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Bhakti Mathur

A diagnosis of “end-stage” osteoarthritis usually signals the termination of an active life: the end of mobility, the inevitability of surgery and the narrowing of life’s possibilities. But Reynaldo Espineli was not going to let it slow him down.
The 68-year-old Hong Kong finance professional has spent the last two years proving that severe bone-on-bone joint degeneration does not have to spell physical decline.
In his coming book, The Fifth Stage: Living Beyond Stage Four Osteoarthritis, Espineli shares a view rarely heard from the doctor’s office – a deeply personal blueprint for outmanoeuvring a debilitating diagnosis and reclaiming a full, active life.
The book explores severe osteoarthritis from the perspective of the patient, not the clinic. His thesis is simple: your joints might be degenerating, but your mobility does not have to.
“Stage-four osteoarthritis is not the end. It is a threshold. Beyond it lies a lived stage, the fifth stage, where degeneration remains, yet inhabitation widens,” Espineli says.
Movement from an early age
Originally from the Philippines, Espineli was raised in San Diego, California, and has called Hong Kong home for more than three decades.
His life has always been shaped by discipline and movement. Sports were central to his upbringing. He began learning martial arts at age 14 in San Diego and across the border in Tijuana, Mexico. At age 50, he took up Muay Thai in Hong Kong.
“I was drawn to its technical precision and conditioning demands,” says Espineli, who also earned his Padi (Professional Association of Diving Instructors) scuba diving certification around the same time.
That attracted him for its “discipline of breath, buoyancy control and measured movement beneath the surface, an environment where tension wastes energy and calm awareness is essential”.
He also started hiking Hong Kong’s trails and mountains, from the MacLehose Trail to Dragon’s Back and Sunset Peak.

Imaging in 2008 had already revealed early degenerative changes in his knees.
“At the time, the symptoms were intermittent and manageable,” he says. He continued training without any significant hindrance, despite stiffness and occasional swelling in his knees after intense workouts.
The beginnings of degeneration
More than a decade later, in late 2019, Espineli began preparing for a demanding desert trek in the White Sands Missile Range in New Mexico. His knees felt strong, and he had no sense that the degeneration in their joints was advancing.
Then Covid-19 happened. Between 2020 and 2022, prolonged inactivity disrupted his training rhythm, exposing underlying muscular imbalances that years of conditioning had kept in check.
As strength and neuromuscular control declined, his knees lost dynamic support. Stiffness increased. Inflammation and swelling followed.
“I began getting cramps in the evenings in my calves and hamstrings, sometimes intense enough to wake me up from sleep,” he recalls.
What followed was more subtle and consequential: his gait gradually changed to that of an old man.
“I began walking as if I were protecting something fragile. My stride shortened. I avoided bending the knee fully and pushed off less through the affected leg. I shifted weight prematurely to the other side,” he says.
“Without realising, I began bending slightly at the waist, leaning forward to reduce pressure through the knee. What began as a protection mechanism became a pattern.”
Lower back pain followed. Going downstairs became difficult. Eventually, reciprocal descent – alternating one foot naturally after the other – became impossible. Getting down to and up from the floor was a chore.
A Baker’s cyst, a fluid-filled lump, developed behind his left knee, adding to the stiffness and irritation.

In February 2024, an MRI confirmed stage-four osteoarthritis, the “bone-on-bone” stage. He was told surgery was the logical next step.
“I wasn’t angry, but I felt confronted. The language made it sound definitive and inevitable, as if I had no agency left,” he says.
Another transformation
He had already begun to explore whether knee function could still improve despite severe physical damage. He and his wife had started attending classes at the Iyengar Yoga Centre of Hong Kong (IYCHK) in July 2023, and he committed to a disciplined practice.
The turning point came in August 2024, when he joined the “specific needs” class at IYCHK, designed for students working with injuries or medical conditions. By May 2025, he was attending twice a week and practising at home for 30 minutes each day.
The director of IYCHK, George Dovas, says helping Espineli did not begin with the knee.
“I observed his movement patterns – where there was restriction, where there was possibility. As awareness increased, we gradually introduced more movement around the joint. The key was building confidence in movement within an environment of safety,” Dovas says.
“It is not the pose that does the healing, but the approach to the pose. In Virabhadrasana II [Warrior II], the focus was on bringing stability to the shin bone, giving a feeling of safety to the nervous system, which leads overly protective mechanisms to release their grip and make more movement come than was possible before.”

The transformation was incremental rather than dramatic.
The range of motion returned over two years, Espineli says, and he was able to walk down stairs normally again. His lower back pain gradually went away, the inflammation subsided and the cyst resolved.
Before practising yoga, Espineli had iced his knee each evening.
“I no longer need to do that. I am pain-free. The cartilage did not regenerate. The osteophytes did not vanish. The stage four classification did not change,” he says.
“What changed was the system around the joint – neuromuscular coordination improved, and load was redistributed more efficiently. Iyengar yoga did not fix my knee; it gave me the conditions to listen to it.”
He adds: “There was something quietly powerful about practising alongside people who were also navigating pain, limitation or recovery, without comparison or competition. Progress was individual, but the atmosphere was collective.”
Reframing ageing
Today, Espineli maintains his daily practice and continues his yoga classes. He and his wife, Betty, have started to travel again.
In recent months, the couple have visited Sri Lanka, the Jebel Akhdar mountain paths in Oman, and several rugged terrains across mainland China – including Huashan in Shaanxi province, the Loess Plateau, and the scenic regions of Guilin and Yangshuo.
For Espineli, the implications extend far beyond joint pain – his journey reframes ageing itself.
“Ageing is not optional. Structural change is part of it. But restriction and dependency are not automatic consequences. The body adapts. The question is whether we give it the conditions to do so,” he says.

He recalls looking at the medical imaging that seemed to define his future. “The MRI showed narrowing, cartilage loss and osteophytes – structural change. It did not show how my body could reorganise itself around those changes. Structure sets boundaries. Adaptation defines experience within those boundaries.”
Finding ways to adapt has given him the physical vitality to stay fully engaged with his career and move without fear – proving that degeneration does not dictate destiny.
He recalls a favourite quote from B.K.S. Iyengar, the founder of Iyengar yoga: “Yoga does not just change the way we see things; it transforms the person who sees.”
For Espineli, that transformation is evident in the way he walks ancient capitals, navigates mountain paths and continues to inhabit his body with dignity and grace.
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How Iyengar yoga helped this 68-year-old Hong Kong man overcome ‘end-stage’ knee arthritis

Espineli in Virabadhrasana II, the Warrior 2 pose, that enables him to explore movement in his knees without putting the sole focus on the knee. Photo: Iyengar Yoga Centre of Hong Kong

Reynaldo Espineli walks up Pottinger Street in Hong Kong’s Central district. The 68-year-old shares his journey to reclaim his mobility after a diagnosis of “end-stage” osteoarthritis. Photo: Jonathan Wong

Espineli says his life has always been shaped by discipline and movement. Photo: Jonathan Wong

Finding ways to adapt to late-stage osteoarthritis has enabled Espineli and his wife to continue travelling the world, including to Oman in December 2025. Photo: Reynaldo Espineli 

Espineli in the Warrior II pose. Photo: Iyengar Yoga Centre of Hong Kong

In April, Espineli and his wife travelled to Shaanxi province to see the Ganquan Yucha Grand Canyon. Photo: Reynaldo Espineli

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Tsai leads a movement training class in which many of his clients are barefoot. Photo: courtesy of Lawrence Tsai

Nigel Yau is a barefoot hiker in Hong Kong. He recommends those new to barefoot hiking start with trails around reservoirs, where the ground tends to be softer. Photo: courtesy of Nigel Yau 

Yau describes hiking barefoot as a way to “mindfully connect with the earth”. Photo: courtesy of Nigel Yau

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Former Hong Kong rugby team player Rob Naylor (centre) plays rugby in 2008. Photo: K.Y. Cheng

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McCosker (right) works with Naylor at the CoreOFit clinic in Causeway Bay. Photo: Jonathan Wong

McCosker helped Naylor get his knee back to normal and the former rugby player does weekly gym strengthening exercises to help prevent recurrence. Photo: Jonathan Wong

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Lifestyle

Health & Wellness

Health

Reynaldo Espineli took up Iyengar yoga after crippling knee pain and a stage-four osteoarthritis diagnosis. Now he’s got his mobility back


Reynaldo Espineli took up Iyengar yoga after crippling knee pain and a stage-four osteoarthritis diagnosis. Now he’s got his mobility back.


How to age well

Disease

Ageing society

Health & Fitness

How Iyengar yoga helped this 68-year-old Hong Kong man overcome ‘end-stage’ knee arthritis

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Reynaldo Espineli took up Iyengar yoga after crippling knee pain and a stage-four osteoarthritis diagnosis. Now he’s got his mobility back

Reynaldo Espineli took up Iyengar yoga after crippling knee pain and a stage-four osteoarthritis diagnosis. Now he’s got his mobility back