Arthritis is is the leading cause of lower extremity disability in older adults, and the hip and knee are the most commonly affected. In this post, adapted from Adaptive Yoga, we explore exercises to help alleviate arthritis in the knee and hip.
An introduction to osteoarthritis
Osteoarthritis (OA), typically referred to in its truncated term simply as arthritis, is the most common condition affecting the musculoskeletal system.
It is characterized by the slow and sometimes progressive loss of cartilage that covers the bones of a joint. Those with OA of the hip or knee often experience pain when performing daily tasks, such as walking and climbing stairs, resulting in loss of mobility, stiffness, or instability.
Why practice yoga for osteoarthritis?
It is important to understand that when considering pain and function, the problem with OA is not the evidence or severity of OA that is seen on X-ray. In fact, many people with evidence of arthritic changes on X-ray actually experience no pain at all. It is reasonable to think that after an OA diagnosis, pain will be a ubiquitous part of life, and the only solutions may be medication or joint replacement surgery. However, recent studies demonstrate that pain and function in OA can significantly improve with exercise and activity modification.
So, if the problem does not rely on the amount of arthritis present, then what is the actual issue? It turns out that muscular weakness is the leading cause of pain and disability in individuals with OA. Increasing evidence has demonstrated that conservative treatment (i.e., targeted exercise and strength training) can actually delay or, in certain circumstances, prevent the need for surgery in younger patients. The guidelines set forth by both the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation recommend exercise programs for hip and knee OA that include flexibility, strengthening, endurance, and balance. Because yoga has all four components, we highly recommend yoga as a therapeutic method for reducing pain and disability in those diagnosed with OA.
The loss of strength and range of motion (ROM) in a joint directly correlate to the progression of OA. A 2018 retrospective cohort study found that individuals with hip OA had decreased strength in their knee flexors (hamstrings), knee extensors (quadriceps), hip extensors (glutes), and hip abductors (outer thighs).
Furthermore, decreased joint ROM is correlated with the presence of OA. Studies have shown that joint impairment is a predictor of disability, particularly due to decreased ROM. We also know that maintaining physical activity through midlife improves flexibility and has measurable benefits on knee function and joint mechanics in osteoarthritis. All this being said, flexibility can translate to a more stable loading environment in the knee and can thus reduce the risk of knee OA in the long term.
The 2019 guidelines from the Osteoarthritis Research Society International specifically recommend yoga for individuals with hip or knee OA, as being “effective and safe.”
The yoga poses
The poses mentioned below will target improving strength and flexibility in the muscle groups that have been found most effective in improving pain and function in hip or knee OA. When we focus on the body as a whole and not just on the arthritic joint, we can facilitate great changes.
Exercise 1: Warrior 1
- Strengthens the knee extensors (both legs, primarily the front one).
- Strengthens the hip extensors and abductors (both legs).
- Stretches the hip flexors (back leg).
- Strengthens the knee flexors (both legs).
- Starting in Downward-Facing Dog, step the left foot forward between the hands so that it is placed next to the left thumb.
- Spin the right heel down approximately to a 45 degree angle and spin the outer edge of the right foot down so the entire plantar aspect of the foot grounds down.
- With your left leg bent and thigh parallel to the floor, inhale your arms up to the sky, hands facing each other, fingers pointing up.
- The back leg remains straight and strong as you anchor the foot to square the hips forward.
- Lift the lower abdomen up and in as you lengthen the tailbone down.
- Draw the shoulders down the back, and gaze forward or slightly up between your hands.
- Hold for 5 breath cycles.
- To exit, bring the hands down in a swan dive to frame the foot, and return to Downward-Facing Dog.
- Repeat on the right side.
If this hurts your knee, shorten your stance and back off of the deep knee bend of the front leg.
Exercise 2: Plank
- Stabilizes and strengthens the core.
- Strengthens the knee extensors and hip extensors.
Precautions: Be careful if you have a wrist injury.
- Start in Downward-Facing Dog.
- Inhale as you extend your chest forward and your heels back, bringing the shoulders over the wrists.
- Align your body in a straight line from your head to your heels.
- Engage the abdominal muscles in and up, firming your arms in toward midline.
- Press into the hands, separating your shoulder blades, drawing your sternum in the direction of your spine, and filling out your thoracic spine.
- Energize the inner thighs toward each other and up as you press back into your heels and forward with your chest, lengthening the spine and neck.
- Your gaze should be two feet in front of the hands on the floor for a long neck.
- Be sure the hips do not sag and are in alignment with the chest and legs.
- Hold for 5 to 8 breath cycles.
- Come down to rest in Child’s Pose.
- Another way to get into the pose is to start in Table Top with the shoulders over the wrists, engage the core, and extend one leg back, and then the other.
- If this hurts the wrists, come down onto forearms for Forearm Plank, as you will still achieve the core stabilization goals on the forearms.
- Standing Plank: Face the wall and extend your arms to place your hands on the wall at chest height. Walk the feet back until the hands are at shoulder height and the abdomen engages. You can walk the feet back farther until you feel the upper arm muscles engage. Be sure you are tucking the tailbone so the hips stay in line with the diagonal of the body.
- Supported by the knees: Start with steps 1 to 5 above. In Plank, lower the knees directly to the floor, without moving your hands and chest. Continue engaging the abdominal muscles and hugging the outer arms into midline. Hold for 10 breath cycles and come down to rest in Child’s Pose.
To challenge yourself, lift one foot off the floor, maintaining a neutral position of the hips. Hold for a few breath cycles, release the foot down, and switch to the other foot, holding for the same number of breath cycles.
Exercise 3: Bridge
- Strengthens the hip extensors and the knee flexors.
- Strengthens the core.
- Stretches the hip flexors.
- Increases hip extension mobility.
Precautions: Avoid this pose if you have a current or recent neck injury.
Before You Begin
Have a strap or a block handy for variations.
- Start by lying on your back with your knees bent, feet flat on the floor, and arms alongside your body with hands facing down.
- Roll your shoulders underneath you as you begin to lift your hips.
- Press your feet and shoulders into the mat as you lift your hips.
- As you rise, walk the feet closer to your buttocks and scoot your shoulders into midline to further elevate the hips and lengthen the tailbone.
- Keep your knees parallel as you engage the inner thighs.
- Interlace the fingers on the mat, extend the palms on the floor next to you or hold on to a strap with the hands.
- Keep your neck neutral by relaxing your chin away from your chest to preserve the natural curve of your cervical spine.
- Your shoulders, feet, and back of the head support your lift comfortably on the mat because you are using the muscles of your buttocks and back to lengthen your hips.
- Hold for 5 to 10 breath cycles.
- To exit the pose, release the hands if interlaced and slowly roll down your spine.
- Hold on to a strap with your hands if the fingers cannot reach to interlace.
- Place a block between the knees to keep the thighs parallel and in line with the hips.
- If your neck feels uncomfortable, place a small rolled-up towel behind the neck for support.
- Challenge variations: Bend one knee into the belly, or for a further challenge, extend the leg straight up.
- Restorative variation: Place a block or bolster directly under your sacrum, allowing the prop to take the weight of your body. Be sure that you continue to lengthen your neck by resting the head’s weight on the back of the head and not on the neck. Lift the chest toward your chin, and your chin slightly away from your chest.
Exercise 4: Gate
- Strengthens the hip adductors.
- Strengthens the hip abductors (kneeling leg).
- Strengthens the knee extensors (extended leg).
If you have an injury to the patella, avoid kneeling on the side of the injury.
- Start in a standing kneel (on your knees and shins, but hips lifted). You can place a folded blanket under the knees for cushioning and comfort.
- Step your right leg out to the side to straighten the knee, with the right toes pointed forward.
- Make sure your hips are aligned over the knees.
- Inhale the arms up to the sky and relax your right hand to draw down your right leg toward the ankle, stretching through the left side of the trunk.
- Continue pressing the hips forward, so as not to let the buttocks bow out.
- Feel the stretch on the right inner thigh as you ground through the right foot.
- Bend farther into the side bend, as much as is comfortable but at the same time challenging.
- Hold for 5 to 10 breath cycles.
- To exit the pose, reach both arms back up to the sky and step the right knee next to the left.
- Switch sides.
- Place a block behind or in front of the extended shin to support your right hand and your trunk.
- You can also place your extended (left) hand on your waist if the side stretch is too intense.
In this post we’ve provided a sample of exercises which can help to reduce pain and disability in those diagnosed with OA. More exercises for arthritis and other chronic health conditions and disabilities are available in Adaptive Yoga.
Ingrid Yang and Kyle Fahey
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