Yoga and MS a Practice Guideline

Yoga and MS A Practice Guideline

Garth McLean Guideline: Overview

ACKNOWLEDGMENTS

I am eternally grateful to Yogacharya BKS Iyengar for his inspiration, insight and guidance, along with the ongoing guidance of his daughter, Dr. Geeta S. Iyengar. Also, Manouso Manos and Patricia Walden who have guided me on the path in the USA.

I acknowledge and thank Gloria Goldberg for her ongoing support, Anna Croxatto for her patient, organizational expertise; Michele Bohbot for providing her studio, Namastday Yoga Center of Beverly Hills http://namastday.com, and Xu Zhang for photographing the asana photos.

DISCLAIMER: Prior to commencing any yoga or exercise program, please seek the advice of your health care provider. The information presented herein is for reference and informational purposes and is not intended to diagnose, treat or cure multiple sclerosis and should not be considered as a replacement for expert medical advice. To the extent permissible by law, Garth McLean, BKS Iyengar, the Estate of BKS Iyengar, Geeta Iyengar, Manouso Manos, Patricia Walden and any of their respective agents, representatives, employees, heirs or assigns, collectively and/or individually, hereby disclaim any liability for any injuries incurred as a result of the information contained in this guideline.

All asana photos in this guideline are the property of Garth McLean and are protected by copyright. Unauthorized reproduction is in violation of copyright laws. © June 2017

INTRODUCTION MS AND YOGA

As a person with Relapsing-Remitting Multiple Sclerosis, the information MS is a chronic, unpredictable neurological disease that affects the central nervous system. below outlines my personal experience with managing the condition through MS is thought to be an autoimmune disorder where the immune system attacks the Central the discipline of yoga as presented by Yogacharya B.K.S. Iyengar. Nervous System, affecting the myelin sheath or protective coating of the nerves. The myelin is lost in multiple areas impeding nerve transmission. There are four general courses of Please understand that YOGA IS NOT A CURE for MS. The practice, however, MS, each of which might be mild, moderate, or severe. They are identified as Relapsing- has helped to get my symptoms into remission, rebuild strength, maintain and Remitting, Primary-Progressive, Secondary-Progressive and Progressive-Relapsing. For more enjoy a relatively normal lifestyle. information refer to the National Multiple Sclerosis Society www.nmss.org

After many inquiries about my practice, I put this guideline together as a reference for others. It is primarily intended for those who are reasonably ambulatory and who are able to get up from and down to the floor. This guideline is based on the teachings of Yogacharya B.K.S. Iyengar, my practical experience and can be adapted according to suit the individual’s ability. For those who require further support and assistance , please seek the guidance of a qualified Iyengar Yoga teacher.

While I am not a medical professional, I am a man who through the daily practice of Iyengar Yoga has dealt with and continues to successfully manage the disease first hand. I am a Certified Iyengar Yoga Teacher, (Senior Intermediate III), a Certified Yoga Therapist, a daily practitioner and continuing student of the subject.

What is presented herein is in no way meant to be complete of all poses that can be done by persons with MS, nor to restrict or limit the growth of the practitioner. Each case of MS is different and can affect the body in different ways. While there are similarities among each course of MS, it is impossible to address every scenario for every For a thorough explanation of the asana and pranayama techniques situation. The information herein serves only as a starting point and general guideline. What mentioned here, refer to Light On Yoga, by B.K.S. Iyengar and Yoga, A is presented is not intended to limit the range and approach to asana for persons with MS. Gem for Women, by Geeta S. Iyengar for instructions and a comprehensive The approach should be modified depending on the specific student’s symptoms, ability and overview on these asana , pranayama and the other limbs of yoga. Also, look needs. to Yoga In Action, Preliminary Course and Yoga in Action, Intermediate Course, both by Geeta S. Iyengar for further practical insight. There is no guaranty that a yoga practice will relieve the condition, however, if practiced daily with discriminative intelligence, it may serve to relieve symptoms, brighten the future, and As a fellow practitioner, I encourage you to be curious to find out what is help to arrest further progression of the condition to enhance one’s life. possible as you explore the practice with honesty, compassion, safety and respect for where you may be on any given day.

I wish you perfect health and happiness!

UNDERLYING PRINCIPLES DIAGNOSIS AND SYMPTOMS

Look to first soothe and calm the nerves before asking the muscles of the body to work, MS is accurately diagnosed by identifying lesions especially if fatigue or weakness is an issue. When feeling in the body is compromised and indicative of the condition through Magnetic Resonance if one is prone to spasticity and/or ataxia, create stability in order to enhance balance and Imaging (MRI). I was clinically diagnosed with Relapsing- mobility. Work to encourage alignment of the structural body to enhance a lift to the organs Remitting Multiple Sclerosis in May of 1996. Lesions were and remove fear. detected in my cervical spine, thoracic spine and on my brain. Look also to create space within the body, an extension and expansion of muscle and nerve fibers. Symptoms I have personally experienced have been loss of feeling throughout my body, numbness and a banding Plug the bones of the limbs into their respective sockets to enhance feedback from the sensation in the torso and limbs, neural pain that manifests peripheral nerves to the motor nerves. Use props, as necessary. Work to bring the flesh as a chronic burning sensation along the skeletal bones in contact with the bones. Be aware to avoid looseness in the limbs and encourage the and muscle fibers of my right foot and in my right hip, restoration of nerve function wherever possible. right side foot drop, difficulty walking, compromised gait, loss of motor skills and refined movement where I could For students that are more physically challenged and may be wheelchair bound or unable to not use my fingers to write with a pen or button a shirt , walk without mobility assistance devices, it is recommended that further adaptations of the compromised proprioception and inability to judge asana (postures) be guided by an experienced Iyengar Yoga teacher. distances from hand to body, for example to pick up an object, or use a fork to eat (dysmetria); optic neuritis (loss of vision in my right eye and compromised vision in my left); bowel and A general principle to follow is to adopt asana and breathing techniques that have beneficial urinary incontinence, L’Hermitte’s symptom (a symptom where electrical charges are felt physiological effects and adapt according to the practitioner’s ability and needs with sensitivity, throughout the body when moving the head in a forward fashion); fatigue; depression. observation and sensibility. Post-diagnosis I chose to forego ongoing medication until July 2001. Earlier in 2001 I had experienced two severe exacerbations within months of one another. At that time, I elected to NOTE: FOR THOSE WITH MS WHO ARE © Garth McLean administer weekly injections of Avonex (Interferon Beta 1-A). As no medication offers a cure HEAT SENSITIVE, AVOID OVERHEATING THE for the condition, shortly thereafter I chose to once again forego the medication and since BODY. A variance of 0.5 degrees Celsius (0.9 January 2004 have opted instead for a continued daily practice of Iyengar Yoga. degrees) Farenheit in body temperature has been proven to temporarily worsen symptoms due to demyelinated nerve fibers in some people with MS, though will not cause an exacerbation (*). As such, avoid looking up or keeping the arms overhead for too long.

(*) See, Ropper, A. and Brown, R.; Adams and Victors’s Principles of Neurology, (2005 8th Edition) p.776, McGraw Hill Publ.

What has become possible through continued dedicated practice.

My agreement with my neurologist is to have an annual MRI to monitor the lesions on my PRACTICE GUIDELINE brain. My recent MRI reports have shown a significant reduction in number and size over the last several years. IMPORTANT NOTE:

I have been able to successfully overcome these symptoms though I still experience fatigue THIS IS A GUIDELINE ONLY. IT IS NOT A SEQUENCE OR A PRESCRIPTION. as well as residual loss of feeling in my right leg and foot, resulting in strength and balance issues on my right side. When tired, the burning sensation in the foot and right hip resurfaces. Although symptoms may be similar among many people with MS, please be aware that there is no magical “one size fits all” protocol when it comes to managing the condition. MS is unpredictable and symptoms can strike VIDEOS at any time, affecting each individual differently. Please use common sense along with sensitivity and observation. Click on the image or scan the QR code with your smartphone In the Iyengar tradition there is an evolution from beginner to intermediate to advanced levels of practice. What is presented here are some basic and a few intermediate asana. In the evolution of the yoga practice, I have found padmasana and the padmasana cycle, especially in the inversions, to be of particular benefit for the legs and organs of the body. I strongly recommend working with a Certified Iyengar Yoga Teacher to evolve the practice beyond the beginning level.

As a reminder, the photos of the work presented herein are provided as a starting point only to open up the door to possibility. Please use common sense as you approach the practice according to your or your students’ capacity and ability.

STANDING WORK A. With Trestle and blocks to brace feet B. With Wall Support C. Independent

If student is capable and when energy allows, all standing poses can be done.

Standing work is the foundation for many asana. The practice can build strength, stamina, balance and confidence. At the same time, it can be challenging and tiring. Approach standing work, with support as necessary. By getting on one’s legs, it may help the mind and body reformulate, translate and refine the relationship to coordination of movement, strength and balance.

Best to start slow, limit the amount of poses and time held in each pose to keep the nerves calm and not exhaust the body. One should feel refreshed from the standing work. It is natural to feel some fatigue, however, avoid working to depletion or if the body starts to shake. When available, take support of a trestle along with blocks and ¼ round blocks to brace the front foot.

TADASANA With brick between thighs to activate inner I have found this helps to plug the bones into their sockets and offers feedback for the legs legs and keep abdominal organs lifted from the peripheral nerves to the motor nerves. Working in this manner, helped me overcome my experience of drop foot. © Garth McLean

In the absence of a trestle, use of a wall and chair can be used for support. One could also use a kitchen counter top, a large desk or something similar that does not move for support. Alternatively, the standing work can be modified with the use of folding chairs (not pictured here).

Be vigilant to see that student avoids compressing or drops the organic body or overworks. If the legs buckle, there is a shakiness or student is unable to support their body weight on their legs, better to forego the standing work and look to Supta Padanghustasana I & II (pictured after the standing work) to bring movement and range of motion in the legs. If student is fatigued, switch to or start with restorative asana.

A. WITH SUPPORT OF TRESTLE. Pictures shown here are with back to trestle. A similar support (kitchen counter, large desk, etc.) could be taken in lieu of a trestle. The support of a trestle, © Garth McLean offers stability, feedback and support for the limbs. If balance is problematic, be between trestle and a wall. Face the trestle, with back to wall. This may offer further stability and remove fear of falling. Arms in Urdhva Baddangulyasana Without brick: In general, if one is heat sensitive turn the head to look downward in the standing work. The same is helpful if there are balance challenges, or vertigo is present. © Garth McLean © Garth McLean

VRKSASANA UTTHITA TRIKONASANA With back of head to trestle:

Modified with leg bent and foot on chair (could have second chair in front of body to hold on to for stability, if required)

Have front foot on 1/4 round brick. Helps w drop foot, and to bring life to leg

With head looking downward is cooler VIRABHADRASANA II

UTTHITA PARSVAKONASANA Looking down is cooler: W back of head resting on trestle

VIRABHADRASANA I ARDHA CHANDRASANA For enhanced balance, hold trestle w bent leg arm for support. Back foot on 1/4 round if Rest back of head and uplifted leg and head on trestle unable to keep back foot on ground.

Alternatively, turn head to look downward VIRABHADRASANA III If balance is a challenge, have the standing leg side of body resting against trestle:

or rest standing legs side of body against a wall or similar support:

PARSVOTTANASANA

B. WITH BACK TO WALL. If balance, leg strength and coordination is significantly UTTHITA TRIKONASANA challenged, the standing poses can be done between a wall and a trestle. or between two trestles. In the absence of a trestle, one can also have the back to the wall with a chair in front of body (back of chair facing the body) so one could hold the back of the chair for further support.

UTKATASANA

Holding back of chair Hold chair to bend knees, then hold ropes.

UTTHITA PARSVAKONASANA UTTANASANA (w support) C. INDEPENDENT. All of the poses can be done independently without props or wall support. I find practicing without supports to be empowering and invigorating. However, it can also be exhausting. Days when I am fatigued, I am feeling a bit shaky or balance is off, I

TADASANA URDHVA BADDA- © Garth McLean ANGULIYASANA

VRKSASANA UTTHITA TRIKONASANA

VIRABHADRASANA II UTTHITA VIRABHADRASANA I PARSVAKONASANA

SUPTA PADANGHUSTASANA I at post/doorway if possible, and with belt around arial foot heel with back of arial leg supported by the post, set femur bone well into socket with belt and/or with foot of Supta leg pressing into a wall, or reasonable facsimile to offer feedback to supta leg to draw femur bone well into the socket.

Using Post or Doorway:

SUPTA PADANGHUSTASANA II (lateral) with lateral leg supported on a chair, stool, With Chair and Weights bolster, again drawing femur bone well into socket and foot of supta leg pressing into wall especially if feeling is compromised as it helps to offer some sensory feedback. If available, can weight the legs.

Supta foot at wall:

If straightening leg is difficult due to inner groin stiffness or spasticity, try keeping the lateral URDHVA PRASARITA PADASANA with wall support to get legs up, insofar as possible leg bent with calf resting on seat of chair. Keep leg that is on the floor, slightly away from and to begin familiarize with an inversion. Have pillow or blanket under sacrum. If unable midline of body with a rolled blanket roll supporting the outer hip of the leg on the floor to straighten legs due to tightness of hamstrings, start with bent legs have support of pillow under sacrum, calves resting on seat of chair(s). Over time, work to build height under sacral region toward Viparita Karani (which appears later).

If legs are weak and unable to keep together, place a rolled sticky mat between inner legs SUPTA VIRASANA and tie legs together with belts. Belt the weaker leg to the stronger leg. with support of bolster(s), blankets, eye wrap , if available.

If body is stiffer, build up height w extra bolster under spine:

Can also be done with use of chair: If unable to do Supta Virasana, try Supta Sukhasana. With shins crossed at mid shin, come to elbows and lie back. Can also be done with support of bolster(s) (not pictured).

SUPTA BADDHA KONASANA If no belt, or if body is stiffer, feet can be braced at wall: with support of bolster, blankets, eye wrap

Support outer hips with blanket rolls to further soften inner groins: ADHO MUKHA SVANASANA with rope support, bolster for head support. In absence of ropes, can be done with feet or hand supported at the wall. Modified to ½ Uttanasana, with hands at wall as necessary (not pictured).

Garth McLean © © Garth McLean

If stiffer or back pain, try with heels raised on Simhasana box: PRASARITA PADOTTANASANA braced within trestle. Work to get sacrum and bones of legs firmly connected into respective pelvic region.

If no trestle available, can work stages independent insofar as possible: ROPE SIRSASANA best to be more familiar with inversions if possible. However this was introduced to me very early on and when I was symptomatic. Once student is familiar with inversions, work toward regular Sirsasana and variations. I believe that between Rope Sirsasana and regular Sirsasana it gave me the psychological strength of will to continue, which was very healing. Avoid Sirsasana if eyesight is compromised, when on menstrual cycle, if there is high blood pressure or vertigo.

Once crown of head reaches floor, if stable hold outer ankles:

With rope swing, if available. More With wall support: Sirsasana also be done between two chairs, against wall, braced on sticky mat so chairs do accessible to enter and exit pose for those not slide, with mat and blanket support for trapezia: who have trouble with legs.

Independent: With legs in Urdhva Padmasana which I’ve found beneficial

SUPPORTED PURVOTTANASANA In the absence of a platform with support for SUPPORTED DWI PADA VIPARITA DANDASANA (on chair or backbender, if feet, can be done over two chairs, or four chairs tied together as a platform, if student available). Helpful if there is a banding sensation in torso. Placing a slanting plank less ambulatory, with bolster support for back and blanket for head. Helpful for banding wrapped in sticky mat placed behind mid-back ribs to offer opening of front chest is very sensation of torso; depression. soothing (not pictured) With heels to wall:

With heels raised on bricks:

With heels raised and bolster support for head SUPPORTED USTRASANA (over a chair, two halasana boxes, a chair, or small tables with bolsters and blanket to support spine and head). Very soothing if banding sensation is present in torso.

With calves on 2nd chair (variation to Be done when on menstrual cycle): © Garth McLean

BHARADVAJASANA Can also be done straddling chair: (with chair; abdomen soft, abdominal organs lifting up, not in). Make front surface of spine longer than back. To help provide some movement to the spine, create space to maximize potential nerve function and to keep the organs healthy and the bowels moving.

Can also place bolster or pillow between knees to help stabilize:

Garth McLean © © Garth McLean

SETUBANDA SARVANGASANA (with bench support). Can be practiced daily. Along Place stick-y mat and blanket on bench, with bolster for back of head and shoulders: with an eye wrap, found this to be most beneficial when my eyesight was compromised.

SALAMBA SARVANGASANA eventually working toward regular Salamba Sarvangasana, Legs in Urdhva Baddha Konasana: Legs in Urdhva Sukhasana: and all variations, especially the Padmasana and Pindasana cycle which I find helpful for stability of the legs. Avoid if eyesight is compromised or when on menstrual cycle.

Independent Salamba Sarvangasana: ARDHA HALASANA (with support of bench/chair) Especially rejuvenating when fatigued. If student is unable to straighten legs in Ardha Halasana, they generally can perform supported Karnipidasana with the legs bent and thighs supported on chair seat. (not pictured) Avoid

© Garth McLean if L’Hermittes symptom is present. L’Hermittes is a symptom where an electrical charge runs down spine and through nerves when head is bent forward as in Jalandhara bandha. Avoid if eyesight is compromised, and during menstruation.

Legs in Urdhva Baddha Konasana: Legs in Urdhva Sukhasana:

NIRLAMBA SARVANGASANA (at wall on double blanket rolls): CAUTION: THIS IS Follow photos for progression of how to get in and out. When coming out, once buttocks is ONLY FOR THOSE ABLE TO DO SARVANGASANA UNSUPPORTED BY HANDS. back on chair seat and feet are on back of the chair upright, slowly slide the chair away from Be near a wall. Shoulder roll: Roll two blankets together from headstand size for shoulders. the wall until buttocks easily comes to floor: Head roll: Roll one blanket from headstand size to be placed above occipital ridge.

Personally, I find this to be very soothing. Although this may seem counter-intuitive for those with © Garth McLean © Garth McLean © Garth McLean lesions in the cervical spine, I found great relief from practicing this version of Sarvangasana even though I have had some of my worst lesions in my cervical spine. Avoid if L’Hermittes symptom is present (see above) or if eyes are affected.

Garth McLean © Garth McLean © © Garth McLean © Garth McLean

From straight legs, can add Karnipidasana w shins to wall to further extend cervical.

JANU SIRSASANA (with support of blankets, bolster or chair so that head is supported). PASCHIMOTTANASANA (with support of blankets/bolster for head support; 25 OR 50 Can also weight the back. See Paschimottanasana below. lb weight on back). If possible, weight on thighs as well, or weighted slanting plank on thighs so femur bones descend toward floor to further encourage nerve function in legs. Weight on back is placed so that the ribs move in and up, front surface of each rib moving from bottom to top.

PARSVA PAVANAMUKHTASANA (side forward twists). If using benches, straddle a VIPARITA KARANI at wall. If unable to keep legs straight, belt legs w sandbag weight on feet pavanamukhtasana bench. Turn slightly to extend over thigh. Extend forward to rest head on to again get bones to move deep into pelvis. Avoid during menstruation. bolsters placed on supports. If no benches are available, be on sticky mat and blanket, start with legs as in Trianga Mukha Ekapadapaschimottanasana. Have bolster perpendicular to straight leg hip. Turn over outer straight leg.Turn torso so that front surface of spine extends over bolster. Place chest of bent leg side of body on to the bolster first. Hold for 5 min each side.

With legs belted and sandbag weight on feet:

If unable to straighten legs, keep legs bent with calves resting on chair or bench (Salamba SAVASANA on bolster. Flat also ok. If feeling in legs is compromised, 50-100 lb. weight Viparita Karani): on thighs, blanket rolls supporting outer thighs, is very soothing. May also wish to put a small bolster behind knees. If hot or feeling anxious, have 10-25lb weight on forehead as well, with weight on sticky mat and encouraged to move slightly from hairline toward bridge of nose. This can also be done at wall with a sandbag on the forehead and blanket underneath skull. (not pictured) Use of a head wrap also helps to cool the brain and soothe the nerves.

Savasana w weight on thighs. Can add more weight insofar as possible It is also quite soothing to have a small weight to on the forehead to encourage the skin to move away from the hairline toward the eye brow line. So energy of the brain can be quiet.

USE OF EYEWRAP Continue to wrap the eye bandage around the head in the same direction, now with the full width of the bandage behind the head and around the forehead until you can tuck the end Using an Eyewrap can be beneficial to keep the brain cool or if suffering from Optic Neuri- of the bandage into the previously wrapped portion to secure the bandage. Ensure that the tis. Best to use a pliable cotton fabric eye wrap, similar to those used at the Iyengar Yoga bandage is snug but not tight. Once in place, position the index fingers by the sides of the Institute in Pune, India, rather than an elasticized bandage. nose and gently encourage the bandage to spread as you take the fingers to the temple skin Refer to Astadala Yoga Mala, Vol 7, Plates n.64-n.66, by BKS Iyengar for various ways to use to draw the outer temple skin back towards the back skull. With the wrap across the brow the eye wrap. line, the wrap can then be drawn slightly downward w the fingers to encourage the muscles For Optic Neuritis and double vision, which is often present in Multiple Sclerosis, I have found of the eyes to soften. The use of an eyewrap can be used throughout the practice to bring a relief by using the eye wrap in the following manner (siropatta bandha). sense of coolness to the eyes and brain.

Start by unrolling the eye wrap by about a 18 inches length feet, being careful to keep the © Garth McLean © Garth McLean © Garth McLean © Garth McLean © Garth McLean remainder of the eyewrap roll intact. Fold the now unrolled portion in half from bottom to top to make a narrow bandage of the unrolled portion.

Place the unrolled narrow portion of the bandage across the brow line. Draw the skin of the outer temples slightly backward with the wrap. Holding the wrap by the outer temples, wrap © Garth McLean © Garth McLean © Garth McLean n © Garth McLean © Garth McLean the bandage away from the forehead to the back skull, from the side of whichever eye is most effected. Slowly unroll the eye wrap around the back of the skull and under the occiput to bring wrap to the forehead, unwrap and continue with a narrow wrap at the browline. Slightly twist the narrowed portion of the bandage across the browline of the effected eye so as to gently encourage the eye to recede into its socket.

To remove the eyewrap and maintain a sense of peace, slowly unroll the wrap. Avoid “popping” the wrap off the head.

Caution: If the wrap it too tight on the skull, it may cause headache. Best to use under the guidance of a Certified Iyengar Yoga Teacher (“CIYT”).

SAMPLE SEQUENCES © Garth McLean 3 4 4 The following sequences are provided as a reference. Please practice under the guidance of a Certified Iyengar Yoga Teacher with courage and caution. Sequences can be abbreviated according to the student’s ability and capacity. The below sequences can be done in their entirety 2-3 times per week. PLEASE NOTE: Poses marked with an asterisk (*) are contraindicated for menstruation. Alternative poses while menstruating are offered following any poses marked in this manner. Refer to Yoga, A Gem for Women, by Geeta S. Iyengar, or consult a Certified Iyengar Yoga © Garth McLean © Garth McLean Teacher for an appropriate yoga practice program during menstruation. Or - Janu Sirsasana for Adho Mukha Savasana w rope support (3 min) or w Hands Menstruation at Wall (1-3 min) General Restorative Sequence

For your reference, pictures of the various poses are provided at the end of the sequence.

© Garth McLean 1. Supta Virasana 5 5 2. Supta Baddha Konasana 3. Side Bolster Twists 4. Adho Mukha Svanasana with support 5. Uttanasana w support 6. Sirsasana* or Rope Sirsasana* a. Viparita Karani (as alternate) 7. Dwi Pada Viparita Dandasana © Garth McLean 8. Chair Bharadvajasana 9. Chair Sarvangasana* Uttanasana w support (3 min) 10. Ardha Halasana* 11. Setu Bandha Sarvangasana 12. Janu Sirsasana © Garth McLean © Garth McLean 13. Savasana 6 6 *Avoid during Menstruation.

1 2 3

Rope Sirsasana* or Sirsasana* (5 min)

© Garth McLean © Garth McLean © Garth McLean If no ropes and independent Sirsasana has yet to be Ardha Halasana* (3-5 Setu Bandha Sarvangasana (5-10 min) — alternative to achieved, do Viparita Karani * min) Chair Sarvangasana and Ardha Haslasana (if no bench, build up cushions or folded blankets to create posterior body support)

© Garth McLean © Garth McLean © Garth McLean Dwi Pada Viparita Dandasana (5 Do Salamba Purvottanasana if Janu Sirsasana (2 min/ Savasana (5 min) min) - alternative for menstruation, the back is bothered by extending side) or Salamba Purvottanasana backward over chair

© Garth McLean © Garth McLean * As a reminder, poses marked with an asterisk are to be avoided on menstruation. Practice 8 9 9 the alternate pose that follows. If one is not menstruating, ok to do all poses.

Strength Building 1 During menstruation, please refer to Yoga, A Gem for Women, by Geeta S. Iyengar, or 1 consult a Certified Iyengar Yoga Teacher for an appropriate yoga practice program during menstruation. Exercise common sense when approaching the standing work. The standing poses can be done facing the trestle for further stability and support. Limit number of standing poses if one becomes fatigued. Rest in Uttanasana in between standing poses as required. If shaky, stick with Supta Padanghustasana I & II and proceed to Adho Mukha Svanasana and inversions. © Garth McLean © Garth McLean Supta Padanghustasana

For your reference, pictures of the various poses are provided at the end of the sequence.

1. Supta Padanghustasana 2. Adho Mukha Svanasana © Garth McLean A. Uttanasana w support 2 2 2 3. Tadasana 4. Utkatasana* 5. Utthita Trikonasana 6. Utthita Parsvakonasana 7. Virabhadrasana I 8. Prasarita Padottanasana © Garth McLean 9. Adho Mukha Svanasana © Garth McLean 10. Sirsasana and Urdhva Padma Sirsasana (once achieved)* Adho Mukha Svanasana (or Uttanasana w support) a. Rope Sirsasana* 11. Dwi Pada Viparita Dandasana w support of chair (as alternative to Sirsasana) 12. Bharadvajasana w chair 13. Salamba Sarvangasana* 14. Ardha Halasana* 15. Setu Bandha Sarvangasana w bench (as alternative to Salamba Sarvangasna, Ardha © Garth McLean © Garth McLean 3 Halasana and Viparita Karani) 3 3 3 16. Viparita Karani (practice Setu Bandha Sarvangasana (15. above) as an alternative, followed by Janu Sirsasana and other forward bends) 17. Savasana *Avoid during Menstruation.

Tadasana (and w brick between thighs to encourage inner thighs to work)

Utkatasana (at wall) - With back to wall, hold chair as necessary. Utthita Parsvakonasana w support Go in and out of pose several times.

Utthita Trikonasana w support Virabhadrasana I Note: If front leg knee buckles, angle a foam block behind the calf to act as a brake.

© Garth McLean © Garth McLean © Garth McLean Salamba Sarvangasana* Ardha Halasana* Sirsasana and Urdhva Padmasana in Sirsasana or Rope Sirsasana* Avoid during menstruation. © Garth McLean © Garth McLean 15 15 15

© Garth McLean Setu Bandha Sarvangasana w bench (5-8 min as alternative Followed by Janu to Salamba Sarvangasna, Ardha Halasana and Viparita Sirsasana (2 min/side) © Garth McLean Karani) (if no bench, build up cushions or folded blankets to Dwi Pada Viparita Dandasana Do Salamba Purvottanasana create posterior body support) (5 min) as alternative to if the back is bothered by Sirsasana extending backward over chair 16 © Garth McLean 17 17 © Garth McLean 12

Viparita Karani* (*see Setu Bandha Savasana Bharadvajasana w chair Sarvangasana and Janu Sirsasana #15 above as alternative)

* As a reminder, poses marked with an asterisk are to be avoided on menstruation. Practice the alternate pose that follows. If one is not menstruating, ok to do all poses. © All rights reserved 78 79 © All rights reserved Guideline: Asanas Guideline: Asanas

PRACTICAL EXPERIENCE FURTHER EXPLANATION FOR TEACHERS

When the MS has been in a flare up and I have been symptomatic As a teacher, one has to be vigilant, courageous and cautious. I have found alternating one day with supported forward bends and the next with supported chest openers to be quite helpful physically and psychologically. I have personally found Generally, for MS students new to yoga, I recommend the student(s) begin with supine asana inverting (headstand, shoulder stand and/or variations and viparita karani) twice a day for to allow their nerves to first settle down before asking them to work. a combined total time of 30 minutes per session to be most helpful in relieving symptoms and getting things back in remission. Specifically the pindasana cycle in Sarvangasana has We want to offer some stability with support of the props to offer feedback from the peripheral been of great benefit in the maitenance of keeping the legs working and the condition in nerves toward the motor nerves so that there can be a possibility of enhanced mobility. remission. I would suggest foregoing long stays in the forward bending asanas if the student is subject to depression (common with MS patients) or if bowel incontinence is present. Damage to or lesions in the cerebellum can cause balance and movement disorders. When my eyes were affected and my vision was lost/ compromised due to MS induced Inversions, in my opinion, are key to help with the health of the cerebellum and overall health acute optic neuritis, I used an eyewrap and found longer stays (minimum 20 min) in Setu to the brain. I recommend incorporating some aspect of inversions as part of the student(s)’ Bandha Sarvangasana (on bench), Viparita Karani (sandbag on feet) as well as ongoing daily program as well as encouraging the muscles of the body to move and work to Parsvapavana Mukhtasana (side bolster twists on floor, with bolster) to be soothing whatever degree possible so they don’t forget their job. and of great benefit. In terms of ataxia, coordination, movement, gait, and balance disorders, depending on the When my eyes have not been affected, I maintain the inversions. However, if I feel weak, I take ability and severity of the case, look to standing work, and the various stages toward the rope Sirsasana and Sarvangasana (with chair) or Setu Bandha Sarvangasana work, to help build strength and refine coordination of movement. (with bench), inverting twice daily, morning and afternoon. If I have been symptomatic with most other symptoms, I still invert approximately 30-45 minutes per day practicing the The standing work and its various stages may help the body reformulate and translate the Sirsasana and Sarvangasana cycles. During symptomatic times, I generally avoid relationship to movement and balance. In general, I find it better to do the standing work in all twists with clasps, as I have found them to be too heating and this has worsened my the morning when student has more energy. symptoms. I also avoid the more physically demanding work. Reclined vs seated Ujjayi and Viloma pranayama practices have also proven to be very helpful in symptomatic times. There are no guarantees, however, the act of getting up on one’s feet, when possible, and coordinating arm and leg movements may impact the mind/body connection. It might be When the MS is in remission and I am symptom free worth it to continue with this despite the students’ potential fatigue (after doing yogasana). I engage in a regular practice, take the support of props as necessary and proceed with Over time, the body may be able to make the translation to find a sense of balance and courage and caution. I invert a minimum of 30-40 minutes daily and all seated pranayama enhanced coordination. is very beneficial. Depending on the ability and or severity of the case, you could have student(s) with their back to a wall with a trestle in front of them so they are between the wall and the trestle, and facing the trestle for the standing work. Have the feet appropriately supported with bricks. The student can then hold the trestle in front and at the same time have the wall behind to feel secure with the support in front of and behind the body.

When working on the trestle, brace back foot against the trestle, as necessary so student can be stable. Use a 1/4 round, under front foot to activate the muscles of the legs and help bring the bones into the sockets. If no 1/4 round is available, use a soft brick under the foot. The arms can be supported on the trestle so that the organic body does not drop and the legs are not doing all the work.

Avoid holding the poses for long periods of time. The student should feel refreshed not I find it beneficial when working to regain feeling in a particular area that is compromised, depleted. As the teacher you must keep a vigilant watch. to work to bring some “resistance” in those areas. For example, sitting on a block in badda konasana with back against a wall helps me with urinary and bowel incontinence issues, If no trestle is available, the student can work with the back against a wall, and also with the which many people with MS experience. I have also found this helps to connect the femur back of head against the wall to cool the brain. Student may also look down instead of up bones into the sockets to activate the nerves if any feeling is compromised in the lower torso/ to help keep the balance and the brain cool. pelvis.

Allow time to give the student(s) appropriate rest after the standing work so that they can recover. If the student starts to to shake or collapse, switch over to Supta Padanghustasana or FOR MORE EXPERIENCED STUDENTS. other resting asana to offer recovery. Fatigue is also an issue for many with MS. For fatigue, Ardha Halasana with support, Work with patience, sensitivity, observation and above all sensibility. (5-10 minutes) with head wrap works great. You may wish to have some light weight (heavy bolster) on the back of the calves moving slightly toward the heels if possible. I find this pose It is vital to draw on your own practice and experiential knowledge to gauge how you might serves to quickly bring the energy level back. If unable to straighten legs in Arda Halasana, be able to modify poses, with support of props as necessary, in order to help the student(s) take supported Karni Pidasana who may be challenged in their movements and strength. If the student is experienced with Salamba Sarvangasana, begin to learn Nirlamba As a reminder, this is only a starting point of where to begin. Sarvangasana (at the wall) with a double rolled blanket under the shoulders and one rolled blanket above the occipital ridge. This gives a very strong stretch to the back of the If possible, try to keep student as part of the regular class to avoid a feeling of isolation. neck. Although it may seem contra-indicated, I found practicing this helped bring some elasticity to the lesions in my neck. I have lesions in my cervical spine at C2, C3, C5. Wait to Always check with the student to see what symptoms the student may be experiencing. give this to a student until they have a stronger and more established Sarvangasana practice. AVOID if the L’Hermitte’s Symptom is active. One must respect the student’s current symptoms, physical, mental and emotional condition, mobility and maturity. When working to achieve the structural archetype of an asana, Additionally, the binding of the legs in Padmasana and the Urdhva Padmasana cycle in remember to look to the foundation of the pose and to work to align the anterior spine with Salamba Sirsasana and Salamba Sarvangasana is also of extreme benefit for the connectivity the posterior spine. Be observant that the organs of the body are lifted and are not dropped of the legs and the health of the digestive and reproductive organs of body. or gripped. If so, switch over to a more restorative practice to offer good support for the organic body. Without “overdoing,” encourage a firmness and compactness to the bones, Paschimottanasana with weight. With a folded stick mat on the back, place a plate especially of the legs, to overcome the “looseness” or lack of control already inherent with weight on the back to move the ribs (with the weight) so the bottom of each rib moves up and the condition. in. I currently look to this to extend the front surface of the spine. It also helps to regain some feeling in my right leg and foot. There are many more involved adaptations for people who may be challenged to the point where they are unable to use the legs to walk without assistance. A more adaptive approach, Days when I am extremely fatigued, I generally stick to a pranayama practice focusing employing use of chairs and other significant prop configuration may be necessary. primarily on Ujjayi inhalations, either reclined or with back supported at a wall, followed by a more restorative asana practice.

INDEX OF ASANA

ASANA PAGE

Adho Mukha Svanasana 39, 40, 71, 75, 77 Ardha Chandrasana 17, 18, 26 Ardha Halasana 57, 73, 79 Bharadvajasana (with chair) 50, 51, 72, 78 Dwi Pada Viparita Dandasana (with chair) 47, 48, 72, 77 Eye Wrap 68, 69 Janu Sirsasna 60, 61, 71, 73, 79 Karni Pidasana in Nirlamba Sarvangasana 58, 59 Nirlamba Sarvangasana 58, 59 Paschimottanasana 61 Parsva Pavanamukhtasana 62 Parsvottanasana 20, 21, 26 Prasarita Padottanasana 26, 41 42, 77 Salamba Purvottanasana (w chairs) 46, 72, 78 Salamba Sarvangasana (with chair) 54, 55 ,72, 79 Salamba Sarvangasana (without chair) 56, 79 Salamba Sirsasana 43, 44, 45, 71, 78 Savasana 64, 66, 67, 73, 79 Setubanda Sarvangasana (with bench support). 52, 73, 79 Side Bolster Twist 62, 70 Supta Baddha Konasana 37, 38, 70 Supta Padanghustasana I 4, 27, 75 Supta Padanghustasana II 28, 29,30 Supta Swastikasana 35 DISCLAIMER: Prior to commencing any yoga or exercise program, please seek the advice of Supta Virasana 33, 34, 70 your health care provider. The information presented herein is for reference and informational Tadasana 9, 25, 75 purposes and is not intended to diagnose, treat or cure multiple sclerosis and should not be Urdhva Baddanguliasana 9, 25 considered as a replacement for expert medical advice. To the extent permissible by law, Urdhva Prasarita Padasana (at wall) 31, 32 Garth McLean, BKS Iyengar, the Estate of BKS Iyengar, Geeta Iyengar, Manouso Manos, Ustrasana (w chair support) 49 Patricia Walden and any of their respective agents, representatives, employees, heirs or Utkatasana 22, 76 assigns, collectively and/or individually, hereby disclaim any liability for any injuries incurred Uttanasana w support 24, 71, 75 as a result of the information contained in this guideline. Utthita Parsvakonasana 14, 15, 24, 25, 76 Utthita Trikonasana 11, 12, 23, 25, 76 All asana photos in this guideline are the property of Garth McLean and are protected by Viparita Karani 63, 64, 72, 79 copyright. Unauthorized reproduction is in violation of copyright laws. Virabhadrasana I 16, 25, 77 © June 2017 Virabhadrasana II 13, 25 Virabhadrasana III 19, 26 Vrksasana 10, 25