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A BASIC YOGA THERAPY PROGRAMME FOR PATIENTS OF MULTIPLE SCLEROSIS

Conference Paper · January 2011

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 A BASIC YOGA THERAPY PROGRAMME FOR PATIENTS OF
MULTIPLE SCLEROSIS
By
Yogacharya Dr ANANDA BALAYOGI BHAVANANI
M.B.B.S, A.D.Y, D.S.M, D.P.C, P.G.D.F.H, P.G.D.Y, F.I.A.Y
Chairman and Consultant Yoga Therapist, ICYER at Ananda Ashram, Pondicherry,
South India-605 104. www.icyer.com and www.rishiculture.org

INTRODUCTION TO MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is a disease in which the nerves of the central nervous
system (brain and spinal cord) degenerate. Myelin, which provides a covering or
insulation for nerves, improves the conduction of impulses along the nerves and also
is important for maintaining the health of the nerves. In MS, inflammation causes
the myelin to disappear consequently slowing down the electrical impulses along the
nerves and also nerves themselves are damaged. As more and more nerves are
affected, a person experiences a progressive interference with functions such as
vision, speech, walking, writing, and memory.
The cause of multiple sclerosis is still unknown though the recent research has
focused on the immune system and genetics for explanations. In MS, researchers
suspect that a foreign agent such as a virus alters the immune system so that the
immune system perceives myelin as an intruder and attacks it. The attack by the
immune system on the tissues that it is supposed to protect is called autoimmunity,
and MS is believed to be a disease of autoimmunity. While some of the myelin may
be repaired after the assault, some of the nerves are stripped of their myelin
covering (become demyelinated). Scarring also occurs, and material is deposited
into the scars and forms plaques.
Although its role is unclear, genetics may play a role in multiple sclerosis. European
gypsies, Eskimos and African Bantu essentially do not develop multiple sclerosis,
while Native Indians of North and South America, Japanese and other Asian groups
have a low incidence. The general population has less than a one-percent chance of
developing multiple sclerosis. The chance increases in families where a first-degree
relative has the disease. Thus, a brother, sister, parent, or child of a person with
multiple sclerosis stands a one-percent to three percent chance of developing
multiple sclerosis. Similarly, an identical twin runs a nearly 30% chance of acquiring
multiple sclerosis whereas a non-identical twin has only a 4% chance if the other
twin has the disease. These statistics suggest that genetic factors play a major
role in multiple sclerosis. However, other data suggest that environmental factors
also play an important role.
There are different clinical manifestations of multiple sclerosis. During an attack, a
person experiences a sudden deterioration in normal physical abilities that may
range from mild to severe. This attack, sometimes referred to as an exacerbation
of multiple sclerosis, typically lasts more than 24 hours and generally more than a
few weeks (rarely more than four weeks).
About 65%-80% of individuals begin with relapsing-remitting (RR) MS, the most
common type. In this type, they experience a series of attacks followed by
complete or partial disappearance of the symptoms (remission) until another attack
occurs (relapse). It may be weeks to decades between relapses.
In primary-progressive (PP) MS, there is a continuous, gradual decline in a
person's physical abilities from the outset rather than relapses. About 10%-20% of
individuals begin with PP-MS.
Those beginning with RR-MS can then enter a phase where relapses are rare but
more disability accumulates, and are said to have secondary-progressive (SP) MS.
About 50% of RR-MS individuals will develop SP-MS within 10 years. Over several
decades, most RR-MS persons will experience progression to SP-MS. Progressive-
Relapsing (PR) MS is a type of multiple sclerosis characterized by a steady decline
in abilities accompanied by sporadic attacks. There are cases of MS that are mild
and can be recognized only retrospectively after many years and also rare cases of
extremely rapid progression of multiple sclerosis symptoms (sometimes fatal)
known as malignant or fulminant (Marburg variant) MS.
Symptoms of multiple sclerosis may be single or multiple and may range from mild
to severe in intensity and short to long in duration. Complete or partial remission
from symptoms occurs early in about 70% of individuals with multiple sclerosis.
Visual disturbances are common while weakness with or without difficulties with
coordination and balance may occur early. Muscle spasms, fatigue, numbness, and
prickling pain are also common symptoms. There may be a loss of sensation, speech
impediment, tremors, or dizziness. Fifty-percent of people experience mental
changes such as decreased concentration, attention deficits, some degree
of memory loss, inability to perform sequential tasks, or impairment in judgment.
Other symptoms may include depression, manic depression, paranoia, or an
uncontrollable urge to laugh and weep. As the disease worsens, individuals may
experience sexual dysfunction or reduced bowel and bladder control.
There are many issues for the patient and physician to consider in treating multiple
sclerosis. Goals of the therapy may include improving the speed of recovery from
attacks, reducing the number of attacks or the number of MRI lesions;
or attempting to slow progression of the disease. An additional goal is relief from
complications due to the loss of function of affected organs (treatment with drugs
aimed at specific symptoms). Support groups or counseling may be helpful for
patients and their families whose lives may be affected directly by multiple
sclerosis.
Once goals have been set, initial therapy may include medications to manage
attacks, symptoms, or both. An understanding of the potential side effects of
drugs is critical for the patient because sometimes side effects alone deter
patients from drug therapy. Patients may choose to avoid drugs altogether or
choose an alternative drug that may offer relief with fewer side effects. A
continuous dialogue between the patient and physician about the medications is
important in determining the needs for treatment.
Drugs known to affect the immune system have become the primary focus for
managing multiple sclerosis. Initially, corticosteroids, such as prednisone or
methylprednisolone were widely used. However, since their effect on the immune
system is non-specific (general) and they may use may cause numerous side effects,
corticosteroids now tend to be used to manage only severe multiple sclerosis
attacks (that is, attacks leading to physical disability or causing pain).
Since the mid 1990’s medications that alter the immune system, particularly
interferons, have been used to manage multiple sclerosis. Interferons are protein
messengers that cells of the immune system manufacture and use to communicate
with one another. There are different types of interferons, such as alpha, beta, and
gamma. All interferons have the ability to regulate the immune system and play an
important role in protecting against intruders including viruses.
Physical therapy is advised to help manage complications associated with multiple
sclerosis. This is especially useful in those who experience difficulty in walking,
muscle spasticity or weakness. Yoga practices can be used to help in these cases as
also in managing other complications such as fatigue and emotional outbursts,
constipation, bladder and sexual dysfunction and pain.

AIM OF THE YOGA THERAPY PROGRAMME:

1. Reduce stress levels that are an aggravating factor
2. Normalise psycho-neuro-immune function that is deranged
3. Improve mind-body harmony
4. Stretch and relax all major muscle groups
5. Provide a sense of complete psychosomatic relaxation
6. Strengthen the self healing potential
7. Improve self confidence and self responsibility
 8. Improve quality of life
9. Develop a positive outlook towards life itself

YOGIC COUNSELLING:
Yogic counselling is a vital tool in Yoga Chikitsa and deals with a wide array of topics
that need to be introduced at opportune moments. This enables the development of
a positive outlook towards life as well as helps improve the self reliance, self
confidence and quality of life for the patient. Concepts of Swadhyaya
(introspectional self analysis), Pranayama (techniques of vital energy control),
Pratyahara (sensory withdrawal), Dharana (intense concentration), Dhyana
(meditational oneness) and Bhajana (devotional music) and their role in stabilizing
emotional turmoil and in relieving stress as well as mental fatigue needs to be
brought to the fore. They bring about an excellent sense of emotional balance that
is vital for good health and group work helps in bringing about emotional balance
that is essential for good health.
Yoga encourages us to step back and take an objective view of our habitual patterns
of behaviour and thoughts. This enables us to cope better with situations that
normally put our bodies and minds under strain. Maharishi Patanjali has emphasized
the need to develop following qualities in order to become mentally balanced humane
beings: Vairagya (detached, dispassionate attitude), Chitta Prasadanam (acceptance
of the Divine Will), Maitri (friendliness towards those who are at peace with
themselves), Karuna (compassion for the suffering), Mudita (cheerfulness towards
the virtuous) and Upekshanam (indifference and avoidance of the evil) etc. Adoption
of the “Right Attitude” is one of the most important aspects of Yoga as a therapy
and if this is not done it is merely Yogopathy and not Yoga Chikitsa.
It is important to stress on the necessity of developing the ability to relax as well
as a sense of relaxation in daily life for this is a central element in Yoga. The state
of relaxation is the body’s own way of recharging its cells and helps to ease
physical, emotional and mental tensions. Satsangha (spiritual gathering seeking
knowledge of the reality) and Bhajana sessions are important aspects of Yogic
therapy that are often neglected in favour of physical therapies alone. Helping
patients understand their inner spiritual nature and realize that “Oneness” is health
whereas “Duality” is disease; is most important. We cannot remain lonely, depressed
and diseased if we realize that we are part of this wonderful, happy and healthy
Universe (Multiverse).
Yoga improves pain tolerance and provides an improved quality of life. It can be
safely said that Yoga helps us endure conditions that it may not be able to cure.
This is vital in end life situations where it is important that the patient has a sense
of improved quality of life during their end days. Yoga can also benefit caretakers
of such terminal patients who are under great stress themselves. The right-use-
ness of these modalities according to condition and needs of patients will enable us
to strike at the root cause of the disease and by correcting its origin. If this is
done properly, the manifestation of the disease corrects itself and health and
harmony can manifest once again.

PRACTICAL COMPONENTS OF THE YOGA THERAPY PROGRAMME

1. General Advise:
• Avoid lifting weights: If you must lift anything off the ground, make
sure that you bend the knees when bending down to lift it and then
straighten the knees as you come up. Take someone’s help if the
object is too heavy. Don’t overestimate your power!
• Take adequate rest. Don’t tire yourself. When lying down it is best to
lie on the side. Use a thin and hard pillow to support the head and
neck
2. Dietary habits:
• Maintain adequate hydration
• Take adequate quantities of fresh fruits, green vegetable salads and
sprouts.
• Avoid refined foodstuffs and junk foods.
• Green leafy vegetables are important sources of vitamins that help
regeneration.
• Vitamin C in citrus fruits will aid the healing process.
• Honey in warm water or herbal teas are good for cleansing the bowels
and relieve constipation.
3. Self Traction: This technique helps to stretch the entire spinal and para
spinal areas reliving any compression that may be present in this region. Lie
down in a supine position and gently turn the head from side to side as if the
head is a bottle cap and is being taken off the bottle. Let the head move
away from the body pulling the upper part of the spine upwards. Then move
the heels, one be one as if walking away from the body downwards. Hold this
self-traction on the entire spine for 30 seconds. Then release and relax for
a minute. Repeat at least three times in the morning before getting out of
bed and at night before going to bed.
4. Gentle stretching and strengthening by various Jattis is to be one of the
first aspects to be introduced to the patients. Hastha (hands), Pada (feet)
 Shirsha (head) and Kati (hip) Jattis are very useful and bring a sense of
lightness and honour into ones monotonous life. They are also safe and easy
to do inmost situations. Use of Nasarga Mukha Bhastrika is very important
to throw out all the tensions that may be aggravating the patient’s condition.
5. Breath-body movement is to be introduced in the early sessions and the
body work that brings about coordination between body movements and the
breathing pattern is to be used on a regular basis for psychosomatic
harmony. Some simple illustrative examples include:
• Lifting and lowering the arms
• Lifting and lowering the legs
• Turning right and left
• Bending forward and back
• Sitting up and lying down
6. Gentle Hatha Yoga Kriyas can be used to harmonise all systems and these
are excellent methods to develop the self-confidence and self-reliance
levels in all patients. Some illustrative examples include:
• Chatus Pada and Chiri Kriya
• Ardha Kati Chakra Kriya
• Ardha Chakra Kriya
• Padottana Kriya
• Pawan Mukta Kriya
• Sethu Kriya
7. Working with a partner gives patients a sense of belonging, thus creating a
positive outlook that enables inherent healing hormones and mechanisms to
be facilitated in a natural fashion. These practices can be done in different
positions and some illustrative examples include:
• Baddhakona Kriya with partner helping push the knees down gently or
push on the back as in Purna Baddhakona.
• Helping to push a bit more in forward bending postures
• Supporting the partner in the back bending postures
• Helping to improve the range of joint movement in different postures
• Giving isometric resistance to the movement in the postures to
improve strength
8. Yoga Asanas: Modified versions of the following Asanas can be used
according to the ability of the patient. Initially going into the posture and
coming out in tune with the breath is advised. Later the postures can be held
for longer duration in a step-by-step manner.
• Back stretching poses:
o Standing: Tala, Ardha Kati Chakra and Meru Asana
o Sitting: Danda Asana, Purvottana Asana and Sashanga Asana
o Reclining: Bhujanga, Dridha Asana I & II
• Back strengthening poses:
o Standing: Ardha Chakrasana and Ardha Utkat Asana
o Sitting: Chatus Pada and Sharaba Asana
o Reclining: Pawana Mukta, Nouka, Eka and Dwi Pada Shalaba and
Bala Asana
• Twisting poses:
o Standing: Trikonasana and Parshava Kona Asana
o Sitting: Vakra Asana and Bharadwaja Asana
o Reclining: Jathara Parivritta Asana
9. Pranayamas to energise, relax and rejuvenate:
• Vyagraha Pranayama
• Vibhagha and Pranava Pranayamas
• Savitri Pranayama in Vajrasana and Shavasana in 6:3 and 8:4 patterns
• Bhramari Pranayama
• Chandra Nadi Pranayama and the cooling Pranayamas
10. Simplified forms of Uddiyana and Moola Bandha to strengthen and tone up
the abdomino-pelvic region and reduce congestion.
11. Mudras: Brahma Mudra for the neck region with the different sounds,
Aswini Mudra in various postures and Bhujangini Mudra from the prone lying
down position.
12. Relaxation of body-emotion-mind complex: Shavasana with Savitri
Pranayama, Tala Kriya, Dridha Kriya, Marmanasthanam Kriya and Kaya Kriya.
Yoga Nidraa and Anuloma Viloma Prakriyas can be used later.
13. Dharana and Dhyana to focus the mind and channelise the healing energies of
our psychic existence: Mandala Dharana on all Chakras and their respective
 Bhija sounds can be done with special emphasis on Anahatha and Ajna
Chakras as these centres are specially related to the psycho-neuro-immune
axis. Om Japa and Ajapa-Japa can be done as also Chakra meditation to
create a sense of mindfulness and being present in the NOW.

RECOMMENDED READING:
1. A Primer of Yoga Theory. Dr Ananda Balayogi Bhavanani. Dhivyananda Creations,
Iyyanar Nagar, Pondicherry. 2008. www.rishiculture.org

2. Back issues of International Journal of Yoga Therapy. Journal of the International

Association of Yoga Therapists, USA. www.iayt.org
3. Back issues of Yoga Life, Monthly Journal of ICYER at Ananda Ashram, Pondicherry.
www.icyer.com

4. Back issues of Yoga Mimamsa. Journal of Kaivalyadhama, Lonavla, Maharashtra.

5. Four Chapters on Freedom. Commentary on Yoga Sutras of Patanjali by Swami
Satyananda Saraswathi, Bihar School of Yoga, Munger, India. 1999
6. www.medicinenet.com/multiple_sclerosis/article.htm. Accessed on 18.5.2011.

7. Yoga for health and healing. Dr Ananda Balayogi Bhavanani. Dhivyananda Creations,
Iyyanar Nagar, Pondicherry. 2008. www.rishiculture.org

8. Yoga: Step-by-Step. A 52 lesson correspondence course by Dr Swami Gitananda Giri.

Ananda Ashram at ICYER, Pondicherry. www.rishiculture.org
9. Yoga Therapy Notes. Dr Ananda Balayogi Bhavanani. Dhivyananda Creations, Iyyanar
Nagar, Pondicherry. 2007

Yogacharya Dr. ANANDA BALAYOGI BHAVANANI (MBBS, ADY, DPC, DSM, PGDFH, PGDY, FIAY)is
Chairman of the International Centre for Yoga Education and Research at Ananda Ashram,
Pondicherry, India (www.icyer.com). He is also chairman of Yoganjali Natyalayam, the premier institute
of Yoga and Carnatic Music and Bharatanatyam in Pondicherry (www.rishiculture.org). He is son and
successor of the internationally acclaimed Yoga team of Yogamaharishi Dr. Swami Gitananda Giri Guru
Maharaj and Yogacharini Kalaimamani Ammaji, Smt Meenakshi Devi Bhavanani. He is a Gold Medalist in
Medical Studies (MBBS) with postgraduate diplomas in Family Health (PGDFH) and Yoga (PGDY) as well
as Advanced Diploma in Yoga under his illustrious parents in 1991-93. A Fellow of the Indian Academy
of Yoga, he has authored 18 DVDs and 18 books on Yoga as well as published six dozen papers,
compilations and abstracts on Yoga and Yoga research in National and International Journals. He is a
Classical Indian Vocalist, Percussionist, Music Composer and Choreographer of Indian Classical Dance
in addition to his duties as Programme Co-ordinator of the Advanced Centre for Yoga Therapy
Education and Research (ACYTER), JIPMER, Pondicherry. In recent years he has travelled abroad nine
times and conducted invited talks, public events, workshops, intensive residential retreats and been
major presenter at Yoga conferences in the UK, USA, Italy, Germany, Switzerland, Australia and New
Zealand. He is an Honorary International Advisor to the IAYT (International Association of Yoga
Therapists), USA and various Gitananda Yoga Associations all over the world.

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