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Julia McNally (The RA Yogi), certified yoga teacher living with rheumatoid arthritis
When were you diagnosed with rheumatoid arthritis (RA)?
I was diagnosed with juvenile idiopathic arthritis (JIA) at the age of two years. At 16 I was diagnosed with rheumatoid arthritis. I also live with other autoimmune diseases, likely because I’ve lived with an autoimmune disease for most of my life and the chances are greater to have more than one. I was diagnosed with Eosinophilic Esophagitis (EoE) a few years ago, which is another challenge when I travel. In addition to managing pain, limiting walking and standing time, as well as fatigue, EoE affects my eating and drinking. EoE is an allergic/autoimmune condition that happens in the esophagus. During a flare-up the esophagus becomes inflamed and does not contract properly due to more white blood cells collecting in the esophagus. This can make it difficult to swallow, causing choking, vomiting, nausea and sometimes malnutrition.
Why are you studying to be a yoga therapist?
I am studying to be a yoga therapist because I believe in the power of yoga and have experienced it for myself. While our medical model is slowly changing towards interdisciplinary personalized patient care, there is still a gap in the medical system and yoga therapy can help to bridge that gap. Yoga therapists are not replacements for medical doctors, psychologists, psychiatrists, physical therapists or occupational therapists, we simply offer something different and complementary. We work with clients through the yogic scope with the goal of assisting our clients to prevent or reduce their suffering. The professional order of International Yoga Therapists (IAYT) defines yoga therapy as “the professional application of the principles and practices of yoga to promote health and well-being within a therapeutic relationship that includes personalized assessment, goal setting, lifestyle management, and yoga practices for individuals or small groups. “Yoga therapy is well-known and respected as a healing discipline for physical health, mental balance, and spiritual consciousness.” – IAYT
Yoga therapists can offer more time to their clients which is nice when a patient sees a doctor for 15 minutes or less and doesn’t have enough time to communicate or explore their needs as a whole person. Yoga therapy is a holistic approach to healing including physical exercises, breathing techniques, meditation, relaxation, yogic philosophy and chanting. Yoga therapists work with a wide-range of people experiencing anxiety, depression, mood disorders, chronic pain, insomnia, arthritis, autoimmune conditions, pre and post joint replacement surgery patients, to name a few.
For more information about Yoga Therapy: www.iayt.org
“Travelling can be wonderful for the soul, but not the best idea if someone is in a flare-up” Can you elaborate on why that is?
If I’m in an RA flare-up the most important thing for me to do is rest, speak to my rheumatologist and other healthcare professionals to make a plan to help me get out of the flare-up. Travelling is often hard on the body and it can be stressful and disappointing if you’ve planned a trip and are experiencing a lot of pain and challenges with mobility and accessibility.
For instance, I travelled to Mexico to do my yoga teacher training in 2017 and experienced an RA flare-up while I was there. I told my teachers about my health situation, I spent a lot of time icing my knees, taking NSAIDS. Instead of sitting on the floor during class, I sat on a chair and got up when I needed to, to aid stiffness. I took a lot of naps throughout the day when I wasn’t in class. I had to ask to be picked up after a long group walk instead of walking back with everyone. When I think of this act of listening to my body, I think of what is called Ahimsa in yoga (non-harming to oneself and others). It’s a principle I come back to again and again with myself and a reminder to my students.
Asking for help or accommodations is an important part of making travelling possible while living with arthritis.
How did you come to realize that?
Travelling is not the best idea for someone in a flare-up, sometimes it cannot be helped. Another example: I had a planned vacation out of town at a bed and breakfast during an RA flare-up and didn’t foresee the bedroom being upstairs in a loft until I got there. I had much difficulty walking up and down the narrow stairs to the bedroom. The ceilings were very low and it was difficult for me to bend over to get around. I had to sleep on the couch downstairs the first few nights alone while my partner was upstairs. I couldn’t take the pain anymore from sleeping on a small couch, so I asked the owner of the bed and breakfast if she could accommodate my health issues by putting me in another lodging that offered everything on one floor. Luckily she accommodated me, but I was lucky she had the availability and that I had the wherewithal to advocate for my needs. I also had to reduce my activities during that entire trip. Instead of going out the first day, I stayed at the bed and breakfast and iced my body and ordered food instead of going to sit out at a restaurant. I changed my expectations of myself and the itinerary of the trip.
Tip: If you are in a flare-up travelling, speak to your doctor as soon as possible to talk about a plan and coping strategies. Bring ice packs, appropriate medication and walking aids, or call in advance to make sure the bus or airplane is accessible and that the place you are staying is accessible.
How can people with arthritis physically prepare for travelling, whether it is trip by public transportation or going abroad for a few days? And what are your suggestions for during and after the trip?
As someone living with inflammatory arthritis, I try to prepare for the mode of transportation I am taking, where I am staying, the activities planned, and by packing tools/accessibility aids with me. If I am travelling on public transportation, I try to get an aisle seat, so I can stretch when I need to and not have to ask the person next to me to move all the time. I always opt for preferred seating on planes for extra leg room. It is not a big expense compared to how I will feel if I don’t get preferred seating. I can’t sit or stand for short periods of time, so I have to get up and stretch my legs every 15-30 minutes or so, which can be adapted to the amount of time that works best for each traveller. If you are a nervous traveller, breathing exercises can really help.
On my YouTube channel you can follow along with some guided breathing exercises that are good for managing stress, such as balanced breath, alternate nostril breathing or ocean breath.
Meditation is another yoga tool that can support someone who is preparing for travel. Practicing meditation can help ease nerves, deal with uncertainty, and cultivate more self-love and compassion for yourself as you adapt.
Close your eyes and focus on your breathing for a few minutes then repeat a mantra (a sacred sound) or affirmation (supportive words) for 2-3 minutes silently in your mind, for example, I am safe, I am calm, I am peaceful. When you are ready to end the meditation, take a moment to let go of your mantra or affirmation and come back to your breath, your body and check in to notice how you feel after practicing this meditation.
You can follow along with my free meditation series on The RA Yogi YouTube channel – A Meditation Series.
On a physical level, if you are sitting in the same position for a long period of time, it’s nice to take stretch breaks, stretch during the trip as I mentioned by getting up carefully and moving around a little. Another option is a few stretches in your seat,
Fully seated yoga for arthritis during travel
Begin by sitting nice and tall and take 3 conscious breaths to connect to your breathing and present moment.
- Seated neck stretches (flexion and extension, looking left and right, ear towards shoulder on each side x 3 breaths per side).
- Seated flexion and extension of the feet (helps to increase the blood flow in your lower legs) x 3 breaths per side.
- Seated circles with your ankles x 3 breaths per side.
- Seated Flexion and extension of the knees if there is room to do so x 3 breaths per side.
- Seated glute stretch: cross right leg over the left thigh, flex toes towards you for a hip and glute stretch. With a long spine and open chest, lean slightly forward moving from the hips until you feel a stretch in the right glute. Hold for a few breaths, release and switch sides. You should now feel the stretch in the left glute. Hold the pose for 30 seconds each side or a few mindful breaths per side.
- Seated cat and cow – one of my favourites: gently rounding the spine and extension of the spine with your hands on your knees x 3-4 breaths.
- Seated side bends – Mindful side to side movements of the spine x 3 breaths per side.
- Seated gentle twists with your two feet flat on the floor x 3 breaths per side.
- Seated full body stretch/seated arm stretches. Either stand up and lift the arms over head for a full-body stretch or in a seated upright position inhale, lift your arms over your head exhale, lower arms, feel the whole body lengthen as you reach your arms up x 1 deep breath.
- To close this yoga practice, take 3 conscious breaths in and out, thank yourself for taking the time to stretch your body out of gratitude for your body and notice how you feel.
After travel yoga for arthritis
This yoga routine can be practiced as indicated or fully seated in a chair following along with the guided video on The RA Yogi YouTube channel under Accessible Journeys Yoga For Arthritis Series.
- Mountain pose x 3-4 breaths.
- Moving mountain pose: inhale arms lift up and exhale arms lower down, moving and breathing x 3 breaths.
- Forward fold: inhale – lengthen the spine, exhale – fold from the hips, bend the knees as much as you’d like, release the head completely and hold for a few breaths.
- Gentle backbend: hands behind the low back or interlaced behind the back, lift the heart and chin inhale and exhale back to starting position x 1-2 breaths.
- Warrior 1: hands to the top of a sturdy chair, feet shoulder width apart, step one foot back on two separate tracks, bend into front knee, knee over ankle and gently send your back heel towards the floor. Option to lift arms and open the chest or keep hands to top of the chair x 3 breaths per side.
- Warrior 2 x 3 breaths per side.
- Side angle pose x 3 breaths per side.
- Standing chair table top leg extensions x 3-4 breaths per side moving and breathing.
- Lying twist: can be performed on a bed or yoga mat x hold the twist for a few mindful breaths x 6-8 breaths each side.
- *Savasana: this pose is the most important: conscious relaxation for 5 minutes lying on your back. This could be in bed or a yoga mat on the floor with any pillows under the knees or head if needed for more comfort. Arms by your sides, palms facing up, legs open and relaxed, feet relaxed.
Enjoy a yoga nidra practice before going to sleep in bed, to help you key down and aid your nervous system to rest and rebalance after travelling.
You can find a Yoga Nidra For A Deep Sleep on my YouTube channel titled Accessible Journeys Yoga Series.
A common experience for people living with arthritis is sometimes they can do a certain activity and sometimes they can’t. What, in your experience, are the benefits of deep breathing for managing these fluctuations?
In yoga, the breath is called prana and considered one’s life force and vital energy. Yogis look at prana as something that is infinite, and can be controlled through breathing exercises (pranayama). These breathing exercises may include full yogic breath (breathing into the belly, diaphragm and chest and exhaling, noticing the belly fall as you exhale), kapalabhati breath of fire which is good for increasing energy, anuloma viloma /alternate nostril breathing to help bring focus and grounding energy if you’re feeling scattered or anxious and intercostal breathing to help aid depression/low mood because of its expansive nature. Placing the hands on sides of the ribcage breathe in through the nostrils notice your body expanding into your hands, try to create equal breath of each side, notice the lungs filling with air slowly and expansion of the breath as you inhale and as you exhale relax and let go of any stale energy, moving the stuck energy out of the joints and the body.
Deep breathing brings you into the present moment, so even taking 3-4 simple conscious deep breaths is such a great practice. I actually have an alert on my phone and my computer to remind me to take 3 conscious breaths every day, just in case I forget.
Practice ahimsa: listen to your body, your body knows best.
Use my yoga for arthritis travel practices to help you reduce pain, stiffness, anxiety, stress and fatigue.
Enjoy the things you can do, and let go of what you can’t do.
Cultivate gratitude for the opportunity to travel, explore, expand, and be proud of yourself for going for it. You can do hard things.
I hope this was helpful for anyone who is living with arthritis and loves travelling.
Be sure to subscribe to The RA Yogi YouTube channel to discover free yoga for arthritis online and let me know how these yoga routines went for you!
Founder of The RA Yogi
- Ex Personal Trainer and Group Fitness Instructor (2008-2016)
- Certified Yoga Instructor (Yandara Yoga Institute, 2017)
- Certified Chair Yoga Instructor (Sunlight Chair Yoga, 2019)
- Certified Yoga For Arthritis Teacher (Johns Hopkins Arthritis Centre – Yoga For Arthritis, 2020)
- Yoga Therapist in-training (Breathing Deeply Yoga Therapy, present)
Location: Montreal, QC, Canada
The RA Yogi YouTube Channel
- Arthritis Society Canada
- YogArthritis TV Series
- A Warrior Series
Search for more videos by Julia McNally on their YouTube channel or website.