Yoga Therapy for Parkinson's Disease and Multiple Sclerosis. Jean Danford

stabilise one joint – that is, the shoulder to enable the wrist to move, or to hold the hip or knee steady so that the foot can move.

      SITTING WARM-UPS

      As transferring from the floor to chair to standing can be a problem for some students, it is helpful to vary the programme so that some weeks there are fewer ups and downs.

      I discovered ‘Undulating’ on a visit to America, and find that this simple spinal work can be fun and helps release tensions before class. Anita Boser (2007) invented this work, and it is suitable for anyone with limited movements as it encourages an exploration of movement and limitations.

      Here is a simplified preliminary version. It can be done sitting on the floor, on a block in any comfortable cross-legged position, or with the legs bent and hands resting on the knees, or seated on a chair.

      1.Sit upright on the ‘sit’ bones, the ischia.

      2.Begin exhaling with a hollowing of the abdomen, rounding the back and drawing the abdominal muscles in.

      3.Begin to arch the back, opening the chest, and breathe in.

      4.Let the movement flow from one action to the opposite, hollowing and then rounding, extending and flexing.

      5.Feel into the movement and notice any areas that are not moving or that feel stuck.

      6.Focus on letting the movement begin from the stuck place and keep the spine moving into a ‘C’ shape, back and forth.

      The next step would be to move from the ‘C’ shape into an ‘S’ shape. This is meant to be a free-form flowing movement; allow the group to play with it.

      This can then be changed into a side-to-side ‘C’ shape action. Again, allow the students to explore the restrictions and keep the movements flowing.

      The whole spine is energised during this process; the joints, muscles and fascia get a workout. As everyone is working within their own parameters, there are few contraindications to this flowing warm-up. It also encourages people to ‘put their mind into their body’ and to envisage the action as well as to physically feel it.

       Side stretches

      Sitting side stretches are a good way of connecting through the ‘sit’ bones, whether on a block on the floor or on a chair.

      Instruction

      1.Through the side bend the ‘sit’ bones should remain in contact with the floor, thus placing the stretch into the latissimus dorsi, obliques and intercostals.

      2.From this position open up the ribcage and encourage breathing through the stretch.

      3.Hold the arms downwards, finger tips on the floor to stabilise. Progress the stretch by extending an arm up and over the head.

      Teaching focus

      •Keep the ‘sit’ bones on the floor/block/chair.

      •Root the tailbone into the ground, grow the spine long.

      •Open up the side stretch and breathe into it.

      •Grounding – keep the student’s awareness down in their feet and conscious of their relationship with the ground.

       Cat Pose (Marjariasana) warm-ups (known as Cat/Cow in the US)

      Cat Pose takes a little preparation as there may be varying problems and restrictions. Props need to be on hand. Offer rolled blankets for supporting inflexible ankles, folded mats or folded blankets to cushion knees, wedge-shaped blocks or folded blankets for wrists, particularly if there is carpel tunnel or arthritis. It sometimes takes time for students with Parkinson’s to move onto the floor. In severely affected students, assistance may be needed in transitioning to the floor.

      Instruction

      1.On hands and knees, align the knees under the hips and wrists under the shoulders, inner elbows facing each other. Check that you have the correct spacing to enable the spine to flex and extend freely.

      2.Bring awareness into the spine and tilt the pelvis downwards, lifting the tailbone on the inhale breath. Allow the upper spine to extend.

      3.Move awareness into the pelvic floor, connect and contract slowly as you begin the pelvic curl, drawing the tailbone under, as you exhale.

      Teaching focus

      •This is the movement that all yoga teachers will recognise as an easy relaxing warm-up for the spine. As the group continue to work this posture, there is an opportunity to observe each individual and to work with them on the posture.

      •Give permission to release the wrists any time they need to, and to come out of the pose when a rest is needed.

      •Be sensitive to the fact that the group may not be able to sustain a kneeling position for too long.

      Parkinson’s note: In this pose coordination difficulties surface. You may see bent elbows, and rocking backwards and forwards from the hips instead of the spinal movement that we are expecting. This is where individual attention is important. Move alongside the student and state exactly what needs to happen – that is, ‘Keep your hips over your knees and move your waist up and down’. Place a hand where you want the movement to be. Note when the movement changes and give encouragement; give a simple direction such as ‘be still here’ or ‘lift here’. Encourage steadiness throughout the whole movement. Look for balance difficulties; core strength is also essential.

      Contraindications are for knee problems, if there is pain or swelling, and similarly for wrists. You may find that this same action is still a problem a week later, so simply go over the same ground. This is due in part to a lack of dopamine.

      CAT POSE PROGRESSIONS

      From Cat Pose you can offer stretches and other poses. Cat Pose is useful to work some other strengthening asanas and warm-ups. Leg extensions from Cat Pose are useful for strengthening the lower back, legs and buttocks, and offer time to practise balancing.

       Extend and curl

      Stabilising on three points, without collapsing or dropping one hip, is the challenge. In order to do it, there has to be core strength. So, in preparation, engage the abdominal and pelvic floor muscles.

      Instruction

      1.Lift and extend one leg by sliding the toe along the floor to keep steady, and then lift and stretch. Lengthen the leg and push the heel away. Stay steady throughout the move, and try to keep the hips level.

      2.Keep everything as stable as possible on the return journey.

      3.Draw the leg right through and curl the spine. The nose towards the knee gives a natural balance to the action.

      4.Repeat using the other leg.

      This movement can also be done in the chair version (see page 200).

       Arm strengthening

      Instruction

      1.With the hands and knees placed in the correct alignment, transfer the weight of the body forward, so the hands, arms and shoulders bear more weight. This enables you to get used to taking the weight onto the hands, and will help when transferring from lying to sitting to standing.

      2.Rock the weight back into the knees, and then repeat the action a few more times.

       Circles

      Instruction

      1.Rock forwards and then move the whole spine in a flat circle to the left.

      2.Shift back and move up through the right, as if drawing a horizontal circle with your navel.

      3.Then go the other way.

       Mini balance

      Instruction

      1.From Cat Pose, lift the right hand a few centimetres off the floor along with the opposite knee, so that there is balance