Growing evidence shows that gentle yoga can bring powerful joint-pain benefits
As we age, our joints become a bit creaky — even cantankerous.
Wear and tear can slowly damage them, causing pain and stiffness, and limiting mobility.
This common condition, called osteoarthritis, is much less serious than rheumatoid arthritis —an autoimmune disease — but can still be very troubling and painful.
The American College of Rheumatology (ACR) is the leading association of physicians who treat osteoarthritis, as well as rheumatoid arthritis and related autoimmune conditions.
Somewhat surprisingly — but in line with the evidence — the ACR’s guidelines for managing osteoarthritis pain and stiffness emphasize drug-free options.
Their stance reflects the fact that regular use of pain medications can cause health problems ranging from stomach or liver damage to opioid addiction.
The caution concerning stomach and liver damage applies to non-steroidal anti-inflammatory drugs like ibuprofen (Advil), naproxen (Aleve), and aspirin.
And the liver-damage caution applies much more strongly to acetaminophen (Tylenol), surprisingly low doses of which can seriously harm the liver, with high doses being deadly.
Those risks explain why the physicians in the ACR say it makes sense to rely primarily on non-pharmaceutical ways to manage discomfort.
Regular exercise features prominently among those drug-free approaches to osteoarthritis.
However, exercise can be daunting for some patients, and yoga is both less threatening and potentially more effective than standard exercise regimens.
Before we dive into the research on yoga for osteoarthritis, let’s take a quick look at the condition, in comparison with rheumatoid arthritis.
Osteoarthritis (OA) 101
Osteoarthritis — which means “bone arthritis” — occurs when chronic wear and tear on joints causes the cartilage that cushions them to gradually erode, allowing bones to rub together.
In turn, this loss of cartilage leads to inflammation, swelling, stiffness, and pain.
By comparison, rheumatoid arthritis is a condition in which the immune system attacks and degrades joint tissue, causing pain and inflammation, and body-wide symptoms such as fatigue.
Osteoarthritis (OA) typically occurs in your most-used joints – knees, hips, hands and spine. It’s also more likely to develop as people reach their 50s and 60s.
And while you may be more prone to OA if you’ve had an injury — or consistently stress joints during your job or hobby — a lifetime of use is often all it takes to develop osteoarthritis.
These are the primary symptoms of osteoarthritis:
- Joint pain
- Limited range of motion
- Swelling or warmth in the joint
- Muscular weakness from “working around” the painful joint
- Stiffness, particularly in the morning or after periods of sitting still
It’s not clear why some people are at greater risk for osteoarthritis, but the risk factors include aging, excess body weight, repetitive joint stresses, and metabolic disorders.
Because pain is affected by physical, psychological and social factors, there’s great interest in mind-body techniques such as yoga.
That said, it’s not clear that yoga as it’s generally practiced today is any more — or less — of a mind-body exercise than other forms that require a focus on movement and posture of your body.
Exercise methods that require a similar focus on the body include Pilates, calisthenics, high-intensity interval training, and gymnastics. (Repetitive-motion exercise like running, swimming, or stationary bicycling don’t require as much focus on the body.)
Despite what many assume, modern yoga bears little resemblance to the earliest recorded physical yoga postures, which date back to 900 A.D. — and possibly as early as 1,600 A.D.
In those days, yoga consisted primarily of meditation and breathing techniques, with minimal use of physical postures. If you’re interested in the little-known history behind modern yoga, scroll down to the end of this article.
Over the past several years, researchers have reviewed the evidence from studies examining the effects of yoga on people with osteoarthritis — so let’s delve into their findings.
Most recent evidence review revealed good results for arthritis pain
Five years ago, German researchers published a review of the evidence from 16 studies that tested the effectiveness of yoga for easing back, knee, muscular, carpal tunnel syndrome, rheumatoid arthritis, and osteoarthritis pain.
All 16 studies reported positive pain-relieving effects from yoga. And while mood was not the initial focus of the research, studies that also asked people about their state of mind found that yoga brought moderate mood-boosting benefits.
Better yet, the participants in short-term studies reported nearly immediate relief, while longer-term studies found that yoga’s benefits grew over time.
Studies in both types of arthritis yielded positive results from yoga
Six years ago, scientists from Baltimore’s Johns Hopkins University reviewed the evidence from 11 Clinical studies that tested yoga in patients suffering from osteoarthritis or rheumatoid arthritis.
As the authors pointed out, many arthritis patients become less physically active in an ill-advised attempt to avoid pain, which explains why compliance with doctor-recommended exercise is often very low.
To be fair, while vigorous exercise is generally good for overall health, it can be difficult to impossible for people suffering from serious arthritis, whether osteo or rheumatoid.
Yoga is an ideal entrée to exercise, because its relatively gentle, low-impact movements work well to raise blood flow, warm muscles, and enhance flexibility, strength and balance.
The research team looked at 10 studies, all with small sample sizes, that looked specifically at yoga and arthritis pain and disability.
Overall, rheumatoid arthritis patients who practiced yoga reported less joint tenderness, swelling, pain, and disability.
Likewise, studies involving OA patients demonstrated that yoga reduced pain and enhanced mobility.
And the studies that recorded the participants’ psychological status generally detected high levels of “self-advocacy”, mental well-being, and energy.
Hatha yoga can decrease arthritis symptoms
The authors of a clinical study published in 2005 focused their research on using yoga to treat the symptoms of osteoarthritis of the knee.
They focused on a popular school of hatha yoga developed by B.K.S. Iyengar, which “emphasizes strength, flexibility, and relaxation, with particular attention to alignment of body structures … [it’s] accessible to all through the use of props that help the practitioner to achieve appropriate and precise positioning.”
(Excepting the use of props, that description applies to standard hatha yoga. Researchers probably chose Iyengar yoga because he wrote best-selling yoga books and Iyengar teachers are generally considered well-trained and careful.)
This pilot study involved a group of overweight female arthritis patients (average age 58) with osteoarthritis of the knee.
The participants attended a weekly 60- or 90-minute hatha yoga class, during which they learned a basic series of 15 poses or “asanas”.
After eight weeks, the participants showed statistically significant improvements in pain and disability, experiencing less of both.
The study’s authors echoed many other researchers in concluding that yoga can be a safe and beneficial arthritis therapy.
Why would yoga ease muscle and joint pain?
The authors of the 2012 German evidence review described above had this to say:
“The beneficial effects of yoga can be explained, in part, by increased physical flexibility, coordination, and strength, by calming and focusing the mind to develop greater awareness and diminish anxiety, reduction of distress, improvement of mood, etc.”.
And, as they wrote, “Because patients may recognize that they can be physically active despite persisting pain, they experience higher self-competence and self-awareness, which contributes to higher quality of life.”
It’s no surprise that the known psychological benefits of yoga would make it even more effective than simple stretching or standard physical therapy exercises.
The mind part of mind/body fitness is just as crucial. That said, most yoga classes don’t focus on meditation or breathing, and instead provide the usual Western focus on physical activity.
Studies of yoga for arthritis and other physical conditions do not generally involve much if any yogic meditation or breathing practice.
So, it’s clear that just yoga postures and movements — without meditation or breathing exercises – bring substantial benefits for arthritis and other musculoskeletal conditions.
This makes perfect sense, because the mind-body connection runs in both directions — it’s well-known that exercise usually eases stress, reduces pain, and lifts people’s moods.
The physical aspect of yoga forces you to focus on your body — like the focus on breathing common to “mindful meditation”, which is proven to ease anxiety and stress — two proven aggravators of chronic pain.
How safe is yoga? Just be careful when choosing a yoga class
Yoga is generally safe, especially when supervised by a well-trained, careful instructor.
Most injuries are linked to excessive effort, extreme stretches, incompetent instruction, and medical preconditions.
Just be sure you research the credentials of the teachers in any class you’re considering joining, and talk to current students if possible.
An Australian survey from 2012 provide some insights into yoga -related injuries. The survey was completed by 3,892 yoga practitioners, including 2,567 students and 1,265 teachers. The respondents averaged 41 years of age, most had a college degree, and 85% were women.
Among the students, yoga-related injuries in the previous 12 months were uncommon, being experienced by only 2.4% of respondents.
However, the Australian study found that that about one in five yoga teachers reported experiencing a yoga-related injury — probably because they practiced yoga more often, and more vigorously than their students.
According to published surveys, the postures most commonly associated with injuries are headstand, shoulder stand, downward-facing dog, and variations of the lotus pose.
This explains why most experts caution beginners — and even more-experienced yogis — not to practice headstands or shoulder stands, and to be very cautious about performing downward-facing dog.
If you perform an Internet search for “downward-facing dog rotator cuff”, you’ll see that this common yoga posture should not be taken lightly.
Make sure that your instructor is aware of the significant risk of shoulder injuries from downward-facing dog, and knows how to minimize that risk.
Extreme forms of yoga heighten risk
Vigorous forms such as Bikram or “hot” yoga and Ashtanga yoga are riskier than standard hatha yoga.
For example, almost two out of three Finnish practitioners of Ashtanga yoga responding to a survey reported suffering an injury that lasted at least one month.
And some practitioners of Bikram or “hot” yoga stretch their muscles, tendons, or ligaments so much that their joints become overly loose.
This happens because the extreme heat of the room in Bikram yoga studios warms connective tissues so much that they can be overstretched without the practitioner realizing it.
That risk from extreme heat can be heightened by the large mirrors and emphasis on form typical of Bikram yoga studios — which may encourage disregard for the unique characteristics and limits of each person’s body.
As one physician told The New York Times in 2004, “Heat increases one's metabolic rate, and by warming you up, it allows you to stretch more,'' said Dr. Robert Gotlin, director of orthopedic and sports rehabilitation at the Beth Israel Medical Center in Manhattan. ''But once you stretch a muscle beyond 20 or 25 percent of its resting length, you begin to inflict damage.”
How old — and authentically Indian — is today’s yoga?
Modern yoga bears little resemblance to the clearly non-physical practices called "yoga" in the ancient Vedic texts that form the foundation of Hinduism.
In the Sanskrit language of ancient Vedic texts, yoga simply means "yoke" or "union", and refers to seeking oneness with the divine, with no mention of a physical regimen like today's hatha yoga.
And today’s yoga bears little resemblance to the practices of the monks and ascetics who were the first recorded practitioners of physical (hatha) yoga about 1,600 years ago.
Most historians trace the roots of today’s physical or hatha yoga to a Hindu/Buddhist guru named Gorakhnath, who lived in the 11th century A.D. — about 900 years ago — and inspired the Nath monastic movement and its famed kanphata yogis.
The postures practiced by 11th century kanphata yogis were much less numerous and varied than the postures that constitute the core of today’s hatha yoga.
And that’s even more true of hatha yoga’s most vigorous — virtually aerobic – offshoots, such as Ashtanga, Bikram, and Kundalini yoga.
(Kundalini or "laya" yoga also dates to Gorakhnath but modern kundalini yoga also includes elements found in the yoga verses composed by Patanjali in the 2nd to 4th century A.D.)
Research by yoga author Mark Singleton, Ph.D., of Cambridge University reveals what had once been known but since forgotten, or deliberately ignored.
As Singleton found, modern hatha yoga developed in India in the early-to-mid 20th century, largely to build patriots’ physical and mental discipline for the struggle against British colonial rule.
Those Indian patriots copied and emulated European exercises, but added the breathing, meditation, and limited number of postural techniques found in old yogic texts.
It’s no surprise that modern yoga incorporates many aspects of Western calisthenics and gymnastics, because books on the subject were very popular among educated Indians of the early 20th century.
During Singleton’s journeys through musty library racks, he discovered a Danish book titled “Primitive Gymnastics”, which portrays many postures identical to modern hatha yoga poses — postures not described in the ancient Hindu texts or practiced by India’s wandering yogic ascetics.
British Army calisthenics manuals were also likely to have influenced the patriotic Indians who sought to refine and promote yoga as a physical/mental discipline.
These materials were published long before Westerners were aware of Indian yoga postures — excepting illustrations of Indian street performers known as fakirs, who performed crowd-attracting stunts like sitting on their backward-turned feet, or wrapping their feet behind their head.
The first Indians to visit the West and proselytize for Hinduism in the late 19th and early 20th century — such as Swami Vivekananda — emphasized meditation and were even embarrassed by fakirs and their physicial contortions.
Vivikenanda and other early proselytizers to Western audiences denied that the unusual poses practiced by fakirs had anything to do with yoga — an assertion that was not entirely accurate.
The apparent fact that modern hatha yoga combines Western and Indian practices doesn’t diminish its health value in any way.
Instead, it underlines the reality that — versus a more complex, nuanced account — a simple, romantic story usually wins out.
- Bosomworth NJ. Exercise and knee osteoarthritis: benefit or hazard? Can Fam Physician. 2009;55(9):871–878.
- Brenneman EC, Kuntz AB, Wiebenga EG, Maly MR. A Yoga Strengthening Program Designed to Minimize the Knee Adduction Moment for Women with Knee Osteoarthritis: A Proof-Of-Principle Cohort Study. PLoS One. 2015 Sep 14;10(9):e0136854. doi: 10.1371/journal.pone.0136854. eCollection 2015.
- Broad WJ /The New York Times. How yoga can wreck your body. Accessed at http://www.nytimes.com/2012/01/08/magazine/how-yoga-can-wreck-your-body.html
- Bukowski EL, Conway A, Glentz LA, Kurland K, Galantino ML. The Effect of Iyengar Yoga and Strengthening Exercises for People Living with Osteoarthritis of the Knee: A Case Series. International Quarterly of Community Health Education. 2007;26(3):287–305.
- Büssing A, Ostermann T, Lüdtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012 Jan;13(1): 1-9. doi: 10.1016/j.jpain.2011.10.001. Review. PubMed PMID: 22178433.
- Cramer H, Krucoff C, Dobos G. Adverse Events Associated with Yoga: A Systematic Review of Published Case Reports and Case Series. Acott TS, ed. PLoS ONE. 2013;8(10):e75515. doi:10.1371/journal.pone.0075515.
- Fishman LM, Saltonstall E, Genis S (2009) Understanding and preventing yoga injuries. Int J Yoga Therap 19: 47–54
- Garfinkel MS, Schumacher HR, Jr., Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol. 1994;21(12):2341–2343
- Kolasinski SL, Garfinkel M, Tsai AG, Matz W, Van Dyke A, Schumacher HR. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005 Aug;11(4): 689-93. PubMed PMID: 16131293.
- Mikkonen PP, Pedersen P, McCarthy, P W (2008) A survey of musculoskeletal injury among Ashtanga Vinyasa yoga practitioners. Int J Yoga Therap 18: 59–64 [Ref list]
- Moonaz SH, Bingham CO 3rd, Wissow L, Bartlett SJ. Yoga in Sedentary Adults with Arthritis: Effects of a Randomized Controlled Pragmatic Trial. J Rheumatol. 2015 Jul;42(7):1194-202. doi: 10.3899/jrheum.141129. Epub 2015 Apr 1.
- Penman S, Cohen M, Stevens P, Jackson S. Yoga in Australia: Results of a national survey. Int J Yoga. 2012 Jul;5(2):92-101. doi: 10.4103/0973-6131.98217.
- Sharma M. Yoga as an alternative and complementary approach for arthritis: a systematic review. J Evid Based Complementary Altern Med. 2014 Jan;19(1):51-8. doi: 10.1177/2156587213499918. Epub 2013 Sep 10. Review.
- Steffany H, Bartlett SJ. Yoga for Arthritis: A Scoping Review. Rheumatic diseases clinics of North America 37.1 (2011): 33–46. PMC. Web. 2 Feb. 2017.
- Ward L, Stebbings S, Cherkin D, Baxter GD. Yoga for functional ability, pain and psychosocial outcomes in musculoskeletal conditions: a systematic review and meta-analysis. Musculoskeletal Care. 2013 Dec;11(4):203-17. doi: 10.1002/msc.1042. Epub 2013 Jan 9. Review.
- Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008;16(2):137–162.