Yoga for Menopause: Joint Problems

by Shari

I feel a little foolish presenting this topic because until quite recently I didn’t associate my various injuries or aches and pains as part of menopause. I didn’t really connect the dots; I just figured that I must be doing something wrong to cause myself injury. This has really come home to roost with my current knee injury that could be something I might have to address with surgical intervention! And my conversations with Nina about menopause prompted me to take a closer look at this problem that isn’t just my own personal issue.

It turns out there is actually a term for this experience: arthralgia. A diagnoses of arthralgia is given when the joints become swollen, stiff or painful during menopause. Joint pain associated with menopause is also referred to as “menopause arthritis.” It can affect hips, knees, back and extremities (how about the whole body?).  In the journal "Semin Arthritis Rheum 2009," the researchers state that genetic alteration, menopause-related estrogen deficiency and aging cause changes in joints with resultant cartilage damage. The changes in the joint are what physicians call osteoarthritis but they don't classify it beyond that. However, these researchers recommend that primary osteoarthritis be classified in the three categories listed. The literature also presents some disagreement in the usage of arthralgia and arthritis. In one source arthralgia is classified as non-inflammatory and arthritis as inflammatory. But pain is experienced in both situations.

Menopausal joint pain is often described as increased stiffness with joint swelling that increases at the end of the day. For some women, the pain may shoot down an extremity as well as feel hot within the surrounding area, which gets worse (not better) after exercise. In menopause and perimenopause the radical hormonal fluctuations are affecting the joints but researchers can’t say exactly how. They do state that changing levels of estrogen play a major role in joint pain caused by menopause. It is known that estrogen helps control joint inflammation and as estrogen levels decrease, inflammation can increase. Concurrent with the sensation of pain experienced in menopausal joint pain, range of motion may become limited (such in as the condition called "frozen shoulder").

So if it's possible that menopause is causing sporadic back or neck pain, the questions some of us may then grapple with are: "Do I investigate hormone replacement therapy?" and "Do I make dietary changes to work with my changing hormonal levels?" These are personal issues that we all grapple with, but the context of this blog is to address our menopausal symptoms with the practice of yoga! In general, for joint pain—whether menopausal or not—there are certain issues our yoga practice should address:

1. pain management
2. range of motion
3. muscle strengthening
4. acceptance

Pain Management: The key point here is how we can manage the pain (maybe not alleviate it) so we can function. What I am learning in my own pain management is that it is counterproductive to ignore it. I have to use the pain response to guide my own movements in asana. For instance, I cannot squat to the floor as I am used to doing, nor can I sit in Hero pose (Virasana) anymore (with any combination of prop usage). Do I need to sit in Hero pose? No, I don’t. Do I need to squat? Well, I do need to bend my knees to get up and down from the floor to practice yoga as well as for functional tasks. So I have learned how to do it so I don’t hurt my back and I can smoothly execute my tasks. When I do try to test things out, my knee responds with increased swelling and a nasty ache that is not fun, but I'm learning to adapt. For asana, I try to keep the injured body part within its comfort zone, and if that is not possible, I do something else in my practice. For me standing poses have always been a favorite part of my home practice, but now I find that seated forward bends are better. Certain twists are challenging for a sore knee but with a bit of creativity some of them can be nicely modified. If I was a student in a class and my teacher could not come up with a modification for me to safely do a pose, I would not do that pose and would wait until I could rejoin the class.

Shari's Go-To Pose

Yoga postures where the blood is flowing toward the heart also help with pain management, especially for swollen extremities. That means inverted poses. Try to figure out which inversions feel good to you, and then practice them daily.  For me, my go-to pose is Shoulderstand with a chair. In the past I would always choose the active Shoulderstand, but now the more passive version is more nourishing for me. When all else fails, Legs Up the Wall pose (Viparita Karani), either with straight legs on the wall or bent legs on a chair—anywhere you can make your legs higher than your heart—is lovely.

Range of Motion: As we've mentioned many times on this blog, to keep your joints healthy you need to move them through their range of motion (see Range of Motion: Yoga's Got It Covered). But too much movement into and out of pain is counterproductive. So finding the amount of motion you can do without increasing your pain response is crucial. And non-weight-bearing positions generally work better than weight-bearing poses. What does this mean? Well, lying on your back and bending your knee to its limit is non-weight bearing. Standing and putting weight on your legs to bend them is weight bearing, and when we bear weight, we compress the joint. When there is inflammation and swelling, weight-bearing compression just aggravates the inflammation and things feel worse. Time is also an important factor. Let’s say I can bend a body part for five seconds without a pain response, but if I hold it for fifteen seconds I get pain. The idea is to hold the joint in position and release it before a pain response occurs. If you have immediate pain, then that position probably should be avoided for now. In asana, using a chair for standing poses can still allow you to experience the benefits of the pose but can decrease weight bearing on the lower limbs to help you avoid increase of pain while still working with your range of motion.

Muscle Strengthening: We have to keep our bodies strong because as menopause progresses our ability to build healthy bone is affected and weight-bearing activities are what stimulates the bone to remodel. A simple technique for building strength is timing your poses (see Arthritis, Exercise and Yoga). But it may not be immediately obvious where you need strengthening. My current physical therapist (who is not a yogi) is addressing my knee injury not by strengthening my knee, but instead working on my hips. That means buttock muscles and hamstrings. Interestingly, my hips (on both sides) were a lot weaker than I thought, and I'm someone who was aerobically walking two miles a day and had a strong standing pose practice! So I am humbly learning how to do exercises that target specific muscle groups. I personally am finding this more challenging than I thought, so here is when I am trying to employ some yogic principles of breathing into the challenge and trying to engage my mind to embrace my hip abductors. If you want to work on strengthening, it might be a good idea to consult a professional, such as a physical therapist, so see which areas you should focus on.

Acceptance: We all grieve when we suffer a loss. For some women menopause is a period of grief because of the loss of the ability to bear children. I felt that acutely when my youngest child was weaning himself from breast feeding. He was 3 ½ and it was time for both of us. It was very smooth, but in my heart I did feel sadness because I knew I would never nourish my children that way again. The feeling of loss in menopause is very subtle for some of us and not so subtle for others. We are changing and there really isn’t anything we can do about it. Some of us dye our gray away because that holds our fears of aging at bay. Others have cosmetic procedures to deny the changes in our aging bodies. We all cope differently, but eventually we all do look at ourselves in the mirror and come to accept what we see. And as Nina talked in her recent post about fatigue (see Yoga for Menopause: Fatigue), sometimes we have to accept that we can’t do things at the same pace as we have always been used to. When we experience joint pain in menopause and have made our individual choices of how we want to live our menopause, yoga allows us the opportunity to explore avenues of acceptance. We will all find our way eventually.