Saturday, 19 August 2017

Ankylosing Spondylitis and Iyengar Yoga

This is a case study of one of my student aged 38 years, who came to  the Therapy class with the complaint of inflammation, pain, and stiffness in the joints of his spine and also other parts of the body. His entire spine was stiff like a bamboo stick, pressing on nerves and causing increasing numbness in lower parts of his body. There was stiffness in his neck also and if he had to see something on the side, he had to turn his whole body. These are the symptoms of Ankylosing Spondylitis. 

The term Ankylosing Spondylitis is derived from Greek words - Ankylose meaning stiffening and Spondylitis connotes inflammation of the spine. It is a type of progressive arthritis that leads to chronic inflammation of the spine and sacroiliac joints. It can also affect other joints and organs in the body, such as the eyes, lungs, kidneys, shoulders, knees, hips, heart and ankles. However Ankylosing Spondylitis primarily affects the axial skeleton, including ligaments and joints.
This disease causes stiffness, aching and pain around the spine and pelvis. The disease can eventually lead to a total fusion of the spine. This occurs when the vertebrae (spinal bones) actually grow together fusing the spine due to calcification of the ligaments and discs between each vertebrae. If the vertebrae fuse together, the spine is robbed of mobility, leaving the vertebrae brittle and vulnerable to fractures. 

Working with him from a Therapeutic perspective:

Initially worked with a few simple basic asanas along with Tadasana to create some mobility and access to the stiffened joints to be able to work further on those joints.

Gradually taught him to use the muscle fibres that were moving to approach, reach and work on the muscles that were stiffened and fused. Over a period of time the joints gradually began to respond. I then asked him to use his breath as a facilitator to synchronise with the mobility available to increase the access and create the required action and movements.

I first worked on his basic hip joints and shoulder joints to facilitate the movement / action in the spine. 
Initially he was more concerned over his cervical area and tried to draw my attention to the affected area on several occasions. It took him some time to understand why I hadn't addressed his cervical area in the beginning. Once the muscles and area around the hip and shoulders began to respond, then the cervical spine became accessible to work on.
  
To facilitate access to his bone structure, movement was generated from outside with the help of props. The Props gave support, access and lift to the muscle fibres which in turn acted as further support to access the bones so that when traction is applied it doesn't pressurise the bones. Though the action is strong it is not harsh and the impact is that of a smooth opening with freedom in joints but not like a tug of war. When traction was applied in this manner, slowly he also learned to access the inaccessible areas himself.
  
He was then taught to align and use the props according to his needs - (How a simple holding of the belt higher on one side and lower on the other side in the asana can correct the mal-alignment of the body) so that he moves from dependency to practicing independently.
  
This also worked on the mind. It gave a boost to his confidence and his optimism in the recovery process increased. Each movement and opening not only led to a sense of freedom in the body but, also helped in uplifting his spirit towards life. Though the asanas and props worked through the body, the change/transformation went way beyond it and helped in positively changing his perception, perspective and understanding to experience the essence of the practice of Yoga.

Now I would like to take you to the narration by the person himself on his encounter with Ankylosing spondylitis, diagnosis, treatment and the role Iyengar yoga practice played in improving his condition.

Personal Experience of the student:

(a) Encountering Ankylosing Spondylitis:

Year 2010: It all started in the mid 2010 with a spasm on left side of the neck.  There was lot of work tension during that period. My initial thought was too much stress at work might have caused the problem.

I visited a good Orthopedist. He is the same Doctor who treated me when I was injured in Cricket. With Allopathic medicines the spasm subsided but reccurred in 15 days again. I used the same medicine.

However to get a second opinion, I consulted another Orthopedist who is specialised in sports medicine. He asked whether I get morning stiffness and whether I can get up from bed lying on my abdomen. There was stiffness for sure and was very uncomfortable in getting up from bed lying on my abdomen. He then recommended a blood test for HLA-B27 gene and diagnosed Ankylosing spondylitis. May be, I heard the term Ankylosing spondylitis for the first time in my life. Not knowing what it really is, started swimming and doing yoga (watching on TV). But gradually the stiffness was building up in the neck.

(b) My struggle with the disease, treatment and medication:

Year 2011 to 2014: This was the period of my struggle. I was not sure what exactly needed to be done to counter the disease and did everything possible from my side without much awareness. Late 2010 and early 2011 continued with whatever exercises I was aware of that I learned in my Karate classes. Things were not really good and neck was going on and off.

Early 2012 in a short time, I realised that my flexibility was going down with the wrong exercises I attempted so far. Multiple effects started to show up. Catch or cramping of muscles while travelling on bikes especially riding through bumps on road, while jumping and while turning sides on the bed. Discomfort in right shoulder blade and region below (the lats). Tightness in hip, hamstring, lower spine and off course the neck. To get more flexibility, I joined a rehabilitation-cum-physio centre. The concept was to release the trigger points (muscle knots) or myofascial points. I learned stretches for various muscle groups like multifidus, pectoralis etc. while the trigger points getting released, felt good but that comfort was not consistent enough. During this period my left eye was effected with iritis which was relieved through Ayurveda medicines.

In the year 2013 I started taking Ayurveda treatment. I underwent Panchakarma and diet recommended by the doctors. 

I felt some relief in the condition of Spondylitis with Ayurvedic diet and physio exercises but not seen any improvement in the condition of my body.

(c) Introduction to Iyengar Yoga:

Year 2015: I observed some tilt in my right hip, discomfort in sitting cross legged, lats were kind of catchy at times and my walk got misaligned. 

I searched over internet and did every exercise that came across to get some relief. During this time I saw couple of exercises/stretches done using props; especially the hamstring stretch by lying on top of brick using a belt. I tried this and found good. I did search over internet for "props" and came across a name "BKS Iyengar".

I searched through many US based websites and found that "BKS Iyengar" is from India. Look at the irony. I got into BKS Iyengar official website and searched for teachers in Hyderabad and found the name of Ms Zarna Mohan  the only teacher of Iyengar Yoga in twin states of Telangana and Andhra. I then called her up on the number given in the website. I had to wait for sometime to get a slot in the medical class. 

I got admission into the therapy class. I joined the class with lot of apprehensions. Madam assigned Mohit and asked me to do some hand rotations. Then I found that my arms were also stiff. While adjusting the posture in Tadasana if my head was touched, I felt lot of pain across. In a way it was all crooked and tilted. 

(d) Began to understand my body better:

I tried every sort of medicine and exercises and I had no choice left but to follow the path shown by my teacher. 

Initially I felt great difficulty in doing the asanas as my body was too stiff, crooked and misaligned. With great difficulty I could only move my body to a very less extent. It was difficult and painful and at times  confusing also. 

Initially, not many asanas were given to me and I used to work with some assistant teachers.  At times I developed a feeling that why madam is not correcting and not fixing me as she does to others. It took me sometime to realise that I was allowed for seasoning. She allowed me to get used to the practice and system of yoga she teaches.  

(e) Iyengar Yoga brought me hope and relief:

Year 2016: I was regularly practicing at home the things learned in the class. Slowly madam began to introduce new asanas and she herself started making corrections in the body. She used to touch me at the points where I need to push, extend or expand. The sync and push would be so gentle and soothing that my body began to respond to her touch. She is very clear about the areas where she needs to work and knew exactly how to work to mobilise it.  Without removing my t-shirt she would tell where the problem is and would correct accordingly. Few months later I saw a new ray of hope and used to walk out of the class with a pumped up chest.
Year 2016 was really amazing for me. I realized that Guruji BKS Iyengar's light is on me through my teacher Zarna Madam. I never imagined that I will be doing Sirsasana on my own; off course with the support of wall ropes . My body correction has just begun. I was trying to focus and get inner consciousness.
(f) Impact of Iyengar Yoga Practice on my Life:

Before Yoga I was going through a phase of physical and psychological discomfort in my life. Iyengar yoga practice has created tremendous impact on my life and has brought in unbelievable transformation. 

1. Body Awareness:  It is only after joining the class, that I became aware of the stiffness/rigidity in my shoulders and my hips which was responsible for arresting spinal movements. I was totally unaware of the fact that my chest was caving in and was unable to lift and open my chest.

2. Improvement in my body movements:

There is a good deal of improvement in my shoulder rotations, freedom in the lumbar and dorsal spine and tremendous improvement in my hips. There is also some improvement in my cervical spine. As a result of this there is comfort in driving a car, improvement in swimming, and also no discomfort in riding a motor cycle anymore. There is an ease in my breathing and my snoring that troubled my family members at night has vanished. There is lot of ease in waking up from the bed. I can turn on both sides and sit up on bed but, Off course I can't sit up completely straight as yet. 

I still remember when I first went to the class I was not able to keep the legs on chair while lying down on the floor for Supta Padangustasana2. Assisting teachers would support and help me to put my legs on chair with great difficulty. But today I can keep my legs up straight to the wall and do Supta Padangustasana2 on my own. The opening in hip joints changed my walking gait and I now feel a lightness in my walk.
When I used to lie down on the floor, the shoulders would not touch the floor and neck would be around 12 inches above the ground. So I had to pile up couple of folded blankets to rest my head. But now the shoulders are comfortably resting and the the distance between the floor and neck has greatly reduced.

With an opening in my entire spine, I can now turn my body to look at things in the sides.
 
3. Growth in Psychological strength and confidence:

Before Yoga, I was under lot of stress and psychological pressure. I used to get angry, irritated and frustrated quite easily and was unable to hold my emotions. I used to express my anger and frustration on my family members for no fault of theirs and I would express on things if can't express on people. For example, if I am driving and someone comes across, I used to horn continuously and express my anger by blowing horn loudly. 

Regular practice of Iyengar yoga has brought in great transformation in my perception and thinking. Due to the confidence I gained through my practice, my anger, irritation and frustration disappeared. Let me tell you this, I peacefully drove my car for six months without a horn (that was damaged and repaired recently). 

Though I haven't got fully corrected and I know, still a long way to go but at least I found a path to go. With the blessings of Guruji and my teacher I hope will make my journey successful. I am still in the middle of the elite group like Narasimha sir who successfully fought out prostate cancer and regularly practicing like a new student. Inspirational words from him are really good. Found abundance enthusiasm in him when he says I am one inspiration. Parameshwar sir and all other assisting teachers Mohit, Raghavendra, Jagruti, Ram, Dinesh and Dr. Shasikala have always encouraged and guided me with new viewpoints. I am thankful to all. All I can say about my teacher is only one thing. If my mother knows yoga and is supposed to teach, correct and adjust me, she might have done exactly in the manner Zarna Madam is teaching me. I am really amazed at the way she synchronises with my breath and body while doing the corrections needed. 

Little late but I got the Light of Guruji and with the support of my teacher started walking on the path of Iyengar Yoga. The Quest has just begun. I sometimes wonder had Guruji not developed these props and spread his knowledge to the World, thousands of people like me would have not benefited from yoga. I am really grateful to him and for the path and knowledge he has passed onto the world. 

An Assessment by Dr. Saraswati - A Professor of Internal Medicine at Shadan Medical College, Hyderabad and an Iyengar Yoga practitioner.


"I asked the said patient to fill the activity index prescribed by a very prestigious Organisation "BASDAI" (Bath Ankylosing Spondylitis Disease Activity Index) which is the gold standard for measuring and evaluating disease activity in Ankylosing Spondylitis.

The summary of the activity index reflects the status before and now. The evaluated score before Iyengar yoga practice stands 9 and the present score is 6 in terms of   improvement in the movement and activity in day to day life. There is certainly a good improvement in this short span of 1 year.
 
Apart from this I have been monitoring him from time to time upon the request of my teacher Zarna Mohan.

I still remember his initial days in the therapy class. He used to walk slowly with his neck and spine movements completely arrested. He used to appear dull, worried and preferred to remain aloof from the other companions. I am a live witness of his hard work and progress through Iyengar yoga regimen. Within a span of one year he made remarkable improvement in his neck and spine movements. The recent X-Ray report shows normalcy in his Sacro-Illiac Joint which was narrowed before joining Iyengar Yoga. As on today the inflammation process is reduced and he is free from pain and stiffness to a considerable extent.

He is now cheerful, friendly, socializes and looks happy. I regularly observe him in the store room carrying chair, bolster, mat all at a time. He doesn't walk now, he runs. I see a lot of positive energy in him. 

The disease that he has is a deteriorating disease which is now arrested and the reversal process has set in. The disease that would have progressed and have made him disabled or crippled but instead he became flexible to a great extent. He says, there is tremendous improvement in his energy levels as his fatigue has drastically reduced."

Conclusion:

The above case study clearly demonstrates the efficacy of Iyengar Yoga in addressing even chronic diseases like Ankylosing Spondylitis. However, one needs proper understanding of the problem to work on it actively and the student must be prepared to sincerely continue with the practice to experience the benefits.

I would like to end the case study with a quotation from Guruji :


“Yoga allows you to find a new kind of Freedom that you may not have known even existed.”
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