ANATOMY & ARTHRITIS The Basics

1. ANATOMY & ARTHRITISThe Basics SteffanyMoonaz, PhD and Nancy O’Brien, RYT

2. Direction Distal/proximal Superior/inferior Medial/lateral Prone/supine Sagittal/horizontal/vertical

3. Basic Landmarks- Lower Limbs Toes- phalanges Feet- metatarsals, tarsals Shin- tibia, fibula Knees- patella Thigh- femur Pelvis- illium, ischium, pubis

4. Basic Landmarks- Upper Limbs Fingers- phalanges Hands, Wrists- metacarpals, carpals Elbows- humerus, radius, ulna Shoulders- scapulae, clavicle

5. Basic Landmarks- Axial • Spine • lumbar (5) • thoracic (11) • cervical (7) • Head • Frontal • Parietal • Occipital • Maxilla • Mandible

7. Stress The brain can’t differentiate stress from a hungry bear or a job interview. Same response: -- elevated blood pressure, -- faster heartbeat -- faster breathing -- suppressed immunity, digestion and reproductive function -- protective inflammation (injury)

8. Chronic Inflammation Sustained stress response releases pro-inflammatory substances that attack instead of protecting -- healthy cells -- blood vessels -- tissues Chronic stress & chronic inflammation heighten risk of disease

10. Stress, Inflammation & Disease Diseases themselves can cause dysregulation of immune response Inappropriate vs. appropriate responses (Rheumatoid Arthritis, etc.) “Why does my body hate me?”

11. Effects – Subject to Intervention Chronic stress increases vulnerability to infectious diseases Stress slows healing Too little sleep wreaks havoc on the immune system, increasing inflammation.

12. Parasympathetic/Sympathetic Sympathetic - Flight or Fight -- Potential for chronic stress (cortisol) Parasympathetic --Rest, Restore, Renew, Tend & Befriend – Frees up the energy for work crews to rebuild, cleanse, repair, heal

13. Genes and Telomeres Dean Ornish lifestyle program including yoga affects genes Changes course of disease Telomeres lengthen -- better copies

14. THE CELL, Dave Bolinsky, TED

15. Respiration/The Breath The Diaphragm -- Moves heart, lungs, upper abdominal muscles, ribs --Facility with diaphragm allows practitioner to match or supplement states of energy (stimulating or calming circulation/oxygen delivery) --- Pranayama can provide physical support for sitting and standing --- Ujai breath can bring physical/mental support to an asana in form of strength or focus or centering -- Longer exhalation sends powerful signal to the nervous system to bring out the work crews to build, cleanse, renew

16. Gentle Waves, Rising and Falling http://www.youtube.com/watch?v=c6LH_svUr5w

17. The Diaphragm

18. What is Arthritis? Umbrella term for category of diseases Musculoskeletal Joint conditions Systemic or localized Can be associated with weakness instability deformity reduced quality of life difficulty with ADLs May impact other organ systems

19. Bones and Joints

20. Arthritis Prevalence 50 million adults Leading cause of disability More prevalent among: women older overweight sedentary Expected to approach 70 million by 2030 Limits activities and work for many

21. Relevant Conditions Osteoarthritis- “wear and tear” Rheumatoid arthritis- autoimmune in joints Psoriatic arthritis- red patchy skin Gout- uric acid Lupus Fibromyalgia- “tenderpoints” AnkylosingSpondylitis- spinal fusion Lyme Disease- prior infection Polymyositis- skeletal muscles IBS, Crohn’s Disease- digestive tract

22. Osteoporosis vs.Osteoarthrits

23. RA vs. OA

24. Important Considerations- OA Most prevalent Often diagnosed by PCP w/o radiograph May be undiagnosed or self-diagnosed Most common in weight-bearing joints Symptoms can be reduced and progression delayed with weight loss (if overweight) Medications address symptoms only Surgery can be solution if “bone on bone” Genetics, demographics, joint use, BMI Younger incidence w/obesity epidemic

25. Important Considerations- RA Requires close monitoring and regular care of rheumatologist Deformities more common for those with diagnosis prior to current treatment or if treatment is delayed Disease modifying agents for lifetime use May experience “flares” and require change in activity and/or medication Middle-age onset common, mostly women Immune concerns, stress can exacerbate Loss of muscle tissue, heart disease

26. Common Comorbidities

27. The Role for Exercise Slow RA muscle cachexia Reduce loss of function from low activity Can help prevent cardiovascular comorbidity Weight management Stabilize joints with muscle strength Maintain mobility Increased self-efficacy for daily activities Lessen likelihood of damaging falls

28. BALANCE Grounding -- Feet & Toes – activates cerebrospinal fluid – mountain pose at the wall Messages through all the bones, nerves, epithelial tissue, muscles tendons, fascia, senses Stimulation, learning – foot massage, tree pose at the wall

29. The Role for Mindfulness Stress reduction has biopsychosocial cascade Ability to cope with daily disease fluctuations Awareness of abilities, not just limitations Change framing of disease Understanding of connection with others Tools to use during flares or other challenges

30. The Brain Meditation changes it More grey matter, connections, larger areas representing compassion -- Improved powers of observation -- Improved ability to concentrate -- Nonlocal healing effects (quantum consciousness, neutrinos, muons)

31. Important Points We are not clinicians. Those of us who are clinicians are likely not their treating clinician, or a rheumatologist. Knowing more about our students’ condition(s) can help us understand their experience and help accommodate them. Students should have medical clearance to begin an exercise program at this time.

32. More Points Learn as much as you can about each individual’s struggles and needs. Arthritis is incredibly variable, even in the same joints. Sedentary students may not be familiar with the difference between muscle engagement or stretching and joint pain. Have few enough students that you can be very aware of what each is doing.

33. Still More Determine the range of function you can comfortably accommodate. When all else fails, breath and relax. Don’t hesitate to contact a mentor with questions or concerns about your class or specific students.

34. The Relaxation Response