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Yoga and MS

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Overview

“Yoga teaches us to cure what need not be endured and endure what cannot be cured.” - B.K.S. Iyengar

Yoga is an ongoing practice rather than an end in itself. The practice of yoga was written down thousands of years ago as a system to live a healthy, happy life. The word ‘yoga’ means to yoke or join together—uniting the mind, body and spirit. Joining physical poses with the breath, action with thought, and awareness with intention can bring peace to body, mind and spirit.
 
The simple practice of breathing, something all of us do every day without thought, becomes a powerful tool when you can become aware of how your breathing affects every part of your body. As you learn how to focus awareness on your breathing, you can observe how your mind can feel calmer and your body more relaxed.
 
Each pose is designed to support the body’s joints, muscles, structure and function. Every pose can be modified to its simplest form and can be practiced in a variety of positions. You can be standing, sitting in a chair or wheelchair, or even lying on the floor or in bed –- wherever you are most comfortable at that point in time. Visualization, which involves combining a breathing practice while imagining performing the poses, may also be beneficial for people with MS, including those with reduced mobility.
 
Before you begin to practice yoga, speak with your healthcare provider(s) and discuss any questions or concerns that you or they may have. Be aware that any exercise can elevate the body’s core temperature and temporarily aggravate MS symptoms.
 
The benefits of yoga can be experienced in just a few minutes of practice. You should always feel better after practicing yoga than when you started!

A simple breathing practice

Get comfortable—sitting or lying down; Breathe in slowly through your nose and then breathe out slowly through your nose. Cool air in/warm air out. Close your eyes and continue to breathe in this way for a few moments. Concentrate on your breath. If your focus drifts, bring your concentration back to your breath.

Who can practice yoga?

     * If you have ever wondered whether yoga is something you can do, it is.
     * If you have ever wondered whether yoga is too difficult, it's not.
 
Each body is different - in its shape, strength, flexibility, mobility, height, weight, tension, energy level and ability – at any given time. Yoga is a flexible practice that can be modified to accommodate all of these variables.
 
Support partners can also benefit greatly from practicing yoga. Taking the time to care for their own bodies and practicing strategies to reduce stress and relax are all very important for support partners as well. Strengthening and learning proper alignment can help when providing assistance to someone with MS, whether the assistance involves hands-on caregiving activities or household chores.
 
Practicing together can be fun and gives you and your support partner better awareness of each other’s needs and abilities. In addition, more poses may be accessible to you with the assistance of your support partner. 

Adaptive Yoga

Adaptive Yoga adapts the instruction and practice of yoga to each body in a safe, comfortable, 'makes sense' way. Yoga can be accessible to everyone no matter how your body is at any moment.

All the different styles of yoga ask you to 'start where you are'. Only you know how it feels to be in your body. Adaptive Yoga helps you identify where that starting point is without making any judgment about it. For example, if you can’t lift your toes or your arm right now, you can adapt the pose to accommodate your body’s needs and abilities. Your abilities may be different from day to day, even hour to hour. Awareness of the changes always allows you to adapt the poses to “where you are.”
 
The aim of practicing yoga is not to merely assume specific postures, but rather to combine breathing, posture, movement and awareness to achieve relaxation, body awareness and possibly other benefits.

How can yoga help manage multiple sclerosis?

Living in a body affected by MS may be uncomfortable or even painful. Everyday tasks can be difficult.
 
Practicing yoga can give you tools to help manage everyday tasks that include balancing to stand or walk, strengthening and alignment for standing up and sitting down on a chair, toilet or bed, and core strength for everything you do. The relaxing benefits of yoga may also help manage the unique challenges of MS, such as lying in an MRI machine for extended periods of time, receiving injections or infusions, staying calm during an exacerbation and focusing when meeting with your health care professionals.
 
Dr. Allen Bowling, in Optimal Health with Multiple Sclerosis, 2014 summarizes the existing research on yoga and concludes:
 
“Yoga is relatively inexpensive, generally safe, and may potentially improve multiple sclerosis symptoms. One rigorous MS clinical trial found that yoga decreased fatigue. Other studies in MS and various other medical conditions have reported improvement in anxiety, depression, fatigue, bladder function, pain, spasticity, weakness and walking. There are anecdotal reports but minimal research on yoga and sexual function. For general health, yoga may improve arthritis pain, reduce blood pressure, and promote weight loss. The effects of yoga on these conditions may secondarily benefit those with MS because these conditions may worsen disability and lower quality of life in those with MS.”

A simple posture practice

Feel where your shoulder blades are on your back. Now, ‘slide’ the bottom points of your shoulder blades downwards toward your waist. Feel your shoulders lower and your chest open

Meditation

Meditation is stilling your mind and quieting your thoughts – taking notice of them without being distracted by them.
 
Many people incorporate meditation into their practice of yoga. The physical poses of yoga prepare your body to sit in stillness for meditation. Sitting isn’t necessary, though. You can also meditate lying down.
 
There is no single, correct way to meditate. You may already do it, but without calling it meditation. Walking can be a meditation practice. Knitting, gardening, observing the birds out your window or any other activity that causes you to narrow your focus can be meditative.
 
Guided meditations can help you to focus your concentration and relax your body. Repeating a phrase or sound, focusing your gaze on one object–like a candle–or breathing slowly and intentionally are all different ways to focus concentration during meditation.
 
The benefits of meditation address many of the issues faced by people diagnosed with MS. A research study published in 2011 that examined the effects of meditation on pain and quality of life in MS found that participants in the meditation group showed a significant improvement in pain scores and scores for overall physical health, mental health, vitality, and physical role.  
Most studies tend to be small, however, and while they suggest a positive impact, the evidence is not always clear. More research is needed.    
Dr. Alan Bowling’s review of the research on meditation and MS (Optimal Health with Multiple Sclerosis, 2014) concludes that:  

“Meditation is a well-tolerated, low-cost therapy that may provide medical benefits without the use of medication. Limited studies indicate that meditation may be helpful for relieving stress, anxiety, depression, fatigue, insomnia, pain and cognitive problems. It also may improve self-esteem and feelings of control. For general health, meditation may reduce blood pressure and improve blood glucose control.”

Finding a qualified yoga instructor

There are many styles of yoga. Most yoga studios offer different styles and levels of classes. Finding the ‘right’ class for you is very important.
 
Certified yoga instructors teach yoga classes in yoga studios, in private homes, and even in introductory workshops. Some people with MS who have found yoga to be beneficial have taken Accessible Yoga Training to become certified to teach others. You can look for yoga classes specifically for MS--contact an MS Navigator at the National MS Society for a list of registered yoga instructors in your area.
 
It is beneficial to work with a qualified instructor when you begin to practice yoga to learn the proper alignments, adaptations specifically developed for your body and how to use props (blocks, straps, chairs, etc.) to assist you gently into the poses. Always ask the instructor you will be working with:
  • what their qualifications are,
  • how long they’ve been teaching,
  • what style of yoga they teach, and
  • if they have worked with people with special needs.
 The National MS Society offers an online course for wellness and fitness instructors, including yoga teachers, entitled Introduction to MS that provides important information about working with people with MS. (And is approved for continuing education credits through the American Council on Exercise.)
 
Explain to your instructor how your body is feeling and what your individual needs are. Always stop any part of the practice that doesn’t feel right to you. Again, you should always feel better after a yoga practice than when you started!
 
Even if you are not able to leave your home, there are books, videos and Internet streaming yoga resources available.

Additional resources

  • Accessible Yoga: recently formed non-profit organization training and compiling a worldwide directory of certified yoga instructors who teach Adaptive Yoga to people with disabilities.
  • Therapeutic Yoga for MS Videos: a series of videos about yoga specifically for people with MS
  • Your Own Gentle Yoga Approach: free instructional videos on the basics of Adaptive Yoga. Cherie Hotchkiss, E-RYT 200, CMT, has been managing her own MS for 17 years and is an accessible yoga ambassador.
  • Healing Yoga: search for adaptive yoga teachers and other resources.
  • International Association of Yoga Therapists: provides an online search tool to locate yoga therapists and practitioners throughout the world (more than 3,300 listings).
  • Yoga Alliance: Yoga Alliance® is the largest nonprofit association representing the yoga community. Yoga Alliance provides an online search tool to locate Registered Yoga Teachers (RYTs) and Experienced Registered Yoga Teachers (E-RYTs). Search from more than 69,000 listings by location, yoga style or therapist name.
  • Yoga Finder: provides an online search tool to locate yoga classes and events throughout the world.
  • Yoga and Multiple Sclerosis: A Journey to Health and Healing: written by Loren Fishman and Eric Small.

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