By Robin Smith

Approximately 1.4 million people in the US today use wheelchairs either part or all of the time. There are numerous origins for such confinement: cerebral palsy, multiple sclerosis, amputation or paralysis, prolonged illness or coronary disease, or simply advanced age with its often accompanying lack of muscle tone. Many people cannot perform basic daily functions unless they are able to do them from a chair. Yoga is well suited to assisting all these individuals. Its non-competitive atmosphere, gentleness on muscles and bones, and overall lifestyle of health and cleanliness make it useful for persons partly or completely confined to wheelchairs.

First, the potential benefits of yoga will be explored. Then, specific poses, exercises, and modifications will be detailed.

PROBLEMS YOGA CAN ADDRESS

People who spend much or most of their time seated or in a wheelchair may develop a slouch. The strength in their back muscles has not been maintained since they are able to lean back most of the time. They have a tendency to become round-shouldered and concave in their thoracic area. As a result, their neck may also be unnaturally curved. If there is a one-sided weakness, or if there are tasks routinely performed only on one side of their body or with one arm, there may additionally be a slackness or a curvature to one side. The inner effects of this outward slouching or leaning are compromised breathing, weakened and contracted abdominal and thoracic muscles, reduced blood and lymph circulation, and sluggish digestion. Yoga, with its emphases on posture, deep breathing, flexibility, and balance in the body, can counter many of these effects.

Constant slouching, besides being a result, is itself a cause of other problems. The almost continual seated posture can reduce space between the vertebrae. Pressure is placed on the discs and the associated radiating nerves. Especially for persons with cerebral palsy who are already restricted in muscle control, this disc and nerve pressure further restricts nerve function and coordination. Yoga’s stretches and counter-stretches can work toward increasing the space between the discs. Muscular tension is released, messages between brain, spinal cord, and nerves is enhanced, and greater flexibility of movement is allowed.

Unlike the blood, which has the heart to pump it, lymph has no pump other than muscle movement. Therefore, it is circulated less in a person who spends much of his time seated. Lymph affects a person’s natural immunity, and yoga postures can encourage the lymph to circulate, improving the patient’s ability to fight off infectious diseases.

Additionally, wheelchair patients frequently suffer from kidney, bladder, and liver problems. Part of this results from not drinking enough water, as one’s thirst doesn’t get stimulated as much without exercise. But lack of movement can be a problem as well, reducing stimulation to internal organs. Seated twists and folds can “wring out” these internal organs, improving their tone and fitness.

When one is confined to a wheelchair, that person can lose the spatial and body awareness that most other people take for granted. Mental focus while focusing on breath and proper positioning during asanas helps such individual regain some of that lost awareness.

Another side-effect of being wheelchair-bound is the common feeling of inadequacy, or being unable to accomplish things “normal” people can accomplish. Especially in Western society, one’s self-worth is measured by one’s achievements, and when a person is unable to walk or even sit up without assistance, self-worth can disintegrate. This emotional stress and dissatisfaction can lead to higher cortisol levels, bringing–in addtion to simply the sadness and frustration–more calories being turned into fat and more frequent flare-ups of auto-immune diseases like multiple sclerosis. Yoga teaches relaxation of the mind, tranquility, non-competition, and compassion (even to oneself). A combination of right-thinking plus greater muscle control through asanas offers disabled persons a feeling of greater personal competency in their daily lives and perhaps longer intervals between recurrences or intensifications of disease.

PRANAYAMA

Even if individuals are largely sedentary in their work and home life, simple daily tasks such as climbing stairs, bending and stooping to pick up objects, gardening, or pushing a lawnmower or a grocery store cart require most people to periodically breathe deeply and clean out at least a portion of the stale air in their lungs. However, even people who do virtually no physical activities, or who necessarily adapt them so that the tasks require little exertion, can bring vitality to their lungs by practicing pranayama.

The first goal should be simply breathing deeply and in a controlled manner. Inhale deeply to a count of three (or any suitable number), hold for one, exhale for three, hold for one, repeat. The student should place his hands on his stomach and feel his abdomen inflate on the inhalation and empty out on the exhalation. He could also place his hands on his ribs to feel them lift and expand. This can be done while seated in a chair, but it is advisable to also doing this while lying on one’s back. It is usually easier to feel the breath’s effect on the abomen and ribs if the body is not contracted, and if a person is concerned about balance (such as, a fear of falling sideways if hands or arms are on the ribs instead of on the arms of the chair), lying down will eradicate such a concern.

It may be at first that only two or three deep breaths at a time are possible without a person getting light-headed. This is fine. Capacity will increase with practice. It is also not uncommon for a person to cough at times when they are breathing deeply after years of not having done so. This is normal. They should simply take it slowly, and as the days and weeks go on, their lungs will clear of the old, toxic air that is causing them to cough.

Alternate-nostril breathing is also valuable and not difficult to do. Breathing is slowed down when only one nostril is used, so the light-headedness possible with other deep breathing may not be as likely to be a problem, and body awareness is built.

If the student has enough control of abdominal muscles, bellows breath (or cleansing breath) is recommended. Through contracting and releasing the stomach area, the internal organs are massaged and stimulated. It is common for the wheelchair-bound to have kidney problems and slow digestion, and bellows breath has a beneficial effect on these organs.

SEATED YOGA POSTURES

Following is a sample, partial list of asanas adapted for students in wheelchairs or otherwise largely confined to seated positions, along with their benefits.

Tadasana (mountain pose) is quite adaptable, and there are many hand and arm positions that can be used as variations. Instead of standing tall and rooting down through the feet, the seated practitioner sits tall, thinking of lifting his back off his hips and lifting the crown of his head toward the ceiling. As with the standing posture, conscious thought is brought to lifting one’s sternum and rolling one’s shoulders down and back without curving the chest forward. It is a lift, not a curve. Arms can be straight down at the sides (if the student is able to sit in a chair without sides for support) or relaxed in the lap. With each inhalation, the student can picture himself growing taller and straighter; with each exhalation he relaxes into the pose. Mountain pose can reduce depression, boost confidence, strengthen the spine, correct the posture, and reduce pressure on vertebrae that spend much of their time constricted.

There are numerous hand and arm positions–variations–that offer additional benefits. The student can raise his arms straight overhead while continuing to pull his shoulders down and back. He could interlock his fingers and lift his hands overhead, arms straight and palms facing the ceiling, to give a stretch to the underside of the arm. This pose is very beneficial for carpal tunnel syndrome. Or, the student might fold his arms behind his back and either grab elbows with opposite hands or fold his hands into reverse prayer position. Both of these variations assist in opening up the chest and developing greater flexibility in the back. Reverse prayer position additionally helps made the wrists and elbows more supple. A last variation is cow-face hands, one arm reaching down over the shoulder and the opposing arm reaching up the back from underneath, and the two sets of fingers clasping in the middle of the back (or both hands grasping a strap). This stretch activities the shoulder and back muscles and relieves arthritis in the shoulders, elbows, wrists, and fingers.

Parsvakonasana (side stretch) can follow the mountain pose variations. The student begins in mountain pose, arms extended overhead, and allows one hand to drop back to the chair or to a support (blocks or low table) to the side of the chair while stretching over that arm. The opposite arm is lifted and stretched over the body. It is important to continue to lift out of the spine rather than simply collapse into it. This pose helps the shoulders and shoulderblades align properly and relieves backache and neck tension. It is especially beneficial for sciatica and sacroileitis, and a variation of this pose (done while lying on one’s back) is a familiar and frequently used physical therapy exercise.

Dandasana (staff pose) can be adapted for those in wheelchairs by placing a low table in front of the wheelchair and assisting the student in lifting his legs upon it. A blanket can be placed under the heels if the surface feels too hard. The student then lifts up into a very straight posture while pressing his hands down on the sides of the seat. This posture stretches the legs, improves digestion, and tones the kidneys.

Baddhakonasana (bound angle pose) is a seated pose with many benefits if the student can move to the floor or sit in a wide chair without sides. It is especially good for women and tones their pelvic organs. The student sits flat on the floor (on a blanket or pillow if this is more comfortable) or on the middle of three armless chairs with the soles of the feet facing and touching one another and knees out to the sides. Bring the heels as close to the groin area as possible. Hands can be behind the buttocks, pressing on the floor, or in front of the student, holding the ankles. Sit very straight. This pose stimulates the heart and alleviates sciatica.

Paschimottanasana (intense back stretch) can be modified in many ways. If the student can sit in dandasana on the floor and fold from there, that is most beneficial, but if the student can only sit with the knees folded in a chair, there are still benefits. If the student sits in dandasana, it is desirable to lift and stretch forward, visualizing and attempting to put his chest on his toes rather than simply curling forward and trying to put his nose on his knees. If the student is seated in the chair, it may be more difficult to fold at the hip creases and not round his back at all, but the intention should still be there. This position soothes the sympathetic nervous system, stretches the ligaments of the spine, and has a beneficial effect upon the thyroid and adrenal glands.

Bharadvajasana (torso twist) can easily be adapted to a chair. If possible, it is best to be seated in a straight-backed chair without sides. The student would sit with his knees facing, for example, the right side of the chair, and while holding the back of the chair, twist around to the right, keeping his chin level to the floor and lifting his heart while rolling his shoulders down and back. He would then slowly come out of the twist and repeat the asana on the left side. Twists massage one’s inner organs and create suppleness in the spine.

Padangusthasana (big toe hold stretch) is another pose that adapts well to a wheelchair. It is usually difficult, especially for beginners, to reach the big toe with the hands, so wrapping a belt around the foot brings the hands and foot closer together without strain. Straighten the leg that has the belt around it, and while maintaining correct posture, pull the leg up with the belt. Never go so far that it is causing discomfort, only as far as a gentle stretch will allow. This helps prevent osteoarthritis of the hips and knees by stretching the calf and hamstring muscles. It also helps align the pelvis.

Agnistambhasana (fire log pose) can be adapted to a seated pose. One knee is bent with that foot on the floor. The other knee is also bent, but this ankle rests on the opposite knee. The intention is to keep the hips level, crease at the hip joint, and lower the knee, while maintaining good posture.

Gomukhasana (cow face pose)–arms only–is a good chest opener. If the student is able to sit on the floor, then the legs can be added as hip flexor stretches, but even reaching the arms behind the student’s back without posing the legs is very beneficial, reversing the tendency to slouch and opening up the chest area that is often allowed to collapse forward.

ADAPTATIONS FOR THE DISABLED

In a standard yoga class, the teacher stands in front of the students and models the postures, assisting or correcting as necessary. However, it may be necessary to move some students into the postures rather than simply demonstrate them. Some brain disorders (i.e., cerebral palsy, certain expressions of autism, sometimes after-effects of a head injury, etc.) make it more difficult for a person to get the thought in their brain to express itself in motor control. They may see that the teacher’s arm moves backwards but not be able to send that message to their own arm. Therefore, their teacher will need to hold their arm and move it backwards for them. The teacher moves it backwards, then relaxes it, moves it backwards, relaxes, backwards, relaxes, until the student can “feel” the movement for themselves and duplicate it on their own.

CONCLUSION

Yoga means hope to people who may have believed there was little they could do to improve their fitness or muscle tone. When a person has been limited to a wheelchair much or all of the time, especially for a period of years, they have become accustomed to thinking of what they cannot do. Yoga–because of its adaptability to any person’s body current strengths and level of flexibility and its lack of competition with others or even self–helps such people comprehend what they can do. Where previously they only noted such things as, “I am slouching even worse this year,” or, “Even though I am always sitting, my back still aches a lot,” now they have a medium or mechanism to mediate those observations. And hope builds on itself. Once a little more flexibility is reached, or a little more strength obtained so that muscles do not ache with use, there is even more hope and more enthusiasm to do the postures. In addition, as health improves through better spinal alignment and renewed internal organ activity, a more optimistic view of life in general usually follows, even if the practitioner (because of paralysis or amputation, for example) never is able to leave the wheelchair behind.

Yoga is compassionate to the wheelchair-bound.

Bibliography

Accommodation and Compliance Series article for employees with wheelchairs, Linda Carter Batiste, J.D., http://www.jan.wvu.edu/media/wheelchair.html

Fishman, Loren M., and Small, Eric L., Yoga and Multiple Sclerosis: A Path To Health and Healing. Demos Medical Publications, New York, NY, 2007.

Freeman, Arthur, Cognitive Behavior Therapy in Nursing Practice. Springer Publishing, New York, NY, 2005.

Interview with Daniel O. Thompson, physical therapist, RDT Physical Therapy, Bluffdale, Utah, April 16, 2009.

Interview with Susan Perry, instructor of disabled children, Mountain Valley Private Academy, Bluffdale, Utah, July 24, 2009.

Iyengar, B.K.S., Yoga: The Path to Holistic Health. DK Publishing, New York, New York, 2008.

McCall, Dr. Timothy MD, Yoga As Medicine. Random House, New York, NY, 2007.

National Center on Physical Activity and Disability (NCPAD.org)

Rehabyoga.com

Robin Smith is a certified Yoga teacher. She teaches Yoga classes in the West Jordan, Utah area.