On July 2, 2018, I posted this to Facebook:
Me: Hey yoga teacher hive mind: I’ve been asked to work tonight with a student who has Parkinson’s (sp?). Any thoughts, dos, don’ts, awareness I should know about this going into the session! Thanks for any quick thoughts you might have! 
First response: Any awareness as to his/her severity or symptoms? Good luck! What a gift, for both of you!
My reply: Going in, I know his name, and that I’m working with him privately because he doesn’t want his movements to be disruptive to the rest of the class. I’m really excited to just see what happens. Start with inhale and exhale and then go from there! Any thoughts on how to organize with & around shaking/tremors? Aim to watch, to minimize, to soften into, to focus beyond them?
Many of the responses that followed this dialogue really impressed, inspired and guided me, so I decided to bring some of the wisdom to a blog. Thank you to everyone who contributed to the post, and I hope this collection of ideas might help someone else in the future! Enjoy!
PS – I did post the messages, unedited as they appeared in my feed. If you have feed back regarding any of these suggestions, please reply with the relevant #. Thanks much!
- I’d def avoid intense pranayama like kapalabati. With my clients with the same condition, we work on Gentle balancing breaths, things that work w the nervous system, restorative yoga, restorative inversions, joint freeing movements, and standing balance work.
- I’ve had a couple of yoga therapy clients living with Parkinson’s. From my experience a lot depends on how it manifest in each individual. One client could do no more than gentle restorative posture work and visualizations. In another situation, we eventually got comfortable doing a krishnamacharya style vinyasa with a fairly deep meditation and bhavana practice. Wishing you much success….you got this brother!
- How wonderful he has you! Ditto above and maybe think of some support from the wall in warrior etc. DD with a strap assist may also feel supportive. Look forward to hearing how it goes!
- I worked with a Doctor in NYC privately for 2 years with advanced Parkinson’s. I did mostly hands on therapeutics with him and can share a lot more but it’s too much info for a post. Message me if you like and we can exchange numbers and talk.
- If it were me I would try to focus beyond the shaking or tremors, exploring how just gentle breath awareness impacts their intensity and frequency in the moment and the next day. No pranayama, just awareness exercises. I would start with recognition of the 4 phases of breath as you would anyone else and see where you notice imbalance and bring awareness to that. Focus on what is working well and avoid complexity. More interception than proprioception.
- I’d start with things that would benefit the CNS and build balance around the midline of the body. Perhaps a gentle yin approach would be good to begin with.
- In my limited experience, I agree with above about manifesting differently. Rythm, cross body kriyas and vocal toning are tools I found helpful. And while we can Google anything, I liked this article for general awareness: https://yogainternational.com/…/yoga-therapy-and…
- Following with interest…
- William, I have a student with Parkinson’s who has been attending weekly for several months now. I don’t focus on her shaking/tremors because that’s her 24/7 state. Rather, I focus on developing the breath and giving her space to explore gentle to moderate asanas and kriyas within her body. She had never been to yoga prior to her diagnosis but she shares with me weekly how much better she feels in her body. I make it a point to check in with her at the start and end of class. If the practice helps her feel better while creating calm mindfulness, it’s a win win for not only her but for my more able-bodied students who have also learned in the slowing down. Hope this helps!
- I did a Thai session with a Parkinson’s patient once. I have long thought there is a tremendous potential for combating neurological degeneration diseases by improving Sen Line flow. I would be fascinated to hear how it goes for you!
- From years as a physical therapist, some general thoughts – poses to incorporate spinal rotation will be good, initiating movement is often difficult for these people, a flow series may be better than static, although it will be challenging. Probably easier to say in one place for a bit (all upright or all on the floor) instead of constant transitions between the two. Also, lots of cues to GO BIG, MOVE BIG.
- I work with several PD clients! Do kriyas in seated or lying positions; standing positions for stability, strength and balance. Don’t worry about tremors – just keep going as you go. Mantra is very good for PD even if using secular sounds (eg the vowel sounds). If you want to chat more after you work with your client because you will be continuing give me a ring. I have a lot of experience in this arena.
- I have worked with Parkinson’s clients. All of these ideas are great
- William, there is a group called PD Gladiators that works with people who have Parkinson’s. It’s a boxing group. Also Tai Chi helps people with balance.
- Poor proprioception and rigidity are big issues for my dad
- this is one of those sessions where music of their preference can be a huge game changer… not necessarily the kind of music you would prefer. I’ve worked with s lot of Parkinson’s patients, and often the tremors subside or calm and the movement frees up when the brain grabs the music
🎶
🎵🎵🎶🎶🎵
🎼🎵🎶 - yes to slow, repetitive movements from seated or supine positions – a gentle flow focusing on gross movement and big range of motion. expansion & interoception would be great themes to work with. and standing balance with the support of a chair.
- What I know about you dear William is that your lovely presence of Beingness will attune and you will know what to do…and that along with all this extraordinary responding wisdom and experience…and… well…these folks are very fortunate indeed..I hope to hear your own ideas from the inquiry of your engagement. Perhaps in some ways we should treat everyone with as much care and consideration of their uniqueness….Big Love to you always..☆♡
💖🎶
- Focus beyond them. Try to avoid isometric holds as they tend to increase the tremors. And use your incredible watchful eye to see what brings them the most ease…
- You’ll be moved in lovely ways…..
- I’ve had a lot of experience with Parkinson’s. Meditation is amazing for them. Deep breathing obviously and restorative yoga with sandbags. The weight reduces tremors and soothes the nerves.
- My clients respond most favorably to seated or supine slow kriya movements and breath awareness.
- I have worked with a couple of Parkinson’s patients. They were very appreciative of gentle overall opening, as the body gets very stiff. Focus on breath and releasing has been helpful. Both people I work with have really appreciated simple balance poses. Usually, at some point, P patients loose coordination. Hope it goes well for both of you.
- Send them to someone with experience with their condition, that already knows what they’re doing!
- I have worked with a couple of Parkinson’s patients. They were very appreciative of gentle overall opening, as the body gets very stiff. Focus on breath and releasing has been helpful. Both people I work with have really appreciated simple balance poses. Usually, at some point, P patients loose coordination. Hope it goes well for both of you.
- Following
- I’m late to this William so it may have been mentioned but you may expect delayed reaction time. Motor processing delays require a little extra time – so pauses and space between cues are helpful
- Heart opening chair sequence. It’s a movement disorder, eventually focus on muscle engagement. Sitting up straight, open and closing hands, stretch feet and balance!
- I specialize in working with Parkinson’s patients. If I can help, let me know. In general, they need to be encouraged to move bigger than they think is normal. As for shaking/tremors: when they come, get the person to redirect his/her attention, maybe by asking the person to recite a list of vegetables by alphabetical order (asparagus, broccoli, cabbage….) or finding some other way to redirect their attention. People with Parkinson’s often freeze when walking–redirecting their attention when this happens sometimes works, and sometimes it works when a person freezes while walking to tell them to turn sideways and move forward by taking a sidestep until they see they can keep moving, then have them turn back and face the direction in which they’re moving to continue walking. Above all, focusing on making really big movements helps them, and lots and lots of repetition helps them. With complex moves, break the moves down into chunks, practice the chunks over and over, focusing on large-amplitude movements, and gradually assemble the chunks into larger chunks until you get the full movement sequence you’re wanting to accomplish.
People with Parkinson’s often have a great deal of tension (hypertonicity) on the musculature of the front of their body, and considerable laxity on the musculature of the back. Getting them to lie on their stomach to extend their spine and open the front of their body is really helpful. Often they have so much tension in the front of their body you have to put a pillow or two under their midsection before they lie face-down, because they’re so tense and often so fearful of relaxing in the face-down position that they need physical support to accomplish that position reasonably well.
There is a system of movement called LSVT BIG, a series of seven basic large-amplitude movements designed for people with movement disorders. I’m certified in its use within the realm of physical therapy, but you can see it practiced on YouTube–just don’t call yourself an LSVT-BIG facilitator without getting certified by LSVT Global, or they’ll respond negatively–they control the system, which is intellectual property. Another system of movements for PD is Parkinson’s Wellness Recovery, which also offers a series of positions/movements that focus on large amplitude movements and repetition. You can see PWR online and you can buy their book without getting certified, which is costly. If you look at all these systems, you will see much that you recognize from yoga, with the primary added component in PD movement systems of sustaining movement for long time and moving with really large amplitude.
It is rewarding working with these people. They are often quite interesting individuals.
