Observations in a Yoga Class for Students with Multiple Sclerosis

Sannyasi Samadhimurti, New Zealand (2007)

MS (Multiple Sclerosis) is a progressively degenerative, auto-immune disease of the nervous system in the brain and spinal column. The myelin layer that usually protects and supports the nerves becomes inflamed, damaged and eventually completely destroyed. The communication through the nerve impulses may break down. The course of the disease can be different for each person. Often people will experience attacks of varying duration (days, months or even years) followed by a restoration period where functions will improve again, only to then experience another relapse years or even decades later.

All parts of the individual that are controlled by the nervous system can be affected including functions of vision, hearing, speech, walking, writing and memory. Muscle weakness and spasms, fatigue, numbness, and prickling pain are common symptoms. Decreased concentration, attention deficits, depression, manic depression and paranoia can be part of the mental changes. As the disease worsens, patients may experience sexual dysfunction or reduced bowel and bladder control.*1 Symptoms can vary during different phases and among different people.

It is estimated that there are approximately 4,000 people living with MS in New Zealand. Unfortunately, as Medline Plus*2 states, “There is no known cure for multiple sclerosis at this time. However, there are promising therapies that may slow the disease. The goal of treatment is to control symptoms and maintain a normal quality of life.” The Happy Families web site,*3 states that yoga and Tai Chi are good for stretching and a sense of well being.

A study*4 in 2004 in the USA showed improvement in fatigue in the groups that exercised and practised yoga compared to the control group that performed neither. No effect on attention or alertness or any clear changes in mood were noted.

Professor Burk,*5 a leading neurologist in the USA, noted that people with MS: utilize available resources, have a good relationship with their health care professionals, educate themselves – find out more through MS support groups and their own information library, learn to say “no” to work and family commitments when not well, maintain a healthy lifestyle including healthy diet, exercise, and adequate rest, take up recreational activities and hobbies that give positive support, reduce toxins: alcohol and tobacco and negative friends and family, reach out to peers with MS to share common issues, and be an advocate for MS causes.

Implications for a yoga class

The above information suggests that yoga (asana, pranayama, meditation and yoga nidra) can benefit people with MS by improving health and well being on the physical, energetic, mental, emotional and spiritual levels. In fact, yoga is an excellent complementary therapy for people with MS. Practising yoga in a group environment on a regular basis allows clear instructions and assistance from the yoga teacher as well as encouragement and support from peers. When people with MS take up yoga, they need to be especially cautious with balance and standing movements, as well as being aware of their own limitations so as not to overdo. A yoga class therefore needs to be gentle and flexible to cater for each person’s different abilities.

Because students with MS tire easily, the class which we give in New Zealand is only one hour in duration. We meet once a week in a gym where exercises are practised on other weekdays. The group is small at this stage, only five regulars come: three women and two men, all over fifty years of age. They have agreed to start the class sitting up, even though one participant cannot do so for extended periods. People either lean against the wall or sit cross-legged without any other support during stages 1 to 3 of kaya sthairyam followed by chanting the mantra Om three times and the Shanti Path.

Some observations on yoga practices

Often, it is a struggle for everyone to be ready on time for an already short class. Some of the students may take several minutes to move into any of the base positions. Because most students cannot stand or are unable to stand without support, asanas are restricted to those starting from sitting, lying on the stomach or back, vajrasana and on all fours. An easy flow of postures has been created to save time by avoiding unnecessary changes in base positions. This flow moves from sitting asanas to postures on all fours and/or vajrasana, to postures starting from lying on the stomach, then rolling onto the back and finally completing the class with yoga nidra in shavasana for the last 15 to 20 minutes.

In each session, some movements from the pawanmuktasana (PM) part 1 series are practised while still sitting up. Sometimes one of the first three asanas of PM part 3 is added (rajju karshanasana, gatyakmak meru vakrasana or chakki chalanasana). Favourites from vajrasana include shashankasana and ananda madirasana. Marjariasana and vyaghrasana are practised with varying outcomes. Lying on the stomach, asanas like the full locust or half locust as well as simple backward bends play an important role in keeping the back flexible and strong. Lying on the back, all asanas that strengthen the abdominal muscles are particularly important as well as spinal twists.

The willingness of the students to try new asanas keeps astounding me and often the result is much more encouraging than expected – by me. We have done a vipareeta karani asana variation against the wall, where apart from getting the legs in place, the main problem was to keep them from slipping back down. We have given hasta pada angushthasana and meru akarshanasana a go and performed a TTK (tadasana, tiryak tadasana, kati chakrasana) variation sitting up against the wall.

The class finishes with yoga nidra to counteract any fatigue that may accompany the physical exertion of getting to class, onto the floor and then performing asanas. Rotation of consciousness especially supports the growth of new neural pathways, and the breathing will sustain a sense of well being and connectedness. Usually pranayama – other than yogic breathing in shavasana just before yoga nidra – falls prey to the time shortage.

We introduced ashwini mudra, then vajroli/sahajoli mudra followed by moola bandha a fortnight later. Within a month the feedback from the students was that urinary incontinence had now been mastered without drugs. This possibility was not known before. Originally the mudras were introduced in preparation for moola bandha, which was to be taught for pain control as well as energy preservation.

Students respond

The students are a chatty bunch and focus continues to be a challenge for some. The mood is always cheerful. People are determined to see the good in their situation and make the best of life, as Brendon says, “The word ‘giving up’ is not part of my vocabulary.”

The students say they are feeling great and relaxed at the end of the yoga class. They find it generally enjoyable and the effects remarkable. Brendon comments, “Yoga and exercise complement each other. Since I started practising both several times a week, I have been able to do things again I couldn’t before. It is a pity not more people attend.”

Brian explains, “Without yoga and gym I wouldn’t be able to walk now. The yoga class challenges me to give movements a go I wouldn’t think of trying otherwise.”

Diane observes, “It makes you feel good, the stretching is so good for our bodies, and we don’t get it like we do while doing yoga, also the breathing is really great, especially for an asthmatic like me. It also has enabled me to be a much better sleeper. I relax more fully and concentrate on the eyebrow centre and can then drift off to sleep which has been a godsend when the pain is really bad. Also I love finishing off with the yoga nidra; it is so good.”

The social aspect is important, and the feeling of a support group shows when a cup of tea and biscuits are enjoyed after class.

References

*1 www.medicinenet.com/multiple_sclerosis/article.htm
*2 www.nlm.nih.gov/medlineplus/ency/article/000737.htm
*3 www.honeybalm.com/diseases/multiple-sclerosis.php
*4 Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, Hugos C, Kraemer DF, Lawrence J, Mass M, Randomized controlled trial of yoga and exercise in multiple sclerosis, Neurology, 2004 Jun 8; 62(11):2058-64
*5 Snippets from Professor Burks’ Talks, MS Waikato Trust Newsletter, April 2006, Hamilton: MS Waikato Trust