By Roger Nolan
Sclerosis is an autoimmune disease in which the body's defensive
immune system attacks and destroys the fatty tissue -- myelin
-- surrounding nerves in the brain and spinal cord. These myelin
sheaths perform the same function as insulation around an electrical
wire. Without the myelin insulation, nerve impulses from brain
to body can short out and become confused, misdirected, or be
completely blocked. Symptoms can include numbness and/or tingling
in the extremities, weakness, lack of coordination and/or balance,
gait difficulties, slurring of speech, blurred or double vision,
bowel and bladder dysfunction, vertigo, and heat intolerance.
activity is extremely important for individuals with MS, and
yoga is now recognized as an excellent means of MS management,
whether the individual manifests little or no outward signs
of the disease, or whether they spend most of their time in
a wheelchair. The benefits of yoga postures (asana), working
with the breath (pranayama), and meditation may include increased
body awareness, release of muscular tension (thus relieving
spasticity), increased coordination and balance, increased flexibility
and strength, control over fatigue, increased tolerance to heat,
improved circulation and breathing, improved organ function
(including bowel and bladder), enhanced alertness, better management
of stress and an overall feeling of well-being.
As an Advanced
Teacher of Therapeutic Yoga (certified through Integrative Yoga
Therapy), I have been specializing in the application of yoga
disciplines for the management of MS. In addition to my IYT
training, it has been my privilege to study with Eric Small,
an internationally recognized Iyengar yoga instructor, who was
himself diagnosed with MS in the early 1950s, and through yoga
was able to bring himself back to health. For the past two years
I have been working with students and clients, in groups and
privately, and I would like to share some cases that may be
of interest to those dealing with MS, either as yoga students
or as teachers.
of MS is unpredictable. The four categories used to classify
the clinical course in persons with MS are: Relapsing-remitting,
Primary-progressive, Secondary-progressive, Progressive-relapsing.
What follows is a brief description of my work with individuals
manifesting three of these courses.
In the category
of Relapsing-remitting is L, a 35 year-old female Pilates instructor
and former dancer and figure skater who is now pursuing an advanced
degree in Physical Therapy. True to course, after an initial
flare-up and diagnosis of MS, she has had extended periods with
mild flare-ups and minor disease progression. Her symptoms include
numbness/tingling, some balance issues, and heat intolerance.
In addition to yoga, she also receives injections of Copaxone.
I would design a gentle practice for students with MS to avoid
overheating the body, but because L. has been so used to an
active vigorous lifestyle, the practice I designed for her includes
a modified Flow Series of standard postures linked by a sun
salutation. To avoid tiring her, however, I have L practice
this series slowly, mindfully, and with complete awareness.
In this way the practice becomes more meditative and less fatiguing,
but still invigorating and relaxing. Since L has a well-developed
sense of body awareness, she is able to let me know when the
practice is too much for her. I also include meditative or cooling
pranayama practices such as Shitali, Nadi Sodhana, and Pratiloma
Ujjayi as well as a long guided imagery meditation at the end
of each session.
time we have been working together, L has developed an increased
ability to handle stressful situations and has a much more balanced
perspective about her life. It has been well over a year since
her last flare-up.
In the category
of Secondary-progressive MS is M, a 43 year-old former ER nurse
who was diagnosed when she was 28. In this course, the person
experiences a relapsing-remitting disease course at the outset,
followed by a more steady progression. M's symptoms include
near-blindness, severe vertigo when reclining, slurred speech,
and muscle weakness. She is able to transfer from her wheelchair
into a regular folding chair, so that's where we do most of
our work, often using two chairs to simulate working on the
floor. I have modified seated forward bends (paschinmottanasa,
janu sirsasana), seated backbends (matsyasana, yoga mudra),
hip openers (badha konasana), twists (ardha matsyendrasana),
and modified standing postures such as forward bends (uttanasana,
padottanasana), and even a variation of warrior (virabadrasana
II). I've also included strong breath awareness to get her diaphragm
working again and to get some life-force stirring inside her.
objective with M is to help her regain muscle strength and flexibility
lost to years of being in a wheelchair, and she is doing quite
well, and has even been able to stand for brief periods. She
was never able or willing to keep up with any kind of physical
activity in the past, but now faithfully practices her yoga
to time the Los Angeles Chapter of the MS Society places me
in a nursing/rehab setting to work with individuals for whom
the course of MS is steadily progressive, or Progressive-relapsing
MS. One such person is J, a woman in her late 40s whose range
of motion is limited to moving her head, some lifting of her
shoulders, and moving her arms and hands only slightly. In this
case I do some hands-on manipulation, where appropriate, of
the arms, hands, and legs, but mainly we work with mindful breathing
(ujjayi, viloma and anoloma pranayama), dynamic movement of
the head, shoulders and arms linked to breath, and guided imagery
meditation to promote mindfulness and relaxation.
In J's case,
the obvious physical limitations preclude even a modified physical
yoga practice to a great degree. However, yoga does not stop
at the physical level. It permeates into the other aspects of
our being, such as the energetic, mental, emotional, and spiritual
aspects (the koshas). My work with J has, I believe, improved
the quality of her life on all these levels, even though what
we do together may not look like "yoga" to an outsider.
If you are
a teacher working with students with MS, or any other special
concerns, do not limit yourself to the physical alone. Utilize
breath work, mindfulness based meditation, guided imagery, and
experiment gently to find the appropriate practice for your
students, keeping in mind their needs and desires.
Roger Nolan can be reached via email at firstname.lastname@example.org.
Contact the National Multiple Sclerosis Society at (800)
FIGHT MS or www.NMSS.org. Reprints of a profile of
Eric Small in the July/August 1997 Yoga Journal are available
from the MS Society's L.A. chapter by e-mailing Miranda.Mirsec@cal.nmss.org.