By Joy Karl

Yoga is one of the best physical exercise programs for seniors. It allows older people to proceed at their own pace and to gradually gain more strength and flexibility. It goes without saying that there is no one “type” of senior. Technically, one becomes a senior around age 60-65. Some people at that age are already having a multitude of medical problems and some are as healthy and strong as people 20 or more years younger. It is important to take a good physical history so you know why type of senior you are proposing to teach. Many yoga classes treat all seniors as needing modifications and special treatment. I work with a sixty-one year old woman who is getting Pilates Instructor Certification, her husband who is on the pro gold circuit, and a seventy-nine year old with two hip replacements who rides his bike and runs every day. These are the people I term active seniors. They already have a regular physical practice of some sort. They need a yoga program that will allow them to reach their fullest potential, not one that treats them like invalids because of their age. However, regardless of their physical fitness, there are some inescapable signs of aging that may affect their yoga practice. Some of these conditions are arthritis, hypertension, and joint related injuries. I have personal experience with two of the three. I do not have hypertension, but I did have to have rotator cuff surgery to repair a torn tendon, and I have arthritis of the hands and knee. Even with these conditions, I can do a fairly rigorous program of yoga. I would like to discuss each of these three conditions in depth.

Arthritis is a condition that affects many people, especially older persons. Arthritis causes swelling and inflammation and stiffness of the joints. It is one of the most common diseases in the world and affects 40% of Americans 45-64 and 60% of those over 65. Although it is more common in older adults, it can affect teens and children. (Borreo) When the soft tissues surrounding the bones begin to deteriorate the bones rub against each other causing pain. The most common joints affected are the knees, wrists, spine, feet and the shoulder. There is no known cause of arthritis but many believe that not only wear and tear affect the joints but also obesity and heredity. It appears also that poor bone and muscle health may play a significant role. (Borreo) Yoga can help improve bone and muscle health and help keep joints mobile. As long as the yoga practitioner and teacher remember to not push beyond the capabilities of the student, yoga can help diffuse some of the pain of arthritis.

There are two main types of arthritis, rheumatoid arthritis and osteoarthritis. Rheumatoid arthritis (RA) is a chronic disease characterized by inflammation of the joint lining (synovial). This inflammation leads to weakness and eventually deformity or destruction of the joint. RA is a systemic disease and will also affect others organs. According to the Arthritis Foundation about 1% of Americans suffer from RA. A person with RA will need special modifications to practice yoga. Osteoarthritis (OA) is a breakdown of cartilage in the part of the joint that cushions the ends of bones. The pain of this type of arthritis is caused by two bones rubbing against each other OA is a degenerative disease related to wear and tear and age. It usually affects the hands and weight-bearing joints like knees, hips, feet and the spine (Crews). This person will be able to do most poses in yoga and may or may not need modifications.

Many studies have been conducted by the Arthritis Foundation that show that exercise, maintaining a healthy weight, and avoiding injuries can reduce the pain of arthritis and even slow the progression of it. (Crews) The full range of motion of yoga poses help facilitate flexibility of the joint and may even help to alleviate pain.

Leigh Crews in her article, Yoga for Seniors has several suggestions to help a yoga teacher work with a person who has arthritis. She recommends you choose poses that:

• Increase the space within the joint, such as bound angle pose

• Provide both extension and flexion, such as the moving cat pose

• Strengthen the surrounding ligaments and tissues, such as tree or stork pose (Crews)

According to Crews, many arthritis suffers report that holding poses is more painful than moving poses. (Crews) Some poses lend themselves to moving in and out of the pose, rather than holding it – such as Warrior I and Warrior II. This might be easier for someone with arthritis in the hip or knee. My knee pops and cracks when I bend it. Sometimes, by moving it gently into better alignment, I can ease the pain. In Anatomy for Yoga, Paul Grilley talks about making adjustments based on the skeletal limitations of students. (Grilley, 2003) Yoga teachers need to learn how arthritis affects the joints in order to become aware of possible adjustments that will ease the discomfort or pain. Teaching people with arthritis to self adjust may or may not be a good thing. Make sure the adjustment still provides the same benefits as the classical asana. A better idea is to walk around and check the alignment of people with arthritis. Other general suggestions include a longer period of warm-ups, late afternoon or early evening practices, and possibly avoiding vigorous yoga practices such as ashtanga or power yoga. I do, however, know a older woman who has debilitating arthritis and she loves a vigorous workout. She knows her body and its limitations. A beginning student would need more direction than my friend. Also, extra padding under the knee is a good idea. An extra mat is usually a good idea. Additionally, I find moving into and out of Downward Facing Dog from table pose is easier on my knee and shoulder than moving into in and out from plank pose.

A final benefit of yoga to those who suffer with arthritis is that yoga can help with postural adjustments. Many times what is thought o be arthritis may be misalignment of the bones and/or joints, muscle weaknesses which pull the body out of alignment and unconsciously holding stress in parts of our body. I can attest to this personally. What I had been told was arthritis in my hip was an extremely tight piriformis muscle pulling against the opposite hip flexor which was also very tight. This had torqued my pelvic girdle to the point I was limping. Regular yoga practice has eliminated the pain and the limp. With regular yoga practice, you will notice a decrease in the amount of stress you hold in your body and a great improvement in your posture. These changes alone may be enough to enable to you have less pain. In his book, Yoga as Medicine, Timothy McCall states that “yoga can get you out of an unhealthy groove, literally and figuratively.” (Timothy McCall, August, 2007)

Hypertension or high blood pressure is another malady that often affects many seniors. Even active seniors can hypertensive issues. Hypertension affects close to one in six people in the Western World, though many, according to Timothy McCall, are unaware of the problem (Timothy McCall, August, 2007). Symptoms can include headaches, blurred vision, dizziness or, the most frightening, no symptoms at all! Problems that can arise from hypertension are heart attacks, strokes, and kidney failure among other problems. Most doctors will recommend a combination of diet, medication and exercise to bring high blood pressure back to normal. The exercise prescribed is usually aerobic in nature which helps build up the cardiovascular system. A better approach might be to combine the aerobic exercise with a regular yoga practice. It is well documented that stress can cause your blood pressure to rise. Just going to the Doctor can increase blood pressure 10-20 points for some people (Timothy McCall, August, 2007). Regular yoga practice can help bring your stress level down. A regular meditation practice will almost certainly lower your stress level and thus your blood pressure.

Certain yoga poses should not be practiced by those with high blood pressure or hypertension. Most commonly mentioned are inversions. An inversion is any move where your head is lower than your heart. Mild hypertensives may find that Downward Facing Dog and other moderate inversions do not bother them at all while head stands, hand stands and shoulder stands do. More severe hypertensive seniors should avoid even mild inversions. Yoga poses can be modified for them by using a chair or by bending forward with a flat back to a hip level position rather folding over the knees. Half Standing Forward Bend or using a wall in this pose is a good substitute for Downward Facing Dog. This allows them to do a forward bend without lowering their head. More aggressive styles of yoga that encourage you to jump from position to position are not indicated for the hypertensive senior. Timothy McCall suggests you concentrate on the exhalations, making them longer and slower to help a person ease into a pose (Timothy McCall, August, 2007). Any pose or pranayama that causes undue stress or tension in the body should be avoided. Additional suggestions include rest periods between asanas, especially if one is breathing heavily, and not holding positions too long for this may raise the blood pressure (Crews).

Injuries are the third topic I want to discuss in this essay-specifically shoulder injuries. I have known so many people in their 60’s and beyond with shoulder injuries that could have been prevented, including myself! We tend to ignore various parts of our body until something happens to bring that particular body part back into focus. For me, it was my shoulder, specifically, my rotator cuff. I had felt an odd twinge now and then but assumed because I was doing yoga on a regular basis and some weight training that my shoulders were basically sound. I couldn’t have been more wrong. After surgery to repair a torn rotator cuff, I found both my shoulder strength and mobility greatly diminished. In addition to physical therapy, I started to research ways to use yoga to rehabilitate my shoulder and to maintain shoulder health.

Shoulder injuries can come on suddenly or can develop over time. There are many reasons why our shoulders may start to hurt or lose strength or mobility. One of the biggest factors is age. Wear and tear on the shoulder joint gradually causes the tendons and muscles to weaken. Repetitive motions such as those in sports, gardening, and lifting can further damage the shoulder joints.

The shoulder is the most mobile joint in the body. It allows us to move our shoulder in virtually every direction. There are three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone). The muscles of the rotator cuff stabilize the back of the shoulder joint. These muscles help to keep the head of the humerus in place against the shoulder blade. The rotator cuff is comprised of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis). Four tendons of the same names join these muscles to the bones. There are many reasons for shoulder injuries but the most common are bursitis, tendonitis, and arthritis. Any of these conditions could lead to a serious shoulder injury if care is not taken.

In yoga practice, it is necessary to allow the shoulder joint to warm up gradually. Stretches that move the arms overhead and out to the side are important for the he alth of your shoulder. Even one painful twinge should be reason to stop and assess what you are doing in yoga class that might be hurting your shoulder. One of the more helpful things I read while recuperating from surgery was that your arm starts in your back. Any move you make with your arm should originate in the back. This has really helped me stabilize my shoulders during poses such as plank pose, side plank pose, Upward Facing Dog , Sun Salutation, etc. There are modifications for these poses which put less pressure on the shoulder area. In plank and Sun Salutations, keeping the knees on the floor will help a lot. There is a modified Side Plank which keeps one knee on the ground for balance and shoulder stability.

I read the quote below in an article about yoga and shoulder injuries. It so closely mirrored my own understanding that I wanted to copy it whole into this article.

“Muscle imbalances often develop in yoga due to the over-preponderance of push type exercises such as Chaturangas that most practices entail, without sufficient counter poses. Over the long run, this can lead to muscle imbalances and instability. A great counter pose to Chaturanga is Purvottanasana (upward plank). This pose helps to stretch the muscles that Chaturanga stretches, and vice versa. Dhanurasana (Bow pose) is also a great way to stretch the front of the shoulders and build strength on the posterior side. Setu Bandha Sarvangasana (bridge pose) is another great chest and anterior shoulder opener. Another beneficial pose is Jathara Parivartanasana (revolved abdomen pose). By keeping your arms and shoulders pressed into the floor, you strengthen the back of the rotator cuff. Other counter poses include Ustrasana (camel), and Gomukhasana (cow face pose). Off the yoga mat, practices that require a pulling motion and thus strengthen the backside of the shoulder might include rowing or pull-ups. The idea is to provide a balance of strengthening and stretching across both the front and back of the shoulder. The increased stability will help to both minimize the occurrence of dislocations as well as protect the shoulder girdle from tendinitis, bursitis, and certain forms of arthritis.” (Fetz, 2009)

I would encourage you if you have a client with shoulder pain to encourage them to seek a professional opinion before proceeding with yoga asanas that put pressure on the shoulder joint. I feel very strongly that had I gotten help when I first noticed the pain, I might have avoided surgery.

It is important to encourage all seniors to engage not only in the physical aspects of yoga but also the pranayama and the meditation. There is a bumper sticker that reads “Old age is not for sissies.” I couldn’t agree more but with the tools that a regular yoga practice provides, I feel certain seniors can continue to lead active lives.

Works Cited

Borreo, M. (n.d.). Yoga for Arthritis. Retrieved 07 20, 2009, from maxlifestyle.net: http://www.abc-of-yoga.com/yoga-and-health/yoga-for-arthritis.asp

Crews, L. (n.d.). Inner Idea. Retrieved 07 22, 2009, from Inner Idea: http://www.inneridea.com/library/yoga-for-seniors-program

Fetz, A. (2009, January 27). Aero Core. Retrieved August 20, 2009, from Aero-Core: http://www.acrocore.com/yoga-and-shoulder-injuries/

Grilley, P. (2003). Anatomy for Yoga. Pranayama, Inc.

Timothy McCall, M. (August, 2007). Yoga as Medicine. New York, New York: Bantam Dell.

Joy Karl is a certified Yoga teacher. She teaches Yoga classes in the Centerville, Ohio area.