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ОглавлениеChapter 3
Therapeutic Practices
In this chapter we explore a range of yoga practices suitable for people with Parkinson’s or MS or people with limited mobility for other reasons. Many of the postures described will be familiar to yoga teachers, but are offered in easy stages and in simplified and adapted versions, so that even the most physically challenged person can advance. Instructions are given to help the teacher, and points for directing the practice are included.
All of the information for contraindications and safe practice, along with guidelines for good alignment in postures that are familiar to most yoga teachers, will apply to these specialist groups. When working with any group in a therapeutic context, it is essential to have a full picture of each individual’s health profile, as this will determine any contraindications for them personally, and will enable you, the teacher, to adapt postures for them.
Planning yoga for Parkinson’s disease and multiple sclerosis
When working with these diseases, it is important to consider:
•Evaluating the needs of the individual. People often have other health problems that need to be identified and taken into consideration.
•MS and Parkinson’s can also affect the internal muscles as well as the external muscles, so there may be digestive/bowel and bladder issues as well as mobility issues.
•Disempowerment, lack of confidence, low self-esteem, anxiety and depression are often present.
•Low energy states and sleep issues.
•Mobility and the ability to control physical movements may be limited.
•Hands-on help and adjustments, with permission, can make all the difference.
The Pancha kosha model needs to be examined for each individual.
Useful yoga tools are:
•warm-ups and mobilising techniques
•balance practices
•developing awareness – proprioception
•visualisation – bhavana for positive thinking and renewal
•strengthening postures adapted for the individual
•work that helps to ease any muscle spasm, gentle stretches and relaxation
•coordination practices
•relaxation – Pratyahara
•breathing and meditation
•adapting postures with the use of props, to assist the individual.
Considerations in planning for one-to-one or group work
Practicalities
•Class size – can you manage the group safely and give individual attention? (A maximum of 6–8 is recommended.)
•Room size – it should be big enough to accommodate a full class as well as equipment.
•Room temperature – warm but not too hot; check the recommendations for the condition.
•Disabled access to hall/bathroom, etc. Are stairs/lift manageable?
•Chairs – stable/sturdy chairs that will not slide around easily and can be placed on a mat.
•Props – blocks/straps/extra chairs.
•Adaptions for wheelchairs – if the user’s feet don’t reach the floor, for example.
What you might do with your class
•Assess their stamina – they may tire quickly, so plan for rests.
•If the session is an hour, for MS and Parkinson’s allow a maximum time of 20–30 minutes for postures, depending on how people are on the day.
•Warm-ups are essential – work the small joints, fingers and toes, as these become more important in limited mobility issues.
•Give instructions at a suitable speed – don’t rush, as there might be cognitive issues.
•Include movements that open the chest, strengthen and stretch. Include plenty of breathing and breath awareness.
•Don’t hold poses too long – this may tire them too quickly, and exacerbate spasticity and cramping in the muscles.
•Hands-on adjustments can be gentle but firm, without ‘manhandling’ forcefully.
The practices are grouped according to their action and benefits to the body for this particular student group; adaptations and modifications are described, and a separate section for chair work is included for ease of reference. Some postures are shown in several places, according to their application.
•Preliminaries and warm-ups
•Asana for:
oposture and the spine
ostability and strength
oshoulders and the upper back
ohips and pelvis
obalance
osuperstretches
orestorative postures
odigestion
•Pranayama (breathing) exercises
•Practices for mind and emotions:
orelaxation
omoving into positivity – bhavana, visualisation, affirmations
omeditation
•Chakra practices
Safety and the environment
Before beginning to work with an individual or a small group, there are practicalities and safety aspects to consider:
•Working one-to-one is of great benefit, as full attention can then be given to all aspects of the individual, to their health and wellbeing. However, a great deal of benefit can be gained from working with a small group, as this allows time for giving personal attention and making adjustments, and for teachers to be assured that they can observe everyone in the group.
•Over 6–8 students, it is better for there to be a yoga teacher assistant as well as the main tutor, as help will be needed in giving personal guidance and adjustments. Up to 12 people could be taught together. Alternatively, helpers may be willing to be on hand (but bear in mind that although helpers are willing, they may not have the skills that a trained teacher-therapist has).
•It may be necessary to use touch, to guide the postures and movements that you teach, so be sure to ask permission first before you get ‘hands on’.
•The room should be warm but not overheated for those with Parkinson’s, but students with MS like a cooler room, as too much heat can be a bother for them. As always with yoga, quietness and time free from interruptions is essential. These groups need all the teacher’s attention, so the fewer distractions the better. The floor should be clean and non-slip.
Equipment
•yoga mat
•a stable chair
•blocks, hard and soft
•belt
•resistance band
•blanket
•bolsters are useful for specific practices, but not essential overall.
When setting up, make sure that the chair is placed on a mat so that it can’t slip away, and that other support equipment is to hand.
Check that there are no obstacles around the floor. Cables, mats and so on are a hazard, especially for those for whom walking is a challenge.
Points for teachers
The range of ability, mobility, strength and presence of symptoms in both Parkinson’s and MS will vary greatly. Even with the same medical diagnosis, each person’s experience of the disease process is different, and each person manifests it differently, even though the symptoms look similar. Parkinson’s disease does sometimes manifest in younger people, but mostly those with Parkinson’s are over 50, and the ageing body needs to be respected. People coming into a yoga class with a Parkinson’s diagnosis may have other conditions that need to be taken into account, and many come into class having no experience of yoga before.
Some people are very able and can easily get up and down off the floor, and others cannot do this at all. A preliminary health questionnaire is useful in determining the level of fitness in the group. A range of questions about movement, flexibility and Parkinson’s symptoms, along with information on any other medical condition that exists alongside the Parkinson’s or MS, give a fuller picture to enable planning a therapeutic programme.
In those with Parkinson’s, facial muscles are often severely affected, which means that they may be unable to respond and communicate through facial expression. This can present a challenge for some teachers. As human beings, we communicate meaning and emotions through facial expressions and gestures, and we look for responses from others, which helps us to consider our response. When working with people with Parkinson’s, remember that there may not be such a response, and yet personality and intelligence are still present.
In yoga philosophy we have the idea that the atman is eternal and dwells within – the person standing before you is present and engaged; they just can’t show it. Speak to the true self element of the person.
It is essential to observe the group each time, before starting, to ascertain if everyone feels well, or whether there are other factors to consider. The timing of medication plays a big part in life for those with Parkinson’s, so beginning class before the medication activates can be problematic. People have ‘off’ days and may have other health issues, so be ready to change your plans.
Key teaching skills and qualities are:
•observation
•modification, adjustments and adaptation of yoga postures and practices
•Ahimsa, working within a non-harming rule
•compassion and respect
•patience.
When teaching a Parkinson’s-focused group we need to consider which yoga practices will be of most value. Those that develop the following are more important than ‘achieving’ a perfect posture. This would be similar in other conditions such as MS and other neurological problems where coordination and muscle strength are affected:
•awareness
•breath
•coordination
•proprioception, balance and stability
•empowerment and self-confidence
•mobility, particularly in the small joints
•strength.
Where there is restriction in the body, there is often a negative dialogue. Here the student is subject to mind chatter of a critical nature, where we have a thought process of ‘I can’t do this, my body won’t respond’, ‘this hurts’, ‘I’m too stiff’, ‘I never get this right’.
This flow needs to be converted into positive optimistic encouragement. Offer some positive phrases, such as ‘with each move I release a little more’, ‘I am feeling looser and freer’, ‘my muscles are softening and lengthening’.
We can add visualisation, such as ‘imagine the muscles releasing and lengthening’, ‘see them strong and elastic’, ‘imagine breathing golden light into the stretch’, ‘imagine pouring golden light into the joint like magical lubricating fluid’.
KEEPING AND IMPROVING THE ABILITY TO ‘TRANSFER’
Moving from a chair to the floor and from floor to sitting and standing are all essential skills for life, and it is important to maintain the strength and coordination to do this. Yoga postures practised regularly will give confidence in performing these familiar actions, and the ability to transfer will impact on how the yoga session can flow.
Moving from standing to sitting on the floor
Instruction
1.Using a stable chair, stand in front of the chair and place your hands on the seat. Hinge at the hip, and bend both knees.
2.Lower one knee to the ground, steadying yourself with the your hands on the chair.
3.Come down onto all fours, and push the chair away.
4.Lower yourself onto one hip, and then lower yourself down so that you are lying on your side.
5.Roll over onto your back.
Getting up from the floor
Instruction
1.Make sure there is a chair nearby. Crawl over to the chair if need be.
2.Or, from lying, roll onto your side.
3.With one arm, push up so that you are sitting on one hip, legs to the side.
4.Turn onto all fours.
5.Bring one foot forward, and hold the chair for support.
6.Come onto your other foot, and with both knees bent, push up to stand.
Getting up from a chair
Getting up and down out of a chair is something that we all need to work on as we get older, so that we can build and maintain strength.
Instruction
1.Sit in a chair. Practise using the pelvic floor and abdominal muscles. (This is emphasised throughout the book in almost all of the practices as it is an essential factor in stability, mobility and back care.)
2.Keep your feet parallel, and feel them on the floor.
3.Press them into the floor, breathe out and engage the core.
4.Lean forward, keeping the natural curve in the spine, and guide the knees over the toes, reach the arms forward, letting the crown of the head lead the movement.
5.Follow the movement through, lifting off the chair just a few inches, and hold.
6.Try to sit down slowly and control the action. The chair is still there.
7.Practise this often.
This exercise can be a challenge for the quadriceps, but practice will improve stability.
Plank Pose (Phalakasana)
Being able to support our bodyweight is vital in enabling transition out of the chair, and up and down from the floor. This asana can help to maintain that strength and ability. Plank Pose should be worked towards in stages, and progress as the students get stronger.
Instruction
1.Begin with simple weight-bearing poses, such as Cat Pose (see p.50). With the hands and knees placed in correct alignment, transfer the weight of the body forward so that the hands, arms and shoulders bear more weight. This will enable you to get used to taking 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 times more. Keep the spine in a straight horizontal line.
3.Breathe in, breathe out, and draw the abdominal muscles in and the pelvic floor up.
4.Lift the knees a little way off the floor, and try to hold.
5.Repeat four times.
Over the weeks, when strength is building, you can progress to:
6.Take one foot back, toes curled under, keeping the hips low and the core muscles engaged.
7.Take the other foot back, taking the weight of the body for a short time, before placing the knees back on the floor.
8.Rest back into your heels with arms stretched forward, in Swan Pose (see page 109).
Progress to full Plank Pose:
9.Keep the hips low and the legs and spine aligned.
Side lifts
Instruction
1.Sit on the floor with your legs to the right, and use your left arm as a prop.
2.Engage the pelvic floor.
3.Lift your hips off the floor, taking your weight onto your knees and hand. Come up just as far as you can.
4.Lower yourself back to the floor.
5.Lift and lower four times.
6.Repeat on the other side.
Other useful postures for building strength are:
•Cat balances (see pages 52 and 147) and standing balances (see pages 140–146).
•Chair Pose (Utkatasana) (see page 88).
•Downward-facing Dog Pose (Adho Mukha Svanasana) (see page 106).
Practise these in class regularly. Semi-squat, Cat Pose, leg and arm strengthening will all help to enable these vital movements.
WARM-UPS
It is essential to offer loosening, stretching and mobilising warm-ups before full practice. This will enable you to see how everyone is, to let them become aware of their bodies and begin to focus on what they want out of the session. As with any yoga class, it is good to offer awareness and centring practices and to modify them according to group needs, time of year, temperature and the general demeanour of the group as a whole.
You might offer a standing, sitting or lying start, and you will probably find that there is a mixed range of ability in the group, with some people sitting and some standing. Offering a variety over the weeks means that there is always something that everyone can do as part of the programme.
Breath awareness, as a starting focus
This can be done in any position, and allows the student to explore their normal breathing pattern. It can be guided by asking the following:
•Where do you feel your breath?
•Is it low down in your belly, or higher in your chest?
•Can you feel movement in your sides as you breathe?
•Can you feel any movement in your back? Whereabouts in your back can you feel it?
•Where do you feel your breathing starts?
•Can you take your breath down lower?
At this point we have the opportunity to explain full breathing and its benefits, and to follow this with teaching full three-part breath with the focus on experiencing the breath in the front, sides and back of the body.
Parkinson’s/MS note: If there is severe curvature of the spine or poor posture, as we often see in Parkinson’s, this will limit breathing. Muscle spasm can also be a limiting factor. However, encouraging even the smallest change can be energy-enhancing. Good breathing will have a knock-on effect in the prevention of infections and other breathing problems that can be a complication for people with Parkinson’s and MS. Further Pranayama (breathing) practices are discussed in a later section (see page 211). In order to breathe well, the whole musculature needs to open, soften and release. Working on the muscles of the neck (scalenes and sternocleidomastoid), muscles of the occipital ridge and muscles of the upper chest (pectoral) and upper back (trapezius and rhomboids) will help the breathing process and improve posture to aid good breathing. One of the characteristics of Parkinson’s is a drooping head, and neck problems can ensue. Yoga can help strengthen and stretch the related areas, encouraging good posture and thus boosting confidence.
Body scan, levels of being
I often use this as a starting point in a class. It engages attention and brings mindfulness. It is a useful way to make a ‘before and after’ comparison. A similar process can be used at the end of class so that differences can be noted.
Instruction
1.Come into a comfortable lying (or seated) position.
2.Let your breathing steady.
3.Be aware of how your body feels.
4.Begin at your feet and notice any sensations in your feet: are they comfortable, heavy, warm? Is there any pain, stiffness, tightness? Are they numb?
5.Bring your awareness up through your legs, through your knees and thighs, and be aware of any sensations.
6.Continue up through your body, with awareness of what is happening today, where there is comfort or discomfort. You may notice areas that feel in need of stretching or softening, and even areas that feel good.
7.Move up through your middle, chest and back, noting what you feel.
8.Through your arms, shoulders, head and neck, which parts feel alive and which feel as if they need attention?
9.Become aware of your whole body, just as it is right now.
10.Now be aware of your energy level. Do you feel bright and alive, or tired and drained? Are you full of energy or depleted? You do not need to look for reasons why; this is just how you are now.
11.How are you feeling emotionally? Are you happy, angry, bored, feeling down, frustrated, calm? Again, do not look for reasons why, as this is a snapshot of how you are now.
12.Do you feel spiritually nurtured and connected with your higher self?
13.As you practise yoga, feel that your whole being can be brought into balance.
14.Move and stretch, ready to begin.
NECK RELEASE AND STRENGTHENING
These movements can be done either sitting or standing. It is good to do them at the beginning of class as a warm-up, but they can also be used as a ‘wake-up’ after relaxation.
First, attention must be paid to the position of the spine, encouraging an upright posture and lengthening up through the crown of the head. Encourage the shoulders to move downwards and to soften.
Rotations
Instruction
1.Turn the head along the central axis of the spine. Keeping in a level plane, moving first right and then left, coordinate the breathing with the movement.
2.Maintain a long spine, and rotate the neck only as far as can be comfortably reached – no straining.
3.Rotate the head to the right as if you are going to look over your shoulder.
4.Find the end of the range of movement and breathe into the stretch; visualise moving a tiny bit more.
5.Come back to the starting point with the spine upright and a feeling of a long neck.
6.Rotate to the left.
This rotation can also be done lying down, with the floor as a guide, and supported by a block or blanket that aligns the spine and keeps the neck long, to avoid over-arching.
Teaching focus
•Correct the line of the neck using gentle hand guidance, where needed.
•Observe whether there is any one-sidedness, but do not push the limited side; notice and wait.
•There should be no movement in the shoulders. Put your hands on the student’s shoulders to steady if needed, or encourage with words.
•Visual imagery can help here. Ask the student to imagine that they can take their head all the way round like an owl, using their eyes as well.
•The chin should be kept level.
Side moves
Instruction
1.With an upright head, and neck and chin level, allow the head to move laterally, as if putting the right ear on the right shoulder. Avoid pressing down or straining, and let the neck travel within a pain-free range.
2.Return and repeat on the other side, noticing any differences or limitations, but do not try to correct and over-stretch.
Teaching focus
•There should be no movement in the shoulders or upper back. Put your hands on the student’s shoulders to steady if needed, or encourage with words.
•If it is comfortable to do so, allow the student to stay in this position and breathe. Ask them to direct the breath into the stretch on the opposite side, to imagine the muscle lengthening, creating a space between the tip of the shoulder and the ear on the other side, and to then breathe into this space.
This whole exercise can be offered with an arm extended over and across the head so that a hand can be placed over the ear; in this way the movement has an added weight.
Root of the neck
Instruction
1.Push the chin forward, like a tortoise coming out of its shell.
2.Draw the head back, creating a double chin.
3.Repeat forwards and backwards.
This move mobilises the vertebrae and works the capitis muscles.
Occipital ridge
Instruction
1.Begin by folding the arms to anchor the shoulders down.
2.Draw tiny circles with the tip of your nose and gradually spiral outwards so the movement increases.
3.Spiral back in again.
Teaching focus
•This should not result in throwing the head back or forward; the movement should be kept subtle.
EASING OUT THE SHOULDERS
Simple shoulder rolls
These are a good starting point as shoulders are often rigid and tight.
Parkinson’s note: Directing the students to simply shrug the shoulders around in a circle often results in them only moving their arms rather than their shoulders. This is where it is helpful to demonstrate clearly what you want the class to do, and do it with them. Walk around, and stand in front so that they can easily copy you. Sometimes you will find that people need you to show them by hands-on guiding, moving the shoulders gently in a circling action. The finger tips to shoulders version with elbow circling is easier to handle.
Lift and drop
This offers a good opportunity for release, using breath to facilitate the ‘let go’.
Instruction
1.Lift the shoulders up around the ears with an in-breath.
2.Drop down with a sigh.
Hugs
Instruction
1.Start with arms outstretched and then cross them over, bringing them in, to hold the opposite shoulder.
2.Creep your hands around and feel for your shoulder blades, giving yourself a big hug. This stretches the teres major, minor and infraspinatus. Note which arm is on top.
3.Take the arms out wide again and repeat, bringing the other arm on top.
Joint Freeing Pose (Pawanmuktasana)
All of the familiar Pawanmuktasana can be offered, and are particularly helpful in keeping the joints in action. They do often pose a problem with coordination, as the student may move joints other than those directed, which is due to faulty ‘messaging’. Guide with demonstration and light-touch hands-on to show how the joint should move.
Arm twists
Instruction
1.With arms outstretched at shoulder height, release the shoulders downwards, with palms facing down.
2.On an in-breath rotate them, to palms facing up. Move between one position and the other with coordinated breathing, exhaling as the palms turn down.
Teaching focus
•Some students find it hard to maintain this position for more than one or two breaths, so allow rest time when needed.
Swimming
Instruction
1.Breathe in, with hands together and elbows bent.
2.Push both arms forward on breathing out, as if swimming breaststroke.
3.Turn the palms up and open the arms wide, as you breathe in.
4.Repeat four times.
These are good general warm-ups in any class, and are essential before working more specifically into the shoulder and upper back area. See the postures in the shoulder and upper back section on page 97.
Further shoulder mobility and strength is gained in other classical postures, where movement and alignment work with the function of the whole body.
HANDS AND FINGERS
It is worth spending a little more time than usual to check out how each individual can manage wrist rotation, hand and finger exercises, as these areas are particularly affected by spasm, and where motor control is lost.
Spread and clench
Instruction
1.Separate and spread the fingers wide; feel the stretch across the palm and between the fingers.
2.Make tight, tight fists or ‘claws’.
3.Flick the fingers away sharply.
4.Repeat a few times for each hand.
Shake
Loosely shake the hands as if you are shaking water off. This is good to do on a cold morning, to get the hands a little warmer.
Parkinson’s note: Some students with Parkinson’s have real problems with this and cannot loosen up enough to do the flicking. The same will apply if you offer foot loosening. Keep going and allow them to explore it anyway, and with practice, a little letting go can be achieved.
Up and down
Instruction
1.Start with the arms stretched forwards and palms facing down.
2.Push the heel of the hand away, and turn the fingers up towards the ceiling.
3.Flip them downwards. Up and down.
This can be varied using slow or fast movements, and a number of repeats. It can also be coordinated with the breathing – for example, two repeats for the inhale breath and two for the exhale.
Other variations are:
•Polishing: With the arms outstretched and palms facing down, move laterally from the wrist, out and in, as if they are moving on a flat surface.
•Wrist circling: With the hands in fists and the fists joined together, circle the wrists several times in both directions. Progress to doing this with the hands apart, but still circling the fists in the same direction.
Parkinson’s note: The same challenge with coordination will occur here as with other joint-mobilising practices. In Parkinson’s there is commonly difficulty with nerve transmission. You may observe that the student is moving the whole arm rather than just the wrist. Take time to work with this. Gently hold the arms still and encourage the work to happen in the wrists. Or give verbal direction, to bring this into focus and to isolate the wrist movement. This way we encourage full use of the body and retrain the nerve impulses.
Steeple
Instruction
1.Join the fingertips together.
2.Press them inwards and encourage the fingers to move towards each other, keeping the palms apart.
3.Encourage a stretch up into the length of the fingers and the finger joints.
4.Release the stretch, make the hands soft and repeat a few times.
Encourage the group to stop and release their hands whenever they feel the need.
Parkinson’s/MS note: Prolonged practice can be tiring even for these hand/finger exercises; encourage awareness of any tension that might build up in the shoulders.
FEET
The feet are often affected by muscle spasm, joint stiffness, rigidity and poor circulation. Working on the feet is important for better standing and walking.
•Start by standing with good alignment, parallel feet, hips and knees. Have a chair nearby if needed for support. Explore your own feet with a range of practices such as:
–Awareness enquiry: Where is your weight? Left/right, toe/heel, inside edge/outside edge?
–Inking: This brings aliveness and wakes up the nerve endings.
Inking
Instruction
1.Place one foot forward in a very deliberate step.
2.Feel the heel; roll your foot around along the outside edge and then onto the ball of the foot and through each toe. Imagine you are putting your foot on an ink pad and you have to get as much ink onto the sole of the foot as possible.
3.Press firmly through every part, and then do the same on the other foot.
4.Wriggle your toes. Lift them all up off the floor, if you can. Place the little toes down first, then all the others. (Not many people can actually do this, but it can be fun.)
Teaching focus
•Bring attention to the sense of aliveness experienced in the feet as the nerve endings are stimulated.
•Encourage the students to feel into both feet, and explore any differences they notice, any tingling, warmth, numbness, stiffness or immobility.
•This improves circulation.
High heel press
Instruction
1.Lift one heel and press the ball of the foot into the floor, then swap over to the other foot.
2.Move on to lift one foot as the other lowers. This also gets the knees moving a little, and is good for warming up if the feet are cold.
3.Awareness of the foot positions should be brought into all standing postures.
Make your feet talk
Basic stretches and joint rotation are essential. The wide range of commonly known Pawanmuktasana for the feet is useful. These can be done from a standing position to encourage strength and balance, or from a chair or floor seated position.
Contraindications of applied Ahimsa: Although these joint freeing moves are generally safe for everyone, they would be contraindicated if toe joints were swollen and painful, as they might be in rheumatoid arthritis, bunion or similar joint problems or plantar fasciitis. I would always recommend working within a pain-free range.
Point and flex
Instruction
1.Simply point the toes away, lengthening through the ankle, and then pull the toes up, as you push the heel away.
Teaching focus
•Bring attention to the movements felt in the lower leg, as this action involves far more than just the foot itself.
•Isolate the toe joint action by keeping the ankle down but the toes up, as in ‘ankles down, toes down, toes up, ankles up’.
•Using a resistance band can really help strengthen the feet and toes, which is especially helpful for those who have difficulty in feeling what is happening. The student should place the band around the toes and ball of the foot and hold the ends firmly. They should action the movements by pushing and spreading the toes into and against the band. People with Parkinson’s find this resistance helpful, but be careful of catapult action of suddenly released bands!
Circling
Instruction
1.With both feet together, draw circles with your toes and ankles.
2.Try it with the feet apart and then move them both in the same direction (this is counterintuitive, but good for coordination and the brain).
Flippers
Instruction
1.With the heels together, flex the ankles and pull the feet apart.
2.Draw the soles of the feet together. Try to join the little toes.
Teaching focus
•This tones and strengthens the flexor muscles in the sole of the foot, helping to combat flat feet. Again it is useful to draw attention to the action in the lower leg.
Spread and scrunch
Instruction
1.Open out the toe joints as much as possible, and try to make a space between each toe.
2.Scrunch the toes up, as if making a ‘fist’ with your feet.
Teaching focus
•Although it is helpful in the first instance to sit with the group and to demonstrate, hands-on help may be needed. Physically moving the feet (check out permission first) can help the student to be more able to then do the movement alone.
•If there is little movement, add in visualising so that creative thinking can enhance the experience.
•Use humour to engage a light-hearted positive energy.
Parkinson’s note: There is often a malfunction in motor control that limits activating a particular joint, and this may result in movement transferred to the joint above or below, as the student tries to follow the instruction only to find the message has been scrambled, so their knees and hips move instead of their ankles. This is where hands-on help and instruction to focus can really assist. Moving near to or in front of the student and doing the move so that they can follow is supportive. It can help to 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 on a diagonal basis.
Teaching focus
•Encourage the students to hold the balance. This challenges balance, strength and core strength.
Side bends
Instruction
1.Walk your hands around to the right and then to the left, as if you are looking at your ‘tail’.
2.Stretch along the sides of the body and open up the ribs.
3.Hold and breathe into the stretch.
4.Repeat a few times.
Knee circles
Instruction
1.Stabilise over three points and lift one bent knee out to the side.
2.Lift the knee up out and around, moving the hip joint.
3.Repeat on the other leg.
CAT POSE ADAPTATIONS
These can be used if the student is unable to kneel.
Instruction
1.Using a chair, stand facing the chair and bend to rest the hands on the chair (blocks can be used to adjust height). Legs should be parallel. The spinal movement can be done from this position, but the legs may need to be slightly bent, if the hamstrings are tight. If the chair option is not suitable, a standing Cat Pose could be an alternative – that is, with knees slightly bent, bend forward a little to rest the hands on the thighs, just above the knees.
2.From this position start the spinal ‘cat’ movements.
Cat Pose is a wonderfully useful posture as it can be done by almost everyone and has the benefit of working the spine, easing back pain and improving coordination.
Hip sway in Cat Pose
Instruction
1.With the knees together and arms apart, swing the hips over towards the floor to the right, and then to the left. This creates a ‘slalom’-type action, and is helpful in the ability to transfer to and from the floor.
LYING WARM-UPS
Starting the session in a lying-down position is always a popular option. It gives the student time to arrive, to put the journey aside and to steady the breathing. It allows the teacher time to observe the group and to judge their state of being. During this time students can be guided in bringing their energy into focus for the session. This is a good time to do ‘body scan’ awareness, and for the student to tune in and acknowledge what is happening for them physically, any aches and pains, tensions, trouble spots, their energy and emotional state. It is an opportunity for a snapshot of how things are now in the moment, and for them to feel that they can carry that awareness through into the whole practice.
Neck releases in a lying position
Alignment is still important even in the lying position, and the floor can offer a good guide for the spine, head and neck. Starting in semi-supine with the knees bent gives a comfortable way of working with the neck releasing, but brings different things into focus. The head needs to be supported until the neck is long and not over-arched, supported by one or more blocks if necessary. A head roll can be guided with awareness of the rotation on the axis of the spine, and having the head supported in this way can help with the release, as there is little effort in the action.
Contraindication: In elderly students there is often much rigidity in the neck – there may be arthritis or spondylitis, conditions that may be painful and restrictive, so it is important to work within a pain-free range and to allow the student to work within comfortable parameters, guiding gently to gain further movement. If the upper spine has kyphosis, it may be impossible to work this safely from a lying position, and sitting would be better.
Teaching focus
•When working with limitations in the neck, it is helpful to use visualisation. Offer the idea that each rotation moves a little more, and that with each turn of the head there is a freeing of the cervical vertebrae; add visualisation, such as imagining the muscles are like elastic.
•Ask the students to breathe into the stretch, to imagine it opening, softening and lengthening.
Hip releasing
A good place to start is the familiar Pawanmuktasana, circling the knees by guiding with the hands. There are many common variations and progressions to this releasing movement that a yoga teacher will be familiar with:
1.Circle the knees outwards and inwards, separately, and then together.
2.Keep one knee pulled in an out-breath, lifting the head to the knee, and repeat with each breath. Repeat on the other side.
3.With the knee pulled in, slide the other leg along the mat, and extend through the back of the leg, pushing the heel away.
4.Pull both knees in, curling into a ball to extend the spine.
All of this can be worked with breath coordination.
Parkinson’s/MS note: It is sometimes helpful to assist with this, as there is often one-sided action. With permission, you can gently take the knee and move it in the correct way, until the student is ready to take over.
Rock the baby
This movement helps to work into the hips and sciatic area.
Instruction
1.In a sitting position either on the floor or on a chair, sit up tall.
2.Bring the right foot onto the left knee, and let the right knee fall out to the side, by allowing rotation in the hip. Do not force the knee into position.
3.Hold the knee in the right hand and the foot in the left, and lift the leg as far as is comfortable, as if you are cradling a baby. Be gentle.
4.Rock gently from side to side.
5.Repeat with the other leg.
More flexible people will be able to draw the leg up closer to the body.
WARM-UPS FOR COLD DAYS
Unless you have a beautifully heated room, there are sometimes cold winter days when being on the floor is just too cold. These days are when we practise standing dynamic warm-ups. These are good to get the circulation going and warm up hands and feet.
Swing arms
Instruction
1.Swing the arms, backwards and forwards, keeping the arms loose in the shoulder joints and moving freely. Coordinate with the breath – in with a forward and backward swing, and then out with another forward and backward swing.
Parkinson’s/MS note: In Parkinson’s the loss of arm swing is characteristic of the disease, but can be improved. Observe the group, to see where people cannot loosen or let go. Encourage that swingy puppet-arms feel. This can be worked into a forwards and backwards step. Step forwards as the arms swing up, and then shift the weight onto the back foot and let the arms naturally drop. Repeat with the other foot forward.
Swing twist
With a loose turn of the shoulders and upper body, allow the arms to hang loosely and to ‘hit’ the body where they land.
DYNAMIC BREATH WARM-UPS
These are done breathing in through the nose and out through the mouth.
Instruction
1.With an ‘easy step’ forward (see page 80), turn the shoulders and hips to the front.
2.Bring the arms up and hold the hands in fists in front of the chest, knuckles together, elbows lifted out to the sides.
3.Breathe in, and sharply pull the fists apart. Breathe out, snapping the fists back together.
4.Repeat five times. Bring the feet back together.
5.Step forward onto the other foot and repeat.
6.With the feet in the same position as before, arms straight out in front at shoulder height, on a sharp in-breath lift the arms up quickly, then bring them down on an exhale. Repeat 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.
Instruction
1.Extend the heels and stretch through the hamstrings; gradually, it may be possible to take any under-the-knee support away.
2.Draw the trunk up tall; engage the pelvic floor and the abdominals.
3.Place the arms down on the floor firmly or with fingertips, or on supporting blocks or bricks. The whole body should be strong and taut.
4.Hold for a number of breaths (that can gradually be extended), then experience release and softness on letting go.
A version can also be offered from a chair with a couple of possibilities:
1.With knees bent and feet parallel, be aware of sitting up on the ‘sit’ bones. Hold the sides of the seat and raise one leg straight, lower it, and then try the other leg. This way we can notice whether we have one side more responsive or stronger than the other. Try both legs together.
2.Use two chairs facing each other and spaced so that straight legs can be supported. Raise the legs to the chair in front, as you would if you were on the floor (but take care that you are safe enough to sit this way).
Teaching focus
•Inner strength, core muscles active.
•Long spine.
•Feeling the strength of the ground and connecting to that, through the base of the spine.
•Move attention to, and root through, Muladhara.
•Breathe up through the spine, and grow tall.
•Offer ‘hands-on’ guidance for straightening the spine, placing your lower leg behind the student’s spine to assist uprightness without pushing too much, so that they can feel what ‘upright’ is like.
•Offer hands-on assistance to ease the shoulders down, or to even up lopsidedness.
The posture can be progressed by extending the time it is held. You can add levels of difficulty with arm lifts. Lifting the arms in parallel while engaging the pelvic floor and abdominals will build strength and improve posture. Holding a block widthways and actively engaging the subscapularis and teres major, drawing the shoulders down, is another strength-building postural-improving move.
Inner core awareness in semi-supine
Instruction
1.Lying with the knees parallel and bent, place a supporting block under the head to keep good neck alignment.
2.As you exhale, pull the navel towards the spine, engaging the abdominal muscles, This will enable the back of the waist to press into the floor and the pelvis to tilt, as the pubic bone moves toward the head.
3.Release, and create a small natural arch under the waist on the inhale breath.
4.Practise this pelvic rocking action.
5.Actively use the abdominal muscles to initiate the movement, and tuck the tailbone under, and then release and feel as if you are rolling the tailbone out along the ground.
Teaching focus
•Offer this movement regularly so that students become accustomed to the feel of this muscle action.
Working the core in Cat Pose (or Cat/Cow Pose)
Instruction
1.Balance on all fours with the hands under the shoulders and knees under the hips. Check that the spacing is enough to let the spine move.
2.Begin to inhale and lift the tailbone, hollow the spine and lift the head.
3.On the exhale, draw the tailbone under, arch the back up and at the same time pull up the pelvic floor and draw the abdomen in.
4.Hold, and release on the inhale breath.
5.Repeat to become familiar with the action of the inner core.
MOVEMENTS OF THE SPINE
The spine can move in the following ways:
•Extension: back bending, maximal in lumbar, but also in cervical.
•Flexion: forward bending, maximal in cervical, but also in lumbar area.
•Rotation: twisting maximal in the upper thoracic.
•Lateral flexion: sideways bending, lumbar and cervical regions.
•Circumduction: swaying and circling.
To keep the spine mobile, we need to offer practices that cover the wide range of movements that the spine can make. By observation, we can assess where our students have rigidity or weakness. This does not necessarily need to be at the level of an osteopathic or medical examination. As a yoga teacher, you will ‘see’ where your class are struggling, and be able to plan a programme accordingly.
Instruction for some of these simple movements for mobilising the spine can be found on page 40 and pages 49–50.
Extension: back bends
Back bends are useful for keeping the spine strong and flexible, and for combating the ‘simian’ posture in Parkinson’s. For MS students, they will be invaluable in maintaining strength in the spine. Standing and kneeling back bends have more possibility for bad technique. Gentle seated back bends offer a passive method of gaining flexibility and lying, where the floor provides good support for starting to build both flexibility and strength in postures such as Cobra and Locust.
Prone/face-down postures
This is a useful group of postures essential for strengthening the back and ensuring good shoulder positioning and strengthening for the upper thoracic. Encourage students to work within their own physical limits and within a pain-free range. Age, injury and kyphosis will all add limitations.
A folded blanket placed under the hips will offer comfort and support. Check whether the feet are able to lengthen and the top of the feet can rest on the floor. Offer a rolled blanket under the ankles for ease if this is not the case.
Be clear about the intention and goal of the posture – that is, to combat round shoulders, bring extension into the upper back, strengthen the muscles of the buttocks, lower back and core. The aim is not to lift up as high as possible, or to create as big a back bend as possible.
If you demonstrate the posture, do not show the best you can do – show what you expect your class to do.
Cobra Pose (Bhujangasana)
Cobra Pose is an amazingly strengthening posture that helps to maintain an upright strong spine; it aids in combating round-shoulderedness and stooping postures. Start with the simplest version so that people can gain confidence and feel that there is a level that they can achieve.
Instruction
Begin with Sphynx version:
1.Lie with the elbows placed under the shoulders and the forearms on the floor, providing a supported lift and curve to the upper back. In this position feel the active movement of the shoulder blades, down and back.
2.Keep the spine extending, so that the posture becomes active.
3.Follow with a release of the head that can hang forward to stretch the base of the neck.
4.Repeat this movement a few times. It can provide good loosening of the neck that is often held in tension.
For Cobra Pose:
1.Lie face down, bring your hands under your shoulders, draw the elbows back and the shoulder blades down your back; keep the legs parallel, feet pointing away.
2.Exhale, draw in the abdomen and engage the pelvic floor.
3.Let the nose travel forward and then lift the head away. Don’t push the chin out, compressing the back of the neck; keep the back of the neck long.
4.Feel that the legs are strong, and use the buttocks and hamstrings to anchor you to the floor. With the shoulders pulling down and the shoulder blades feeling as if they are sliding down your back, explore how far the upper body can lift off the floor without using any pressure in your hands. This may not be very far.
5.Let the chest move back onto the floor and lower the head down, then the chin, nose, and then the forehead. Rest and practise abdominal breathing. Repeat to familiarise yourself with the effort needed and the technique.
To further the practice:
6.By using the breath to help the lift, begin to press into the hands to assist. Come up higher, but maintain the down shoulder position and upper back extension.
7.If lying on the floor is impossible, a more gentle back bend can be worked from the chair.
Teaching focus
•Pay attention to arm and shoulder strength, and where people may be struggling, encourage working within personal limits.
•Awareness in the upper back and hands/shoulder/elbow placement.
•Encourage by stating the benefits, such as ‘feel strong and graceful’.
•Counteracts round shoulders and a humped spine.
•Activate the buttocks and legs.
•Encourage the lengthening and extending of the spine.
Parkinson’s/MS note: Some may find that this is tough, as it requires strength and upper back mobility, so praise even the smallest changes. My experience is that this is often a posture where I see a lot of improvement over the weeks, and that improvement is built on in the standing postures. For those with MS, there may be overall weakness in the muscles that aid the push up. Allow the student to do whatever is possible, and give encouragement.
Chair back bend
Instruction
1.Sit tall towards the front of the chair, with feet and knees parallel.
2.Hold the back of the chair seat and anchor your tailbone down, as if you are growing it towards the floor.
3.Begin your back bend from the very base of the spine. Lift the spine up and the breastbone forward and arch the back.
4.Support the head and neck by tucking the chin in a little and lengthening the back of the neck. Keep the chest open and hold for four breaths.
5.Come out of the posture and release the head and neck forward.
Teaching focus
•Keep the breastbone lifted.
•Make allowances for kyphosis.
•Encourage the bend through the whole of the spine.
•Enjoy the release following the posture.
•Anahata chakra – heart-centred energy focus.
Standing back bend
This is contraindicated for some back problems, such as a strongly kyphosed spine and scoliosis. Work with it sensitively and steadily.
Instruction
1.Bend your knees, support your hips in the lower back, and keep the pelvis forward.
2.Lift the spine and keep the breastbone forward; keep the neck supported. Go only as far as feels safe and comfortable.
For the chair-supported version, experiment with a standing back bend similar to a Cobra stretch:
1.Stand behind the chair about 2 feet away, and hold the back.
2.Engage the core, lift and lengthen the spine and arch the back from the hips.
3.Lift the breastbone, and keep the chin slightly in, with the head supported.
Locust Pose (Shalabhasana) (leg lifts)
Instruction
1.Place a blanket or pillow under the front of the body, if needed. Check that the tops of the feet are on the floor and long, and support with a rolled towel if needed.
2.Lie face down. Place your forehead down on the mat, arms down by your sides. Alternatively, place your elbows out and forward, to rest your head on your hands.
3.Exhale and draw the abdominal muscles in, toning the buttocks and back of the legs.
4.Without tipping over to the side, lift one leg, keeping it as strong and straight as possible. Lower it in a controlled way.
5.Repeat four times.
6.Do the same on the other leg.
Teaching focus
•Keep the whole body stable.
•The height of the leg lift doesn’t matter as much as the feeling of strength extension.
•Check that there is no tipping over or outward turn of the leg. Make individual adjustment where needed.
•Swadisthana chakra, and lower back awareness.
•Feel into the front of the hip joint and imagine the leg lengthening away from that place.
If you are working individually, you can offer some hands-on correction for alignment and to discourage tilting to one side – for example, a hand placed on the lifted hip or gently holding the leg in place, while asking the student to connect to the muscles needed to do the job.
Progress to the full posture with both legs lifted, supported by a fist under the hip joint to provide leverage. Although this requires strength, the preparatory work will be of benefit even if no lift is achieved.
This is contraindicated for inguinal hernia and severe kyphosis.
Standing Locust Pose
If working on the floor is impossible, a wall- or chair-supported version can be offered.
Instruction
Using the wall:
1.Stand close to the wall and place your hands on the wall at shoulder height.
2.Keeping the pelvis facing the wall, lift one leg away at the back.
3.Hold it for a moment and bring it back in. Repeat four times.
4.Repeat with the other leg.
With chair support:
1.With the chair back facing you, hold the chair.
2.Keep the hips facing the back of the chair and lift one leg back and away.
Teaching focus
•Check that the body does not tip forward to give the feel of a leg lift.
•It doesn’t matter how high or far the leg is lifted.
•Keep the core muscles engaged.
•Strength and stability.
•Swadhistana chakra.
Flexion: forward bending
Stretching and lengthening the muscles of the back of the body will provide a counter-pose to the back-bending asanas, but also help to work any rigid areas.
Contraindication: Forward folding is contraindicated for people with osteoporosis, high blood pressure, glaucoma or a detached retina.
Standing Forward Fold (Uttanasana)
The bending action for this posture will come from the hip joint, so that the spine can stay long throughout.
Instruction
1.First step. Stand in parallel, and feel where the hip joint is.
2.Offer a preliminary bend with the hand on the hip joint, and with knees bent.
3.Exhaling, bend from the hip joint in a hinging action. Fold over as far as is comfortable, and then come up to the start position, inhaling.
4.On an inhale breath, lift the arms up towards the ceiling, and lift and lengthen through the front of the body as well as the back.
5.Exhaling, bend from the hip joint, keeping the spine long and allowing the knees to bend.
6.Reach forward and then down. Let the hands and arms rest wherever is comfortable.
7.Come out on an in-breath and stretch the arms forward, and then bring the spine up.
8.Alternatively, from the folded position, come up by uncurling the spine.
9.Walk the hands up the legs to come out of the posture if the back needs support.
Teaching focus
•Keep the knees released unless the hamstrings are able to allow the legs to be straight.
•Check that the knees don’t roll inwards.
•Be aware of the muscles that are used in completing this movement.
•Let each student work within their own limits.
•Don’t hold for too long at first; work with going into the posture and coming out of it.
Using the wall or a chair
This forward-bending action can be offered from seated position or using the wall or a chair (Paschimottanasana, Seated Forward Bend) for support.
Wall- or chair-supported bend
Whether you use a wall or a chair depends on the height of the student. The wall is usually better for taller people.
Instruction
1.Stand about 1 metre away from the wall, and place your hands on the wall at shoulder height. Adjust the position of your feet to get the best alignment for the spine – they can be a little wider than your hips. Explore what is comfortable.
2.Keep your knees bent if the hamstrings are tight.
3.Walk the hands up or down the wall until there is a feeling of comfortable supported stretch.
Teaching focus
•Allow each student to explore their own limits.
•Explore the distance, by moving further away from the wall.
•Let the student begin with bent knees if necessary, and work towards straightening them gradually.
•Look for body sagging, and encourage work into the abdominals, and check the shoulder position.
•Check that the heels are down – a wedge-shaped block might help if there is strong shortening of the Achilles tendon.
•Bring attention to the feet.
MS note: For some people with MS, numbness is an issue. This affects balance and stability and therefore needs to be considered in the standing postures. Not being able to feel the feet will impact on how the other muscles are moved and used, so individual attention and adjustments to alignment are essential. Here you are playing the part of giving feedback that is lacking in the nervous system.
Seated Forward Bend (Paschimottanasana), on a chair
Instruction
1.With the feet parallel and placed on blocks, if that helps the feet to feel grounded, lift the arms in parallel, lengthening the torso and spine.
2.Forward bend from the hips on the exhale breath. Move into the bend slowly, going all the way down, hands to feet, or as far as they will go.
3.To progress, this posture could be worked more slowly, stopping halfway with the spine and arms horizontal with the floor, inhaling and exhaling on bending further.
4.To come out of the posture, lift and extend the arms up and forwards first, creating a horizontal line with the arms and the spine.
5.Lift all the way up and then relax.
6.If this is too strenuous, lift the spine with the arms in a soft relaxed position.
Seated Forward Bend (Paschimottanasana), on the floor
Props are helpful in this posture – a block to sit on to enable a better bend if the hip joints are tight, or a rolled blanket to support under the knees if the hamstrings are tight and the legs cannot be comfortably straight, or a strap to help facilitate alignment of the spine.
Instruction
1.Sit on the block. Feel for the ‘sit’ bones and connect into them.
2.Take note of the knees and whether they want to bend; support underneath them with the rolled blanket if necessary.
3.Place the strap around the soles of the feet and leave the ends loose beside the legs.
4.Sit up tall and breathe in.
5.Lift the arms up to lift up the ribs, and reach up.
6.Hinge at the hip and bend forwards.
7.Let the knees bend.
8.Imagine you are going to lie along your legs. Go as far as you can and hold the ends of the strap, or hold your legs.
9.Move a little further into the stretch.
10.Come out by lifting the arms up again and sitting upright, or let the arms drop and return to upright in a softer way.
This is contraindicated if there is osteoporosis, and hiatus hernia may also prove problematic if acute.
Teaching focus
•Go only as far as is comfortable.
•Imagine a long line down the front of the body, and keep the line long.
•Let the crown of the head move towards the feet, not the knees.
•Swadistana chakra.
•Breathe along the stretch, imagine light and space in the spine.
•Avoid poking the chin forward, and keep the back of the neck long.
Parkinson’s note: Those with severe kyphosis should focus on extending the upper back and avoid ‘crouching’ over. Give guidance for the position of the head and neck.
Apanasana
This easy flexion posture is a great way to begin to warm up and to release tension in the lower back.
Instruction
1.Lie flat on the floor. Support the head with a block to keep a length in the neck. This pose can also be started in a semi-supine position.
2.Bend one knee, reach and clasp it in your hands, and fold it towards your body, as you exhale. Hug the knee and inhale, exhale again and lift your head up towards your knee.
3.Inhale and put your head back on the block, exhale and lift it towards the knee.
4.Repeat this action five times.
5.Slide the leg away, and draw the other leg in.
6.Repeat the movements and breathing.
7.Draw both knees up together and hug them in on the exhale breath. Hold and inhale.
8.Exhale and lift the head to both knees. Inhale and lower the head back to the floor.
Teaching focus
•Check for the head/neck position and support where needed.
•Observe any difference in mobility in right and left.
•Imagine breathing into the whole length of the spine.
•Imagine the muscles lengthening and stretching like elastic.
Rotation
Twisting postures enable the small joints of the spine to be mobilised. Yoga offers standing, sitting and lying versions of this same action. Each offer something a little different and are more passive or active depending on application.
Standing twists
The important thing about this posture is to bring attention to the length and alignment of the spine and to discourage forward or back bending that is often seen as people try to attain a full twist. This move can be offered in several ways.
Instruction
Beginning with hands on hips, and spine upright, this is an exploration rather than a posture offered with attention to correct alignment:
1.Allow the whole body to twist from the feet and ankles upwards. This way you can experience the twisting, noticing whether there is an unpleasant pressure in the knees or any other places. This is not a very effective twist and can easily be detrimental, so we are using it here for a comparison. We can see how much of the twist is actually in the hips and legs rather than in the spine.
The next step would be to bring in the ‘rules’ for good alignment in standing twist:
2.Keep a long upright spine, keeping its natural curve, but staying with the idea of an upright pole.
3.Keep the hips facing front (imagine that your hip bones are like car headlights).
4.Let the spine turn, feeling this mostly in the upper body, as the hips stay facing forward.
5.Notice the limitation, don’t push or strain, but rather use the inhale breath to grow taller and the exhale breath to turn a little more. The teacher will encourage this with guiding words, reminding you not to force the pose.
6.Repeat this two or three times, on each side.
Teaching focus
•Remind the class of the benefits of this movement: mobilising the spine is essential for good posture, movement and balance; twisting stimulates blood flow and stimulates nerve function.
Twisting posture, chair version
This twisting posture can also be offered in seated form, which is useful for those who cannot stand for an extended time are unable to balance well enough, or if there is incidence of low blood pressure. It helps to stabilise the hips.
Instruction
1.Using a chair, let the student sit towards the front to give room for the turn.
2.Sit up on the ischia (or ‘sit’ bones) to enable an upright posture rather than a slumped back position.
3.Turn, coordinating the breath with the movement as described above, taking the arm across the body right hand to left knee; the left hand can move around towards the back of the chair. Keeping the spine upright, encourage the tailbone to lengthen and the crown of the head grow towards the ceiling.
Some alternatives:
1.An option that gives more stretch is to sit sideways on the chair so that the back of the chair is to the side of the body. Turn toward the back of the chair and hold it, using it to aid the turn.
2.Using a block in both the standing or sitting twist aids the upper back and shoulder positioning – hold a firm block widthways out at shoulder height, draw the shoulders down and press the base of the little finger into the block (supination).
3.With the spine long and working with breath coordination, let the turn begin from the thoracic spine. This helps to keep the spacing and brings strength and steadiness.
Teaching focus
•In both standing and sitting versions it is helpful for a little hands-on support. Hands on shoulders encourages the student to open, and this should be a very light touch, as once the direction is given with the hands, the student will often very readily respond, and can manage further movement.
•Hands-on guidance can be helpful when there is a tendency for round shoulders or pulling away from the upright stance we want to encourage.
•Breathing up the spine in a spiral action – feel that this is bringing prana into the spinal column.
•Lengthening both at the tail and crown – imagine creating spaces between the vertebrae.
•Good positioning of the shoulders to aid pectoral stretch and to act as an antidote to round shoulders.
Half Spinal Twist Pose (Ardha Matsyendrasana) (seated twist)
