Managing Parkinson´s disease with Yoga therapy.
Physiology, causes and symptoms of Parkinson´s disease
Parkinson’s disease is a neurodegenerative brain disorder that progresses slowly in most people. This means that individuals will be living with PD for twenty years or more before the time of diagnosis, being more common in population over age 60. The cause of the disease is idiopathic (unknown), and there is currently no cure for Parkinson’s. However there are treatment options to help to control its symptoms and improve overall health and well-being for PD patients.
Parkinson’s involves the malfunction and death of dopamine-producing cells, which plays an important role in basal ganglia activities. The basal ganglia are associated with a variety of functions, including voluntary motor control, procedural learning relating to routine behaviors or “habits” and emotional functions. The basal ganglia, is a group of interconnected brain areas located deep in the cerebral cortex. The main components are: the striatum (caudate nucleus and putamen), the globus pallidus, the substantia nigra, and the subthalamic nucleus. The pars compact, a portion of the substantia nigra produces a neurotransmitter, called dopamine (that is also produced in several areas of the brain, including the ventral tegmental area). Dopamine it’s a chemical messenger that helps in the transmission of signals between the substancia nigra and other areas of the brain. When approximately 60 to 80% of dopaminergic neurons dies -unknown cause- in this specific area, the motor symptoms of Parkinson’s disease appear.
The name of the disease is due to an English physician called James Parkinson who first defined it as a “shaking palsy”, back in 1817. The main physical symptoms are tremor, bradykinesia (extreme slowness of movement), flexed posture, loss of balance, and muscular rigidity, although the type and severity of symptoms vary from person to person. Apart from this motor symptoms PD patients often shows diverse complaints such as fatigue, constipation, sleep disorders, difficulty with swallowing and even diminished ability to smell. Another very common symptom is the speech and voice disorders, such as soft, monotone, breathy and hoarse voice, and imprecise articulation. Depression is one of the major and most common non motor symptoms for people with PD. At least 40 percent of people with PD experience clinical depression at some time during the disease. It causes personal suffering and also appears to intensify problems with mobility and memory.
According to Ayurveda medicine PD- Kampavata- is a disease of Vata disturbance, (dosha related to the brain and nervous system). This dosha is more prominent after the age of 55, and when there´s an increase of prana vayu - air element - in your body, it can cause many kinds of disturbances, such as Parkinson´s.
How is PD treated?
As I was mentioned before there is no cure for Parkinson’s disease. Instead, therapy is directed at treating the symptoms that are most bothersome to an individual with PD.
Treatment approaches include medication, exercise, support groups and occupational therapy.
For the speech and voice disorders Lee Silverman Voice Treatment (LSVT LOUD) and speech therapy method are used. This LSVT LOUD therapy improves vocal loudness by stimulating the muscles of the voice box (larynx) and speech mechanism through a systematic hierarchy of exercises. Focused on a single goal — “speak LOUD!” — the treatment improves respiratory, laryngeal and articulatory function to maximize speech intelligibility.
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. While DBS has proven helpful for some patients, there is potential for serious complications and side effects. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications, or whose medications have severe side effects.
Yoga Treatment
Yoga refers to a scientific scheme of physical and mental practices that originated in India approximately 5000 yrs ago. The word ‘Yoga’ means “unity” or “oneness” and is derived from the Sanskrit root word “Yuj”, meaning “to join” or “to unite”. The spiritual connotation of this word interprets to the union of the individual consciousness with the universal consciousness. Yoga philosophy attributes most diseases to insufficient life force- pranic energy-, either in the body as a whole, or a blockage of life force localized to one part of the body leading to decrease in immunity and increased susceptibility to illnesses. Yoga modulates health by influencing almost all systems in our body and improving the quality of life of the practitioners, leading to a state of positive health, attitude and enhancing immunity. This is attained through the practice of asana, pranayama, mudra, bandha, shatkarma, mantra and meditation.
The different practices of Yoga can definitely help patients suffering from Parkinson´s. First, controlling and releasing the symptoms of the disease, secondly, slowing the progression and possibly preventing the disease. How? With the practice of the different techniques of Yoga one can alter the way the brain works. Our brain has neuroplasticity, that is, if we stimulate our brain, it creates new nerve pathways to take over the role of what it may have lost from a neurological disorder, such as Parkinson´s disease.
Different techniques and benefits:
Asanas
The practice of asanas helps to prevent the negative effects of inactivity and also helps to prevent secondary effects that may develop in PD patients such as:
poor posture;
decreasing range of movements (losing flexibility);
decreased strength particularly in the muscles that hold you upright, resulting in a tendency to stoop forward;
decreasing endurance (being out of breath or fatigue);
poor balance.
With the regular practice of asanas one is:
able to maintain a good range of movement in all joints and improve muscle strength;
able to improve balance and posture;
less likely to fall;
able to carry out more daily activities.
Useful Asana practices:
All basic movements from Yoga Sopan and preparatory movements from Pravesh book;
Surya Namaskar to help loosening up, stretching, massaging and toning all the joints, muscles and internal organs of the body;
Pawanmuktasana Series Part I (concerned with loosening up the joints improving their coordination) and Part II (concerned with improving the function of all digestive system), very useful to release stiffness, muscular tension and constipation, symptoms related to PD;
Balancing asanas are very beneficial to improve the poor balance of the PD patients because they help to develop the functions of the brain that controls how the body works in motion;
Backward bending asanas expand the chest and strengthen the muscles that control the spine helping the patients to improve their posture. It also creates a big pressure on the abdominal area, massaging all the internal organs, very beneficial for constipation;
Inverted asanas encourage blood to flow to the brain, nourishing the neurons and flushing away toxins. They improve health in general; these practices are very refreshing and revitalizing;
Forward bending and spinal twist asanas, they are very good to improve the digestive system.
A slow, rhythmic and deliberate practice with focus on the breath is ideal.
Pranayama
Pranayama is the technique used to control the pranic energy within your body, being the medium for it the breath. The breath is the most vital process of the body, it influences the activities of each and every cell. The breathing process is intimately linked to the brain and central nervous system, it´s also related to the heart and circulatory system regulating their functions.
Abdominal breathing- due to tension and poor physical posture of PD patients, this technique is very useful because the correct breathing is restored and there´s a great improvement at the physical and mental level.
Anulom Vilom- this practice cleanses the lunar and solar channels (ida and pingala), helping the balance between body and mind.
Bhramari Pranayama- relieves mental tension, anger, anxiety and insomnia, all symptoms related to PD.
Ujjayi Pranayama- it is a very tranquilizing Pranayama soothing the nervous system and calming the mind. It has a profoundly relaxing effect at the psychic level and helps to relieve insomnia. It also has a heating effect on the body. Very beneficial for Vata dosha.
Mudras
Mudras are described as psychic gestures or attitudes that help manipulating the pranic energy within your body, which alters the mood, attitude and perception of the individual. Mudras are easy to practice, because they are mostly free hand body gestures, and they can be practice everywhere at any time.
Parkinson´s is a Vata disturbance so it s advisable to practice Mudras that balances the Vayu- Air element within your body such as:
Jnana (Dyana) Mudra- Mudra of Wisdom
Vayu (index finger) causes movements and thoughts. Agni (thumb) is related to the brain. When the tips of the index finger and the thumb join together the Vayu gets stabilized. Vayu and Agni together control the mind. Empowers the Pituitary gland and thereby the entire endocrine system. Empowers the muscles both voluntary and involuntary. Rectified the disorders of the nervous system.
Vayu Mudra
Excess Vayu is decreased, blood circulation improves and any area of the body experiencing pain starts getting relief.
Shunya Mudra
The middle finger is lowered into the base of the thumb and is covered by the thumb, while the other fingers remain extended. This is good for ear afflictions, listening and speech difficulties.
Prana Mudra
The major parts of our body is Prithvi (ring finger) and Jal (little finger). Joining the finger tips balancing these elements results in increasing stamina, vitality, strength and immunity. This Mudra starts the flow of vital energy in our body making a person mentally and physically strong.
Mantras
A Mantra is a mystical energy encased in a sound , syllable, word, or group of words. Every mantra contains within its vibration a certain power. The practice of Mantra librates the mind from all the suffering, irritability, over attachment, and ego. By chanting a Mantra one feels absolutely blissful and attain peace of mind quickly.The verbal and loud repetition of mantra can be very helpful for PD patients because of its benefits and also as a therapy for the problems related with speech.
They can benefit from the repetition of Omkar that makes one feel energetic throughout the day, reducing laziness, improving concentration and memory. The chanting of Gayatri mantra is very powerful, it removes all obstacles in our path and increases wisdom and spiritual growth and development.
Meditation
Meditation is a safe and simple way to balance the physical, emotional and mental states. There are physical and psychological benefits to people with Parkinson‘s who wish to practice meditation. The physical include deeper rest, decreased high blood pressure, and easier breathing. The psychological benefits include increased brain wave coherence, decreased anxiety, depression, irritability and moodiness, as well as increased learning ability and memory, increased self-actualization, happiness, vitality and rejuvenation, and increased emotional stability.
Yoga Nidra
Yoga nidra is the blissful relaxation. The practice of Yoga Nidra is the scientific method to remove all the physical and emotional tensions, leading to a quiet and peace mind.
Shatkarmas- cleansing practices.
Cleansing techniques that purifies the physical body and consequently the mind. PD patients can benefit and practice any of the six cleansing processes, such as neti (purification of the nasal tract), basti (cleaning of the lower abdomen) and tratak (fixed gaze and concentration on a single point), being more beneficial for PD the ones above:
Nauli Kriya- this technique provides a powerful massage to the intestines and digestive organs, avoiding constipation;
Kapalbhati (Cleansing Breath)- a breathing technique for purifying the frontal region of the brain energising the mind. It as also a positive effect on digestive system. It promotes well being in general.
Shankhaprakshalana (Intestinal Cleansing)- the various metabolic acids and chemical wastes causing stiffness, lethargy and heaviness such as lactic acid and uric acid are washed away. A clearer and more alert mind is experienced.
Ayurvedic treatments
Shirodhara is meant for eliminating diseases of vata disorders that affects the nervous system, such as Parkinson's disease. It is a curative as well as rejuvenating process, improving vitality and strengthening the sensory organs. It helps to relieve the symptoms such as insomnia, stress, tension, anxiety, and gives mental relaxation to the patient.
Steam bath helps to reduce stiffness and inflexibility of the limbs.
Abhyanga, body oil massage, that improves joint flexibility, reduces physical fatigue and releases muscle spasms and cramps, symptoms related with PD. It is normally recommended in vata disorders.
Diet
There are no special diets required for people with PD. Eating a well-balanced nutritional diet, filled with a variety of fresh fruits, vegetables, fibrous grains, nuts and no meat is preferable and is extremely beneficial. With proper diet, bodies work more efficiently and have more energy.
Contra-indications
Because PD is a disease of Vata imbalance, any postures that are too energizing and effortful are contraindicated, for example, power/vinyasa practices and Bikram would charge and fatigue the nervous system. A slow, deliberate practice with focus on the breath is ideal. Pranayamas that are stimulating like bhastrika are not recommended, also cooling breath including sheetali and sheetkari Pranayama. A slow, gentle ujjayi pranayama may be used. Inactivity is a huge contraindication to PD. It is essential for the PD person to embrace a life-long commitment to exercise due to the debilitating nature of the disease. In summary, any activity, thought, action, situation, person, food or liquid that brings about stress to the nervous system should be eliminated.
In the management of PD, daily practice is essential. The patiente should be encouraged to embrace yoga as a way of life.
