Yoga Case Study for Multiple Sclerosis

Yoga Therapy Case Study

Kirsty Norfolk


Yoga Therapy for Multiple Sclerosis

Yoga techniques have been shown to improve circulation, balance, the ability to relax, flexibility, eyesight and to reduce muscle tension, nervousness, depression, anxiety, and emotional stress – all common symptoms of multiple sclerosis. Yoga can aid the body’s own self-healing mechanism and may slow down or even halt the disease process.

Yoga exercises gently stretch the large muscles of the legs, arms, and back. This increases flexibility, helps to reduce the incidence of muscle spasms, and improves circulation to all parts of the body. Improved circulation also helps prevent bedsores in less mobile or disabled sufferers. Yoga compression poses reduce physical and emotional tension by changing the breath, adjusting the body’s chemical balance, and pushing fresh blood and oxygen to the brain and other vital organs. Yoga asanas gently strengthen muscles, improving balance and posture; this results in greater stamina. A daily Yoga exercise program can be therapeutic, non-strenuous, enjoyable, and self-motivating because it can be done regardless of physical condition; many techniques can be done in a bed or chair.

Adequate rest is necessary for everyone’s health, and especially for those with MS. Yoga relaxation and meditation techniques teach you how to recognize physical tension and release it so that your whole body rests; you can also learn how to quiet the constant mental chatter that prevents your mind from resting. Meditation can help you to learn to stop all thoughts for a few moments; this not only relaxes you but allows your inner strength, creativity and power to emerge.

Breathing techniques have long been used to reduce stress and to relieve pain. The deep breathing pranayama techniques, besides strengthening respiratory muscles, improve concentration and willpower.

What is Multiple Sclerosis?

Multiple sclerosis (MS) is an autoimmune disease that affects the brain and spinal cord. In MS, the body’s white blood cells attack tissue called myelin.

Myelin forms a sheath that is the protective covering for nerve fibers in the brain and the spinal cord. Much like the insulation around an electric wire, myelin sheaths cover nerve fibers as they transmit impulses within the nervous system.

When a myelin sheath is worn down or destroyed, the process is called demyelination. Demyelination causes the nerve fiber to be exposed. The exposed nerve fiber is less able to transmit nerve impulses. As a result, messages between different parts of the nervous system and the body are not transmitted as effectively. After the myelin is destroyed, scar tissue called sclerosis is left behind in the damaged areas, which are referred to as lesions or plaques.

MS can affect people in different ways and in different areas of the body. How MS affects individuals depends on which parts of the brain and spinal cord are damaged by the scar tissue.       

Although multiple sclerosis has been recognized as a disease since the mid-1800s, researchers still aren’t sure exactly what causes MS. MS affects up to 2.5 million people worldwide with women more likely to get it than men. In fact, about 70% of the MS population is female.

Since most people are diagnosed before they turn 30, MS has been called the most common disability-causing illness for people under 45. The place where you grew up may also influence how likely you are to get multiple sclerosis. MS is more common in cooler areas of the world.

Our genes may also play a key role in MS. People from different ethnic groups have different tendencies to develop MS: People of European descent are twice as likely to have MS as African Americans and Asian Americans. Children, siblings, and non-identical twins of people with MS have a one in 100 to one in 40 chance of having MS themselves. The chances of the identical twin of someone with MS also having MS increase greatly to one in four.

Pain & Stiffness

Due to the changes in the body caused by MS sufferers tend to spend much more time seated which means the tendons and muscles down the back of the legs and also the area from the knee through the front of the thigh to the hip all shorten so that when straightening out the legs they go into painful twitches and spasms (most often in bed). There is also a tendency to keep arms close in to the sides whilst seated, working at desks or driving and, over time, the tendons through the inner arms shorten pulling the shoulders forward and causing the chest wall muscles to shorten. This can lead to an upper body stoop, which in turn can cause painful shoulders and neck, restricted breathing and a change in the center of gravity, upsetting balance.

MS & Heat

The humidity in Singapore is much more likely to affect people with MS than the drier heat in Europe and the effects of high temperatures can worsen every symptom you have until you cool down. There is a scientific explanation for this. When we get hot the neurons in the nervous system become slightly further apart and messages get slower. This affects everyone but if your “messaging service” is already sluggish it may grind to a halt until you lower your temperature.

Yoga Therapy Case Study

Name: John

Age: 33

Condition: Relapsing remitting Multiple Sclerosis diagnosed October 2011

Current condition controlled with medication, stable no relapse since December 2012.

Sequence for MS

Warm up (standing or seated depending on condition)

1. Toe clenching

2. Ankle – plantar/dorsi flex

3. Heel raises

Spending a lot of time sitting allows the tendon in the back of the leg to shorten which can lead to a foot that droops increasing the possibility of you tripping over it and, at the other end of the tendon, a tail-bone (coccyx) and pelvis that tilts backwards causing lower back ache. Using a chair or stable surface if necessary, moving your legs and feet about 2ft back and hip width apart and slowly raising onto the balls of the foot and lowering back down again.

4. Knee kicks

5. Pelvic tilts (modification – seated version on ball) Relieves lower back ache

6. Shoulder rotations – loosen tight shoulders

7. Fingers and wrists

8. Neck – Alleviate upper body stoop


Modified Surya Namaskar (5 times)
Tadasana – focus on feeling grounded and balance moving into upward salute|
Uttanasana/Half Uttanasana/Ragdoll – Stretch up and forward lengthening spine, knees slightly bent, fold forward can use any props necessary wall/chair/blocks
Ashtanga Namaskar
Cobra/Upward Dog
Downward Dog – knees can be bent, step one leg back at a time into Uttanasana/Ragdoll
Upward salute

1. Airplane – Arms out by sides for additional balance or can use chair/wall. More challenging arms back or out front into warrior III

2. Reverse warrior – Step foot back down bending front knee can use chair for support

3. Triangle

4. Swaying Palm Tree (If necessary rest in Tadasana for few breaths between sides or before moving to next pose

5. Tree

6. Supine Thread the needle – Hip/Hamstring stretch

7. Janu Sirsasana

8. Baddha Konasana

9. Ardha Matsyendrasana/Bharadvajasana

10. Bicycle – Legs and arms if able, if not just legs

11. Boat – Legs bent

12. Bow or camel

13. Prone leg lifts
Lie on stomach with the head resting comfortably then bend the knee so the foot raises up towards the ceiling. Slowly lower the leg back down and repeat 3 times then repeat on other side. When this becomes easier increase the stretch by gently pushing the hip into the floor as you breath in and releasing the push as you exhale. As this becomes easier you can use both legs together.

14. Balasana – restorative pose, helps reduce anxiety can use pillows/blankets for extra support to hold longer focus on ujjayi breathing here

15. Superman – Roll over bring knees to chest wind removing pose

16. Wind removing pose individual leg stretches – Can use belt

17. Bridge – Can use blocks or cushion/blanket to support lower back counter in Balasana

18. Matsyasana – supported with block if too difficult to hold

19.Reclining side twist – Individual legs or if able both, can use cushions/blocks for support

20. Legs up wall/bent on chair – straight legs then baddha konasana variation or if able to shoulderstand into reclining baddha konasana

If suffering from restless leg syndrome can stay in legs up wall for 5-20mins to relieve symptoms.

Stiff & painful hips

Many yoga postures involve the knees and hips rotating outwards and that can be very challenging if your legs and their tendons have started to contract so this variation can help and is an easy way of starting to ease into these positions – lie with both feet up on a chair, knees over the hips and the feet resting against the backrest. Slide one foot towards the front of the seat and allow the knee to relax outwards, relax here for a few minutes making no attempt to force the leg. Repeat to the other side. As hips and knees become looser you can do this with both legs at once.

Shoulder stand & Variations

The shoulder stand is very beneficial but, most of the benefits are lost if the practitioner is so tense and frightened of falling that they hold the breath.

A much more relaxed way of achieving this posture is to start with feet resting on a chair, close enough to the chair to hold the front legs firmly in each hand. Bring feet towards the front edge of the seat. Holding the chair legs firmly, slowly press into your heels and gently lift seat up from the floor. Raise the seat up breathing in and gently return to the starting position breathing out. As strength increases can lift higher, this posture lengthens out the middle of the body, strengthens the muscles in the back of the legs and lower back and has beneficial effects on heart and vascular system.

21. Lie on back – Eye exercises – Savasana

Eye exercises
There are many different things that can affect the eyes in someone with MS ranging from double vision in one or both eyes, nystagmus (the eyes flickering and jerking) or retrobulbo-neuritis (blank or black patches within the field of vision). Other people have pain within the eye (inflammation of the optic nerve). Many people with MS have one or all of these symptoms at one time or another and fortunately, most people find that the symptom passes given time. Doing eye exercises flexes and tones all the muscles in and around the eye ensuring that poor circulation is improved as well as stiffness in the muscles.

Squeeze the eyes tightly shut with the eyebrows pulled down and slowly let that tension seep away

Now widen the eye socket by pushing your eyebrows as high up as they will go and slowly relax

Now turn your eyes up as high as they will go without moving your head and hold for a slow count of ten then let them return to center and soften and relax

Look to the right (as if you were trying to look out of your ear), hold for ten and relax

Then to the left – hold for ten – relax

Finally looking down as if to see into the roof of your own mouth – hold – relax

Now circle the eyes just around the socket three times in each direction


Guided meditation/Yoga Nidra – Helps to relax whole body assisting the calming of the nervous system

Upon coming out of nidra and into sitting position rub the palms together to generate some heat and then cup them over both eye sockets and let the static electricity and warmth relax the eye.

Anuloma Viloma – Activating parasympathetic nervous system giving practitioner calming effect.

Left hand in any of the following mudras depending on most prominent issue:
Gyan mudra to help mental affliction and insomnia.
Varuna mudra for muscle shrinkage.
Prana mudra to improve immunity and eye problems.


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