Yoga, through its philosophical and physical practices, tends to teach us to embrace life’s natural changes. For anyone nearing or beyond mid-life, these natural changes seem to occupy our awareness more frequently and bring with them a sense of disruption and discomfort to our everyday lives.
If we are lucky to live long enough, all of us will experience some degeneration of our joints. And based on what you do in your everyday life, how you move can either speed up or slow down the process of joint degeneration.
Osteoarthritis is a degenerative condition of the cartilage present in our joints. While it is known to either be genetic or age-related, as with most medical conditions it’s not always straight forward.
Symptoms for many usually include pain, swelling, joint stiffness, limited range of motion and difficulty with many functional tasks, while other people remain relatively asymptomatic. Severe pain or functional loss associated with osteoarthritis (OA) of the knee or hip in particular, often leads to joint replacement surgery.
My personal and not so straight-forward experience of life with OA first got my attention when I was 36, after a decreasingly weakened knee joint advanced to the point where my own daily functional tasks - including my yoga practice - were significantly affected. I had all of the symptoms listed above but for the age category, shifting my understanding of age as years of use and abuse without rest and recovery, rather than number of trips around the sun. Without many case-studies of women needing total knee replacements prior to the age of 40 to learn from, the path toward my first joint replacement was unclear and stressful. Luckily, upon second opinion, I found a surgeon that acknowledged my symptoms and condition and, knowing I would need both knees completely replaced and to endure two rehabilitation periods, his compassionate guidance revealed a hard but manageable road ahead in order for me to get back to doing what I loved, in a new way. I tried to listen the best I knew how during each difficult moment.
Because it’s relatively an invisible disease until your noticeably compensating in your movement patterns, or grimacing from discomfort or pain, OA is not something that fits neatly into a box nor does it offer a one-size-fits-all approach to healing. Not only the success of the recovery process, but it’s symptoms and disease progression can vary from person to person, and often times it can be a deeply personal experience as one tries to reckon with the increasing changes to their body, and their physical abilities. I know for me this was certainly the case.
Early symptoms of OA may reveal crackling or clicking in the knee or hip while exercising or moving without much pain. The lack of severe pain or even any pain at all in the early stages of OA is because cartilage (the structure between the joints that is degenerating) doesn’t have any nerve innervation or blood supply, making it not only hard to heal but unnoticeable when it comes to sensations of pain. As the cartilage between the two joints begins to break down, the surrounding muscle tissue becomes overactive as a means of compensating for the weaker muscles closer to the joint until those muscles later begins to atrophy as the degenerating cartilage only increases. With weakening and inhibited muscle support the space between and around the two meeting bones decreases bringing the ends of those bones - which, unlike cartilage, are richly innervated with nerve and blood supply - into the ability to contact the other where the smooth gliding articular cartilage has worn away.
As I progressed to this later stage of OA, I experienced chronic stabbing pain around all sides of the knee joint and chronic inflammatory conditions and further compensations both while my body performed demanding physical work and at rest. It wasn’t long before rounds of steroids for relief fell short of their promise and I underwent my first of two total knee replacements in a 18 month frame. I was just 39. Stubbornly, and thinking I was more resilient than I actually was, I did everything “almost wrong” during the first experience - grueling from start to end. But intelligently I used that knowledge to my advantage to do everything right the second time around - so much that I hardly experienced any intolerable symptoms as I physically prepared my body for the surgery despite the condition of the knee being nearly equally deteriorated. Proving that our individual experiences with OA are very unique and subjective, not neat, tidy and simple to explain.
Yoga tends to teach us to embrace life’s natural changes. And it was through rediscovering the power of yoga following my first joint replacement that I was able to embrace these natural changes with grace and determination. Regular yoga gave my whole body the best opportunity to prepare, recover and heal. While yoga wasn’t the lone intentional movement that helped me to prepare for joint replacement surgery and recovery - I swam, pedaled my bike, incorporated weights and resistance, and changed my diet - it is solely responsible for giving me the productive state of mind to build courage and resiliency.
Strengthening the muscles around a joint can help reduce stress on the existing cartilage and other structures. A sublte, simple yoga practice can be an essential ingredient to support your therapeutic outcomes while preparing for a future joint replacement. A slower, purposefully-driven practice most easily helps you increase body-awareness as a way to mediate pain. This style of therapeutically-minded yoga Is best suited to strengthen your body’s neurocircuitry, neuromuscular control and tissue capacity while offering a sustainable way to move on the yoga mat - one that can help you efficiently and safely balance support around your joints and shift your mindset to embrace life’s natural changes and your resiliency to them.
Joint replacement is natural and doesn’t have to be a painful process. The key is to acknowledge your patterns and lifestyle, pay attention to and respect your symptoms and find the right dosage of exercise and activity and combination of recovery practices to gradually improve the health of your cartilage and the structures that support it and you.