Thank you so much for being a part of this interview for the Celebrating Age issue. Can you tell us about your professional roles and background?
I’m the research director at Southern California University of Health Sciences which trains integrative health professionals. I research the use of yoga for arthritis, chronic pain, and musculoskeletal conditions. I am also the founder and director of Yoga for Arthritis, an organization that I started over 20 years ago. The landscape of yoga was very different then because there were not a lot of ways for people living with arthritis to access safe, accessible, appropriate, evidence-based yoga practices. I train yoga teachers and yoga therapists, provide yoga to people who are living with arthritis, mentor emerging professionals, and I advocate for access and a change in the conception of how we manage arthritis and chronic pain.
I have a PhD in public health from Johns Hopkins School of Public Health, where I also worked in the rheumatology department. That’s where my training and background in arthritis and rheumatic diseases comes from. I also have a Master of Fine Arts in dance, which is relevant in the way I think about movement and the moving body and expression. I’m also a certified health and wellness coach, yoga teacher, and yoga therapist.
I love your connection to dance. You’ve mentioned the balance between stability and free range of motion that happens simultaneously in dance and yoga; can you elaborate on this?
In my memoir, Yoga Therapy for Arthritis, I quote a song that says, “Are we human or are we dancers?” Which is something that my son and I ask each other all the time. What we’re talking about is the otherworldliness, the different ways of being in the world. When you have access to that, it’s transformative. It doesn’t require any particular movement ability to find ways of relating to and being in embodied experience.
I know you spent some time in an ashram, and it was there you experienced real clarity about how to serve through yoga. Can you please share more on this?
There are many yoga teachers who do not intend to become yoga teachers; they pursue a yoga teacher training program out of a desire to dive deeper into their own yoga practice and their own experience of yoga, to learn more about yoga in a deeper, different way. I was one of those. So when others come to me for training and say, “I don’t really want to teach,” I chuckle. Yoga was the one thing that I did only for me.
In my early 20s, I was teaching at multiple universities. I was already leading and training in a variety of ways, but my yoga was mine. I went to an ashram because I wanted to have an immersive experience of yoga. When you’re trained to be a yoga teacher at an ashram, you are immersed in the yogic lifestyle along with the yogic teachings for the duration. Since this and many other experiences after, I am certain of Divine guidance.
I never would have gone to that yoga teacher training to become a leading expert on the science of yoga as it applies to arthritis and chronic pain. But clearly, I needed that training along with everything else that happened since. It was because of that training that I was hired as a research assistant in the Johns Hopkins Arthritis Center. A researcher there took a yoga class and thought that it was really a powerful, viable option for the patients with arthritis in their clinic and needed somebody who was a yoga teacher to partner with in order to begin studying this. Going to the ashram gave me the tools that I needed beyond asana, the physical postures. In the West, a lot of times, that’s what we think about when we think about yoga. But it is such a small fraction of what yoga is, and being at the ashram allowed me to get a broader understanding of the expansive toolbox of yoga, so that when I did take it into the clinic, I could optimize its usefulness for the patients there and beyond.
You mentioned that arthritis is a “whole person” disease. What does that mean? I get the impression that everyone’s going to get arthritis to some degree or another as we age. I first want to say that when we’re talking about the arthritis that is associated with aging, we’re generally thinking about one specific form of arthritis called osteoarthritis. Osteoarthritis is the most common form of arthritis, and the prevalence of osteoarthritis does increase dramatically with age. Age is a primary predictor of osteoarthritis onset. Arthritis, though, is an umbrella term that includes over 100 different diseases, and it can affect people anywhere in the lifespan.
There is juvenile arthritis in many forms that can affect babies and toddlers all the way up to the onset of arthritis at the end of life and everything in between. Each of these forms of arthritis has different characteristics and different risk factors. If you are fortunate to live long enough, then your body tissue will start to age. What starts to happen is that we have cell turnover all of the time. Our body is shedding old cells and making new ones throughout the lifespan.
When we’re young, we grow more cells than we lose. That’s the growth that happens in early age. We have some homeostasis in the middle, where it’s an even balance. Then at a certain point, there’s more death than birth. We are losing connective tissue in the joints at a faster rate than we’re building it. We could think about that as being a natural consequence of aging, but there are reasons that it happens to some people earlier and more than others.
We are all losing connective tissue past a certain age, but not everyone feels it. Not everyone suffers from the experience of it because there actually is very little relationship between the amount of tissue damage and the symptoms that we experience. There are some people who have a lot of pain from very little tissue damage, and there are other people who have very little pain with a lot of tissue damage. You don’t go to your doctor about your knees unless they hurt. You may have what we would call pre-arthritic changes. There may actually be a wearing down of the cartilage in some of your joints, but because you’re not experiencing symptoms, it doesn’t really affect you.
And this gets to the “whole person” aspect of arthritis, because when you do have symptoms of arthritis, which for osteoarthritis the most prominent symptom generally is pain. But there’s also stiffness, swelling, fatigue, disability, and changes in the activities we’re able to do. All of this is different depending on the experience of arthritis, but also all of it can be changed without changing the tissue damage in the joint. While the experience of arthritis is a whole person experience, there are ways to address it that span all of the aspects of a person, too.
Oftentimes, when people hear that I study the effects of yoga for people with arthritis they go, “Oh, well, yoga is movement, and movement is good for arthritis. Arthritis is a disease of the musculoskeletal system. Movement is good for the musculoskeletal system.” What they fail to realize is actually what yoga offers to a person living with arthritis. Yes, it can directly affect the joints, but goes so far beyond changing the structure or the tissue and how it’s organized in the joint.
Can you share how yoga is a “whole person” practice?
Arthritis has no cure. It’s irreversible. You can’t build back the cartilage that you’ve lost, but you can strengthen the stabilizing muscles that surround the joint and help improve the integrity of the joint even while it’s losing tissue. We can slow the progression of the disease. We can also maintain physical function, even if we’re losing joint tissue. We can also use the tools of yoga to help change things like pain. People think of pain as being in the part of the body where you’re feeling it, but pain is actually a set of signals between the brain and the body.
For example, if we’re talking about the knees, there’s a message that goes from the knee to the brain, that is the ascending pain pathway. Then there’s another signal that goes from the brain back to the knee, that’s the descending pain pathway. This is happening in the nervous system, not the cartilage, and there are all kinds of tools that we can use in yoga that change the functioning of the nervous system, including things like breath control. When we deepen the breath, we’re changing the state of the nervous system, which affects pain even if the cartilage doesn’t change. Tools of yoga can also help to lift our mood and can help change our mindset.
Do you have any success stories?
So many! There was one situation in a Yoga for Arthritis class at the Johns Hopkins Clinic with a patient who had a systemic inflammatory form of arthritis called rheumatoid arthritis, but she believed that she had osteoarthritis. The treatments are completely different, and she was not receiving the medical treatment that she needed. She was middle-aged and very disabled. She had a very difficult time getting around, let alone engaging in a physical yoga practice.
She was able to get down to the floor with some difficulty but could not get back up to standing on her own. One day, I walked over to support her and reached out my hand, and she waved me off without saying anything. It was clear that she wanted to do this herself. And so she was leaning forward, had one foot up, one knee down, struggling, but was finally able to bring herself up to standing. I was nervous about everybody staring at her struggling to get up, but as soon as she got to standing, the whole room burst out in applause.
It was such an important moment for her. It was the first time that she had been able to get up from the floor in as long as she could remember, and it also emphasizes the importance of community and support in that experience.
If there were someone reading this that is suffering from arthritis and is looking at yoga as a potential means to help themselves, are there any pieces of advice?
Something you can do immediately by yourself, without any assistance, is to breathe in a way that can help to manage pain. We all have experiences in our lives of using our breath to manage pain. We do it automatically, and don’t even think about it. An obvious example for anyone who has gone through childbirth, because you definitely are using your breath for pain management there.
We can shift our energy by changing how we breathe. If you put a hand on your belly and a hand on your chest, you should notice that as you breathe in, your whole torso expands, and as you breathe out, it softens. The first thing is, if your belly doesn’t move when you breathe, change that. Some of us who are feeling stressed are breathing high up into the chest, we’re holding tension in our abdomen as a coping strategy, we’re not getting the benefit of full deep breathing. So that’s one way to start, just take deeper breaths, allow your belly to move.
Another way is to slow down the exhale. Take a deep breath in and then let it out nice and slow, it helps to take us out of stress response into relaxation response. Stress makes pain worse, and pain makes stress worse. If we start breathing more deeply, and especially lengthening that exhale when we’re feeling stressed or when we’re feeling pain, you can feel an immediate shift in your state of being with just that simple technique. If there’s one thing that you’re going to do, it is to breathe more deeply.
If you also want to get started with a yoga practice, with that whole big toolbox of postures and breathing practices, mindfulness, meditation, relaxation, applied philosophy, and all of the rest, you’re going to want a teacher. You want to look for a teacher who has training and experience working with people who have different needs, who have physical limitations. It can be called a lot of different things, yoga for seniors, chair yoga, or gentle yoga, but instead of just going by what the name of the yoga class is, contact the studio and ask, “Hey, I have arthritis. It’s hard for me to get down to the floor. Is this class appropriate for me?” Or, “I’m new to yoga, I’m a little bit older. Do you have a class that would be a good place to start?” If you can’t find a class that’s right for you, you might want to start one-on-one with a yoga teacher or a yoga therapist who can help you learn the basic skills of how to practice yoga at home, or how to go into a yoga class and know and keep yourself safe no matter what the instruction is that’s being provided.
If you try a class and it is not a good fit, don’t assume that there is no yoga for you. It’s the same when you go to a medical visit and you think “this is not a good fit.” You don’t give up on medical care, you go find someone else.
Is there anything else that you would like to share on the topic of “celebrating age.”
I think that it’s unfortunate that in our society, we tend to devalue the wisdom of older people. We have a lot of work to do to change that societally, but we can change that ourselves by appreciating our own wisdom as we age, by seeing all that we gain instead of only looking at what we lose. We’re gaining far more than we’re losing as we get older, and we can be such an asset to our families, to our communities.
In yoga, there is this idea of different stages of life. And as we get older, we move from growing and developing as individuals to creating families, creating careers or creating households. Then we move into this stage of life that is stepping back and passing the torch to the next generation. Being mentors, being guides, being spiritually wise, intellectually wise. No matter what, you have a unique perspective to offer. Yoga provides a model for how we can show up as we get older in a way that is fulfilling to us and also useful to the world.
Learn more: arthritis.yoga
