More than 22 years ago, Martha Patt's life changed when she was diagnosed with multiple sclerosis. Suddenly suffering from intense pain in her legs, bouts of numbness, and spotty vision, she lost her job and her boyfriend, and was advised to go on welfare. Things looked bad, until Patt noticed that her nascent yoga practice seemed to alleviate her symptoms. She devoted herself to the practice, and began to see significant improvements. Eventually she found out that others were doing the same. After studying with Eric Small, a well-known yogi with MS who has taught thousands of MS patients, Patt found herself teaching others how yoga can increase mobility, ease tingling and pain, and calm the anxiety and depression often associated with the disease.
MS is believed to be a disease of the central nervous system. It is a little-understood autoimmune condition that damages the protective coating that surrounds nerve fibers. MS can have a wide range of symptoms, from tingling and numbness to general pain, muscle spasticity, bowel and bladder dysfunction, and cognitive problems. With some 400,000 people diagnosed with MS in the United States alone, it's possible that one day someone with MS will enter your yoga classroom. If you really want to help MS patients over the long term, you should study with an expert on adaptive yoga for MS and learn as much as you can about the condition. In the meantime, you can prepare yourself to help MS-affected yogis as you would with any illness: by learning the basics about the disease and the ways yoga can help manage its symptoms.
On a recent afternoon in Berkeley, California, where she teaches a weekly yoga class, Patt, 48, said that yoga helps her students on many levels. "When you're walking around like this because your left side is weak," she explained, twisting and bending her body to one side, then everything is off. Sometimes you feel like, 'These legs just hurt so much, I just don't want to move.' And then the student becomes the chair they sit in all day. They lose their mobility. Doing yoga gets them out of the chair. It's liberating. You have the option to see yourself as something other than the chair." Beyond that, Patt's students find that many of their symptoms subside, and flare-upsa difficult aspect of certain types of MSare easier to manage.
A Case-by-Case Basis
Many people with MS are so disabled that they aren't likely to stroll in to a regular yoga class. But others are not visibly affected, either because the disease has not progressed or because the symptoms they experience are hard to see, such as problems with cognition or non-disabling pain. So as a first step, Patt recommends teachers keep an open mind. Even if you don't know anything about MS, approach MS patients as you would any other student with special needs.
From his home base in southern California, Patt's teacher Eric Small, 75, manages his MS with a daily yoga practice. Small, who studied extensively with B.K.S Iyengar and has a book (Yoga for MS) coming out this summer, cautions that teachers should proceed carefully with MS-affected students. "You're dealing with a disease that has no boundaries. You can't just say, 'Open your sticky mat and join us.' The person with MS will get very frustrated." Because there are so many different symptoms and because symptoms can vary widely week to week, if an MS student you don't know shows up to a regular class, Small recommends using restorative poses until you can learn more about his or her specific needs.
"It would be great if everybody with MS would feel comfortable walking into a class and saying, 'I have MS,' but there's a lot of ignorance. So first: Don't get a blank stare. Say, 'Tell me what your considerations are,'" Patt advises. And, she adds, "Don't think that you're limited in what you can do together because of the adaptations."
Pose Adaptations and Pranayama
In a class designed for MS, Small suggests starting and ending the practice with Viparita Karani (Legs-Up-the-Wall Pose), which stimulates the brain without agitation. "Most people with MS are more sedentary, so turning them into an inversion gets fresh blood into their bodies," he says. "Second, you're dealing with a nervous system that's really whacked out, and Viparita Karani is really calming." Small suggests using a belt around the thighs to relieve tension.
In general, Small says, it's important to keep students relaxed and breathing deeply, and out of stress. If the body begins to shake, that agitates the system, so Small recommends students hold non restorative poses for just 10 seconds. "What's really more healing than anything else is that quietness," he says. Small also says students shouldn't hold the breath, but that pranayama is extremely beneficial.
Small and Patt agree that all yoga poses are helpful, with the exception of full inversions, which should only be attempted by experienced students. For those with limited mobility, they suggest keeping an open mind about ways to adapt poses, using chairs, blocks, blankets, the walls, and the floor. Tadasana (Mountain Pose) can be done sitting, for example, and Virabhadrasana I and II (Warrior I and II Poses) can be done kneeling or with chairs. Many posesincluding backward and forward bends and spinal twistscan be done while seated in a wheelchair. For more specific suggestions, see Small and Patt's websites (below); both have instructional videos that offer more options.
Encourage Daily Practice
Consistency, Small says, is essential for students to realize the benefits. He says students should practice six days a weekeven if it's just for 20 minutes a dayto have a palpable effect on their MS symptoms. In recent years, regular yoga practice has become more accepted by doctors as a palliative for MS, and there are several studies under way to prove its benefits. One study, a 2004 project by the Oregon Health and Science University, found that after six months of practice, yoga significantly reduced fatigue in MS patients.
As they improve physically, MS patients also find new reservoirs of mental strength, which Patt says is essential. "They have to wake up every morning and say, 'I'm worth something today,'" she says. Yoga, she believes, helps make that possible.
For more information, visit sites for Martha Patt and Eric Small.
Rachel Brahinsky is a writer and yoga teacher in San Francisco.