Teaching Yoga for ME / CFS

Jane has had ME for twenty-five years. For most of that time her life has been very restricted and she has been unable to leave the house or do simple tasks like cooking. She also suffers from constant pain. Jane started remedial yoga eight months ago and since then her energy has increased dramatically, the pain has subsided and she can now walk for up to forty minutes at a time; something she though she would never do again. In October she travelled to a yoga retreat in Turkey. This was the first time that she had been abroad for 14 years. As well as taking part in the twice-daily yoga classes, she also swam in the sea. “I know I have a long way to go before I fully recover,” she says, “but yoga has changed my life. I am now heading towards a state of wellness. Best of all, I feel much happier in myself and much more accepting and calm about where I am in my life.

There are many claims made about ‘cures’ for ME. Is yoga just another one, or can it provide a genuine way out of this complex syndrome? Many yoga teachers don’t even understand the condition, although there are around 250,000 people with ME in the and teachers inevitably come across it; usually with students who try to keep up with a class and then give up. So what exactly is ME and how can yoga help?

Chronic Fatigue Syndrome describes the symptoms of a collection of illnesses including lupus, cancer, MS, depression and ME (Myalgic Encephalitis). These illnesses may produce a profound and debilitating tiredness which goes on for a long time; in other words, a chronic fatigue state. ME also produces a chronic and extreme tiredness, so much so that those who have it may become bed-bound or need to use a wheel-chair. ME is usually caused by a combination of stress plus a virus or a toxin (such as an allergen or inoculation), shock, or organophosphate poisoning. ME has other symptoms too; most notably muscle pain, brain fog and dizziness, poor memory, disturbed sleep and trouble with digestion. All this may be combined with the kind of malaise that comes with a post-viral infection. There are various theories about what prolongs the illness but it seems that the immune function is compromised and may be always ‘on’ so that the white blood count is continually raised. There is some evidence that the body is also over-adrenaline-ised and permanently switched to a ‘flight and fight’ situation.

Symptoms vary from day to day or week to week, so that those who have the illness may appear to have normal energy for part of the day but may become profoundly exhausted after very little exertion. Yoga teachers may find these fluctuations confusing and difficult to judge – especially as the symptoms change from person to person. Some people are able to hold down a job, although their lives will be restricted as a result, whereas others who are severely affected may hardly be able to move or get out of bed. Some find that their cognitive functions are more affected, so may find it difficult to concentrate in a class, whereas others can be affected more physically and find it impossible to do anything too strenuous. What all people with ME have in common however is that if they do too much, this provokes a relapse. It can take those with ME many years to learn how to pace themselves and to understand how much activity they can do – so this makes it doubly difficult for yoga teachers to help, especially as those with ME may have a tendency to push themselves too hard. Also, symptoms from a relapse may be delayed. If a student does too much in a yoga class they may feel fine at the time but suffer for it one, two or even three days later.

“Having ME is like having flu, then running a marathon through treacle, then being forced to stay up all night and revise for an exam. Sometimes the fatigue is just incredible,” explains Jane. “The trouble is that those of us with it don’t always look ill, so people just don’t understand. Also, we had so much bad press a few years ago that there are still people out there who think that we are malingerers or just being lazy. Some doctors think this too – that we should be forced back to health with more activity when actually we need rest. The term ‘yuppie flu’ used by some journalists was incredibly unhelpful.” Like many people with ME, Jane initially had a bad experience with yoga. When she was first ill she went to a class where the teacher pushed her too hard, although she admits that she also pushed herself by trying to keep up with everyone else.

Those who have ME are unlikely to be helped too much by the medical profession.Until 2002 ME wasn’t officially recognised by doctors as a ‘real’ illness. After a two-year working party, the Chief Medical Officer, Sir Liam Donaldson, directed that it was indeed a real medical condition and that GPs had to take it seriously. Not all doctors do though. Confusion still remains, with patients insisting that the illness is physical and the medical profession, hijacked to some extent by a powerful psychiatric lobby, claiming that there are psychological reasons for the illness. NICE (The National Institute for Clinic Excellence) recommends a treatment protocol of CBT (Cognitive Behaviour Therapy), combined with graded exercise and anti-depressants. This is very controversial as too much activity may cause a relapse and rather than being depressed may be frustrated at having a chronic illness.

I had ME for fifteen years and was blessed to make a full recovery. I say blessed because not everyone gets better and the illness can take hold for many years, truly limiting the lives of those who have it. When I was ill I also felt strongly aggrieved that we were accused of having something that was psychological, when clearly this was not the case. As a yoga teacher however, I see things slightly differently now. I understand that each of us is a whole person – a combination of mind body and spirit - and that this applies in all cases and conditions, including ME. “All disease starts in the manomaya (mind) kosher” says Dr Nagerentha who teaches yoga therapy at the Vyasa ashram in Bangalore. She proposes that stress is the root of all disease and that in all therapeutic yoga we need to teach students to switch back into a state of being rather than doing, to embrace Patanjali’s approach of quietening and controlling the mind, in order to connect with the true inner being.

I believe that I recovered partly by getting in touch with my authentic self through the practice of yoga and certainly by connecting with my spiritual centre – something many of us are embarrassed to acknowledge. Certainly, I take this approach very gently with my students, but I do believe that all illness is there for a reason and so perhaps we should be learning to adopt a more healthy lifestyle, including the nurturing of our spiritual side. This also means becoming more focussed on the present and less concerned and anxious about the future. Many of my students have profound experiences when they start to relax; years of habitual tensions and samskaras are relieved. I also believe that there is a personality type with ME (and I include myself in this) and it tends to affect those of us who are perfectionists, competitive and ambitious. I see this very much in ME yoga classes and I constantly have to remind students that yoga is non-competitive, that they don’t need to push and that it is more important to relax and release tension, rather than create it through trying too hard in a posture. I still have to remind myself of this too – my own yoga journey is a work in progress!

I now run retreats for those with ME which gives the opportunity to focus on yoga philosophy and the yogic way of life. During this time we look at what really makes us happy and how attachment to external objects can create tension. The idea of true karma yoga – non attachment to the end result - and study of Patanjali’s sutras are invaluable for many. I believe that it is much harder to live in the 21st century than it was years ago. We are bombarded by information, which sets the mind constantly to ‘on.’ Even 20 years ago we didn’t have the Internet, text messaging, 24 hour TV and the degree of consumer pressure that we have today. All this stimulates us to an extent to our brains may not be able to deal with the continual information overload. “Stimulate, stimulate, stimulate!” exclaims Dr Nagarantha. “All this means that our stress response never has time to rest and recover!” So illness can then develop because the autonomic nervous system is always on red alert, so any infection or toxin that comes our way is harder to fight and shake off.

There is a huge demand for yoga teachers who can teach those with ME, so consequently I have taken over and developed two-day intensives from Angela Stevens, my teacher who inspired this work in the 90s. On these workshops we explore teaching techniques based on what Bill Feeney of The Yoga for Health Foundation, describes as ‘The Remedial Yoga Tool Box’. This includes very gentle stretching but with an awareness from the teacher of limitations and an emphasis on working from the heart, with love, non-judgement and compassion. Other important tools include teaching about breathing and posture as many people with ME chronically hyperventilate which prolongs the fight and flight state. Relaxation techniques including yoga nidra and visualisation are important, as are pranayama, gentle inversions (those with ME often have low blood pressure), mantra, chanting and meditation. Most of all, teachers really have to understand that less is more and that yoga is not just about doing postures. Many yoga teachers just don’t get this and can’t understand that strong postures can do more damage than good for someone with a chronic health problem. This applies especially in the case of ME, where students may be so out of touch with their own bodies, that they are unable to guide the teacher about what they can and can’t do. This means the teacher initially has to do this and generally has to encourage the student to do less. Having said this, there is usually a problem with secondary de-conditioning of muscle tone, so that students need to be helped very slowly towards building up strength. This is important, especially if they are flexible, so as to prevent injury and so that they are not exhausted when they start to become more mobile as the muscles take up more oxygen. Muscle de-conditioning can lead to a host of problems such as a weak back or core stability, which affects posture amongst other things and consequently interferes with diaphragmatic breathing. Teachers need to also beware of putting students in to an aerobic state, which can happen very quickly if students are very unfit. “Autonomic dysfunction may lead to an inability to achieve an increased heart rate,” explains Dr Andy Wright, who runs an ME clinic in Bolton. Teachers therefore need to teach very gently to help ME students learn to become self-aware and to pace themselves.

“I have had a couple of bad experiences with teachers who have actually pushed me too much and made me very ill,” cautions Jane. “But I still believe in the value of yoga and have taken the time to shop around for the right teacher. Yoga has now changed my life dramatically for the better.”

Above all, teaching yoga to those with ME, or indeed any chronic condition, is about teaching students the value of pacing, of slowing down; of breathing properly and learning to relax, whilst allowing them to get back in touch with their spiritual centre and to live more in the moment. The remedial yoga toolbox can then be adopted for any level of activity, even for the severely affected. And, as Desikachar says, if you can breathe, then you can do yoga.



This article by Fiona Agomabar first appeared in Yoga and Health Magazine.



Fiona Agombar teaches workshops for teachers interested in working with those with ME and Chronic Fatigue Syndrome. Fiona runs regular retreats for those with health challenges including a yoga holiday to Turkey in October. Details from www.fionaagombar.co.uk. Fiona is author of Beat Fatigue with Yoga (Cherry Red books). Angela Stevens has a series of CDs of yoga, breathing and relaxation for ME, details at www.angela-stevens.co.uk

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