university for those who need a more appropriate and specialized class to address their changing needs.
—Baxter 
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