April 13

Yoga Therapy For Arthritis With Steffany Moonaz

We discuss how:

– Steffany is a yoga therapist and researcher specializing in rheumatic diseases
– She demonstrates in this episode lots of do-it-yourself exercises to relieve finger, hand and wrist pain
– She has written a book called “Yoga Therapy For Arthritis” and has conducted pioneering research in the benefits of yoga for arthritis
– Her research confirms Yoga can help with arthritis in a variety of ways
– Yoga is currently built into many of the recommendations for safety management of arthritis
– It primarily deals with the union of mind and body and is strictly connected with meditation
– Managing stress response and relaxation response is key in arthritis treatment
– Some simple breathing exercises can help reduce stress

Clint Today we’ve got a tremendous guest. She has a PhD in public health her name is Dr.Steffany Moonaz. She is a yoga therapist and researcher in Baltimore specializing in rheumatic diseases. She has written a book called yoga therapy for arthritis and she has conducted vast pioneering research in the benefits of yoga for arthritis and is now one of the leading experts in this area. So Dr.Stephanie thank you very much for coming on this episode.

Steffany Oh it’s such a pleasure. Thank you for having me.

Clint Tell us straight away what does the research tell us about the benefits of yoga for arthritis?

Steffany Well the quick answer to that is that the research says it helps and there are a variety of different ways that it helps.

Steffany The research in yoga is really still somewhat in its infancy. There was a dramatic increase in the amount and the rigor and quality of yoga research around 2010 which was very recent compared to other fields so we still have a long way to go. But the earliest research first just had to demonstrate safety to be able to say yoga is safe for people with arthritis. Now yoga is built into many of the recommendations for safety management of arthritis. We know that exercise is important for arthritis and yoga is now recommended as part of that as a way to stay active for people living with arthritis. In addition to being safe however there are a variety of benefits for people with arthritis when they practice yoga. The most obvious is that it helps you stay physically fit right. Like anybody else with or without arthritis staying active helps you to stay fit and that can be in the areas of strength, flexibility, mobility, balance.

Steffany One of the good things about yoga is that it doesn’t just train one aspect of fitness but it touches on all of those areas. Beyond that, exercise is also good for your mental health. Good for your mood. For the way that you feel and that is also of course true for people with arthritis. Those kinds of challenges with having a good mood, feeling good tend to be more complicated for people with arthritis because of the inflammation, because of the challenges to daily living so the research shows that yoga improves mood depressive symptoms, stress, anxiety for people with arthritis. Additionally it improves quality of life the way that you feel about how you’re doing, how healthy you are, how your health impacts your daily life, how your arthritis impacts your daily life and then beyond that there is some suggestion that the yoga practice is also affecting the underlying disease status so that you see some suggestion of changes in things like number of joints that are tender or swollen and the underlying disease processes may also change. Some people report that they are able to use less medication when they’re practising or when they’re practising yoga. These are the questions that we’re starting to ask now. All of this is predicated on the yoga being the right kind of yoga that is appropriate for people who are living with arthritis.

Clint Yeah wonderful, you’ve touched upon the physical and the non-physical. We know through recent work that the non-physical can have clinical improvements to inflammation and because it’s so non quantitative, you know it’s hard for us to kind of therefore feel as satisfied with the information. But you know, look, happiness, gratitude, these things are certainly showing up now as being influential as well as just feeling good, feeling calm. And I say that with exercise you get the stress reduction on the meditation effects for free especially with yoga. Right. Because correct me if I’m wrong but didn’t Yoga originate partly to enable people who wanted to meditate more, to be more successful at longer meditations?

Steffany Right. So actually the term yoga means union and we can think about that in a lot of different ways but one of the ways that we might be in union or unified is in mind and body. And so in order to achieve a state of yoga, you have to be in balance in order to be fully present and connected in mind and body. You were saying that the psychological affects the physical, the physical also affects the psychological. As anybody who has physical challenges knows it’s a two way street. And so the initial yoga practices were just ways to experience union, ways to be able to feel connected. And the physical part of it really just started with the seated posture. The first yoga pose is just a seated posture for meditation and all of those other poses that we now think of in the West as what yoga is evolved in order to bring the body into a state of readiness, to be able to sit. In union. Right. So you know we have these like long elaborate processes that we do just to be able to sit still because anybody who has tried to sit still knows that it’s not easy. And but after a yoga class doesn’t it feel so much easier to be able to just be still and that being still is not just being physically still. But it’s being able to quiet the mind and the stories that we tell ourselves and the worries that we have and are hanging out in the past and hanging out in the future. And so the yoga practices are intended to bring us in to that readiness for a unification of mind body. It just so happens that all that physical stuff we do also has its own benefit right. Even if you never sit and meditate, at the end there is a whole bunch of good stuff that happens as a result of all the preparation in and of itself.

Clint Oh most definitely, can definitely relate to that. A lot of my audience are familiar with Bikram yoga which is on its own kind of branch out of the yoga spectrum. And by the end of that, you know it’s very hard to be worried about what’s happening on the outside world.

Clint I mean you’re just hanging in there and you’re very much connected with your body by the end of a 90 minute Bikram class. But let’s talk about what you do when someone shows up. They have some kind of rheumatic condition maybe psoriatic arthritis, ankylosing spondylitis they might have rheumatoid arthritis. Let’s spend some time walking through how you help someone who presents with these symptoms using yoga.

Steffany It’s alright I confuse the terms all the time. So. I’m a yoga therapist and I think maybe it helps to distinguish for a moment the difference between a yoga teacher and a yoga therapist because one of the distinguishing features is an intake process. So when you go to a yoga class they might ask “Does anybody have anything I need to know about,” you have any health conditions you know maybe you sign a waiver. Maybe you answer a few questions, maybe you raise your hand if you need to modify something. But generally speaking the class takes all comers. And it’s up to you as the student to figure out what class is appropriate for you where you belong and how to take care of yourself. What instructions to follow or not follow. What to do a little bit more or a little bit less, when to bow out of something entirely. Whereas a yoga therapist is in a therapeutic relationship with the client. So that means just like when you go to a medical doctor or you go to a massage therapist or a chiropractor and they want to know about your health from a yoga perspective because they’re operating from a yoga framework. So that means they want to know about all the aspects of your health not just physical but all of the coaches or the coaches are sort of the layers of like the bio psycho social spiritual model in medicine. Yoga thinks about it in the same way you have different aspects of yourself, you have your physical body your energy body, emotion, intellect etc. So they want to know well you know how balanced are you in all of those ways and you know in what ways are you imbalanced. Because that way I can work with you to figure out what the practice is that’s going to be safest and most appropriate for you meeting you exactly where you are right now.

Steffany So if I, every yoga therapist is also a yoga teacher because you have to be a yoga teacher first to become a yoga therapist so if I’m teaching a class, I’m not going to have the luxury of all of that information. But if I’m working with you one on one or I’m doing a small group of people who all have arthritis I’m going to get all of that information so that the practice can be tailored to you and I’m thinking not just what poses my he need in order for his back to feel better but I’m thinking how is his energy, where is his mindset, what’s the meaning and purpose in his life. Why does he care about any of this, what’s bringing him to yoga, what does he want to get out of it so that we can partner in developing a practice that’s going to serve you. From the whole toolbox of everything that yoga is not just the physical postures. Not just the breathwork. Not just the meditation. The mindfulness but also lifestyle and also the philosophy I bring in a whole lot of philosophy because yoga has gems of teachings that you can apply to your daily life and totally change your mindset. So that whether or not your arthritis changes, your relationship to your arthritis changes.

Clint Yeah for sure. I didn’t expect you to finish speaking at that exact moment. So I was just listening I wasn’t formulating a question. I was fascinated. I was thinking about everyone walking in and you having conversations with them and getting their background and everything and um and I was drawn into that world. So can you give us some case studies or some examples. Describe a typical person that walks in. You go through that questionnaire with them and you establish all of this background information about them and then what happens after that. Do they see you on a regular basis or do you send them home with a routine to work on?

Steffany Yeah that’s a good question Clint. And it can happen in a variety of ways and it’s based on the readiness of the client and you know what they’re up for, what they feel like they need how deep they want to go. There are some people who are regular yoga practitioners who now all of a sudden have arthritis. And they are already very familiar with yoga but they want to figure out what do I need to do differently now that I’m experiencing my body in a different way. And so that’s going to be different from somebody who maybe has been living with arthritis for decades but has never been in a yoga class before. Right so I’m meeting you where you are both in your yoga experience and also in your arthritis experience because somebody who is newly diagnosed is just wrapping their head around what all of this means, what my life is going to be like, where I’m going to have to let go of, what’s going to be possible for me. There are aspects of grief of letting go of you know the person that I may have been before I had this and accepting a new normal of these are things that I’m going to be dealing with that are different all of the information from the medical doctor that might have made your head spin around multiple times. And so what someone like that might need is perhaps just to learn how to breathe deeply. And maybe that’s where we start. Without even any postures. And so I am always sending my clients home with homework because Yoga, unlike a lot of forms of. Integrative Health is not something that someone does to you but something you do for yourself. So you don’t show up to me like an acupuncturist who puts needles in you or a massage therapist who works on your muscles or you know an herbalist who gives you a pill to take. I think of it more as an educator role. That I’m introducing you to skills and then expecting you to take those skills out into your life. So if you only are using yoga when you’re with me then I’m not doing my job because hopefully eventually you’ll get not only is a set of practices that you use in your life on a regular basis but also is a way that you just are in your body differently, are in your breath differently, are in your mind differently. And so we work toward that in baby steps. In both the meetings together and also in your homework outside.

Clint Yes I love that. What I’ve learnt in my yoga classes which by the way have been absolutely instrumental to my health improvements and in fact for a period of a year I was going to yoga every single day just so that I could walk. Such was the importance of attending yoga for my..I wouldn’t even say health I would say disaster avoidance, it was that crucial.

Clint And every time I go to the gym which I’m going to this afternoon I went to yoga yesterday, I’m going to the gym after our call and I incorporate the pranayama breathing whilst I’m at the gym. It helps well, I use it actually to open up my shoulders and my shoulder blades and so on. I like it from that point of view but obviously the deep breathing as well. And I use some postures within the yoga class at the gym to stretch out after I do some leg exercises, some squats and things because I’ve just found that those postures from class are also the best way for me to stretch without causing injury on a very bad left knee. And so yeah I’m always incorporating stuff that I’ve learnt from the yoga class outside the class and in fact, you know even the concept of sort of trying to meditate in challenging conditions you know with the yoga being a moving meditation. I’ve tried to apply also to my other career which is performing and doing stand up and stuff.

Clint And I’ve found that very helpful as well so yoga is just as you say becomes part of your life, it becomes part of who you are. And if I. Yeah if you only do it at class and then you don’t bother doing it outside I think the benefits are certainly not as great which makes. So I’m now going to put you on the spot and I’m going to ask you to help people who are listening and other things that are generic that everyone really could benefit from that you could help us with over the coming portion of our call whether it be some breathing techniques or whether it be posture related or just some. And what I’d really love to get into if if you feel that you can be generic in this area when it’s half, is if someone has for instance a knee problem or for instance pain in their fingers could be perhaps even explore things for particular scenarios if I may put you on the spot like that.

Clint But first of all, get as helpful as you could be please.

Steffany I guess you just laid out a whole bunch of options.

Clint Yeah whatever you feel, whatever is the most common. What is the most common to your clients?

Steffany I think let me just say something about the nervous system here because many of us with arthritis are not or not are living in a state of ongoing stress response. Because we’re not getting enough sleep, because we’re always busy, because there’s sort of our pride in always being busy and feeling rushed and feeling like you have too much on your plate worrying about the future, worrying about the past it’s just a part of many of our cultures to live like that. And then you add a disease on top of that that has a lot of complications and all the more so. So when we’re in a stress response our body does what it has evolved to do which is prepare us to fight, freeze or flee. And that makes a lot of sense when you’re worried about a bear attack in you. It doesn’t make a lot of sense when you have a work deadline. Or you know when you have a sick parent or whatever it is. So the physiology that happens in a stress response is bad for our bodies and also for our minds and it’s accompanied by a particular breath signature that many of us walk around with all the time which is that our breath is shallow and short and high up in the chest. And if you were trying to exert then you need that faster breathing rate you know you don’t have time to be able to slow down and take full deep breaths but it’s not healthy to stay in that acute stress response for long periods of time. And it turns out that we can turn that off with the breath. So instead of or in addition to trying to change all those things that feel so stressful, we can change the way that we breathe.

Steffany So the stress response has an opposite and it’s called the relaxation response. And it’s like a light switch. It can’t be both at the same time. It’s either one or the other so either we’re in a stress response or we’re in the relaxation response. This is the sympathetic and parasympathetic aspects of the Autonomic Nervous System. So when we breathe in our heart rate is increasing. And when we breathe out our heart rate is slowing down. And so we have this sort of wave where our nervous system goes in to the sympathetic and parasympathetic rhythm. The more time we spend on an exhale, the calmer our nervous system gets. And even just thinking about a slow exhale you can sort of almost feel that already. Right. So when we take a slow long exhale we’re engaging the relaxation response and turning off the stress response. Now in order to be able to take a long slow. exhale, you have to have enough air to let out slowly. If you’re breathing high up into your chest that’s not possible so the way that we start is by allowing the diaphragm to move.

Steffany Now the diaphragm separates the chest and the abdomen. It’s like a little barrier. And as it descends, it allows the lungs to draw in a bunch of air and then it rises as the air goes out of the lungs and back out on our exhale. If your hands are on your belly you can feel that when you breathe in your belly expands. The belly is expanding because the diaphragm moves down and it sort of squishes all the organs in the abdomen and they have no place else to go. So if you’re breathing properly, to engage the relaxation response your belly is going to move out as you inhale. And then it’s going to move back in as you exhale. Now some people get really uncomfortable with the idea of their belly moving out. And so one of the things that I tell people is that what’s actually happening when you breathe in and out and your belly moves is that you were toning your abdominal muscles by allowing them to engage and relax and engage and it’s like doing crunches by just breathing. And if you’ve ever watched a sleeping baby breathe you can see that their belly rises and falls quite naturally. So if we breathe in and we allow the diaphragm to descend and the belly expands then we can take on really nice slow long exhale so let’s just do that together now.

Steffany And you find that when you do that that there’s almost a little pause at the bottom before the breath just naturally rushes in again. I like to think of that as there is the saying about there being a pause between the stimulus and the response. But that pause between the exhale and the inhale, there is nothing happening. There’s no doing there’s only being. So it’s a really nice metaphor for taking a moment which we rarely do in life, just take a moment and just be without reacting, without rushing into the next thing. So when you notice that your breath does that naturally it takes a little break. And then it dries in new air. And then it takes a little break and then it lets it out. So that’s a tool that people can use when they’re driving, when they’re standing in line, when they’re you know on a phone call, in a meeting. Nobody knows that you’re doing it just that long slow exhale to calm down the nervous system and it turns out that the nervous system is also where pain happens. And so when we calm the nervous system we also calm the pain response so we can change the experience of pain by changing the activity of the nervous system.

Clint Something that’s so common and we give so little thought to has so much potential to influence us so positively if we give it some consciousness.

Clint I loved when you were talking about that state in between the breaths where you have that state of being and nothing else. I’ve heard that referred to before as far as that’s where you can find God. You know it’s that kind of thing. It’s that moment where you really are just purely present and it’s lovely it’s just a moment but it’s it’s a nice one Ah I feel nice and calm just by working on this with you just in those few moments. So if we did it all day when we’re you know out and about I’m sure that the effects would be much more profound.

Clint Tell us…give us some more things. That’s obviously one that we can implement right away nice and simple. Are there some others that you teach that are also kind of generic. And if you like, I’d like to also explore some more you know individual cases like some hands and elbows and knees and ankles if you want to go there. So I missed all that is what you could teach.

Steffany Let’s go some some place more grossly physical. Okay okay. Let’s go to the hands because they’re really easy to see and it’s a really common place for people to have arthritis of several varieties. So not everybody has arthritis in their hands but lots of people do and even those of us who don’t have arthritis in their hands still can benefit from these practices both in terms of prevention and also just in terms of stiffness and achiness that happens when you’ve either been still for long periods of time or you’ve been over using your hand so I think this one is good for everybody.

Steffany And so we’re going to do a few things with our hands here. There’s something that I do. Especially if I am going into a place that has a large crowd. Let’s say it’s a stadium full of people. Maybe it’s an arthritis event like a an arthritis walk and so there are going to be people of all kinds of all ages with all different kinds of challenges and I want something that everybody in the room can do or I’m going into a senior center and there are lots of people who are wheelchair bound or have a lot of limitations. These are things that I do for just about anybody and it involves essentially moving every single sinovial joint in the body. So what I’m going to show you for hands I would really do from the toes all the way up to the head just very quickly moving through the whole body and it’s great to do especially for people who have morning stiffness who wake up in the morning and feel very stiff and achy and it’s hard to work that out. But just getting every joint in the body moving can be really helpful in those situations. So what I would do with the hands is start by bringing up the hands in front of you. And you can bring the fingers toward each other and away. And toward each other and away. And so not everybody is going to be able to touch the fingertips and that’s fine they don’t have to touch so it might just be this. Right. It’s working within whatever range you have taking them apart and together and you might find that as you do it your range starts to improve so that you can spread your palms a little bit wider and you can squeeze the fingers together just a little bit more. Okay and roll all the rest one way, and roll them the other way.

Steffany And then imagine that you’re playing the piano.

Clint You know I do this, this part I call this sending twinkles or whatever my wife come up with that idea. And we were doing this at an event in Florida recently I had everyone do this exact same thing. Get them really moving because we’re getting movement through those little joints aren’t we, we’re just getting all.

Steffany All the joints in the hand, it’s not just the fingers. Yeah. And then being one finger at a time toward the thumb. So I actually do this one and again it’s fine if it doesn’t touch I do this one with kids and I teach them a little meditation with it. Peace begins with me, peace begins with me..

Steffany So it’s a little sort of mantra that they can say in their minds while they’re moving finger to finger and it’s a way to calm the mind as well as moving the body and then bring the palms toward each other and away, and toward each other and away. And again fine if the palms don’t touch you just bring them toward each other. We actually had somebody in one of our yoga research studies who at the beginning of the study her hands looked sort a like this. And by the end of the study she was able to bring her palms together and that was such an incredibly powerful experience for her because she felt metaphorically like it allowed her to express a prayer of gratitude for being able to move into this position. And from here you can roll the wrists this way.

Steffany And then take the hands out in front and like flex some point. And then give it some distance you don’t knock your microphone over and then you alternate one and then the other. So this is also good for the brain. And then just shake the hands out. Yeah and let them go. You don’t want to do any of that for too long because as with anything the poison is in the dose. So if a little bit can be beneficial and a lot can be harmful. So if you especially are someone who is hand start to hurt from over-exertion or from too much activity, then there is a fine line between doing enough movement that you don’t get stiff but doing not doing too much that you get sore and only you know how much that is. So what we just did right now, we did some of those things for a longer than I might have especially in a large group but there are little things that anybody can do for as long as it feels okay.

Clint Let me run something past you obviously all that what you’ve just gone through you’ve tried and tested with multiple people and you’ve found that overall this is beneficial. There is something that I’ve not talked about. I don’t think on an episode before or given in any kind of training videos or anything that I’ve found been helpful for me over the years and that is to clasp my hands together very tightly. And then what I’ve actually got going on here is a torniquet effect in between each of the joints because each fingers pressing firmly against the soft tissue of the other fingers and then when it’s released I just feel this wonderful blood flow through.

Steffany Yes like when you put your arms in a doorjamb and then you let go and your arms float up. It’s a similar. Have you done that?

Clint I know I’ve done it. I haven’t thought about that since I was 12 then yeah but I just feel that there is a fresh blood flow coming through the finger joints and in the Bikram style of teaching he calls that the anti-arthritic grip. So yeah that’s why I didn’t come up with it. I get something I took out of class and applied in my day to day life and I still like to use that from time to time just to get the fingers feeling really juicy.

Steffany Yeah they love it. You know there’s a lot with hands in yoga, there’s a whole aspect of yoga called Mudra which is all kinds of different hand positions and those hand positions are intended to change subtle energy by the way that like acupuncture has Chinese meridians, yoga has similar channels of energy through the body. But different hand positions can be beneficial physiologically too unlike a musculoskeletal level. But it depends on the person because what is beneficial for one person can be harmful for another and so there are some hand positions that I might think feel really good like just for example something like this might feel really good if your arthritis hurts when you go this way but if you have carpal tunnel then this is going to be terrible right. So that it all has to be considered in the context of what are the joints that are affected by the arthritis, is there any deformity, are there osteo(inaudible) at the joint that we need to be aware of. So that’s why the individual intake is so important.

Clint Oh definitely. I mean you know I’ve gotten to know my heavily osteoarthritic knee very intimately through yoga classes. I know for example that if I try and sit Japanese style or fixed firm pose, you know anything that involves putting my weight off or on my buttocks back onto my heels in that direction. This is helpful in class if I try and do it if I got up now and got down the floor and started doing this I would aggravate the torn meniscus in the knee joint. And I’ve often pondered why is that the case. And I’ve concluded that it’s because the joint gets warmed up, it seems to get warmed up during the other sessions and so, sorry the other postures that lead up to those postures in class and so I’ve stopped doing them. I’ve just stopped doing that but that’s just an example to support your comment that you know what works for one person might not work for another and it’s very individual which I guess is why it’s so important that someone gets that kind of concierge or bespoke help from someone like yourself because these things are hard to work out especially when you’re in class and the teachers say do downward dog, do downward dog and your wrists are killing you and you’re on trying to do downward dogs. This is why this is the number one complaint of people to me with rheumatoid arthritis who don’t go to Bikram which I keep bringing up because it doesn’t put any loading on any of the wrists and they’ll do something like a Vinyasa or something and they’re in these downward dogs and they’re like my wrists are killing me so.

Steffany Yeah or it’s child’s pose. If you have problems with the knees or the hips you know they’re. And that’s why in our research the poses are tailored to the individual. So you know as I said yoga is union. Yoga the ancient art of yoga doesn’t say that you know you need exactly a 45 degree angle between you know this joint and that. And so there’s actually some writing that I’ve done around this issue of what makes a pose yoga. And there are a whole bunch of things that make a pose yoga that are not about the actual physical position of the body. But. It’s up to the student to one, be able to advocate for themselves and say this doesn’t work for me. I need a different option and either I’m going to be creative and figure it out myself or I’m going to ask for help or whatever the case may be but in order to advocate for yourself when something doesn’t work for you, you have to first be aware of it.

Steffany And that is a skill that yoga teaches is just paying attention to what’s happening in your own body especially for people who are in pain. There can be an impulse to say you know what, I’m just going to ignore everything that’s happening in my physical body because it’s all bad news and I need to get through my day and if I indulge in what’s happening in this hand, in that knee then I’m going to be debilitated and so I can’t even go there. But while that may be adaptive in some ways it also prevents us from being able to make informed decisions about what is working and not working. And no one can be more of an expert of your body than you. I say you know I may be the world’s leading expert on yoga, but you’re the world’s leading expert of your body and so I bring the yoga and you bring everything that you know about that body that you’ve been living in and let’s figure it out together because I can’t know how your hip feels in this pose, only you can know that but in order to know it you have to pay attention to it.

Clint Yeah definitely. Tell us does everyone get results when they come and see you are there I mean, if there’s people who are thinking about if they live in the Baltimore area or whether or not they would even travel to see you or whether or not you might do consultations over Skype and so forth. Superficially we’re all interested in pain relief, physical pain relief. Yes we would love to have better connect mind body connection and feel calmer and everything and and so forth. But pain relief is the results. That’s the golden ticket we all after. Are you successful in most instances in achieving that.

Steffany 30 percent reduction in pain.

Clint 30 percent reduction in pain. Okay. That’s what we want to hear.

Steffany With no side effects, with good side effects right?

Clint Now are figures coming out of your clinic or is that from the studies that you’ve helped pioneer in the past.

Steffany Yes that’s our research.

Clint That’s your research.

Steffany Yeah. So the research that I’ve done has been at Johns Hopkins Arthritis Center at the National Institutes of Health in Washington D.C. and now at major hospitals in New York City. So this is are you know very well designed studies and people who are coming to a tertiary care clinic so these are people with serious challenges and all kinds of different joints involved. You know when you say it would be nice to have more of a mind body connection. But what we really want is pain relief. I’m just going to play devil’s advocate and say that’s where the pain relief comes from because the pain signal, I teach this to my students I make them say it over and over again. Pain is an output of the brain. Pain is not something your knee tells your brain, pain is something your brain tells your knee. So if you can change what’s happening in your brain, you can change the pain even if you’re knee doesn’t change at all. You may be familiar with the studies that have shown that there’s actually very little correlation between tissue damage and arthritis pain. Right so you could have only a little bit of damage but a whole lot of pain or you could have a lot of damage and very little pain. Which seems like well that stinks. It’s terrible news that you could have a whole lot of pain from just a little bit of tissue damage but it’s actually a huge opportunity because it means that you can change the nervous system to effect the pain without even making any structural changes.

Steffany And so to me you know if I’m thinking like a scientist about this. I actually think that’s why yoga is so effective is because what is happening in your brain besides these impulses that are going back and forth a message goes from your Nedia brain and then your brain has to decide what that message means. And your brain makes that decision based on who you are, past experiences that you’ve had, knowledge that you’ve been told, you know things that you think about yourself, what your parents taught you. So all of that stuff you know in an instant weighs in to how you make sense of this message that’s coming from your knee. And because yoga helped us to be more present in mind and make choices with our mind instead of letting it be like a monkey that runs uncontrolled around the room. We can change how our brain talks to our knee.

Clint Mm hmm. You’re getting very esoteric on us now Stephanie but I totally agree. I totally agree and that part of it. But I’ve also witnessed the physical cause and effect of yoga which I’m seeing is that just the strengthening of the muscles and the connective tissues, the slight separation of the two bones that are touching together to give you that little bit of relief. So you’ve got both going on haven’t we?

Steffany Yes. Absolutely.

Clint We’re physically fixing the joints. We’re physically improving the quality of the joints by all of the physical movement involved and we’re also setting up this mind body connection that becomes more gentler with its interpretations of signals.

Steffany On a physical level you know because we’re talking about the knees here for a minute. You may be aware of the research that shows that there is an inverse correlation between the need for knee replacement or the time to knee replacement and the strength of the quadriceps group. So, to explain that without the jargon, the stronger your quads are the longer it will be until you need to replace your knee for people who have arthritis in the knee. So, how does that work? Well because the quadriceps is a group of four muscles two of those muscles crossed over the knee joint so they attach to the shin bone. And that means that when you strengthen the quadriceps muscles, you’re helping to hold the joint together.

Steffany And for someone who has osteoarthritis which has an inflammatory component but is also mechanical. It’s less wear and tear because there’s less, there’s more integrity to the joint because the muscles are picking up the work that the connective tissue isn’t there to do. So that you know there’s a whole lot in yoga that of course you can do squats and you can do lunges and that sort of thing. But you can also do static poses like a warrior poses and chair pose and you know even moving through the sun salutations which have a lot of use of the major muscle groups, you can strengthen the quadriceps without putting a whole lot of excessive load on the body and on the joints. By not you know adding extra weight and that sort of thing. So it’s a great way especially for people who’ve been deconditioned and may not be able or ready to add a lot of weight to just use body weight and use isometric poses to be able to start strengthening some of those muscles that are going to help to stabilize the joint and especially you know if you think about where do I have arthritis on my body and what are the muscles that operate around that joint so that I can focus on strengthening and stabilizing there.

Clint Could not agree more, that sometimes if I haven’t been to a yoga class in a while I’ll do a yoga class and we’re holding some postures and like the quads are shaking, they’re working so hard and you’re just holding this simple enough looking posture.

Steffany You’re not holding anything…

Clint Just the body weight, the angles of the muscles and so forth. So couldn’t agree more. You can totally put on muscle mass whilst doing yoga as long as you have nutrition is right if you go and engage deeply into the postures to the limit of your joint integrity. There’s muscle mass to be gained and no doubt whatsoever. So okay where do we go from here.Well I’d like to find out if someone buys your book what are they going to learn from your book.

Steffany Right, so I wrote this book. When the publisher approached me for it they wanted a book for yoga professionals, yoga teachers, yoga therapists because lots of yoga professionals don’t know enough about arthritis. I’m sure your audience would agree, I’m sure some people in your audience have been to a yoga class where they felt like the teacher did not understand what they were going through, told them things that didn’t make sense for their body. Maybe put them into postures that were unhealthy, maybe even adjusted them in ways that were harmful or hurtful. And it’s been an important part of my work to educate yoga professionals because arthritis if you look at the umbrella of all arthritis is so incredibly prevalent there’s no yoga teacher out there who is not experiencing you know students with arthritis and it behooves them to know more about it.

Steffany But it was important to me that this not be written for a single audience. And that if I was going to write this book which builds on my entire research career to date and clinical career as well that it be for yes, Yoga professionals, people who are living with arthritis who are interested in yoga or already practicing yoga and want tools and information and health professionals who work with people who have arthritis who want to be more informed so that they can refer appropriately so that they can answer questions, so that they can make recommendations. A rheumatologist, orthopaedist, general medical providers, physical therapists, people who are working with this population.

Steffany So. The book is for all of those segments. And so it goes. It moves sort of you know through the layers that we’ve been talking about. It starts with just the physical body. What is arthritis? What does it do? How does it work? What’s yoga? But then it moves through the other aspects that we’ve been talking about in terms of well what about the breath? How does that work? What is the role for the breath in managing arthritis? How about the mental practices. What is meditation have to do with that? What does the relaxation practices have to offer? So it goes through all of the information but scattered throughout the book are stories of real people living with arthritis whose lives have been changed by yoga. And practices that you can do ot that a yoga professional can bring to class or with a client or things that a care provider can offer. So it’s meant to be informative practical. It’s incredibly important to me that it be evidence based. So I don’t say anything that I can’t back up or I say that it’s from my personal experience, it’s very much grounded in the science but it also has integrity to the tradition of yoga and all that you offer so I think that it’s pretty comprehensive and I’m quite proud of it.

Clint Yeah sounds fantastic and so would it have information for people to implement at home with all for a spectrum of different levels of condition?

Steffany Yeah absolutely so there is a section in the book about home practice and there are a variety of different postures in there and also a lot of different ways to modify the postures. So you’ll see a warrior post for example but you’ll see well you know you could put your arms here, you could put your arms here, you could put your arms here depending on how your shoulders are. You might want to be sitting in a chair, you might want to put a wedge underneath the back of your foot so it has the ways that we in our research and also in my clinical practice modify the poses according to joint activity and limitations as needed. So there are those practical tips in terms of modification of the arsenals but then there are also guided visualizations and guided self enquiry and journaling and breath practices and all of those kinds of tools as well.

Clint Yeah that’s sensational. Do you do Skype calls for people who want one on one help.

Steffany Yeah actually a lot of what I do is over Skype or other video conferencing both with people who are experienced yoga practitioners who are looking for you know to go a little bit deeper or personalize their practice or people who are brand new to your Besso and with all different forms of arthritis and all different joints affected.

Clint Well I think there’ll be a lot of people interested in in maybe exploring that with you so if someone wanted to contact you is it best to reach out to your clinic or do you have to have a contact preference.

Steffany Yeah. So if you go to my website which is arthritis.yoga. There are ways to schedule an appointment with me right there. You can e-mail me and ask many questions that you have, you can just peruse the information, pick up that book or other offerings. There is an option to become a member and then get a whole bunch of additional resources and information. So probably the Website is the best place to start and then find what you’re looking for from there.

Clint Yeah that’s awesome. Well thank you very much for coming on this show and I’ve learnt some great things from you and really enjoyed talking about one of my true passions which is yoga for our health. My wife originally got me into it she’s been doing yoga for a very long time. She started out with dance at a very young age which I think you mentioned when we were talking off line I don’t think we talked about on this call. You started dancing when you were very young and so did she and then she got into yoga and she also was a yoga teacher kind of taking some time off at the moment because of all the kids. But I’ve really this is this conversation very close to my heart so thank you for sharing this great information and there’s so much more to talk about. But we might save that potentially for maybe another call in the future. Mean people can reach out to you or by your books so thank you Stephanie I really appreciate it.

Steffany Absolutely clear. It’s been such a pleasure. I would love to do it again sometime. Thank you so much.


Arthritis, exercise, Meditation, Yoga

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