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Yoga for MS
By Roger Nolan

Multiple Sclerosis is an autoimmune disease in which the body's defensive immune system attacks and destroys the fatty tissue -- myelin -- surrounding nerves in the brain and spinal cord. These myelin sheaths perform the same function as insulation around an electrical wire. Without the myelin insulation, nerve impulses from brain to body can short out and become confused, misdirected, or be completely blocked. Symptoms can include numbness and/or tingling in the extremities, weakness, lack of coordination and/or balance, gait difficulties, slurring of speech, blurred or double vision, bowel and bladder dysfunction, vertigo, and heat intolerance.

Physical activity is extremely important for individuals with MS, and yoga is now recognized as an excellent means of MS management, whether the individual manifests little or no outward signs of the disease, or whether they spend most of their time in a wheelchair. The benefits of yoga postures (asana), working with the breath (pranayama), and meditation may include increased body awareness, release of muscular tension (thus relieving spasticity), increased coordination and balance, increased flexibility and strength, control over fatigue, increased tolerance to heat, improved circulation and breathing, improved organ function (including bowel and bladder), enhanced alertness, better management of stress and an overall feeling of well-being.

As an Advanced Teacher of Therapeutic Yoga (certified through Integrative Yoga Therapy), I have been specializing in the application of yoga disciplines for the management of MS. In addition to my IYT training, it has been my privilege to study with Eric Small, an internationally recognized Iyengar yoga instructor, who was himself diagnosed with MS in the early 1950s, and through yoga was able to bring himself back to health. For the past two years I have been working with students and clients, in groups and privately, and I would like to share some cases that may be of interest to those dealing with MS, either as yoga students or as teachers.

The course of MS is unpredictable. The four categories used to classify the clinical course in persons with MS are: Relapsing-remitting, Primary-progressive, Secondary-progressive, Progressive-relapsing. What follows is a brief description of my work with individuals manifesting three of these courses.



In the category of Relapsing-remitting is L, a 35 year-old female Pilates instructor and former dancer and figure skater who is now pursuing an advanced degree in Physical Therapy. True to course, after an initial flare-up and diagnosis of MS, she has had extended periods with mild flare-ups and minor disease progression. Her symptoms include numbness/tingling, some balance issues, and heat intolerance. In addition to yoga, she also receives injections of Copaxone.

Normally I would design a gentle practice for students with MS to avoid overheating the body, but because L. has been so used to an active vigorous lifestyle, the practice I designed for her includes a modified Flow Series of standard postures linked by a sun salutation. To avoid tiring her, however, I have L practice this series slowly, mindfully, and with complete awareness. In this way the practice becomes more meditative and less fatiguing, but still invigorating and relaxing. Since L has a well-developed sense of body awareness, she is able to let me know when the practice is too much for her. I also include meditative or cooling pranayama practices such as Shitali, Nadi Sodhana, and Pratiloma Ujjayi as well as a long guided imagery meditation at the end of each session.

Over the time we have been working together, L has developed an increased ability to handle stressful situations and has a much more balanced perspective about her life. It has been well over a year since her last flare-up.



In the category of Secondary-progressive MS is M, a 43 year-old former ER nurse who was diagnosed when she was 28. In this course, the person experiences a relapsing-remitting disease course at the outset, followed by a more steady progression. M's symptoms include near-blindness, severe vertigo when reclining, slurred speech, and muscle weakness. She is able to transfer from her wheelchair into a regular folding chair, so that's where we do most of our work, often using two chairs to simulate working on the floor. I have modified seated forward bends (paschinmottanasa, janu sirsasana), seated backbends (matsyasana, yoga mudra), hip openers (badha konasana), twists (ardha matsyendrasana), and modified standing postures such as forward bends (uttanasana, padottanasana), and even a variation of warrior (virabadrasana II). I've also included strong breath awareness to get her diaphragm working again and to get some life-force stirring inside her.

My primary objective with M is to help her regain muscle strength and flexibility lost to years of being in a wheelchair, and she is doing quite well, and has even been able to stand for brief periods. She was never able or willing to keep up with any kind of physical activity in the past, but now faithfully practices her yoga every day.



From time to time the Los Angeles Chapter of the MS Society places me in a nursing/rehab setting to work with individuals for whom the course of MS is steadily progressive, or Progressive-relapsing MS. One such person is J, a woman in her late 40s whose range of motion is limited to moving her head, some lifting of her shoulders, and moving her arms and hands only slightly. In this case I do some hands-on manipulation, where appropriate, of the arms, hands, and legs, but mainly we work with mindful breathing (ujjayi, viloma and anoloma pranayama), dynamic movement of the head, shoulders and arms linked to breath, and guided imagery meditation to promote mindfulness and relaxation.

In J's case, the obvious physical limitations preclude even a modified physical yoga practice to a great degree. However, yoga does not stop at the physical level. It permeates into the other aspects of our being, such as the energetic, mental, emotional, and spiritual aspects (the koshas). My work with J has, I believe, improved the quality of her life on all these levels, even though what we do together may not look like "yoga" to an outsider.

If you are a teacher working with students with MS, or any other special concerns, do not limit yourself to the physical alone. Utilize breath work, mindfulness based meditation, guided imagery, and experiment gently to find the appropriate practice for your students, keeping in mind their needs and desires.

For More Information
Roger Nolan can be reached via email at yoga2go@hotmail.com. Contact the National Multiple Sclerosis Society at (800) FIGHT MS or www.NMSS.org. Reprints of a profile of Eric Small in the July/August 1997 Yoga Journal are available from the MS Society's L.A. chapter by e-mailing Miranda.Mirsec@cal.nmss.org.

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