For those living with arthritis and the corresponding joint pain, stiffness, and fatigue, traditional workouts can be challenging. Yet moving your body is one of the most effective strategies for managing arthritis symptoms. The key is not to be fearful or avoidant of exercise — but rather to listen to your body and know how to move in ways that support your joints instead of straining them.

Over my 25 years as a fitness professional, I have worked with many clients dealing with arthritis. Pain and discomfort can be an obstacle, but proactive care and healthy habits can help reduce inflammation and improve your condition.

A Look at Two Types of Arthritis

There are more than 100 types of arthritis, yet the most common form is osteoarthritis, with rheumatoid arthritis being another prevalent type.

Osteoarthritis refers to arthritis that develops from wear and tear, whether from a breakdown in cartilage, injuries, or overuse. Rheumatoid arthritis is an autoimmune disease in which inflammation occurs from the body attacking the lining of the joints.

Both conditions can be improved from incorporating exercise and other healthy lifestyle choices, though rheumatoid arthritis may need more attention and assistance from medical professionals to help reduce inflammation.

With either type, it’s best to take advantage of the days when you feel your best by being active — and also to give yourself permission to recover when need to. Those with arthritis may benefit from engaging in movement even when they are a little uncomfortable, but it is still important to balance out workouts with proper rest and recovery. Always seek advice and direction from qualified professionals.

The Importance of Maintaining Muscle and Movement

As we age, it’s common to lose muscle mass and strength, and it takes effort to maintain it. Preserving muscle mass is especially important for those dealing with arthritis. If not addressed and prioritized, arthritis has the potential to be devastating to everyday function and quality of life by adding pain and stiffness to that loss of muscle and strength.

If arthritis is already present, the best plan of action for increasing strength is to gradually increase your exercise frequency and intensity, as well as the duration of your workouts, while also ensuring adequate time for recovery between workouts. For efficiency and to help improve overall functional strength, it’s important to prioritize larger muscle groups and multi-joint compound movements.

Creating a routine you can stick to is crucial. You may very well start off with two or three days a week of exercise that expands to three to five days over time. When exercise is a regular part of life, arthritis can be easier to deal with. It’s not the only solution, but it is an important piece of the puzzle.

5 Recommended Exercise Modalities for Dealing With Arthritis

1. Functional Strength Training

When I work with clients with arthritis, I often emphasize the importance of functional training. The best exercises are ones that help you move better during your daily life and regular activities. These include even the basic movements of sitting down or standing up, getting dressed, putting dishes away, carrying groceries, going up stairs, and more.

While some might take these abilities for granted, they all require a level of strength and joint mobility, which is important to keep working on — especially for those with arthritis. Exercises that require pressing and pulling both horizontally and vertically, squatting (sitting to standing), hinging at the hips, stepping up or down, and rotating motions are beneficial as they all require using more than one joint at a time while incorporating multiple planes of motion. They mimic our everyday functions.

As for equipment, resistance bands and cable machines are a good place to start if you’re a beginner. I recommend waiting to use free weights like dumbbells or kettlebells until you’ve developed more control of your movements, which can take a few weeks or months.

2. Core Strengthening Moves

When managing arthritis, it’s crucial to focus on exercises related to core strength and balance. These moves help stabilize the body and support the joints, helping to reduce pain and improve overall function.

By challenging your core in your workouts, you’re preparing your body to better handle forces and movements encountered in daily life without putting extra strain on your spine or arthritic joints. Examples of these types of exercises include arm or leg lifts in a quadruped position, floor bridges, planks, and Pallof presses. Incorporating these into your regimen can improve your balance, enhance joint support, and contribute to more comfortable, confident movement.

3. Flexibility and Mobility Work

Flexibility and mobility exercises are essential to help you move and feel better overall. They focus on increasing your joints’ range of motion, easing stiffness, and improving posture and alignment.

A smart first step is working with a fitness professional who specializes in corrective exercise. Through a movement assessment, they can identify muscular imbalances and restricted areas that may be contributing to joint discomfort. These insights can help them tailor a program for you that targets your specific limitations and builds a more balanced, functional body.

4. Low-Impact Cardio

Our heart and lungs contribute to many other systems of the body, so it’s important to strengthen them by incorporating cardio sessions into your routine, ideally two to three times per week. Opting for low-impact cardiovascular exercises like walking, swimming, or biking can help reduce any strain on your joints. As with strength training, you can start off slow (as little as 10-minute sessions) and gradually increase duration and intensity as your body allows.

5. Activities That Bring You Joy

When you find pleasure in being active, it’s much easier to stay consistent. Maybe you love scenic hikes, spending time on the golf course, or playing pickleball — whatever gets you moving while you are also enjoying the experience. As you continue to work on your strength and mobility, your body will be better able to perform the activities you love.

A Few Tips Before You Start

Consult the experts and find support in your network.

Be sure to check with your healthcare provider before starting any kind of exercise program — and consider working with a personal trainer or other fitness professional. For best overall results, having qualified people to assist and support you can help with staying motivated and accountable while also gaining a better understanding of your condition. You might also want to lean on a close friend or family member as having people in your corner can improve your overall experience and help you feel more supported.

Listen to your body and manage pain wisely.

When exercising with arthritis, it’s essential to stay in tune with your body and your pain levels. Joint discomfort is a common part of arthritis, but it’s important to distinguish between general stiffness and sharp or worsening pain. Pushing through the wrong kind of pain can lead to setbacks rather than progress.

If an exercise causes pain, it’s a sign that the movement needs to be modified. Always be prepared to regress the movement (reducing the range of motion, decreasing the weight, or choosing a lower-impact alternative). Early on, especially in the first four to six weeks of a new routine, it’s best to keep workouts within a moderate intensity range that allows you to complete 12 to 20 repetitions per set. The key is to challenge the body without overloading it.

Prioritize recovery.

While staying active is crucial for managing arthritis, recovery is just as important. Without proper rest, your body doesn’t have the chance to repair and adapt, and that can limit the benefits of your exercise routine.

Sleep plays a key role in the recovery process. Aim for at least eight hours of quality sleep per night to support joint health, help reduce inflammation, and improve energy levels.

You also want to allow for adequate recovery between workouts that target the same major muscle groups. If a particular area is sore or fatigued, give it time to recover before working it again.

It’s also wise to build rest into your workout structure. Between sets, give yourself enough time to pause — especially when performing exercises that involve the same joints or muscle groups affected by arthritis.

Prioritizing recovery helps prevent overuse, supports consistent progress, and makes it easier to stay active without aggravating symptoms.

In 2018, I developed a small rash on my abdomen. It lingered for weeks, slowly radiating outward from the original red spot. I happened to be interviewing a homeopath for an article I was writing, and at the end of our conversation I mentioned the rash. She suggested I try a homeopathic remedy — sulphur — which was available at my local food co-op for less than $10. The day after I took it, my rash disappeared.

A lucky coincidence? Maybe. Maybe not.

Millions of people around the world rely on homeopathy to treat common minor ailments and address stubborn chronic conditions. It’s an accepted medical protocol in the health systems of Brazil, Chile, India, Mexico, Pakistan, and Switzerland. In Germany, where homeopathy originated, treatments are covered by most government medical plans, and remedies are widely available in pharmacies. In a 2021 survey, 54 percent of Germans reported having used homeopathy.

By comparison, the use of homeopathy is somewhat rare in the United States. As of 2012, the most recent year for which data is available, about 6 million Americans — less than 2 percent of the population — reported having used homeopathy within the past year. Although some integrative MDs include homeopathy in their treatment strategies, the practice remains controversial among mainstream U.S. healthcare professionals, even as many of their counterparts around the globe deploy it as a routine, low-cost intervention.

So, what is homeopathy? Kathi Fry, MD, CTHHom, a physician and master homeopath in Boulder, Colo., describes it as “a form of alternative medicine that works by stimulating the body’s inherent ability to heal itself.”

Homeopathy emerged in 1796 with the work of German physician Samuel Hahnemann, who believed that the symptoms we display when sick are manifestations of the body’s healing response. It’s based on the principle of “like cures like” (or the law of similars): Homeopathic treatment involves giving sick patients remedies that, if given to a healthy person, would cause the same symptoms the patient is presenting. In the ailing person, the remedy is meant to help stimulate the body’s inherent ability to heal.

“We have an innate intelligence in our bodies,” says Fry. “In Traditional Chinese Medicine, it’s called chi. In homeopathy, it’s called the vital force.” That power can be depleted by physical, mental, and emotional causes, and that depletion manifests in physical, mental, and emotional symptoms. “Symptoms are the way the vital force communicates and asks for help.”

You can suppress these symptoms with medication, but the problem may then simply manifest in another way. “The more ways you suppress symptoms, the louder the vital force will scream,” Fry explains.

Instead of suppressing symptoms, homeopathy aims to induce the body’s self-healing mechanisms to respond in a gentle, comprehensive way.

How Homeopathy Works

Homeopathic remedies are initially identified through a “proving” process, in which they’re given to healthy volunteers. The volunteers then record their physical, mental, and emotional symptoms. A supervisor collates these responses and looks for commonalities.

“Every remedy has a particular signature, and you match it to a patient’s symptoms based on what it showed in its proving,” Fry says. “It works like a tuning fork — an energy resonance that happens with the vital force.”

Several conventional medical treatments also operate on the law of similars. Allergen immunotherapy, for instance, treats allergies by exposing the sufferer to small traces of the offending substance to desensitize the immune system to it. And many vaccines work by introducing the immune system to an inactivated or partial pathogen, giving the body a chance to prepare to fend off the real deal.

Homeopathy’s low cost and low risk make it an appealing choice for treating common minor ailments at home.

Homeopathic remedies are more subtle. Practitioners believe that they work on an energetic level instead of a biochemical one. They’re prepared by repeatedly diluting and shaking a concentrated natural substance (usually plants, minerals, or animal products) until the substance itself can often no longer be detected. A remedy has been serially diluted in liquid (usually water or alcohol) in a ratio of one part to 100 (written as “c”) or one part to 10 (written as “x”).

Counterintuitively, the higher the dilution, the more potent the remedy. “The physical characteristics of the substance lessen as the energetic or healing properties are increased,” explains Fry. These remedies are typically administered in sugar pellets under the tongue; they are also available in tablets as well as topical ointments where appropriate.

Because most homeopathic remedies contain little or no trace of the original substance, they don’t function in the body as a molecular substance taken into a cellular receptor. They work more like an acupuncture needle than a drug or an herb.

“Homeopathy works by using energy at some level,” says Karen Lawson, MD, ABIHM, codirector of the Integrative Health and Wellbeing Coaching program at the University of Minnesota’s Earl E. Bakken Center for Spirituality and Healing.

Scientists have investigated whether substances affect the crystal structure of water in the dilution process. Others have proposed that solution dynamics or bioelectromagnetics may play a role.

But the fact is that no one knows exactly how homeopathy works. “It’s the biggest barrier to producing more research on homeopathy,” says Lawson. “The National Institutes of Health want a mechanism they can understand.”

Still, there is some research to support its effectiveness. A 2014 meta-analysis of 22 randomized controlled trials suggested that homeopathic treatment can be more effective than placebos, and “medicines prescribed in individualized homeopathy may have small, specific treatment effects.”

And an older (1997) meta-analysis that reviewed 89 clinical trials involving more than 10,000 patients found that homeopathic treatment outperformed placebos in multiple studies.

Another challenge of evaluating homeopathy with the standard biomedical research model is that, like many functional, alternative, and complementary medical practices, it’s highly personalized.

“A person’s constitution is like a jigsaw puzzle.” One person might be fiery, energetic, and assertive, with a preference for certain kinds of foods and weather, and a tendency toward certain symptoms. Another may be quiet and accommodating, with a whole different set of preferences and tendencies.

When prescribing a treatment, a homeopath will first evaluate a patient’s “constitution” — the sum total of their physical, mental, emotional, and spiritual profile. “A person’s constitution is like a jigsaw puzzle,” explains Loretta Butehorn, PhD, DIHom, a psychologist and homeopath in Provincetown, Mass. One person might be fiery, energetic, and assertive, with a preference for certain kinds of foods and weather, and a tendency toward certain symptoms.

Another may be quiet and accommodating, with a whole different set of preferences and tendencies. “The homeopath looks at the whole constitution and matches that picture with a remedy that has similar characteristics,” Butehorn says.

This kind of individuation is what allows homeopathy to be so precise — for example, targeting specific issues like “motion sickness that’s improved by lying down.” “You can have 30 people with the same diagnosis, and they each need a different remedy,” says Fry. “If a kid has a cough, the remedy will differ depending on if it’s a dry or wet cough, or if it’s worse in the morning or the evening.”

This level of personalization is a hurdle to studying homeopathy in randomized controlled trials, because typically everyone in a treatment group receives the same remedy. But research models are becoming more flexible to accommodate personalized systems of care, says Lawson.

Applied clinical research assigns people to receive either standard medical care or an individualized treatment, such as acupuncture, chiropractic care, or homeopathy. “Then you can look at these systems’ efficacy in clinical practice,” she explains.

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When to Use Homeopathy

Homeopathy’s low cost and low risk make it an appealing choice for treating common minor ailments at home. Of the 6 million Americans who used homeopathy in 2012, only 19 percent reported seeing a provider. The remaining 81 percent presumably self-prescribed over-the-counter remedies, according to a 2018 report. (In the United States, these formulations are not FDA-approved, but they are subject to the same marketing restrictions as other supplements.)

Reputable brands, such as Boiron, are available at health-food stores nationwide in a range of potencies (30c is most common for household use), usually for around $10 per remedy. Each bottle or tube contains scores of pellets, and the doses are typically small — usually about four or five pellets.

Companies such as Hahnemann Labs offer kits in a range of sizes for home and travel. (For four common remedies to include in your home first-aid kit, see below.)

Homeopathy can ease acute mental and physical complaints, such as mild anxiety, depression, digestive issues, and respiratory infections, as well as symptoms related to chronic health concerns, including ADHD, allergies, and arthritis.

It may also be helpful when used in conjunction with conventional treatment approaches. “For something like a broken bone, you want a cast,” says Lawson. “But for persistent pain from a fracture, homeopathy can help.”

Homeopathy is not suited to address a tumor or other similarly serious or severe conditions. Yet when used in combination with conventional care, “it can help shift the underlying predilection energetically, and help with adjunct symptoms and responses to things like chemotherapy or radiation,” Lawson says.

In the early stages of arthritis, homeopathy has been found to soothe pain and reduce inflammation. But once arthritis has advanced, it won’t help with deformed joints.

“When major anatomical changes exist, homeopathy should be thought of as complementary or supportive of other more conventional therapies but not as the primary therapy.”

“When major anatomical changes exist, homeopathy should be thought of as complementary or supportive of other more conventional therapies but not as the primary therapy,” write integrative-health expert Wayne B. Jonas, MD, and fellow integrative practitioner Jennifer Jacobs, MD, MPH, in Healing With Homeopathy.

Self-administration for minor health complaints is where homeopathy shines. It’s ideal for families with young kids. Lawson treated her daughter with nothing but homeopathy until she was 7, when she needed antibiotics for strep throat. “Kids are way overmedicated, including for behavioral issues like ADHD,” she argues. “Homeopathy can be far less problematic than prescription meds. But for anything other than acute transitory issues, it should be prescribed by a trained homeopath.”

“A lot of what kids have comes and goes, like teething or an upset stomach,” Butehorn notes. “They can bounce right back with homeopathy, because they don’t have entrenched patterns of energetic insult. The older you are, the more life challenges accumulate that can impact your energy.”

Homeopathy doesn’t work biochemically, so it’s a good choice for those looking to cut back on standard drugs. “Homeopathy is an avenue for those who don’t want to pursue pharmaceuticals, whether because of cost issues or they’re allergic, pregnant, sensitive to medications, or on other medications that might interfere,” Lawson says.

“I work with a lot of people with addiction issues, where the liver is severely compromised,” notes Butehorn. “Homeopathy is an alternative for them that’s not chemically based.”

“Homeopathy is an avenue for those who don’t want to pursue pharmaceuticals, whether because of cost issues or they’re allergic, pregnant, sensitive to medications, or on other medications that might interfere.”

Unlike herbs and supplements, homeopathic remedies typically don’t interfere with pharmaceutical treatments. But those taking medications often find that when they add these remedies, they’re able to lower their medication dose. “We see this frequently in people on psychiatric medication — when we treat them with antidepressants and homeopathy, sometimes over time the need for the antidepressant decreases.”

Fry has observed the same thing in patients with thyroid conditions: “A remedy can help restore thyroid function, so they might need to titrate down that dose of thyroid medication.”

Because homeopathy can reduce the need for medication, people using it for chronic conditions should make sure they’re working with their primary-care provider to continually evaluate levels and dosages.

Are there other risks to be aware of?

“The worst that can happen is that you take too much of a correct remedy and your symptoms get worse,” says Butehorn. This is known as an “aggravation.” It can happen if someone is particularly sensitive to a remedy, or they take too high of a dose. But it’s generally short-lived and self-resolving; a little strong coffee or some mint can alleviate the situation, Fry says.

Taking an incorrect remedy probably won’t do any harm, she adds; it just won’t have any effect. Unlike over-the-counter medications, homeopathic remedies come with no risk of chemical dependency, overdose, or toxicity.

Whether you’re experimenting with remedies at home or working with a skilled practitioner, homeopathy offers a welcome addition to the healing toolkit. As Jonas and Jacobs note in Healing With Homeopathy, “These are drugs . . . that work with the body. These are medicines with eyes and ears.”

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Working With a Homeopath

For minor ailments such as rashes, warts, bruises, an upset stomach, colds, and the flu, self-treatment is generally safe and easy. For more complex or chronic complaints, including fibromyalgia, chronic fatigue, arthritis, and mental-health conditions, it’s best to seek out a professional homeopath, says Karen Lawson, MD, ABIHM, codirector of integrative health coaching at the University of Minnesota’s Earl E. Bakken Center for Spirituality and Healing. She cautions pregnant women to work under the guidance of a pro.

Complex conditions that haven’t responded to conventional treatment are often good candidates for homeopathy. For instance, some homeopaths are seeing positive results treating patients with long COVID.

The first step in working with a homeopath is a substantial intake appointment. Over one to two hours, the practitioner takes a detailed health history and asks questions geared toward understanding a patient’s constitution.

When prescribing a treatment, a homeopath will first evaluate a patient’s “constitution” — the sum total of their physical, mental, emotional, and spiritual profile.

“First, I want to make sure they’ve taken advantage of what science has to offer,” says Loretta Butehorn, PhD, DIHom, a psychologist and homeopath in Provincetown, Mass., who often works in tandem with her patients’ primary-care providers. “Then I take a history to get their constitution, ask when the problem showed up, what was happening in their life at that time, and get any other symptoms they’re experiencing, from head to toe.”

Then she chooses a remedy based on the unique jigsaw puzzle presented by that patient.

Kathi Fry, MD, CTHHom, a physician and master homeopath in Boulder, Colo., generally starts patients on a low-dose remedy (6c or 9c for kids; 12c or 30c for adults) and follows up at six weeks. If the remedy seems to be working, she may increase the dose over time.

Unlike medications to manage chronic disease, homeopathic remedies aren’t meant for long-term use. The remedies are meant to stimulate the body’s natural healing abilities and then be discontinued.

In the United States, homeopathic certifications and diplomas aren’t regulated at the national level. (Some states do certify homeopathic training, however; ­Connecticut, for example, requires that homeopaths also have an MD or DO degree.) But the American Institute of Homeopathy — which actually predates the American Medical Association by three years — oversees a specialized certification.

To receive a Diplomate of Homeotherapeutics (DHt), physicians must obtain 350 education credits and pass written and oral examinations. You can find a homeopathic provider on the American Institute of Homeopathy’s website or those of the North American Society of Homeopaths and the Council for Homeo­pathic Certification.

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4 Essential Remedies for Your At-Home Homeopathic First-Aid Kit

1. Nux vomica

Good for: Upset stomach from overeating or overindulging.

Homeopathic notes: Derived from the poisonous strychnine tree, nux vomica is ideal for treating heartburn or drowsiness from eating or drinking too much. “The quintessential remedy for ailments from ‘high living,’ usually the first remedy to take for garden-variety heartburn or indigestion from drinking too much coffee or alcohol or eating too much spicy food,” says Kathi Fry, MD, CTHHom.

2. Arnica montana

Good for: Bruising, shock, head injury.

Homeopathic notes: Arnica’s effects are primarily anti-inflammatory: It’s good for treating muscle pain, stiffness, swelling from injuries, and bruises. A 2021 meta-analysis published in Frontiers in Surgery found arnica to be comparable to pharmaceutical anti-inflammatories for reducing postoperative swelling and bleeding.

3. Gelsemium sempervirens

Good for: Headaches, influenza, sleeplessness due to anxiety and anticipation.

Homeopathic notes: “This is a big remedy for the flu, chronic fatigue, and people with postviral fatigue — as in long COVID,” says Fry.

4. Allium cepa

Good for: Allergies, runny nose, watery eyes.

Homeopathic notes: Derived from onion, this remedy is effective for treating a running nose, especially with a clear discharge. “If you’ve ever chopped an onion with tears streaming down your face, you know what it’s like to need Allium cepa. The hallmark symptom is a sensation of burning irritation,” explains Fry.

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Homeopathy at Home

There are several good resources for those looking to learn enough to self-administer homeopathy at home:

• The Complete Homeopathy Handbook by Miranda Castro
• What’s the Remedy for That? by Kathi Fry, MD, CTHHom
• Healing With Homeopathy by Wayne B. Jonas, MD, and Jennifer Jacobs, MD, MPH

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Don’t be fooled by the term “tennis elbow.” This painful condition, also known as lateral epicondylitis, can affect anyone who performs repetitive grip-intensive activities, such as knitting, swinging kettlebells, and using a smartphone.

“It usually affects the dominant arm and occurs when there’s frequent and forceful contractions of the wrist extensors, or the muscles that allow us to extend our wrist,” explains Peter Ames, PT, PhD, a Minneapolis-based specialist in sports physical therapy.

Tennis-elbow sufferers will feel pain on the outside of their elbow and forearm that often worsens when they grip.

Unlike many overuse injuries, tennis elbow is not an inflammatory condition; it involves a breakdown of healthy tissue in the muscle and tendon. For this reason, popping an over-the-counter anti-inflammatory, like aspirin or ibuprofen, won’t do much to alleviate symptoms — but therapeutic massage has been shown to be an effective treatment.

Take frequent breaks from activ­ities that trigger pain. If it creeps in while you’re at your computer, step away from the keyboard at regular intervals. If it comes on during a friendly match, build rest periods into your game or take a break from the sport altogether.

For long-term relief, it’s best to incorporate targeted exercises into your routine. Ames suggests these three moves to help relieve pain and to gently strengthen injured tissues to promote healing.

Isometric Wrist Extension

This exercise activates the wrist extensors without shortening or lengthening them. Firing your muscles in a fixed position, Ames notes, is not only less painful, it will actually reduce pain by increasing blood flow to the affected tissue.

Full Instructions

• Rest the affected arm on a flat surface with your palm down and fingers gently curled.
• Place your opposite hand flat on top of your wrist.
• Try to lift your wrist while resisting the motion with your top hand.
• Hold for five seconds and relax.
• Do two sets of 15 reps, twice daily.

Eccentric Wrist Extension With Dumbbell

This move strengthens the wrist extensors while you lengthen them, Ames explains. This promotes healing by helping damaged tissue return to its pre-injury condition.

Full Instructions

• Gently grip a light weight (1 or 2 pounds) in the affected hand.
• Rest that arm on a flat surface so your palm faces down and your wrist relaxes over the edge.
• Maintain a gentle grip on the weight and use the opposite hand to help lift your wrist as far back as you comfortably can.
• Release your helping hand and slowly lower your wrist back to the starting position.
• Perform three sets of 15 reps, twice daily.

Scapular Retraction

While not a wrist or forearm exercise, scapular retractions can help correct a rounded posture, which helps improve the poor arm mechanics that often cause or worsen elbow pain. Shoring up your posture can not only help prevent tennis elbow, says Ames, it can also help improve it.

Full Instructions

• Sit or stand tall with your arms down at your sides.
• Keeping your neck muscles relaxed, gently squeeze your shoulder blades back and down.
• Hold the squeeze for a few seconds and release.
• Repeat five times.
• Perform this exercise several times per day, as desired.

Instinctive as it may be to stretch, lengthening muscles and mobilizing joints is often an after­thought, even for regular exercisers.

But some form of stretching and mobility work is essential to good health. “You’re putting a little WD-40 in your joints and moving them around,” says New York City–based Sonja ­Herbert, founder of Black Girl Pilates. “You’re increasing circulation and bringing life back into your whole body — your head, your shoulders, elbows, wrists, hips, knees, feet, toes.”

A dedicated mobility practice can feel great while you’re doing it and for some time afterward. In the long run, it can help preserve healthy ranges of motion for life. As Herbert puts it, “If you don’t use it, you lose it.”

Stretching is also an any­­where, anytime activity, requiring minimal equipment and no warm-up. You don’t need a lot of space. It probably won’t make you sweaty, and you can do it in tiny increments throughout your day. It may be the simplest, most accessible type of movement there is.

Herbert shares the following full-body mobility routine to help you stretch out and loosen up in as little as five minutes. Try it once a week or every day, as time allows.

The Listening Ear and the Soup Head

• Sit upright, shoulders relaxed.
• Without bending your neck, slowly rotate your head to the right, as if listening for something with your right ear.
• Return to the starting position and repeat on the other side.
• Perform the sequence five times per side.
• Keeping your torso upright, drop your chin to your chest.
• Imagining a spoon extending forward from your nose, and a cup of coffee directly beneath it, slowly stir the coffee with the spoon in a clockwise direction, 10 times.
• Stir in the opposite direction 10 more times.

Kneeling Hip Hinge

• Begin in a tall kneeling position, then extend one leg in front of you with the heel on the floor and your front foot flexed.
• Place your hands on the floor and shift your hips back, allowing your torso to fold forward toward your extended leg.
• Then bend your front knee and shift your hips forward, raising your upper body to come into a low lunge position. Allow the front knee to track over the front foot.
• Move back and forth, shifting the hips back while straightening the front leg then bending the front knee to shift the hips forward, to complete eight to 10 slow, controlled repetitions, keeping your hips and shoulders square the whole time.
• Switch sides and repeat.

The Saw

• Sit on the floor with your back straight, legs extended forward and slightly wider than hip width, and feet flexed.
• Inhale as you raise your arms out to the sides, slightly in front of your shoulders.
• Exhale as you rotate your torso to the right, then dive forward to reach your left pinkie finger toward the pinkie-edge of your right foot while reaching behind you with your right hand.
• Inhale as you return to the starting position, spine tall.
• Repeat on the other side. Perform a total of five slow reps per side.

Bent-Knee Calf Raise

• Stand with your legs and feet together, using a wall or railing for balance.
• Slowly raise your heels, coming onto your toes.
• Keeping your hips still and heels raised, slowly bend your knees. As your knees track forward, actively press forward through the arches of your feet. Lower as far as you can without your shoulders shifting forward, you butt shifting back, or your heels lowering.
• Slowly lower your heels to the floor and return to an upright standing posture.
• Repeat the sequence for 10 reps.
• While keeping your feet flat on the floor and your hips stationary, slowly bend your knees to shift them forward.
• Maintaining that knee-bend, and keeping your shoulders stacked over your hips, rise onto your toes and lift your heels, pressing your arches forward.
• Staying on your toes, straighten your legs to an upright posture. Then slowly lower your heels to the floor. Repeat for 10 reps.

This article originally appeared as “Extend Yourself” in the March 2022 issue of Experience Life.

Your immune system lives to protect you. Like an elite security detail, it guards your body’s perimeters and swiftly deals with troublemakers, such as minor pathogens and cancer cells. It uses a range of tools, including the inflammatory response and specialized immune cells that attack invaders. Once it has vanquished the enemy, the immune system settles back into a state of cool, calm surveillance.

Or at least that’s how it’s supposed to work.

Sometimes the immune system gets confused and attacks the body it’s meant to protect. This is called autoimmunity, or, literally, immunity to self.

Autoimmunity encompasses more than 100 known conditions, including type 1 diabetes, rheumatoid arthritis, lupus, multiple sclerosis, and inflammatory bowel disease. And the number of such diagnoses has continued to rise as healthcare providers have begun to recognize the prevalence of ­immune ­dysregulation.

“Twenty-five to 50 million Americans have some kind of disease characterized by dysregu­lation of the immune system,” says Leonard Calabrese, DO, director of the Cleveland Clinic’s R. J. Fasenmyer Center for Clin­ical Immunology. Symptoms can include joint pain, recurring fever, skin problems, fatigue, swollen glands, and gastrointestinal issues.

But diagnosing autoimmune conditions can be tough. There’s typically no single conclusive test, and many conditions mirror each other. A care provider may need to consider symptoms (which often fluctuate), blood markers, and other factors.

According to the Institute for Functional Medicine, latent or pre-autoimmune disease often exists for seven to 14 years before diagnosis.

The Challenge of Autoimmunity

Autoimmunity rates have been rising steadily for decades, and experts suspect that increasing exposure to environmental toxins may be to blame (more on this later). But the COVID-19 pandemic could be responsible for a massive influx of members to this club that no one wants to join.

The virus that causes COVID was dubbed the “autoimmune virus” in a 2020 article in Autoimmunity Reviews; the authors cited a strong association between the viral infection and the development of autoimmunity. Research shows that the novel coronavirus may activate preexisting “autoantibodies” — the immune proteins that target a person’s own tissues — as well as prompt the body to make new ones.

How can a virus cause the immune system to turn on itself? It apparently has to do with the delicate balance and regulation of this complicated system.

“How viruses interact with our immune system is at the forefront of understanding autoimmunity.”

“The immune system doesn’t work like a radio with a volume control,” explains functional-medicine internist Leo Galland, MD. “It’s more like an orchestra with many different sections that interact with each other. The interactions are dynamic and complex, and the outcome of a novel interaction can be hard to predict.”

Several factors can make us more likely to develop autoimmunity, and genes are one of them. “Some genetic polymorphisms put people more at risk,” says functional-medicine practitioner Keesha Ewers, PhD, ARNP, FNPc, MSN, author of Solving the Autoimmune Puzzle. Polymorphisms on the major histocompatibility complex (MHC) genes that code proteins for the adaptive immune system, for example, can create greater susceptibility.

But a genetic proclivity doesn’t guarantee autoimmunity. “Genes are the cards you’re dealt at birth, but it’s how you play your cards that determines how your genes function throughout your life,” explains Calabrese.

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Calculating Risk

Autoimmune conditions require five basic ingredients, according to pediatric gastroenterologist Alessio Fasano, MD: genetics, environmental triggers, loss of gut-barrier function, a belligerent immune system, and an imbalanced microbiome (dysbiosis).

For instance, if you have a genetic intolerance to gluten, eat a gluten-heavy diet, and develop a leaky gut, “your immune system is already angry,” says Ewers. A baseline state of chronic inflammation sets the stage for an environmental trigger, such as a virus or parasite, to activate a dysregulated immune response.

Traditional approaches to treating autoimmunity involve medications that suppress symptoms without ­addressing root causes, so many people with one autoimmune condition soon develop others. One study found that a single autoimmune diagnosis ­increases the likelihood of a second (or third) diagnosis by up to 34 percent.

By contrast, addressing the root causes of a dysfunctional immune response makes it less likely that the immune system will expand its attack in other areas of the body, forgoing the need for ever more band-aids that simply suppress symptoms.

One study found that a single autoimmune diagnosis ­increases the likelihood of a second (or third) diagnosis by up to 34 percent.

Although the presence of autoantibodies is usually a critical indicator in diagnosing autoimmune conditions, not everyone who has detectable autoantibodies has active autoimmune disease. Those with autoantibodies but no auto­immune symptoms are considered to have “pre-autoimmunity.”

Yet because the internal environment is a key influence on autoantibodies’ behavior, certain precautions can enable these people to remain symptom-free. “Some of the most common autoantibodies we produce only create damage when there’s also systemic inflammation,” explains Galland.

The exact provocations for autoimmunity are still poorly understood. Stress, which includes toxic relationships and thought patterns, is a known trigger, says Ewers. But so are many pathogens, such as the bacteria that cause Lyme disease, and viruses such as Epstein-Barr, herpes, human papillomavirus (HPV), and coronaviruses such as SARS-CoV-2.

Ewers suspects that environmental toxins such as cigarette smoke, pesticides, allergens, and molds can potentially activate autoimmunity. She also focuses on estrogen-mimicking chemicals, including bisphenol A (BPA), which is found in plastic, canned foods, and personal-care ­products. These chemicals can disrupt the modulation of inflammatory proteins called cytokines, which may be one reason women appear to be more susceptible than men to autoimmunity, representing nearly 80 percent of all cases.

It sounds like a hodgepodge, but these suspected triggers are more alike than they seem. Calabrese notes that they are all part of the body’s “exposome,” or the sum total of its exposure to environmental stressors.

“The exposome is everything from pollution and chemicals in food and water to how we eat, exercise, sleep, and handle stress,” he explains. Researchers are just starting to understand the exposome’s role in autoimmunity.

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The Virus Question

Viruses outnumber everything on the planet. Some we catch, like SARS-CoV-2 or HPV; others have been incorporated into the human genome and bestow benefits such as disease resistance or starch digestion.

As journalist Moises Velasquez-Manoff writes in An Epidemic of Absence: A New Way of Understanding Allergies and Autoimmune Diseases, viruses we catch help with training and balancing the adaptive immune system, providing external stimuli that may help prevent autoimmunity.

But viruses have also long been suspected as autoimmune triggers. Epstein-Barr (best known for causing mononucleosis) has been linked to lupus, and influenza can trigger a blood-clotting disorder called autoimmune thrombocytopenia. Chikungunya, a mosquito-borne virus, can cause chronic inflammatory rheumatic diseases.

Now SARS-CoV-2 appears to trigger its own autoimmune cascade, which is revitalizing researchers’ urgency to understand the role of viruses in these conditions. “How viruses interact with our immune system is at the forefront of understanding autoimmunity,” says Calabrese.

Many COVID victims die not from the virus itself but from an overactive immune response to it, characterized by the “cytokine storm.”

One of the most potent effects of SARS-CoV-2 is on the human immune system. Many COVID victims die not from the virus itself but from an overactive immune response to it, characterized by the “cytokine storm.” (Cytokines are inflammatory immune proteins that, in large quantities, can destroy the body’s tissues and organs.) And many who survive COVID seem to generate copious amounts of autoantibodies — the proteins that target the body’s own tissues.

“The question is, What are those autoantibodies doing?” says Calabrese. “Are they predisposing people to inflammation and autoimmunity? Are they contributing to the pathogenesis of long COVID?”

There are multiple theories on how SARS-CoV-2 may be triggering the autoimmune symptoms (including brain fog, fatigue, headaches, dizziness, joint pain, fever, and mood disorders) that have come to be associated with long COVID. The first theory is called molecular mimicry, in which viral proteins that resemble proteins in the body spur the creation of antibodies that attack the body’s own cells.

Another possibility is that inflammation from the infection primes the immune system to mistake the spilled contents of destroyed cells as foreign and create autoantibodies against these cellular pieces.

Again, the health of the gut seems to play an important role. “People with COVID-19 have changes in the gut microbiome of a type that fosters inflammatory reactions,” says Galland. “The bacteria that provoke more inflammation grow, and anti-inflammatory bacteria are suppressed in the GI tract.”

(For more on how mRNA COVID vaccines may resolve some auto­immune symptoms, see “Long-Haul-COVID Recovery and Vaccines”.)

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Repairing the Terrain

One of the greatest challenges with autoimmune conditions is that they can affect multiple body systems. A 2020 study in the Journal of Autoimmunity examined how autoimmune processes may account for the widespread damage caused by some COVID infections, including inflammation of the heart and circulatory system. Circulatory damage can lead to loss of oxygen in the body’s tissues; this in turn slows the function of mitochondria, the energy-producing powerhouses in our cells.

“Immune cells require energy to work properly,” says Galland. “If you have a smart TV and the remote’s battery starts to die, the TV starts doing screwy things. When the power source diminishes, it’s not just that everything gets dim — it gets wacky. That’s the impact of mitochondrial damage on the immune system.”

While researchers still have much more to learn about long COVID, functional-medicine practitioners are already reaching for proven strategies that have helped people manage other autoimmune conditions. There is no one-size-fits-all protocol, but some basic principles apply.

“I go to individualization — what’s at the root?” asks Ewers. “Why was this terrain susceptible to this virus, and what form did it take? Then the treatment protocol matches those things.”

Keep reading to learn about the main tenets of a functional-medicine approach to treating autoimmunity.

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The Functional-Medicine Approach to Treating Autoimmunity

An Anti-Inflammatory Diet

An anti-inflammatory diet is one of the most important tools for managing autoimmune conditions. “Many predisposing factors to poor outcomes [from autoimmunity] come from chronic inflammation, and a largely plant-based diet is a great start toward lowering inflammation,” says Calabrese.

Several special diets have proven to be helpful for people with autoimmune disease, including the Wahls Protocol, Autoimmune Protocol, and variations on the paleo diet. While they vary in their specifics, they share an emphasis on fresh, whole, unprocessed foods; plenty of colorful vegetables; abundant fermented foods; bone broth; and healthy fats. They also minimize sugar, processed carbs, alcohol, dairy, and caffeine.

Ewers recommends working with a functional-medicine provider to identify specific food sensitivities, absorption issues, or nutrient deficiencies. Using diet to manage inflammation and support circulation and mitochondrial function can make a huge difference in autoimmune symptoms and quality of life.

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Microbiome Management

The gut microbiome plays a crucial role in immune function. “The microbiome controls so much of how the immune system responds to invaders,” says Ewers. A comprehensive stool analysis can help identify imbalances in the microbiome, such as a lack of beneficial bacteria or an overabundance of harmful microbes, parasites, or yeast.

“We see similarities between long COVID and chronic fatigue syndrome in the microbiome,” says Galland. For long COVID, he recommends supplementing with specific bacteria strains, such as Bifidobacterium longum BB536 and a form of Bacillus subtilis, which may help stabilize and reorganize the gut microbiome. Studies show that eating avocados and chickpeas may also support the growth of anti-inflammatory bacteria, he notes. (For more on microbiome health, see “Your Microbiome: The Ecosystem Inside“.)

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Adequate Sleep

Sleep helps restore the immune system. Insufficient sleep (less than seven or eight hours per night) has been linked to the production of inflammatory cytokines. But many people with autoimmune conditions have disturbed sleep patterns; they may suffer from profound fatigue and struggle to regularly sleep through the night.

Working with a functional-medicine provider to integrate sleep-hygiene techniques, such as ritualized sleep–wake cycles, environmental and dietary modifications, and (potentially) melatonin therapy, can help restore healing and supportive sleep patterns. (For more on sleep, see “Sleep It Off“.)

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Moderate Movement

Exercise is key for healthy immune function. Multiple studies have shown that moderate exercise offers benefits for patients with autoimmune conditions — including improvements in joint mobility, mood, cognitive ability, energy, and quality of life. If you’ve received a diagnosis recently or are easing into exercise after being sedentary, start with gentle, moderate movement as you build up strength and stamina, and be sure to consult with your provider.

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Supplements

There is no singular supplement protocol that will achieve the same results in everyone with autoimmunity. Most functional-medicine providers make supplement recommendations based on a person’s specific test results and symptoms. Still, these are some of the most common supplements used to support better health and function for a variety of autoimmune conditions, including long COVID, and each one has a range of salutary effects.

• Vitamin D3: Insufficient vitamin D is associated with a number of autoimmune diseases. Raising low levels may help mitigate disease severity and progression and help repair a leaky gut.
• Curcumin: This potent anti-inflammatory chemical is found naturally in turmeric.
• Resveratrol: A polyphenol found in peanuts, berries, and red grapes, resveratrol may help reduce the production of autoantibodies, among other immunomodulating effects.
• Fish oil: This oil contains EPA and DHA, anti-inflammatory omega-3 fatty acids that Ewers says help with healthy gene expression.
• NAC: Short for “N-acetylcysteine,” NAC helps the body make the antioxidant glutathione, which protects against cellular damage and supports immune health. Combining NAC with niacin can help support mitochondrial function, says Galland.
• CoQ10: Naturally produced by the body and also available in supplement form, this antioxidant supports circulation and mitochondrial function.

Stress Relief

Psychoneuroimmunology is a burgeoning area of immune science based on the insight that the central nervous system and immune system are intertwined. “The brain and the immune system are one organ,” explains Calabrese.

To manage the stress of autoimmunity itself, Ewers believes we may also need to look directly at the “autoimmune mindset” — a sense of being at war with oneself.

“People are always looking to be done,” notes Ewers. “The expectation is that we kill the yeast in our gut, get our hormones balanced, and the body should shape up.”

But people with autoimmune conditions need to accept that creating health is a long-term process that involves all the layers of our being — physical, energetic, mental, emotional, and spiritual. “There are no quick fixes or tricks for immune health,” notes Calabrese. “It’s a process.”

Autoimmune patients need to treat their bodies with unconditional love. . . . Praise them when they get it right, and when things go wrong, offer some help and support.

We can use tools like mindfulness meditation, which has shown a capacity to lower inflammation and tamp down inflammatory genes. Mind–body techniques such as yoga, tai chi, and qigong can reduce autoimmune activity. But overall, the recovery process requires patience and lots of self-love.

“When we have expectations that aren’t being met, that’s one thing that sets the immune system off the worst,” says Ewers. She believes autoimmune patients need to treat their bodies with unconditional love, the way we would children who are learning a new skill: Praise them when they get it right, and when things go wrong, offer some help and support.

“It’s about getting into a collaborative instead of a combative relationship with yourself.”

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This article originally appeared as “Autoimmunity Now” in the January/February 2022 issue of Experience Life.