Gentle movement can alleviate pain, maintain joint mobility
For a decade or more, doctors and other health practitioners have been recommending yoga to their patients to manage stress or depression or to serve as complementary self-care for people with back pain, arthritis, multiple sclerosis, cancer and other medical conditions. A growing body of research is accumulating about yoga's health benefits.
Kimberly Carson, a health educator and yoga therapist at Oregon Health & Science University (OHSU) in Portland, has been contributing to the research. She taught yoga at Duke University's Center for Living, in Durham, N.C., for more than 10 years before relocating to Portland.
At Duke, she served as yoga therapist on research protocols using yoga and meditation for various medical conditions, including chronic low back pain, metastatic breast cancer pain and chemotherapy-related joint pain.
In 2010, Carson and her husband James Carson, an OHSU psychologist, demonstrated a significant reduction of pain, fatigue and other symptoms of fibromyalgia in women taking a weekly two-hour class she taught that combined gentle yoga and meditation. Results were published in the journal Pain.
Carson, 42, teaches yoga for chronic pain as well as Mindfulness Based Stress Reduction, a meditation program developed by Jon Kabat Zinn, founder of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts. (Kabat Zinn was featured in the summer 2011 issue of Psoriasis Advance.) In a recent interview, she described how yoga and meditation work together to alleviate chronic pain.
"In the context of chronic pain, it's common for people to guard against their pain by contracting their muscles, which can increase the sensation of pain. One of the really important benefits of yoga is to get movement back into an area that has been contracting," she says.
"Breathing is also compromised by this contracting and can begin to improve, too, as well as joint mobility and the muscle tone necessary to support affected joints. These changes would be especially helpful for people with the joint pain seen in psoriatic arthritis."
"Any sensation of pain is processed in the brain, and the brain can be engaged to change that experience, according to Carson. In the movement-focused part of her yoga class for people with chronic pain, her intent is to soften resistance to sensation and have students "invite the breath in."
She incorporates meditation skills in both the active and less active portions of the class. These skills can be helpful in reducing pain, she explains, because the thought and emotion centers of the brain can directly affect the level of pain someone is experiencing.
How much yoga is necessary to reduce pain? The greatest benefit comes from a committed and disciplined routine, Carson says. "I give students specific practices to do every day, but for just 15 or 20 minutes. Our postures are not advanced or complicated. I am more interested in having people explore range of motion with an integration of breath."
What other benefits might yoga offer to people with chronic pain? Two major benefits, according to Carson, are enhanced sleep and improved mood.
It's not uncommon to hear stories of people who tried one yoga class, had a bad experience and decided it was not for them. A new book, "The Science of Yoga," (Simon & Schuster, 2012) by New York Times science writer William Broad, raises concerns about the potential for injuries and the adequacy of teacher training.
Carson says she doesn't want people to be afraid of yoga. "The potential for benefit and risk is true with everything," she notes. Rather than provide a list of poses to be avoided, she gives an example of her teaching approach. "For someone with arthritis, if the knee joint is really inflamed, you need to be cautious with static, weight-bearing poses until the inflammation subsides."
Carson is co-director of Yoga for Seniors, a national teacher training program. She says there is an increasing number of gentle yoga classes for people with special needs, including seniors who may have arthritis.
Doctors and physical therapists who practice yoga may be able to recommend a suitable class. People can also look for gentle or pain-focused yoga classes at hospitals, medical centers and YMCAs. Online, the International Association of Yoga Therapists (www.iayt.org), an organization that Carson belongs to, lists teachers by city, state and specialties.
People new to yoga may need to try more than one teacher and one class to find a good fit. Carson's advice: "Ask teachers if they've had experience teaching people with chronic pain. Ask, 'Can you make modifications for me? Do you use chairs for seated poses? Will I need to be able to get up and down from the floor?'"
Carson and a colleague have produced a new DVD suitable for seniors and people with medical conditions called "Relax Into Yoga: Finding Ease in Body and Mind," scheduled for spring 2012 release by Pranamaya. For people with special needs, DVDs can serve as an adjunct to taking a class, says Carson, adding that regular guidance from a teacher is especially important for new students.
Gentle movements to ease into yoga
Editor's note: National Psoriasis Foundation recommends that you check with your doctor before beginning any new exercise program.
In this sequence of movements, Mary Agnes Prosser moves from a traditional "table pose" into the "child's pose," which is often used as a resting position between more difficult poses during yoga practice. This sequence enhances mobility in the hips, knees and shoulders by stimulating the joints' natural lubricants, reducing joint friction. It also helps lengthen the spine, which can help people who have arthritis in their vertebrae. For comfort, Prosser uses a folded yoga mat to ease pressure on her knees.
The warrior pose has several variations, but legs are always several feet apart, the back foot slightly angled toward the front, along with the rest of the body. Here, instructor Kimberly Carson leads Prosser through movements designed to bring mobility into the knees while strengthening the thighs and hips. The elevation of the arms helps to strengthen the muscles that support the shoulder joints. Strengthening the large muscles of the thigh and hip can help remove pressure from joints affected by arthritis. As with all yoga poses, it's important to breathe evenly and fully when engaging in these movements.
Prosser sits straight up on a chair for this sequence, which brings mobility to the shoulders, elbows, wrists, fingers and neck. It moves these joints through their range of motion and also gently stretches and strengthens the supporting muscles around them. This stretch should be done slowly, and it's important to remember to breathe evenly. Typically, the movement and breathing become easier after this sequence has been done two or three times.
Martha Wagner is a freelance writer and editor based in Portland, Ore. She has been a yoga student for 40 years. Her website is www.marthawagner.com.
National Psoriasis Foundation thanks Amrita yoga studio in Portland, Ore., for providing studio space for photography.
Photos by Shanda Tice
Additional resources: The International Association of Yoga Therapists »
Kimberly Carson www.yogaofawareness.org
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