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

five times.

      7.Repeat with the other foot forward.

       Facial exercises

      Speech difficulties are a common problem in Parkinson’s and MS, and a frozen facial expression can be a symptom of Parkinson’s, so it is useful to at least keep the facial muscles active. This can be done in a lying position, to overcome any shyness. I usually put it in before relaxation, when people are mostly lying down.

      Instruction

      1.With your mouth, make an ‘eee’ shape; you don’t need to make a sound, just pull your mouth into the shape. Let go and do it again five times.

      2.Now try an ‘ooo’. Repeat five times, releasing in between.

      3.Now move between the ‘eeee’ and the ‘ooo’ shape. Repeat five times.

      4.Clench your teeth together and release. Repeat five times.

      5.Frown deeply and release. Repeat five times.

      6.Arch your eyebrows up, as if you are surprised, and release. Repeat five times.

      7.Move between a frown and surprise, and repeat five times.

      8.Press your tongue to the roof of your mouth and release. Repeat five times.

      9.Roll your tongue up, and release. Repeat five times.

       Making sound

      A mantra is great for encouraging good breathing and keeping the voice strong. Singing is encouraged for people with Parkinson’s. Work with what is culturally appropriate in sound. Exploring the creation of sound through ‘aum’ means that you can introduce the sound without its devotional meaning.

      I also explore sound using the vowel sounds, moving through ‘aay’, ‘eee’, ‘iy’, ‘ohh’, ‘yoo’, which takes away the need for it to sound beautiful. If the group are well bonded, you can have a lot of fun with making sounds. Use your imagination and simple song verses that would be well known to your group.

      In planning any warm-ups, I usually consider movements that will awaken the spine, putting it through its paces and stimulating the nerve junctions. Flex, extend, rotate, lateral bends and swaying wake up the spine; add in joint freeing and overall stretching, and you are ready.

Posture and the spine

      In Parkinson’s there is a tendency for the posture to become increasingly flexed, known as the ‘simian’ posture. The head is held forwards, the spine becomes kyphosed, and the pelvis moves to posterior tilt, as flexion increases at the hips and knees. Trunk rotation and extension become more and more limited. Some muscles may gradually become contracted and shortened, and others lengthen but become ever more weak and unable to contract.

      Poor posture contributes to breathing, speech and swallowing difficulties. Stiffness and rigidity make lying flat difficult, and sometimes a scoliosis develops. For MS students, working on the spine and improving inner strength will keep good posture and aid balance and improve joint mobility.

      Yoga asana is an ideal form of movement to help maintain good posture. Core strength is vital, as is awareness of how one is standing and walking. Mountain Pose (Tadasana) is a good starting point to bring awareness of the standing posture. All of the asana practices should bring in an awareness of alignment, posture and positioning of the shoulders and head, but here are some postures to target the core muscles and flexibility of the spine.

Core strength and stability

      The combination of abdominal muscles and pelvic floor make the inner core, and latissimus dorsi, gluteals, oblique abdominals and hip adductors make the outer core muscles. There is a great emphasis on building core strength, with the advent of the Pilates techniques that have shown how useful it is to keep these core muscles toned and working. Engaging the core muscles within yoga practice will increase the strength of the spine and improve the ability to get up and down out of a chair, for example. We can begin to bring awareness of these muscles in postures such as semi-supine and Cat Pose.

      PELVIC FLOOR

      The men in my groups often ask me if they have a pelvic floor! The answer is yes, of course, although it is structured differently. Personally, I always go into detail about the circles of muscle and how they need to be toned to function well, as this will help continence as well as being a key element in posture and strength.

      For men this is the muscle group that lifts the testes, which sometimes needs an analogy. I describe it as like an aeroplane’s undercarriage – imagine lifting the wheels up and tucking them in. I use a lot of hand gestures (to the amusement of my students, but they get the message).

      For women it is easier to explain, as we use the same muscle group to stop the flow when urinating.

      Imagine that you have two circles of muscle, one within the other. Draw in the inner ring up inside your body and then draw the outer ring up. Do this gently.

       Mountain Pose (Tadasana) (standing well)

      Good posture is essential for the health of the spine, nervous system, breathing and walking well. Posture has a bearing on the wear and tear of joints and helps us to avoid some of the related health complications.

      Mountain Pose (Tadasana) is sometimes taught with the feet and toes together, but for a feeling of strength and balance, the parallel foot form is preferable.

      Instruction

      1.Stand with the feet parallel, so that they are in line under the knees, hips and shoulders.

      2.Lengthen the spine. Imagine being drawn up from the crown of the head, and lengthen the tailbone down, like a dragon’s tail. Don’t tuck it under.

      3.Let the shoulders soften and move them down and back.

      Teaching focus

      •Keep the alignment awareness active, in Mountain Pose or in any other standing pose. This means:

      –keeping in parallel alignment

      –keeping grounding through the feet and tailbone

      –paying attention to the position of the shoulders

      –paying attention to the position of head and neck – with the chin parallel to the floor

      –activating the core muscles

      –maintaining the length through the whole of the spine.

      •Make time to give people individual attention, as they will all be different.

      •Stand facing your student and mirror their posture. Tell them that you are going to do this, and then work together, balancing out the shoulders or any anomalies that you see, and get them to copy you. Give guidance with words at the same time, and use a light touch to adjust. For example, ‘Drop this shoulder a little’, ‘Lengthen the back of your neck and tuck your chin in’, ‘Draw your ribs in’.

      •When aligned and balanced as much as possible, direct the student to breathe along the spine up from the feet. Spread the breath into and around the ribcage.

      •Mountain Pose (Tadasana) is a good starting point for many postures, but if standing is tiring or difficult for some, the same directions can be adapted for sitting.

       Working the core in Mountain Pose (Tadasana)

      Instruction

      1.Stand in Mountain Pose (Tadasana), this time with the feet together.

      2.Exhale and press the insides of the legs together.

      3.Pull the pelvic floor up and in.

      4.Press your hands in to the sides of your body.

      5.Draw everything in and up, and hold.

       Staff Pose (Dandasana) (sitting well)

      With appropriate props in place, this posture offers an opportunity to build core strength.