Yoga and MS A Practice Guideline © Garth McLean 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. © Garth McLean 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 1 © All rights reserved Guideline: Overview Guideline: Overview 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 , i t 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! © All rights reserved 2 3 © All rights reserved Guideline: Overview Guideline: Overview 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 objec​​t , 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. © Garth McLean What has become possible through continued dedicated practice. © All rights reserved 4 5 © All rights reserved Guideline: Overview Guideline: Asanas 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.