Fatigue is the most common symptom of MS, as well as many other chronic illnesses. For some people, fatigue means not being able to get out of bed. For others, it’s flu-like full body pain. For me, fatigue is mainly a cognitive phenomenon. I can’t read or work because my eyes refuse to focus. I can’t listen to podcasts because I can’t follow the discussion. And forget conversations: my words are mixed up, I ramble and I often forget my point before I’ve finished delivering it.
After a recent period of fatigue left me exceptionally grumpy, I wanted to arm myself with tools to cope better next time. There’s three specific things I was looking for help with:
- Relaxing my body and mind fully to allow deep rest
- Easing the feelings of anger and frustration that fatigue brought up
- Stretching my spine and limbs after spending days barely moving
Of course, yoga can help.
Relaxing the mind and body for deep rest
Pranayama, the practice of regulating the breath, is great for calming the mind and body. My favourite practice is Dirga Pranayama or Three-Part Breathing, which uses super slow, deep breathing to trigger the para-sympathetic nervous system (our relaxation response).
Three-Part Breathing
Lie down with one hand on the belly and the other hand on the chest. We ease in by practicing breathing into different parts of the torso, before settling in to three-part breathing.
Belly breathing: As you inhale, draw the air down into your belly, feeling your hand rise as it fills. Pause at the top, then exhale, noticing your hand lower as your lungs empty. Repeat until this feels easy.
Belly and ribs: Now as you inhale, fill the belly then continue on to fill up to your lower ribs. Pause, then exhale, emptying the air from your ribs first then your belly. Repeat.
Three-part breathing: Now when you inhale, fill the belly, then the ribs, then your chest all the way up to your collarbones, noticing your hands rise in turn. Pause, then exhale from your chest first, then ribs, then belly, noting the movement with your hands.
Once you’re comfortable with the technique of three-part breathing, repeat this for 5-10 breaths to flood your body with oxygen and relax your body. This is a great practice for just before bed to quiet your mind, calm your nervous system and relax.
We can also trigger the para-sympathetic nervous system with asana, particularly forward folds that stimulate nerves in the lower back, triggering the relaxation response. My favourite pose for this is Extended Child’s Pose. It stretches the lower back without tightening the hamstrings, and widening the knees (compared to Traditional Child’s Pose) creates more space to breathe deeply without feeling like the chest and belly are compressed.
Extended Child’s Pose
You can practice this on a yoga mat or bed. Start on your hands and knees with your spine neutral.
Bring your big toes to touch, then shift your knees a little wider than your hips. Inhale deeply, then as you exhale sink your hips back and down towards your heels.
Extend your arms out in front of you, and allow your forehead to rest on mat / bed, fully relaxing your neck.
Breathe deeply, and allow all the tension to melt away.
You can make this more comfy with pillows. Try a pillow under your forehead if its not comfortable to rest it on the mat. Try a pillow laid across your heels to rest your hips on. If you have a bolster, try placing it between your knees and resting your torso on it.
Easing anger and frustration
Meditation is a really useful tool to help dissipate emotions and learn to better manage them.
When we meditate, we become the observer, allowing us to notice our thoughts objectively without getting lost in them. This makes it easier to accept them and let them go. When I’m very emotional this isn’t easy, so I use guided meditation to help me. I like the Mindful in Minutes podcast which has episodes for almost every situation, including a meditation for frustration.
Yoga teachings also direct us to think about how we spend our energy resources, particularly important when those resources are limited. The yama brahmacarya teaches us to think about the “right use of energy”. Whenever I’m tired I try not to waste mental energy on things that make me angry, like the news and politics. Instead I seek out things that are uplifting and don’t sap energy, like meditating and re-reading Harry Potter.
Stretching the spine and refreshing the body
Having spent a long time curled up and feeling physically drained, I needed to stretch my spine, ease tension in my neck, and combat the hunching in my chest and shoulders. All without making me more tired.
Restorative poses are best here, especially passive ones – once you’re in them, you don’t need to move.
Asana for fatigue
Mountain Pose (Tadasana)
A deceptively simple looking pose. Tadasana engages muscles in the whole of your body, but in this version, I’m modifying to focus on stretching the spinal column and shoulders, with less focus on the lower body.
Start standing or seated. Imagine a cord threaded through your spine that is gently pulling upwards, lifting you out of your hips, and pulling the crown of your head towards the sky.
On an inhale, squeeze your shoulders up to your ears, then as you exhale, roll them back and down, feeling your shoulder blades come together as they lower. Repeat a couple of times to get the kinks out.
Allow your arms to hang beside you, slightly turned out with palms facing forwards.
Take deep breaths, continuing to lift through the chest and relax down through the shoulder blades.
Supported fish pose
This pose helps to open the chest and tackle hunched shoulders, but you do it lying down. You’ll need a rolled up towel or blanket and a pillow for this.
Start sitting on a mat or bed with your legs out in front of you.
Place the roll behind you, with one end of the roll placed just above the base of your spine. Lay back onto the roll, with your head coming to rest either on the top of the roll or a pillow – make sure your neck is neutral to your spine.
Release your arms to your sides, palms facing up. Your legs can be outstretched, or if it’s more comfortable, bend your legs with your feet planted hips width apart on the mat and knees falling in together.
Breathe deeply. With each inhale, imagine expanding your torso in all directions. With each exhale, let gravity work as your shoulders sink back.
Legs up the wall
Inversions refresh the body by switching up the effects of gravity on the body. This aids lymphatic drainage and eases the effort of your heart to pump blood to your brain. This pose is a way to get all those benefits, without the strength and balance requirements of a headstand or handstand.
These instructions are to do the pose on the floor, with your legs up a wall, but you can also do it in bed with your legs up the headboard. If your hamstrings are tight, move further away from the wall, or choose an option where your knees are bent, such as lying on the sofa with your legs over the back of the cushions, or on the floor with your legs on a chair.
Sit on the floor with your legs outstretched next to the wall, getting as close to the wall as you can.
Lean back and swing your legs up the wall, wiggling to get your bottom close to the wall.
Flex your toes towards you, then relax your feet. Relax your hands out to the side, palms face up.
Breathe deeply, and hold the pose for 5 to 15 minutes to really feel the benefits.
You can make this more comfy by lying on a blanket, lifting your hips with a pillow or using a pillow for your head.
These poses can help to ease fatigue, but more importantly, yoga teaches us to be compassionate and patient with ourselves during this frustrating experience.
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