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

In Praise of Chair Yoga

by Nina

Recently we’ve been featuring some yoga poses you can do while seated on a chair, such as a chair twist, backbend and forward bend. We’ve been offering up these poses as “office” or “travel” yoga, for those times when you don’t have the space or option of practicing on the floor. But it’s also true there are many people out there who cannot practice yoga standing up. They may have a chronic disease, such as Parkinson’s or Multiple Sclerosis, may have balance problems, or may be too weak to get up from the floor for any number of reasons. They may even be in a wheelchair.

To be honest, it’s only lately that I’ve come to realize what a godsend chair yoga can be for such people. As I’ve been learning more and more about the aging process, I’ve started to understand how important it is to keep moving your joints through their range of motion. If you don’t, you will continue to lose mobility, and very quickly (I watched my own father go through this when he stopped exercising). But if you do continue with your yoga, even while seated on a chair, you can help slow down your losses (and, maybe, depending on your condition, maintain or even regain some mobility). That was driven home to me this weekend when I took Shari Ser and Bonnie Maeda’s therapeutic workshop “Yoga for Neurological Disorders.” One of the students in the class shared her story with us. She is a middle-aged woman with an inherited form of Muscular Dystrophy who had been a yoga practitioner before she came down with the disease. As a participant in a study of people with the disease, she was told that keeping up with her practice during her illness was clearly helping her slow down the progression of her disease. She seemed both very committed to and very grateful for her practice. She was also an inspiration to others in the class, whether they were currently dealing with a neurological disorder themselves or were just, like me, interested in learning to help those who are.

Cat Pose in a Chair

And although I’ve read many books that talk about the benefits of chair yoga for people with chronic illnesses and even helped produce the photo shoot for one such book (Yoga As Medicine by Timothy McCall), Saturday was the first time I did a full practice of chair yoga myself. I have to say, I was eating a little humble pie during the practice, as some of the poses were more strenuous than I was expecting. One particular pose was a revelation to me. We did a version of Downward-Facing Dog where you sit on a chair facing a wall, far enough away from the wall so you can touch your fingertips to the wall when you bend forward. Start by sitting upright with your feet flat on the floor, hips-width apart. Then bending forward from your hip joints, bring your fingertips to the wall and walk them slowly up the wall, until they are in Downward-Facing Dog alignment, keeping your ears aligned with your arms. What a great shoulder opener and upper body stretch! I thought it would be wonderful for anyone who can’t bear weight on their hands due to hand or wrist problems, and I found it much more effective stretch—at least for me—than Half Downward-Facing Dog at the wall. My partner in the class and I decided to dub it “Quarter Dog,” and I hope to take a photograph of it one of these days.

If you are interested in learning more about chair yoga, Loren Fishman and Eric Small’s book Yoga and Multiple Sclerosis: A Journey to Health and Healing has some excellent examples (some even done in a wheelchair). And, uh, yeah, Yoga as Medicine also has a number of good ones. If you know of any other resources for these, do let me know!