Do you know someone who has arthritis? Given that 1 in 4 people in the US are currently living with some form of arthritis, the answer is probably yes. While this painful condition is most common in women and older people, it can affect people of any gender and age – even children.
For us as Pilates teachers, this means that even if you don’t specialize in this sort of thing like I do, sooner or later, you are bound to find yourself in a situation where you need to teach someone with arthritis. So it’s good to arm yourself with some basic knowledge.
Types of Arthritis
Before we get to the “how,” it’s important to know that “arthritis” is a little bit of a catchall term. It’s used as shorthand for osteoarthritis (OA), inflammatory conditions such as gout, and a group of autoimmune diseases that includes rheumatoid arthritis (RA), psoriatic arthritis (PA), and lupus. While OA is generally caused by wear and tear on the joints due to aging, injury, and misalignment, all other types of arthritis are tied to inflammatory processes, which means that overdoing it can send those suffering from these conditions into a flare.
Physical Activity and Arthritis
While many people suffering from arthritis understandably avoid exercise due to pain, movement is actually one of the best ways to prevent a worsening of the condition and to counteract pain and stiffness. It also helps improve balance and strength. This helps reduce the risk of falls, which is especially crucial for older people. And, of course, there are mental health benefits such as reduced stress and anxiety.
Why Pilates is Perfect
The exercise prescription for arthritis includes low-impact activities that put minimal stress on the joints and controlled movements. In addition to improving strength, safeguarding mobility, and building balance, these also boost synovial fluid, which helps to lubricate the joints.
Fluid, controlled, low-impact movement? That can only mean one thing: Pilates!
How to Teach Clients with Arthritis
When teaching clients with arthritis, it’s important to remember that different people will have different symptoms. They may be nearly pain-free one day and hurting another day. While Pilates is great for people with arthritis, it is equally important not to overdo it. This can exacerbate the pain associated with osteoarthritis or trigger a flare (a period of worsening symptoms that can last days to weeks) with inflammatory forms of arthritis.
Warmth and gentle movement tend to be beneficial, and it is typical for those with OA to experience stronger symptoms after long periods of inactivity (e.g., getting up in the morning). Gentle movement gradually lessens these. If in doubt, opt for a longer, gentler warmup and a less intense session.
Affected Joints
Although knees, lower back, wrists, and finger joints are most often affected, this will differ from person to person. Symptoms can appear in any joint or joints and in any combination.
What to Ask Clients with Arthritis
Having some basic information is important to help guide your teaching decisions. In addition to your intake form, as a baseline, ask about the type of arthritis and which joints are affected. While teaching, check in with your client regularly to see how they are feeling, ideally at the beginning of every session. Most of all, make sure they feel empowered to stop doing anything that might be too painful or that they fear may trigger a flare.
Hands, Wrists, and Grip
When arthritis impacts the hands and wrists, weight-bearing exercises such as long stretch or plank can be painful. It may also impact grip. Depending on the severity of the symptoms, you may need to avoid these types of exercises altogether. Other options are using extra padding or modifying exercises to be done on the forearms, such as using a box. You can also elevate the heel of the hand using rolled-up towels or pads to decrease the loading of the wrist joint.
If grip is impacted, one option is to wrap or pad bars (pushthrough bar, footbar etc.) with bands, towels or sticky pads. When using weights, opt for lower weights and consider using soft accessories such as weighted balls instead of metal or even coated weights.
Hips, Knees, and Feet
Arthritis also often impacts the lower body. When the hips are affected, internal and external rotation can be challenging. Arthritic knees can cause challenges with deep knee bends. During reformer footwork, you may want to use lighter springs, set the footbar further out, or ask your client not to bring the carriage all the way to the stopper. Footwork is a fantastic way to work with clients whose ankle or foot mobility is impacted, but it may be necessary to go slow, go less deep, or even use the jumpboard to create a larger support base.
Armed with this basic knowledge, some common sense, and, of course, empathy, you are now well-prepared to help your current or future clients with arthritis experience the benefits and joy of Pilates!
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