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What is arthritis?

Arthritis is inflammation of the synovial joints of the body and is one of the most common of all disabling diseases, afflicting an estimated one out of ten people, thirteen million in the USA alone. Arthritis is a crippling degenerative process, which can eventuate in irreversible destruction of the joint. The condition is characterized by pain, swelling, redness, heat and loss of function in one or more joints. Those most often affected are the large, weight bearing joints (hips, knees and ankles) and the small joints responsible for repeated, finely articulated movement, such as the fingers.

In the science of yoga arthritis is not considered to be a disease in itself, but rather as one symptom of a widespread metabolic and pranic malfunction which begins early in a person's life.

Yoga offers a way to arrest this process. In fact, in the early stages, before irreversible damage to the joints has occurred, a complete reversal is often possible. In the later stages, yogic practices can reduce drug dependency, maximize remaining mobility and function in the joints, and make the life of the arthritic more tolerable and acceptable. Remarkable restorations of function and a vastly improved outlook on life have been obtained in severely crippled patients who have followed a daily yoga program with determination.

The physiology of arthritis

The normal synovial joint is a remarkable self-lubricating living structure. The ends of the bones, which form the joint, are covered with a hard yet resilient tissue called cartilage and are bound together by ligaments, which surround the space between the bones (joint cavity). The joint cavity is lined with a delicate synovial membrane, which secretes synovial fluid to lubricate the joint.

The cells of the joint depend on a fairly tenuous blood supply for their vital requirements. If the circulation of prana in joint is blocked or deficient over a long period of time, the supply of blood and lymphatic fluid becomes sluggish and the joint fluid grows stagnant. When this occurs, the waste products and poisons of cellular metabolism build up in the lubricating fluid of the joints, rather than being efficiently transported to the skin and kidneys for elimination from the body.

Acidic wastes and toxins, accumulating in the joint fluid, irritate the sensitive nerve fibers in the joint causing pain and stiffness. If the circulation of prana in the joint remains blocked for a longer period, the structure of the joint itself begins to degenerate. The joint fluid begins to dry up, the soft cartilage lining corrodes away and the bones themselves begin to accumulate excessive calcium, forming new bone growth, which limits movement. As the process continues, the whole structure of the joint is destroyed, movement becomes impossible, pain and deformity arise and the sufferer eventually becomes crippled.

The forms of arthritis

Modern medical science has recognized several distinct forms of arthritis. From the yogic point of view these are different stages of the same basic blockage of prana rather than different diseases. The underlying process is the same, but variations in the rate of symptom development have led to a number of diagnostic tags being assigned to different sufferers of arthritis

Acute arthritis

This transitory condition is well known to all. It is a common symptom of many illnesses and infections, such as colds, flu, fevers and diarrhoea, and occurs because the viral or bacterial toxins liberated into the bloodstream during the illness readily accumulate in the joint fluids. This symptom usually diminishes soon after the purifying process is completed or the infection is overcome.

Gout

This is a special form of acute arthritis, which seems to be due to dietary self-poisoning. Gout is suffered by people whose intake of proteins, especially red meat, exceeds their capacity to metabolize them Uric acid, a toxic by-product of the digestion of protein, is usually excreted in the urine, but in gout it accumulates in the joint fluid also. Eventually acid crystals form in the joints; just as excessive amounts of sugar crystallize in a water solution. Gout exemplifies the significant role of dietary self-poisoning in arthritis.

Rheumatoid arthritis

This severe, crippling and rapidly progressive form of joint degeneration often occurs in young and middle-aged people, and is becoming increasingly common. Though the cause remains unknown in the majority of cases, it is frequently triggered off by a severe emotional shock, or may be precipitated following the sudden introduction of foreign substances into the circulation, perhaps from the administration of a powerful drug, or an acute infection. If these foreign substances accumulate in the joint spaces, the immune system sends white blood cells there to wage a violent inflammatory reaction against them. Offending substances can be eliminated fairly readily from those tissues, which have a good blood supply, but in the joint spaces, which are more isolated from the general circulatory system, their removal becomes more difficult. The joint tissues themselves are not attacked, but they are the battleground upon which the war is waged. This fierce inflammatory reaction can completely destroy a major joint within a few months. A period of remission follows, but the disease frequently recurs in another joint, until finally the body is left crippled and deformed.

Osteoarthritis

This chronic degenerative arthritis is commonly seen in middle and old age, especially afflicting those who are overweight, have a heavy or toxic diet and have avoided exercise. Osteoarthritis frequently develops in a joint, which suffered injury earlier in life, the injury causing pranic, and structural derangement, which was not fully corrected at the time. Osteoarthritis may also be associated with an excess of calcium in the body, either due to high dietary intake, or to imbalance of the parathyroid glands in the neck.

Factors leading to arthritis

A number of factors, including mental and emotional stress and faulty lifestyle and diet, are jointly responsible for upsetting the balance of central controlling mechanisms in the brain and endocrine system, on which the ultimate health or the organism depends.

• Diet: Overeating and excessively rich diet, especially on based upon meat, animal fat, heavy fried foods, highly refined and synthetic foods, and excessive milk, ghee, sugar and salt, play a large part in initiating and aggravating arthritis, constipation aggravates the disease.
• Exercise: Lack of regular exercise causes the joints and ligaments to become stiff and flexible. Habitually sitting in chairs and rarely sitting cross-legged or performing exercises, such as pawanmuktasana, causes stiffness of the legs, hips, spine and shoulders.
• Mental factors: Deep subconscious tensions, suppression of emotion, fear and hypersensitivity can lead to rigidity of the personality, which is then translated into physical tenseness, allergies, endocrine imbalance and so on. Psychic rigidity - stubbornness and fear of letting go, leads to physical rigidity in the form of arthritis, rheumatism, fibrositis and constipation. The individual with arthritis may fail to express his deeper emotions and feelings, especially anger, adequately. He will say, "Don't worry about me: you go out and have fun." Yet all the while he suffers internally and this internalization of feelings creates poisons, which upset the total body metabolism.

Modern medical treatment

Modern medicine has not yet fully come to terms with the overall dimension of arthritis. It concentrates on the relief of arthritic pain, but fails to treat and correct its underlying causes. A wide spectrum of drugs are prescribed, beginning with aspirin derivatives, which act both as analgesics (pain-killers) and anti-inflammatory agents. Aspirin is effective, although tolerance develops and increasing doses can have damaging effects on the stomach, liver and kidneys, so the patient is graduated to the next stage in drug therapy. More powerful anti-flammatory agents, such as indomethacin and phenylbutazone, are prescribed until a tolerance once again develops or the harmful side effects again preclude continuation.

The next step is the corticosteroids, which are analogs of the hormones secreted by the adrenal cortex. These drugs have serious side effects. The patient's own adrenal glands begin to degenerate or atrophy and the body becomes fat. Diabetes and high blood pressure can occur, body hair grows profusely, and calcium is leached from the bones, rendering surgical removal of the afflicted joint and its replacement with an artificial one. Theses joints prove quite effective, often lasting for years. Then, a further replacement becomes necessary; however, the patient may now be at an age when the trauma of a major surgical procedure can barely be tolerated.

Yogic approach

Yogic management of the arthritic process is all-embracing and effectively complements standard medical measures. However, yoga will never advocate drug management of symptoms in isolation, while neglecting to correct the underlying deficiencies of diet, exercise, lifestyle and so on.

All therapy should ideally be learned in an ashram setting, to benefit from its positive and supportive energies. This is especially important if the individual is exposed to negativity at home or work, or if the family is cultivating a dependent attitude in the sufferer for example: "Oh the poor thing, he is suffering so much. You must rest, dear, let me do that for you." Karma yoga is as much a part of the sadhana of the arthritic individual as asana and pranayama. A well-rounded program of yogic therapy includes the following elements:

1.      Asana: The major series of asana for prevention and management of arthritic conditions is the anti-rheumatic group of pawanmuktasana, which puts the body through its full range of movements and fully relaxes and massages all the joints. Before commencing pawanmuktasana, the patient should soak the limbs in cold and/or warm salty water to encourage blood circulation. As the flexibility of the joints increases, other asana can be added; however, never strain or inflict pain. Major asana include Shashankasana, marjari-asana, shashank bhujangasana, and akarna dhanurasana. Vajrasana should be practiced after meals if possible. Ultimately, surya namaskara should be adopted to capacity. Six to twelve rounds each morning should prove sufficient to prevent further arthritic degeneration throughout life.

2.      Shatkarma[The process of cleansing the system] : Body purification like intestinal wash ,stomach cleansing, sinus area cleansing  etc are very important in alleviating constipation and eliminating any metabolic acids and other wastes which accumulate in the joints, bloodstream and tissues. Arthritis will never be fully cured while constipation remains.

3.      Pranayama [The techniques to right breathing]: Including abdominal breath, nadi shodhana and bhastrika bolster the digestive and eliminative capacities.

4.      Meditation: Releases pent-up mental and emotional tensions. Antar mouna stage2, where thoughts are observed, is especially useful in recognition of self-limiting and fixed attitudes and behaviour patterns. Then in stage 3 the sufferer should be encouraged to create mental scenes in which he is expressing deep-felt anger and aggression, thus releasing suppressed emotional conflicts, which contribute to arthritic rigidity, while at the same time remaining a detached witness. Deep relaxation and meditation will develop a positive state of mind in the sufferer.

5.      Diet: The following simple diet will reduce pain and allow the eliminative and regenerative processes to work at optimum efficiency. A strong, clean digestive system readily absorbs all necessary nutrients from the following diet:

• Cooked light grains and cereals in the form of whole meal bread, chapattis, rice, millet, barley etc.
• Boiled pulses (dal) especially the lighter types such as moong are a sufficient source of protein.
• Boiled or baked vegetables, especially greens but not onions.
• Salads using green leafy vegetables, celery, tomato, beetroot, carrots, cucumber, sprouted pulses, seeds and so on.
• Fruits (except bananas), both fresh and dried, and nuts in small quantities. Instead of sugar, a little honey can be taken.
• Reduce intake of milk and diary products such as cheese and ghee; avoid highly refined, processed and synthetic foods, including white flour (maida).
• As a rule, only fruit and vegetables that are in season and grown locally should be selected. If absolutely necessary, small quantities of white meats, chicken and fish can be taken occasionally.
• Meals should be eaten between 10am to 12noon and 5pm to 7pm. The evening meal should be lighter. This ensures that food is in the stomach when digestive energies are high and digestion is well underway at sleeping time.
• Missing a meal or fasting one day per week will ease pain, especially during acute phases, and accelerates relief and recovery of health. Do not take snacks or eat between meals.

6.      Rest: During the acute, inflammatory stage, rest is essential, and subsequently periods of activity must be alternated with periods of rest.

7.      Exercise: It is very important to maintain a determined and positive attitude towards activity and exercise, even to the extent of pushing oneself, in order to maintain a self-sufficient active lifestyle. Walking, swimming, gardening and other gentle forms of exercise help to keep muscles strong and the joints limber, and can be integrated into the daily routine in conjunction with simple asana.

8.      Heat and massage: Total immersion in a hot bath and the local application of moist or dry heat, especially in winter, relaxes muscles and loosens painful contractions. Heat also reduces pain and inflammation, increases the metabolism, aids elimination of poisons, speeds the production of natural lubricants, reduces swelling aids in the re absorption of undesirable calcium deposits, bone formations and fibroblastic infiltrations in and around stiff muscles, ligaments and joints. After heat therapy, general massage of joints and limbs towards the heart invigorates and relaxes the sensory and motor nerves, promotes circulation and irrigation of blood and lymph, and has an overall, relaxing effect.

9.      Mental attitude: Above all, the arthritic person who undergoes yogic therapy must strive for patience and positivity, and try not to be discouraged by the pain and discomfort, which will have to be endured at first. It is well worth the initial struggle in order to break down the vicious cycle of disease, which perpetuates arthritis. Yoga Nidra is most beneficial here and should be mastered as a form of pain relief and mental transformation, which reduces drug dependency and pain sensitivity. The strength of mind gained and the joy, which is experienced when the disease process is controlled and reversed, is something that all sufferers with arthritis can earnestly aim towards.