(peaceful music)
- Hi, I'm Dr. Steffany Moonaz,
Director of Clinical and Academic Research
at the Maryland University of Integrative Health.
For 15 years now, I have been studying the effects
of mind body practices for people with rheumatic diseases.
In fact, my research in that area began right here
at Johns Hopkins University in this very room,
conducting yoga classes for people
with osteoarthritis and rheumatoid arthritis.
What we found in that study, which became the largest
and most rigorous randomized controlled trial
studying the effects of yoga for people with arthritis
was that it can improve the symptoms of arthritis.
Practicing yoga just two or three times a week
for about eight weeks resulted in improvements in pain,
in physical function, in physical fitness, and in mood.
Sometimes people living with arthritis
can feel intimidated from approaching a yoga practice
especially when yoga classes are often geared
toward people who are physically fit
and more mobile than the arthritis population.
I'm gonna show you a few ways that you can modify
a yoga practice to make it more accessible, safer,
and more comfortable for people living with arthritis.
That includes safe ways to get up and down from the floor,
ways to modify the poses for both wrists and knees,
and yoga poses that you can do seated in a chair.
To get down to the floor safely and comfortably,
we're going to use a chair, some cushioning on the mat,
so something like a folded up blanket or pillow,
and then the mat you wanna make sure that your chair
is on the mat all four legs, so that it's not likely to move
when you put your weight into the chair.
So we're gonna start standing facing the chair
and then we bend the hips and knees just slightly
keeping a nice long spine so that we can bring the hands
down to the chair, you can hold onto the chair arms,
bring the hands to the chair seat,
or you could have the chair turned around the other way
and hold onto the back.
Either way, we're gonna bring the weight of our hands
into the chair and then lower one knee down,
and you're gonna put the knee on that cushion
so that it's a little bit of support for that knee.
Lower the knee down, you bring a hand to the floor
and take a hip down and then you're seated
for yoga poses that happen on the floor.
So of course to come up to standing,
you can do the reverse.
Bring yourself onto that cushion for the knees,
the hands go on the chair, step one foot up and plant it,
put weight into the hands, and then come to standing,
take a nice long spine and walk yourself up to stand.
A lot of yoga poses require putting weight into the hands
which can be uncomfortable for people who have arthritis
in the wrists, in the hands, or in the fingers.
So there are a few modifications that can be used
in order to make the poses more comfortable.
I actually have wrist pain
and use these modifications myself.
So one of the options instead of bringing the wrists
right underneath the shoulders,
is just to take the hands a little bit forward
which reduces the angle at the wrist.
Another is to fold the front of the mat
so that it provides a little bit of cushioning
and put the wrists on the mat
while the fingers come over the front.
Additionally, you can tent the fingers
so that the fingertips are on the mat but the palms are not.
You can also use fists so that the wrists are straight,
if that's comfortable for the hands.
Lastly, these are yoga blocks and yoga blocks
have three different heights.
So they can be at the lowest height, at the medium height,
or at the highest height and in any of these positions
you can bring the forearms to the block
and have the hands on the outside.
It's most stable if they're at the lowest setting,
forearms resting here, and then the hands can be
in whatever position is comfortable for you.
Sitting cross legged on the floor is common in yoga practice
and it's not necessarily comfortable for people
who have arthritis or knee pain
which is the most common joint to be affected by arthritis.
There are a few ways that we can adjust a seated position
in order to make it more comfortable.
One is to take some yoga blocks and place them
underneath the knees to lift up the knees a little bit
and as I showed you earlier,
there are several different orientations for the block
so that you can raise them up
a little bit higher if that feels better.
This might be uncomfortable for some people's hips
so you wanna find that place that feels good
for both your knees and your hips.
Another is that your feet don't necessarily
need to be so close to the body,
so one way to make it more comfortable for the knees
is just to take the feet a little bit further away
and it's not important that they're tight into the body,
you can even have the legs extended more
and have the soles of the feet together.
It's also fine if you're sitting in this position
for a long time, to extend one leg.
So if you notice that one of your knees
is getting uncomfortable, it's fine to extend the leg
out to the side for a little bit,
even give the knee a little bit of a massage,
and then bring it back into position
when you feel comfortable.
Another option is to come into
an entirely different seated position.
So you can come onto the knees
and while it may seem like putting weight on the knees
wouldn't be comfortable for knee arthritis,
you can put down a blanket or a pillow underneath the knees
for support and then sit up on something
and that can actually also feel a little bit better
for the hips because it's not so much external rotation
in the hips, so this is another option
and then of course lastly you can do all
of the yoga poses seated in a chair.
So if none of these positions are comfortable for the knees,
everything can be adapted to sitting in a chair,
which might feel better for your joints.
I'm going to demonstrate three different yoga poses
that can be done seated in a chair.
You can think of these as a nice break from your workday
if you're sitting at a chair, at a desk,
for a long period of time.
You can use these when you stop at a rest stop
and you need a little break or a stretch,
or any time you find that you're sitting for long periods
and you could use a little bit more movement.
When we're seated in the chair, we wanna be mindful
of the angle of the joints.
So you wanna make sure that your knees and hips are aligned.
And for some people you might wanna sit up
on a little pillow or cushion
so that it's more comfortable for the hips.
And then take a look at the ankles,
make sure that the ankles are lined up
right underneath the knee so the ankles
are not the inside or to the outside of the knees.
And that has a more even distribution of weight
for all of the joints.
This is what we might call Seated Tadasana
or Seated Mountain Pose.
We're tipping to the front of the pelvis,
drawing the shoulders back and down,
letting the shoulder blade slide in and down the back
as opposed to the position that we might often
find ourselves in, we wanna reverse that
so that the chest and heart is open,
chins parallel to the floor, not forward, not back,
not up or down, eyes straight ahead,
full deep even breath and as you breathe,
you should notice that the abdomen expands as you inhale,
and then retreats as you exhale
so that you are getting the full benefit of deep breathing
which we know is associated with a lot
of health affects as well.
So in this position, we're gonna start mobilizing the spine
in what we call Cat/Cow Sequence and this is oftentimes
done on the hands and knees but it can also be done seated.
So we start moving into Cat by drawing the bellybutton
in toward the spine, rounding the back,
letting the head curl, chin lowers toward the chest,
rolling back onto the back of the pelvis,
and then reversing that, bringing the abdomen forward,
arching the back, you might draw the elbows back in,
and feel an expansiveness in the lungs,
fullness in the breath, and you can move through
that sequence, exhale as you round into Cat,
inhale as you arch into Cow.
You might find that it feels good to have the arms sliding
forward and back on the thighs as you execute that sequence.
And then after a few rounds, bring yourself back to center,
maybe roll the shoulders, feel the length in the spine,
and notice the effects of that sequence.
Another pose that can be done seated
is a side stretch, so we're gonna start by creating
length in the spine and you can bring your hand either
to your shoulder, to your hip,
into what we call Cactus Pose or right alongside the ear.
If this doesn't feel comfortable for your shoulder,
then be sure to choose one of the other options.
From here, we're gonna take a side stretch
and you can put your other hand on the seat of the chair
or the arm of the chair or in your lap,
whatever feels stable,
and you're gonna feel the pelvis really grounding
into the chair as you lengthen through the spine,
and take a little side bend and feel that side stretch
all the way through the whole spine,
from the cervical spine down to the lumbar spine.
And you'll feel an opening in this whole side body here,
really reaching out through the fingertips
and it doesn't matter how far the arm reaches,
just that you're feeling a nice stretch in the side body.
And that you continue to breathe
fully and deeply in this position.
And then come up, lower the arm down,
and then you'll repeat the same thing on the other side.
Arm up into whatever position feels comfortable,
lengthen through the spine, take a nice side stretch over,
full deep breath,
and then as you're ready come back up,
lower the arm down and find that Seated Tadasana
that Seated Mountain Pose again.
Lastly, we'll move into a spinal twist.
So for the spinal twist, you're gonna take one leg
and cross it over the opposite leg
only if that feels comfortable.
So you could cross the ankle over
if that's available to you, you can cross the legs here
or you can keep the feet flat on the floor.
In any of those orientations,
again you're gonna find the length in the spine
and starting at the base of the spine,
very slowly start to twist one vertebrae at a time
so that the head is the last thing to go
as you look over your shoulder.
You can bring the hands to wherever they feel comfortable,
so perhaps a hand on the opposite knee,
and you wanna make sure that you're not holding on
and really pulling into that pose
because you want this to be gentle
and you wanna be sure that you're able to breathe fully
and deeply here without any exacerbation
of pain in the spine so if you're feeling any discomfort
you wanna just back off a little bit,
find the length, and breathe into the pose.
And then to go the other way, you come back to center,
you can choose to cross the leg if you'd like,
sit up nice and tall and then again
very slowly begin to twist over to the other side,
gazing over the shoulder, breathing fully and deeply,
soft easy gaze, relaxed muscles of the face,
and then as you're ready come back to center.
Release the leg,
and find that Seated Mountain again.