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Yoga, MS and Me - by Susan Dobrof

I have known I had MS almost as long as I have been doing yoga. Taking yoga classes started out as a fun activity to share with my partner at the time who had a bad back and needed a gentler activity than the rugged hiking or hours of frisbee throwing that we both enjoyed. Now, after 20 years of my disease's progression necessitating I use a cane, braces on both legs to help with walking and standing, a mobility scooter, and hand controls for driving, yoga is so much more: it helps me stay strong and flexible, it is the basis for important connections to a community of MS comrades, and it helps me learn about compassion and acceptance toward my own body and other people. But mostly, yoga lets me experience, express and expand my physical and mental vitality; it also provides a lovely sense of well-being.

The word "yoga" is derived from a Sanskrit word that means to bind, or to direct and concentrate attention on. It also means union. A most influential teacher of yoga, B. K. S. Iyengar, helped introduce the Indian philosophy of yoga to the western world initially through "Light on Yoga", first published in 1966. Mr. Iyengar (now 86) explained the eight limbs or stages of yoga, including the third limb: "asana", which means pose or posture. Asanas are ancient and are described by Mr. Iyengar as: "bring(ing) steadiness, health and lightness of limb."¹  Teachers who practice Iyengar yoga may use props such as straps, blankets and blocks, and help students gain the strength and flexibility to do the poses correctly. Proper alignment of the head, spine and limbs is important in preventing injury and allows the student to coordinate the movement and the breath to attain the pose. Yoga poses gently stretched muscles of the legs, arms and back which can increase flexibility. Yoga may also reduce muscle spasms and improve overall circulation.

You may have seen a picture of Madonna with her leg behind her neck or other people in yoga poses that look way too difficult for a person who may have weak muscles, reduced flexibility, limited mobility, muscle spasms and not much energy. 20 years ago, I aspired to, and sometimes accomplished, tree pose, a standing pose in which all the weight is on one leg with the sole of the other foot pressed against the upper thigh of the standing leg, bent knee out to the side for balance. Today I practice "gentle yoga" with Iyengar teachers who have modified the poses so the students are in chairs (including wheelchairs) or the floor (with or without back support from a wall) or standing with a chair or the wall nearby for support/balance. All of my teachers in the last seven years have some knowledge of MS and/or training from teachers committed to tailoring Iyengar yoga practice for the benefit of people with MS.

20 years ago, yoga was just another way to exercise. At 30, I could swim a half-mile and jog 3 miles in the same day. I exercised to be healthy, strong and to look good. But I didn’t pay much attention to how my body felt as I exercised. Oh, I noticed if I got a cramp, and always liked the good feeling after exercising. But in my first yoga class, I was too busy checking out other students' superior strength or svelte bodies to follow the instruction to focus on my breath and internal awareness of my own body as I entered and held each pose.

Yoga poses can seem impossible to do. For example, in downward facing dog pose, the body is in a V-shape with only the feet and hands on the floor and the butt in the air. The teacher may attain the pose in one fluid motion, starting on hands and knees. The teacher shows you what's possible and offers guidance to help you get there, but you get there only if you are willing to listen to your body and be patient.

I don't know exactly when it dawned on me that my physical losses because of MS did not have to mean I couldn't be physically vibrant, strong and flexible. At some point, I started actually listening to yoga teachers when they said that if you keep doing the poses, they get easier and they get easier because your body has capacity you don't know about unless you pay attention to it. But who wants to pay attention to stiff or spasming legs that have increasing difficulty walking? Did I really want to focus on this faltering body?

As they say, denial ain't just a river in Egypt. It also helped me pretend for years that I was not afraid of or limited by MS, even as what I described as my "funky feet" couldn't distinguish between clutch, brake and gas pedals and, in a period of five years, I switched from standard to automatic transmission, and then to hand controls in order to drive. I am guessing that I am not the only person who thought that as long as I didn't act like a disabled person (whatever that means) then I wasn't disabled. It took a particularly scary exacerbation coupled with panic attacks landing me in the hospital in 2002, for me to face what this sad charade was all about: my unwillingness to acknowledge, accept and grieve the permanent loss of the me who could hike or swim a half-mile.

So I was sad and grieving, but also hugely relieved. Pretending that everything was hunky-dory was exhausting; actually peeking inside and seeing what was what, freed me from all that desperate and useless effort to act as though MS wasn't doing what it does. (Denial ain't just . . .).

In the rehab hospital, the physical therapists were surprised that my weak legs were flexible and muscular. I had been taking gentle yoga classes for about three years at that time and used my teacher’s stick figure drawings of poses to practice on my own as I recovered. I was also in therapy, which helped me get acquainted with myself (needless to say, an ongoing project). In that process, I discovered I had the nonphysical strength to face myself, and a means, yoga, to explore my physical and emotional/spiritual capacities.

If you can somehow go through the denial and anger and find some compassion for yourself and acceptance of your losses, there is the possibility of discovering ways that your body can stretch and strengthen and move easier. I got stuck hating my diseased body that didn't work like it used to, feeling robbed, full of envy toward people strolling/running/cycling by. The feeling that all the good stuff was in the past grew out of my refusal to tune in to my life and especially my body, as it really was.

So even though I get too fatigued to walk (with braces and cane) more than 2 or 3 blocks, and my 25-foot walking speed has slowed from when my neurologist first timed me, I have become strong and flexible enough to attain that V-shaped downward dog pose and hold it for about 30 seconds.

Many of my classmates have gotten similar benefits from yoga, and most of us have also experienced some worsening of symptoms. Some days, I have the energy to try a standing pose, and, when I have less energy, I do the modified version in a chair. That downward dog I am so proud to be able to do, can also be done over the back of a chair with your weight supported by the wall where your feet rest, and the chair, where your upper body and head can rest.

Sometimes, I do the modified version even if I have the energy for the regular dog, because it can give a better stretch to the arms, since I don't have to use them to support my upper body.

 We also learned how to do the pose using a looped strap on a doorknob looped around the belly, with feet on the floor and hanging from the strap to stretch the arms. Teachers, and sometimes students, devise ingenious ways to modify yoga poses to accommodate limited strength, flexibility and energy so that even significantly disabled people can get, and hopefully enjoy, the benefits of yoga.

My yoga teacher often begins class asking about our energy levels today and any aches or pains or new symptoms. She may ask what poses or parts of the body students want to work on. She sometimes starts our hour and a half with a breathing exercise that helps us transition from the effort and flurry of getting to class to a calmer, more inward focused mode. As she leads us through the movements of a pose, she might say: "stretch your arm toward the sky, any amount" or “can you straighten your leg, and if you can't, that's okay too". In the pose, on an inhalation you stretch and feel the muscles lengthen, on an exhalation, still holding the pose, feel the muscles soften, and relax.

Yoga gently invites us inward, whether or not we want to focus on our bodies. It has helped me make friends with my body, instead of seeing it as the enemy. The last pose of the class is always "savansa", the corpse pose.  It is a relaxation pose and is considered the hardest pose because it asks us to let go of all the effort, become quiet, follow the breath, and relax completely. Some people lie flat on the floor, others lie flat, but with their legs resting on a chair or up the wall. Others sit in a chair, and everyone closes their eyes. In savasana, we are asked to focus on the effects of today's poses and each time the mind wanders away from following the breath, we bring it back to the inhalation and the exhalation. And when the teacher, after 5 or 10 minutes, asked us to deepen our breath, and slowly roll over onto our side and rest for another moment before sitting up, she might also say: "feel how good you feel at this moment and take it with you into the rest of your day."

          Yoga is not about working hard to attain the buff and svelte body I so envied when I first took a class and treated it as a competitive sport. Instead, yoga asks what your body, just as it is, can do today. Even if it is less than you could do yesterday, today you can still get the benefits of lessening fatigue², building strength, improving balance, stretching, and learning techniques for and experiencing relaxation.

          I have been taking yoga with many of the same people for about three years. It feels liberating to exercise with  people who have various physical limitations, but who are undaunted by those limitations and are willing to challenge themselves physically, despite occasional non-cooperating limbs causing one of us to get stuck in a pose (being rescued by our teacher or each other is just part of the fun). We share information about mainstream and alternative MS treatments, our doctors or other practitioners, what's going on in our lives (a new job, needing to stop working, children or grandchildren) and what's going on in the world. For some who have become sedentary, the class is a way to ease into mild physical activity in a supportive environment. Others may get more of a workout. We all get to be part of a shared activity with teachers and especially classmates, who understand the physical experience of MS. Not surprisingly, we laugh a lot.