By Sara Merrick-Albano, E-RYT, C-IAYT
Multiple Sclerosis (MS) can be a daunting diagnosis for patients, and affects over 2.3 million people.1 Yoga therapy, a recognized form of complementary medicine (CAM), can be an effective tool to help mitigate symptoms of MS. It can also help patients cope with the physiological implications of the disease. In an article published in the International Journal of Yoga, Woodyard defines yoga therapy as “the application of yoga postures and practice to the treatment of health conditions (that) involves instruction in yogic practices and teachings to prevent, reduce or alleviate structural, physiological, emotional and spiritual pain, suffering or limitations.”2
Research has shown that “the practice of yoga may be a safe and effective way of managing symptoms of MS.”3 Through yoga therapy sessions, patients may experience improved balance and coordination, reduced fatigue, improved flexibility and reduced spasticity, enhanced range of motion, maintained muscle tone and strength, reduced perceived pain intensity, increased sense of stability, and reduced stress.4
Additionally, due to the chronic and progressive neurological nature of MS, an MS diagnosis may trigger a range of difficult emotions such as anxiety, depression, fear, grief, and frustration. An experienced yoga therapist can provide support to patients as they access difficult emotions, as well as guide patients through movements and mindfulness techniques that may help relieve and mitigate symptoms of MS. In this way, yoga therapy paves the way for further healing.
Why is Yoga Therapy Well-Suited to Help Treat Patients with Multiple Sclerosis?
As a yoga therapist, it is important to have a comprehensive understanding of the four main types of MS: Clinically Isolated Syndrome (CIS), Relapsing-remitting MS (RRMS), Secondary progressive MS (SPMS), and Primary progressive MS (PPMS). It is equally important to understand how MS symptoms are affecting the MS client, as we tailor our work to each individual person. Depending on the type and progression of MS, yoga therapy sessions may vary. It takes experience and expertise to understand how to help patients process their challenging diagnosis, and guide them through yoga practices that may help mitigate their MS symptoms.
1. Improve balance and coordination
A common symptom of MS is impaired balance and coordination, leading to difficulties in daily activities and increasing the risk of falls. Yoga therapy can incorporate postures that work to improve balance and stability in individuals with MS. A recent study published in the Journal of Bodywork and Movement Therapies quantitatively “evaluated the effects of a 12-week yoga intervention on fatigue, balance, and gait” finding statistically significant improvements in balance (p = 0.027), as well as improvements in fatigue, step length, and walking speed.5
For example, a yoga therapist might utilize cross-body work to maintain and strengthen the brain-body connection. This can look like leading the MS client through “Warrior I” pose with one arm up, or “Locust” pose with alternating arms and legs, with cues to sense the opposite limbs.
2. Reduce fatigue
Fatigue is another prominent symptom of MS and can be quite debilitating for patients. Research has shown that yoga therapy is a beneficial complementary medicine for reducing fatigue in patients with MS.6,7 For example, in a study published in the Annals of Indian Academy of Neurology medical journal, Oken et al. found that a “6-month intervention in yoga therapy improved fatigue to a comparable program in traditional exercise.”8
The first method yoga therapy uses to mitigate fatigue symptoms is through a specific type of guided meditation called yoga nidra. By calming the sympathetic nervous system and activating the parasympathetic nervous system, consistent practice of yoga nidra facilitates a deepened ability for the central nervous system to wind down and relax.9
Second, yoga therapists lead MS patients through physical postures in a way that helps them understand their own sense of effort. This way, a patient can start to become aware of how much effort they are putting in at any time, in a controlled and safe yoga therapy environment. Through practicing yoga in a therapeutic setting, patients start to understand the amount of effort and energy needed to carry out the tasks and chores of daily living. This tends to positively shift the way they perceive themselves functioning in the world.
Yoga therapy teaches patients to answer the following questions for themselves:
- Can I still practice the pose without going 100%?
- How can my working pace for this pose translate to the effort I put into my daily life?
3. Manage spasticity and muscle tension
Yoga therapy may reduce spasticity and improve muscle strength and flexibility in individuals with MS. According to an article by Palukuru et al., “the beneficial effects of yoga in patients with MS point to an improvement in body flexibility and muscular strength.”10
For example, yoga therapists often teach MS patients how to physically transition in and out of a yoga pose to increase blood flow to muscles, followed by stretching that area. Clinical evidence suggests that movement in and out of the pose helps to increase flexibility in patients diagnosed with MS.
4. Maintain strength
Another common symptom of MS is muscle weakness, which could lead to the secondary symptoms of loss of muscle tone, poor posture, decreased bone density and shallow breathing. Yoga therapy teaches patients physical postures that help maintain strength, as well as slow the progression of these secondary symptoms.11
Rather than isolate specific muscle groups, as is common in physical therapy, yoga therapists work with MS patients on postures that can help maintain strength across the entire body. Targeted physical therapy work can be very useful, but yoga therapy is unique in that it provides support for the whole body-mind system.12, 13
5. Pain Management
A recent study published by Neurology and Therapy found that yoga may “lead to clinically meaningful reductions in pain interference scores.” This suggests that yoga therapy could be a viable complementary medicine to reduce pain intensity in MS patients.14
By combining stress-reducing mindfulness practices with low-impact movement, yoga therapy can help mitigate pain symptoms.15 As yoga therapy focuses on the mind-body system as a whole, it is a uniquely situated complementary modality to help patients deal with pain and even reduce pain intensity.
To help MS patients manage pain, yoga therapy sessions guide patients through practices such as gentle stretching, healthy breathing techniques, and mindfulness practices.16 This might include teaching patients micro-practices they can incorporate throughout their daily life for some pain relief and potential long-term pain reduction.17
6. Maintain emotional and physical stability
In addition to physical symptoms, MS can also lead to disruptive instability in life, as well as mental health challenges. This is where yoga therapy comes in as a complementary health tool. As patients decide between medications, experiment with different diets, and adjust their lifestyle to work with and around their MS, a yoga therapist can provide accountability and stability throughout this process.
Additionally, challenging emotions stored in the body can be destabilizing for MS patients. An experienced yoga therapist might use breathing techniques, as well as gentle physical postures, to help MS patients build awareness of difficult emotions that can develop as “muscle tension or feelings of disintegration in the affected body areas: head, back and limbs.”18 A recent study, outlined in The Body Keeps the Score by Bessel van der Kolk, found that “twenty weeks of yoga practice increased activation of the basic self-system, the insula, and the medial prefrontal cortex,” leading to a general perception of increased agency in participants’ lives.19
Finally, if an MS client needs help cognitively processing overwhelming emotions, a yoga therapist will refer the client to a talk therapist for further mental health treatment.
7. Reduce stress and anxiety
Living with a chronic condition like MS can be stressful and anxiety-inducing for patients. The approach used by yoga therapists is unique in that it takes into account the entire mind-body system as one entity. Thus, mindfulness practices such as breathing, chanting and meditation are core practices in yoga therapy.
Mindfulness practices are proven to reduce stress and anxiety. As the patient learns to slow the breath, the body responds by “shifting the balance from the sympathetic nervous system and the flight-or-fight response to the parasympathetic system,” thus lowering heart rate, decreasing blood pressure, lowering cortisol levels, and increasing blood flow to the intestines and vital organs.20 Breathing regulates the nervous system, therefore assisting in mitigating symptoms of stress, anxiety, and depression in patients struggling with MS.
Yoga therapy works well as a complementary medicine for degenerative diseases like MS, when difficult thoughts and emotions might come up for diagnosed patients. Yogic practices lead “to an inhibition of the posterior or sympathetic area of the hypothalamus [that] optimizes the body’s sympathetic responses to stressful stimuli and restores autonomic regulatory reflex mechanisms associated with stress.”21 By quieting the mind and breaking up patterns of thought, meditation and chanting can increase the capacity for MS patients to deal with fear, anxiety, and stress.
Yoga Therapy is Well-Positioned as Complementary Medicine for Multiple Sclerosis Treatment
Yoga therapy should be practiced under the guidance of a trained and experienced yoga therapist, who can tailor the practice to the individual needs and abilities of the MS patient. Each body is different, and each patient experiences a unique manifestation of MS symptoms. Yoga therapists are well-positioned to treat the client in front of them as as a whole individual, providing complementary care to MS patients.
Yoga Therapy Associates administers yoga therapy for individuals suffering from physical and mental chronic health conditions.
We accept patients referred by their physician for complementary care supporting healing, reducing suffering from chronic conditions, and slowing degenerative disease progression.
Are you interested in referring your MS patients to yoga therapy? Request a meeting today to meet with a representative of YTA and learn more about how yoga therapy can help your patients.
Yoga Therapy Associates offers yoga therapy at four locations in Connecticut and via telehealth.
- Rogers, K. A., & MacDonald, M. (2015). Therapeutic Yoga: Symptom Management for Multiple Sclerosis. Journal of alternative and complementary medicine (New York, N.Y.), 21(11), 655–659. https://doi.org/10.1089/acm.2015.0015
- Woodyard, C. (2011). Exploring the therapeutic effects of yoga and its ability to increase quality of life. International journal of yoga, 4(2), 49–54. https://doi.org/10.4103/0973-6131.85485
- Rogers, K. A., & MacDonald, M.
- Woodyard, C.
- Guner, S., & Inanici, F. (2015). Yoga therapy and ambulatory multiple sclerosis Assessment of gait analysis parameters, fatigue and balance. Journal of bodywork and movement therapies, 19(1),72-81. https://doi.org/10.1016/j.jbmt.2014.04.004
- Oken, B.S., et al. (2006). Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Alternative therapies in health and medicine, 12(1), 40-47.
- Mishra, S. K., Singh, P., Bunch, S. J., & Zhang, R. (2012). The therapeutic value of yoga in neurological disorders. Annals of Indian Academy of Neurology, 15(4), 247–254. https://doi.org/10.4103/0972-2327.104328
- Palukuru, S. et al. (2021). Content Validity of an Integrated Yoga Module for Practice During Remission in Relapsing–Remitting Multiple Sclerosis Patients. Annals of neurosciences, 28(1-2), 29-38. https://doi.org/10.1177/09727531211023754
- Rogers, K. A., & MacDonald, M.
- Kausthub, D. et al. (2005). The Yoga of Healing: Exploring Yoga’s Holistic Model for Health and Well-being. International journal of yoga therapy, 15(1), 17–39. https://doi.org/10.17761/ijyt.15.1.p501l33535230737
- Nourollahimoghadam, E., et al. (2021). Therapeutic role of yoga in neuropsychological disorders. World journal of psychiatry, 11(10), 754–773. https://doi.org/10.5498/wjp.v11.i10.754
- Lakin, L., et al. (2021). Comprehensive Approach to Management of Multiple Sclerosis: Addressing Invisible Symptoms-A Narrative Review. Neurology and therapy, 10(1), 75–98. https://doi.org/10.1007/s40120-021-00239-2
- Tavee, J., et al. (2011). Effects of meditation on pain and quality of life in multiple sclerosis and peripheral neuropathy: a pilot study. International journal of MS care, 13(4), 163–168. https://doi.org/10.7224/1537-2073-13.4.163
- Lakin, L. et al.
- van der Kolk, B. (2015). The body keeps the score (pp. 267). Penguin Publishing Group.
- Ibid (pp. 277).
- Woodyard, C.