An Ayurvedic Approach to Osteoarthritis Treatment

by Sheila Patel, MD, Medical Director of Chopra Center

Osteoarthritis (OA) is a chronic condition of the joints in which the cartilage cushioning the ends of the bones gradually loses its elasticity and wears away. Without the protective cartilage, the bones begin to rub against each other, causing stiffness, inflammation, and loss of movement. Osteoarthritis treatment therapies with current conventional medicine typically focuses on pain reduction and control of inflammation; however, these approaches have no effect on the natural course of the disease.

The most common medications prescribed for osteoarthritis are, at best, moderately effective. In addition, side effects of these treatments can be quite significant, and at times life-threatening. Often times, the ultimate treatment for a disabling joint is joint replacement, with the inherent risks and cost that come with surgery. If current trends continue, it is estimated that 600,000 hip replacements and 1.4 million knee replacements will be carried out in the U.S. alone in 2015.

Osteoarthritis is the most common form of arthritis worldwide, with symptoms ranging from minor discomfort to debilitation. It can occur in any of the body’s joints but most often develops in the hands and weight-bearing joints, including the knees, hips, and spine (usually in the neck or lower back). For people coping with advanced osteoarthritis, the effects are not only physical but also emotional as pain and decreasing mobility can limit the ability to work, participate in daily activities with friends and family, and enjoy life.

What Causes Osteoarthritis?

While science has no definite answers about what causes OA, researchers have identified several factors involved in the development and course of OA. Some of these factors include inflammation, biomechanical imbalances that put stress on the joints, and cellular disorders that lead to the abnormal breakdown of cartilage. It is important that the approach we use in treating OA address as many of these factors as possible.

Ayurvedic Approaches to Osteoarthritis

Given the only moderate effectiveness and potential side effects of conventional treatment, both patients and health care professionals are seeking out alternative therapies, including those offered by the ancient healing system known as Ayurveda. In this article we’ll look at the three main modalities Ayurveda uses to treat osteoarthritis and other disorders: herbal treatments, meditation, and yoga.

Ayurvedic Herbal Treatments

Ayurveda offers many herbal treatments for the treatment of OA. These plants have documented anti-inflammatory properties without the side effects of commonly prescribed medications. For example, at a recent meeting of the American College of Rheumatology, a study was presented that showed an herbal Ayurvedic therapy to be as effective in treating knee osteoarthritis as a commonly prescribed medication (Celebrex) and glucosamine – and with fewer side effects. The ACR stated that

Ayurveda offers “safe and effective treatment alternatives” for OA.

The herbs boswellia, turmeric, ashwagandha, ginger, triphala, guggulu, and shatavari have all been shown to decrease inflammation by interfering with the production of inflammatory chemicals in the body.

Boswellia

There is evidence that the Ayurvedic herb Boswellia serrata, also called Indian frankincense, alleviates joint pain and inflammation. Boswellia blocks an enzyme (5-lipoxygenase) that plays a major role in the formation of chemicals called leukotrienes, which stimulate and perpetuate inflammation. Researchers have found that people with osteoarthritis who took boswellia along with ashwagandha, turmeric, and zinc reported less joint pain and increased mobility and strength.

Turmeric

Turmeric is a spice commonly used in South and East Asian cooking. It is also used both orally and topically in traditional Ayurvedic medicine to treat a wide variety of ailments, many of which are related to inflammation. The active ingredient in turmeric, curcumin, has been shown to inhibit key inflammation-producing enzymes (lipo-oxygenase, cyclo-oxygenase, and phospholipase A2), thus disrupting the inflammatory cascade at three different stages. Interestingly, some data suggests that it may protect the stomach against non-steroidal anti-inflammatories (NSAIDs). Although current studies for its use in treating osteoarthritis are few, curcumin/turmeric is a promising option in the treatment of OA.

Ashwagandha

Another Ayurvedic herb, ashwagandha (Withania somnifera), has known anti-inflammatory effects. In a study published in 2007, the extract of this herb was found to suppress the production of pro-inflammatory molecules (TNF-alpha and two interleukin subtypes. In one study, the anti-inflammatory effect of ashwagandha was comparable to taking the steroid hydrocortisone.

Ginger

The anti-inflammatory effects of ginger (Zinziber officinale) have also been documented. Ginger works as an anti-inflammatory by interfering with an enzyme (cyclooxygenase) that produces inflammatory chemicals in the body. There is some data showing that ginger has a moderate beneficial effect on OA of the knee. Further research is needed to determine the extent of ginger’s effectiveness in treating OA.

Triphala

The Ayurvedic herb triphala has been used in India for thousands of years for treatment of osteoarthritis. Triphala is a formulary that consists of three herbs (amalaki, haritaki, and bibhitaki). Preliminary studies show that the herbs in triphala have anti-inflammatory effects.

Guggulu

In addition, the herb guggulu (Commiphora guggul) has been shown to be a potent inhibitor of the enzyme NFKB, which regulates the body’s inflammatory response. There are several studies that show decreased inflammation and joint swelling after administration of extracts of guggulu resin.

Shatavari

Shatavari (Asparagus racemosus) is an Ayurvedic herb that is considered to have a soothing, cooling, and lubricating influence on the body. Studies have found that it has an inhibitory effect on chemicals that create inflammation in the body, such as TNF-alpha, and IL-1B.

The Benefits of Meditation

An important principle in Ayurveda is acknowledgment of the importance of the  emotional and spiritual aspects of health and healing. Health is achieved by balancing not only the body, but mind and spirit as well. Meditation provides a way to achieve this balance. The practice of meditation also creates many physiological changes, including reduction of inflammation in the body.

Mind-body practices such as meditation have value as part of a treatment regimen for chronic pain caused by a variety of conditions. Although to date there are no studies specifically done on the effects of meditation on osteoarthritis, several studies have shown that mindfulness meditation can be useful in the treatment of pain syndromes.

A landmark study conducted in 1982 showing the beneficial effect of meditation on pain reduction was carried out by Dr. Jon Kabat-Zinn with a group of patients suffering from chronic pain. After completing a ten-week program of mindfulness meditation, 65 percent of the participants showed a significant reduction in pain levels.  Since then, many other studies have confirmed these findings.

A Tool to Diminish Feelings of Pain

Researchers have found that through the regular practice of meditation, we can actually change how our mind perceives pain. Meditation doesn’t take the sensation of pain away; it develops our capacity for detached observation, which helps us separate our experience of physical sensations from the painful stories and emotions we generate in reaction to those sensations.

Emotional reactions such as anxiety, fear, and depression intensify feelings of pain. As many studies have found, meditation is a powerful tool for training our minds to regulate our emotions, reduce anticipation of pain, and increase relaxation – thereby decreasing our perception of pain.

Meditation Enhances Conventional Treatment

Another notable study by Randolph in 1999 found that meditation in conjunction with conventional medical treatment medicine enhances the effectiveness of Western medical treatment alone. In this study, patients were taught hatha yoga and meditation in two-hour classes. A year later, patients undergoing the pain and stress management program in addition to the medical treatment reported that  their feelings of pain decreased by 79 percent.

Meditation is an important healing tool that uses the mind-body connection to help people deal with pain conditions, such as OA. Meditation is fast becoming recognized as an effective way of reducing pain. The American Pain Foundation

acknowledges the use of meditation and offers many resources for meditation. By using meditation as part of a comprehensive treatment regimen for OA, patients have the potential to experience less pain and suffering.

By addressing pain in a holistic sense, instead of just as a physical problem, meditation offers the opportunity to use the mind to influence the experience of pain.

Releasing the Stress of Chronic Pain

In addition to the emotional regulation of pain, meditation can help deal with the stress associated with living with a chronic pain condition. Since the 1960s, numerous studies have been done on the physiologic effects of meditation. These studies show that meditation results in the opposite of the physiological changes that occur during the stress response. When we’re faced with stress, whether physical or emotional, our body reacts with the fight-or-flight response: our heart beats faster, our blood pressure rises, our breath becomes shallow, our adrenalin and cortisol production surge, our blood sugar rises, we produce lower levels of sex hormones, and our immune system weakens.

In contrast, during meditation, our body enters a state of restful awareness. When we have a regular meditation practice, the physical and emotional healing benefits include:

•  Decreased blood pressure and hypertension

• Slower heart rate

• Lower cholesterol levels

• Reduced production of “stress hormones,” including cortisol and adrenaline

• More efficient oxygen use by the body

• Increased production of the anti-aging hormone DHEA

• Improved immune function and more restful sleep

Getting Started with Meditation

There is an enormous variety of meditation techniques available, and it’s important to find one that resonates with you. The Chopra Center offers instruction in an easy-to-learn practice called Primordial Sound Meditation. It is based on the ancient Vedic and yoga traditions and uses a mantra to help the mind experience deep levels of stillness and silence.

Many people have also benefitted from using guided meditations and visualizations. The Chopra Center’s 21-Day Meditation Challenge is a great way to add meditation into your daily life. Learn more about the Meditation Challenge here.

Yoga for Osteoarthritis

Yoga is a time-honored science for balanced living and self-realization. By integrating body, mind, and spirit with the practice of yoga, we experience physical, emotional and spiritual benefits. In addition, by bringing our attention to the present moment, we increase our body awareness, not only while practicing yoga, but also in our everyday movements.

From a physical perspective, the practice of yoga increases strength, flexibility, and balance, all of which are important for health in general and are particularly vital for those coping with osteoarthritis (OA).

When practiced regularly, gentle yoga movements not only strengthen the muscles that support the joints but also improve the flexibility of the muscles, which is more effective than just strengthening alone. Several studies have shown the benefit of stretching and increasing flexibility for people with OA in the knees.

While some exercise programs focus solely on strengthening the quadriceps muscle (an important part of most approaches to knee OA), including yoga stretches builds strength as well as increasing flexibility. One study that focused exclusively on quadriceps strengthening demonstrated that patients actually lost flexibility when they only focused on strength training. This did not occur in programs that included stretching.

Relieving Stress on the Joints

Yoga’s focus on balance and alignment helps improve biomechanical imbalances that create stress on the joints. As researchers have found, the damage to cartilage often occurs because of the unbalanced positions that the body is put in while sitting, walking, and moving. Misalignments of bones, dysfunctional movement patterns, lack of body awareness, and poor posture can all contribute to wear and tear of the cartilage. Yoga can retrain our body to move in ways that decrease stress on our joints.

Moving

Another benefit of yoga is that it keeps people moving and reduces the pain and stiffness associated with osteoarthritis. Over time, lack of movement leads to tighter muscles and lack of circulation into the joints themselves. Movement is necessary for proper production of the synovial fluid inside the joints. By moving the joints, the synovial fluid can continuously lubricate and cushion the joints.

People with “loose” or hypermobile joints have a higher risk of developing OA due to uneven wear and tear on the joints. In this case, yoga can be used as a therapy to stabilize hypermobile joints by strengthening the muscles around joints and eliminating the uneven forces on the joint.

Yoga Enhances Emotional Wellbeing

Beyond the physical improvements that yoga can provide, it has the additional benefits of enhancing mental well-being and emotional balance. Yoga is associated with increased energy, fewer bodily aches and pains, and increased mental energy and positive feelings. These are all important factors for anyone dealing with chronic pain conditions such as OA.

How to Get Started with Yoga

If you’re using yoga as a therapeutic tool for OA and other conditions, it’s important to work with a certified yoga instructor or therapist to develop a specific program that is appropriate for your individual needs. Here I will offer some general guidance and descriptions of a few poses that target specific areas of the body.

• Always listen to your body and never go beyond what is comfortable.

• Yoga is not a competitive sport; every body is different, so don’t compare your yoga practice with anyone else’s.

• Focus on the breath with each pose to connect you to the present moment

• All poses can be modified for safety and comfort.

• Every yoga session should begin and end with several minutes of corpse pose (savasana) and quiet breathing.

Poses for the Spine

In combination, the following poses strengthen and stretch the back in the six natural directions of spinal movement (flexion, extension, lateral bending, and lateral twisting).

Seated Forward Fold: Pachimottanasana (pah-she-MOH-tahn-AHS-ahna)

In the seated position, extend your legs out in front of you, toes pointed up. Inhale, raising your arms above your head. Now exhale, reaching for your toes, ankles, or calves. Bending your knees if necessary, gently press the crown of your head towards your toes as you breathe deeply. Surrender to the breath.

Cobra: Bhujangasana (boo-jang-ahs-ahna)

Begin by lying on your stomach with your thighs parallel to each other. Firm your leg and thigh muscles as you extend your legs so that your toes push away from you towards the wall. As you inhale, place your elbows under your shoulders and your forearms on the floor. Exhale, using your chest muscles and back to lift your torso, without overextending, by pushing off with your hands.

Focus on rolling your outer thighs towards the floor, which lengthens your lower back and prevents it from being overly stressed. Stay in cobra for a few seconds, breathing deeply, and then slowly lower your chest to the floor. You can gradually increase to ten seconds. Turn your head to one side and take a few more breaths, feeling your back release and broaden. Repeat two to seven times.

Side Angle: Utthita Parsvakonasana (oo-TEE-tah parsh-vah-cone-AHS-anna)

Stand with your feet about three feet apart, turning your left foot slightly to the right and your right foot out to the right at 90 degrees. Raise your arms and reach them out to the sides, parallel to the floor, with the palms pointing down.

Anchor your left heel to the floor and firm your thighs, rolling your right thigh out. Breathe in, and as you exhale bend your right knee over the right ankle, so that the shin is perpendicular to the floor. Bend as far as is comfortable for you, bringing the right thigh as parallel to the floor as is right for your body. You can place your right hand along your calf or just outside your right foot, depending on your flexibility. You can also rest your right forearm on the top of the right thigh or place a block outside the front foot to support your hand.

Extend your left arm straight up toward the sky, and with a deep inhalation reach your left arm over the back of your left ear, with the palm facing down. Feel the stretch from your left heel through your left fingertips as you extend the entire left side of your body. Keep your gaze on your left hand (unless you have neck injuries) and focus on creating as much length on your right side as you have on the left side.

Hold the post for 10 to 30 seconds and come up on the inhale, pressing both heels into the floor, sweeping your left arm towards the sky. Reverse the position of your feet and repeat the sequence for the left side, holding the pose for the same length of time.

Seated Spinal Twist: Matsyendrasana (MOT-see-en-DRAHS-ahna)

Sit on the floor with your legs out in front of you. Cross your bent left leg over your right thigh, placing your left foot on the floor. Place your right arm on the outside of your left knee and hold your right knee, while twisting your spine to the left. Hold this position, breathing easily. With every exhalation, allow yourself to surrender into the pose.

Return to the midline and repeat the posture on the other side by crossing your right leg over your left thigh, placing your right foot on the floor. Place your left arm on the outside of your right knee and hold your left knee, while twisting your spine to the right. Again, breathe easily into the pose, using your breath to increase your flexibility. As you become more flexible, reach around and grasp the ankle of the foot that is placed on the floor. Hold for ten seconds, then return to center.

Close your eyes for a few moments and put your attention on your spine. Envision the life force flowing up from the base of your spine, through your pelvis, into your abdomen, up through your heart, through your throat, between your eyes, and into your head. Imagine the thousand-petaled lotus flower at your crown chakra opening. Activate the intention to live your life from a more expanded state of awareness as a result of energy flowing freely through your body.

Poses for Knees and Hips

The following poses help stabilize the joints and strengthen the muscles around the knee and hip joints.

Triangle Pose: Trikonasana (trik-cone-AHS-ahna)

Bring your legs apart so your feet are wider than your shoulders. Raise both arms out to the side up to shoulder height so that they are parallel to the floor, palms turned down. Turn your left foot 90 degrees outward, keeping both hips facing forward. Turn your right foot slightly towards the left foot and keep the hips forward as if you have headlights coming from your hips, shining straight ahead.

Press your hips to the right and place your left hand on your thigh above your knee. Bring your right arm up so it is straight with fingertips toward the sky. Make sure to keep your body level as if you are between two glass window panes.

Hold pose for five or six breaths. Gradually return to an upright position, with your arms extended out to the sides, palms turned down. Pause for a moment. Repeat on the other side.

Modified Triangle: 5-Pointed Star

Stand with your legs apart. Keep both feet toes slightly turned out to side. Extend arms out to side. Take a breath in. When you exhale, place your left hand on the outside of your left thigh. The right arm extends up toward sky. Inhale, coming back to 5-pointed star, then exhale on the other side. Repeat 4 to 6 times.

 Eagle Pose: Garudasana (gah-rue-DAHS-ahna)

For most people the eagle pose is challenging on their first attempt; however, this pose can usually be mastered within a short period of time. It is helpful to do eagle arms and eagle legs separately for the first few times.

For most people the eagle pose is challenging on their first attempt; however, this pose can usually be mastered within a short period of time. It is helpful to do eagle arms and eagle legs separately for the first few times.

Arms

Extend your arms out to the side. Bend your left elbow in front of your body, fingertips up toward the sky and cross your right arm between your left arm and chest. Place the fingers of your right hand onto the palm of the left and point your fingertips to the ceiling. Gently press your elbows together. Hold this pose for ten seconds and then unwind.

Legs

Standing with your feet together, bend both knees, then shift your weight to your left foot. Raise your right leg, keeping both knees bent and then cross your right leg around the front of your left leg until you can hook your toes around your left calf muscle near the ankle. You will need to keep your left knee bent to achieve this. Repeat this balancing posture on the opposite side.

*When doing full Eagle, do the arms first and then follow instructions for legs.

Warrior 2: Virabhadrasana II (veer-ah-bah-DRAHS-anna)

Stand with your legs three to four feet apart and turn your right foot in slightly to the right, and your left foot 90 degrees to the left. Align your left heel with your right heel. Expand your arms out stretching them parallel to the floor, with your palms facing down.

As you exhale, bend your left knee, bringing your left thigh as parallel to the floor as is comfortable for you. Keep expanding your arms away from your body keeping the torso long and the shoulders centered over your pelvis. Press your outer right heel into the floor and focus on firming the right leg as you bend the left knee. Don’t allow your back to “sway” out; instead, keep the tailbone tilted slightly towards the pelvis. Stay in this position for five deep breaths. Come up on the inhale, reverse your feet, and repeat on the other side.

Additional Guidance for All the Poses:

• It’s important not to hyperextend the knees in any pose, and be sure the knees and feet are in line. In standing poses, the feet should be firmly planted and toes spread apart.

• Some squatting, kneeling or one-legged poses may not be appropriate for certain people with arthritis in the knees, hips and ankles. Discuss this with your yoga instructor.

• If a muscle starts to feel fatigued, don't push it; just rest in corpse pose (savasana), lying comfortably on your back with your legs and arms slightly out.

• It is recommended that people with OA move through poses slowly, rather than holding one for a long period of time.

Ayurveda has many therapies to offer in the treatment of osteoarthritis. These include yoga, meditation, and the appropriate use of herbal therapies. These modalities offer their benefits without the significant risks associated with conventional medical treatments. By treating the underlying imbalances and by integrating body, mind, and spirit, we can develop a better connection to Self and a better sense of health and happiness.

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About the author

Dr. Sheila Patel is a board-certified family physician, Ayurvedic expert, and Medical Director of the Chopra Center for Wellbeing in Carlsbad, California. At the Chopra Center’s weekly Perfect Health program, she offers mind-body medical consultations and leads classes in meditation, Ayurveda, and other integrative healing practices. To learn more, visit www.chopra.com or call 760.494.1639.

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*Note: The information in this article is intended for your educational use only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition and before undertaking any diet, fitness, or other health program.

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