Friday Q&A: Multiple Sclerosis

Q:I am curious about how yoga might be used to benefit someone with a diagnosis of Multiple Sclerosis (MS).  I have heard about it, but am not sure how to proceed.

A: Thanks for checking in about this. I am surprised we have not addressed this to date, so I am happy we will go over it today! After I did my teacher training in 2001, one of the first workshops I ever attended was down in the South Bay, where a well known teacher from Catalina Island, CA named Eric Small was teaching a weekend workshop for the National MS Society on “Yoga for People with Multiple Sclerosis.” In my previous incarnation as a full-time family MD, I had cared for a few patients who had the diagnosis of MS. But honestly, it was their neurologist that really addressed their MS and its symptoms more than I did. If only I had known then what I learned from Eric back in 2001, I would have had some very powerful tools to address this serious condition. And, boy, was I learning from the right person. Eric was diagnosed with MS as a young adult and had a pretty severe first episode, which made it hard for him to even walk without the aid of crutches.  Fortunately, he attended one of BKS Iyengar’s first classes in San Francisco in the late 60s and was taken under the master’s wings and taught how to work with his condition using yoga practices. Eric has rarely had any additional symptoms, a rare story with MS, indeed.

For those of you out there unfamiliar with MS, it is the most common neurological condition that leads to work disability in younger adults. Two-thirds of people with MS are diagnosed between the ages of 20-40, and although it is not a cause of premature death, it does often lead to significant disability. The theory behind MS is that the body develops an auto-immune response to the protective sheath that surrounds the nerves in the brain called myelin sheath, attacking it as if it were a virus or bacteria. Not only does this lead to scarring of the myelin, but it can affect the underlying nerve as well. The result is that communication running down the damaged nerves slows or stops, leading to all kinds of unwelcome symptoms, like muscle weakness, spasticity, lack of coordination, loss of balance, gait difficulties, tremors, swallowing trouble, speech disorders; numbness, tingling, burning, or pain; blurred vision, double vision, blind spots or blindness; bowel and bladder problems like urgency, frequency, retention, incontinence and constipation; as well as vertigo, depression, or emotional labiality; and short term memory loss and impaired concentration are the most common cognitive signs. This is a staggering array of symptoms, and because no two MS suffers will have the same constellation of symptoms, it can take a while to even get to an accurate diagnosis of MS.

There are a few different patterns for the affects people experience, and I am going to suggest that if you want to know more about that, check out the National MS Society website. But let's say that in many cases the symptoms will intensify for a while, referred to as a relapse, and at times they will diminish for a while, called remission. One of the main complaints from those with MS during a relapse is fatigue and heat intolerance. They often note fatigue arising in the late afternoon, and symptoms worsening if the environment is hot or if they overheat with activity. This is a perfect point of entry for yoga, especially quieter poses, restorative practices and breath work.

Viparita Karani (Legs Up the Wall Pose)

Although we have mentioned yoga’s benefits before, the MS society notes the following as particularly relevant in dealing with the huge list of possible symptoms that MS folks may experience: breathing becomes deeper and more regular; circulation increases, for better distribution of O2 throughout the body; flexibility increase; muscles and joints are toned; internal organs are massaged; and a general feeling of well-being arises. And since fatigue and heat intolerance are the most limiting factors to the MS student, the breathing and restorative practices are extremely beneficial for managing these symptoms and you might start out learning these for your benefit or teaching these first for your student with MS (see Mini Restorative Practice).

Because these students also often have some degree of spasticity as well as movement and gait disturbance, the systematic stretching and breath attention of yoga releases tension in the areas affected, while improving circulation and enhancing awareness of the student’s body. Body awarenessaids in recognizing and regulating an individual’s unique MS symptoms. In addition, regular practice will also improve coordination, helping directly with balance issues and helping with transferring.

Many MS students may be using a cane, crutches or a wheelchair some of the time, so you will need to become familiar with using all of the props you can. Chair practices (Chair Yoga) are helpful, but even having poses these students can do in bed will be very helpful if they can not transfer to a chair or the floor easily. So, depending on the individual’s function on any given day, you will either be doing a fairly typical yoga class, a chair yoga class or a very modified class in the wheelchair or in a bed. The key will be to keep things quiet and cooling in general. During times of remission, if there are minimal symptoms, you could try sharing a regular intensity class, as long as heating poses or sequences don’t lead to a flare of symptoms. I’m hopeful these general guidelines will give you a place to begin your exploration of yoga for MS.

—Baxter