If It's Not Parkinson's, It's Something Else

PD, Arthritis and Ligaments - Will Yoga Help?

Well over a year ago I started Aqua and Dry Land physical therapy after being diagnosed with Osteoarthritis to accompany my Parkinson's disease.  I'm now the patient of a different doctor and he thinks it's not the arthritis but rather the ligaments which are causing the knee problems. I'm going in soon for Xrays which will hopefully give him enough information to make a new diagnosis.  This could mean the difference between knee replacement or arthroscopic surgery.  Since he also wants an MRI, to which I am averse (spelled claustrophobic), I have been motivated to research ligament issues and to find ways to improve their strength.

As it happens, a few weeks ago I signed up for a series of Yoga classes which started yesterday at the physical therapy center where I am a member. The classes will run through the winter.  So far it is just me and many women being led by a therapist from the execise center.  The other men don't know what they're missing.

This is just what I need to strengthen the muscles around my knees and possibly avoid either of the operations I mentioned. The Wellness Center is part of a Senior Center. Because they were tight for space on our first class day, we were assigned the room used for the sanctuary.which is a beautiful spiritual space in which to learn yoga.

To accommodate the predominatly elderly demographic, the yoga poses that we were taught were performed on mats on the floor or sitting in chairs depending on individual flexibility and ability to move down to the floor and back.

I was a chair person but by the time the class was over I was starting to feel less rigid. I usually limit my walking because if I walk too far my knee becomes painful or sometimes just gives out.  Inspired by the class, I walked all the way from the synagogue building beck to the aquatic center through about a quarter mile of walkways.  It was certainly easier because the surface was level and not slippery. But mainly I think that I was less tense - more relaxed...confident.

Another important issue is the possibility that there may be some relief of this pain in my future.  It is often important to have another medical opinion.

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FYI: November is National Caregiver month and the Parkinson's Disease Foundation (PDF) will be providing tips and resources for care partners and family members on Tuesday, November 17th at 1:00 pm ET.  You can watch online of call the toll-free number to listen in.  The phone number will be provided after registration.  You can get more information at PDF.

According to the The National Health Calendar of Observances:

November 2009 observes:

*   American Diabetes Month
*   Diabetic Eye Disease Month
*   National adoption Month
*   National Family Caregivers Month
*   National Hospice Palliative Care Month
*   Pulmonary Hypertension Awareness Month
*   World COPD Day - November 18th
*   National Suicide Survivors of Suicide Day - November 21st         

The 2010 Health Observances Calendar sans an April mention of Parkinson's disease.

Yoga as Exercise for Parkinson's Disease and PD Depression

Let's start with a few words about doing Yoga as an exercise for Parkinson's disease and Parkinson's depression:

First of all these exercises are best read aloud slowly and calmly by another person. If you have no one with whom to practice, read them aloud step by step yourself. You should be able to print the article either printing the page or by cutting and pasting this article onto a word-pad or some other docs program or even an email and then printing in the your favorite type face and size for reading.

If you are working with another person, ask them if they will do each exercise first as YOU read it aloud to them. Then it will be your turn. The advantage to seeing the exercise performed first is that of the kinetic experience you can achieve by watching.

If you like to exercise to music, these asanas should be done to calming, slow, soothing sounds. You might choose nature sounds.

It is important to remember that the stiffness of Parkinson's and the tremors may make the simplest of poses seem difficult. That's okay. The benefits accrue with the repetition. As you learn each step, as the muscle stiffness does not impair movement as much with each repetition, the movements will begin to flow from one step to the next. Soon you will be able to reach your version of the pose.

Your reader needs to be aware of your pace and not attempt to move you too rapidly from step to step. The reader should allow time for the practitioner to achieve the step before moving on for the complete pose.

Remember that breathing is an integral part of the exercise and important for the relaxation which will ultimately be felt. Breathing better is very important to help with the depression which is so symptomatic of PD. The exercises themselves are significant in their focus on the relaxation needed for helping with depression.

All floor exercises should be done on a carpet or mat. Bare wood or tile is uncomfortable. Have at least one cushion or pillow available.

Not all positions are possible for all people. You have two options: you can do the best you can do without pain to achieve the pose or you can simply perform the ones which are possible.

Please do not be upset by the Shava Asana title: the corpse pose. It is definitive of a body in repose. It should also be your first and last pose for a session.

About the Asanas: they should be steady and comfortable. Your body should be poised and relaxed. Breathing should be controlled (Pranayama) Do not use force or pressure. And do not exercise immediately after a meal. The purpose is to develop muscle flexibility, tendon strength, better respiratory function, improve the circulatory system, improve sex life and concentration, aid in weight loss. The asanas are designed to aid the flow of prana (vital energy or qi in Chinese) and to help balance the physical and metaphysical body.

Let us begin

SHAVA-ASANA or MRTA-ASANA, The Corpse Pose1. Lie on your back
2. Spread your arms at a 45 degree angle from your body, hands and fingers open
3. Let your legs relax to an open posture - no tension - no toe point - head comfortable
4. Close your eyes
5. Breathe deeply from the diaphragm - through the ribcage - and the upper chest
6. Let your body feel heavy and pliant - relax into the carpet or mat.
7. Sense your body - be aware of where your body is holding tension and send your focus there
8. You may wiggle your toes and your fingers to shake out stress
9. Continue to inhale from the diaphragm - through the ribcage and the upper chest.
10. Exhale in the same pattern
11. Clear your mind and continue to inhale and exhale - slowly and deeply.
Shava-Asana is not a fall asleep exercise although it can be used in that way at bedtime.
In this exercise you are moving to a conscious state of relaxation.

Bala-Sana The Child's Pose
1. Kneel on the mat with the tops of your feet on the floor.
2. Sit back on your heels
3. Adjust your position so that your knees are about 1 foot apart
4. Your hands should rest on your thighs (Vajar-asana or Thunderbolt pose)
5. Bend forward from your hips, bringing your chest to rest on the floor between your thighs.
If this is uncomfortable or if you do not have that much flexibility, rest your head on a cushion or two instead.
6. Stretch your arms full out in front of you on either side of your head.
7. Stretch you spine, your arms, your hips.
8. Relax as you inhale slowly - through your nose and from your diaphragm, your rib cage and upper chest.
9. And slowly exhale
10. Remain in this pose for about 2 mnutes.
11. Now slide your arms back to your sides, palms up and onto your thighs palms down.
Repeat at least once more.
This is a comforting and peaceful pose. It will stretch and relax your shoulders, thighs, neck and back muscles.

If you have Parkinson's constipation you can vary the child's pose by bending first over one leg, holding that pose and then returning to an upright position.
Repeat over the other thigh if you are kneeling.
You can also do this in a chair. It should relieve some of the discomfort as well as helping those smooth muscles of the intestinal tract.

We will be adding more exercises over the next few days.

Because I Have PD, I'm Trying Yoga and Massage for Osteoarthritis in My Knee

Arthritis in My Knees Makes it More Difficult toWalk with Parkinson's Stiffness


I am focused on Parkinson's disease. I have had it for more than 5 years. It has cost me a job that I loved and the friends I had made there. But the symptoms which bother me the most and affect my lifestyle more than anything else are related to the osteoarthritis that I have in my knees.

Osteoarthritis(OA) is a disease that like PD has no definite cause and no actual cure. There are several knee replacement operations but Dr Lee M Zuckerman, President of the American Academy of Orthopaedic Surgeons recently warned that for many PD patients the positive effects of the surgery are gone in a year. The problems caused by rigidity, tremors, movement issues at the onset, can lead to secondary medical problems. One primary example is that Parkinson's patients do not walk as much and tend to stay indoors. Lack of exposure to sunlight prevents the body from producing vitamin D and consequently leads to bone loss. He further noted that the lack of bone density, instability (balance) from tremors and rigidity increase risks of osteoporosis, falling and broken bones.

In 1985 unsuccessful knee replacement was performed on Parkinson's patients in the UK. Flexor problems occurred after the surgery. The surgery was completely unsuccessful. In subsequent years this surgery has been performed with little success. The disease itself seems to be a contraindication because of stiffness. In recent years limited success has been achieved due to lessons learned.

One of the most important lessons was that the muscles must be strengthened and the tendons as flexible as possible prior to surgery. For PD patients the disease may be the contraindication to surgery.

There are all kinds of pain killers, a few actually work, none are really intended for long term use. I've tried many of them especially when I was still working. My doctor sent me to physical therapy but it was only twice a week and I had a week long problem.

My search for a solution brought me to massage therapy. One hour of Swedish Massage per week. Massage takes the pain away and the effects remain for 3 to 5 days in my case...as long as I don't over-excercise or walk too far. The only drawback is the cost of $65 per hour which is covered by very few health insurance plans - mine is not one of them. A plus is that massage helps loosen the rigidity and stiffness of Parkinson's. It helps me relax and not feel depressed.

Now that I've seen that alternative medicine can help me, I'm trying several other things: excercise on Nautilus machines, recumbent bikes and aqua therapy. I try to go five times a week, it takes 3 hours a day counting drive time.

I've just started meditating using Yoga breath control and a mandala, I'm hoping all these combined will help my knee back to normal or even anywhere near normal.

I'm going to add vitamin D to my regimen as soon as possible and spend more time outside when the weather warms.

I'm sure these won't be my last alternative treatments, I'll always be open to new or even 5,000 year old ideas.

Sources:
http://www6.aaos.org/news/Pemr/releases/release.cfm?releasenum=732

Of Interest:
http://orthoinfo.aaos.org/topic.cfm?topic=A00385
http://www6.aaos.org/news/Pemr/releases/release.cfm?releasenum=729
http://www.ncbi.nlm.nih.gov/pubmed/16376267?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/19138496?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedarticles&logdbfrom=pubmed
http://www.ncbi.nlm.nih.gov/pubmed/16140799?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed

5/10/09 UPDATE: I am now trying a simple adjustable hinged knee brace for additional support. I hoped for a miracle, I expected some pain relief. So far it meets my expectations.
12/2009 UPDATE: Turns out I also have weak ligaments on either side of my knee and have a bit of lateral motion ... that doesn't help.

Exercise for Parkinson's

Over the eight years that I've had Parkinson's disease I've learned lots of things but none more important than the need to get at least 20-30 minutes of exercise 6 or 7 days a week

Studies at the National Institute on Aging show that overeating and lack of exercise are not only risk factors for diabetics, cancer and cardiovascular problems,they also increase the risk of neurological diseases such as Parkinson's, Alzheimer's, Huntington's Disease and stroke.

Neurotrophic Factors

Other studies show that physical and mental activity can also increase neuroropic factor production. Neurotrophic Factors are small proteins in the brain that signal neuron cells to survive or grow. This means that dietary restriction and physical and mental exercise can reduce or slow neurocell death. Available data suggests that dietary restriction and physical and mental exercise may reduce the occurence and severity of neurodegenerative disease.

Physical Exercise

Before starting an exercise program check with you doctor about the exercises you can do, how long to do them and how hard they should be. You should start your exercise routine with warm ups and conclude with cooling down. I know you hear that all the time and you can skip that step if you enjoy muscle cramps. Exercise probably isn't going to keep your Parkinson's from progressing but it will help your balance and flexibility and it can help to reduce pain.

Any kind of exercise done regularly will help but make sure to include ones that can aid in improving your balance and that require you to move your limbs to their full range of motion.

You can also start a new hobbies which involve physical activity. Perhaps you'd like walking, gardening or swimming. I've done Yoga with my sister-in-law and am waiting for the next local Tai Chi class to begin.

What you don't want to do is to let those muscles atrophy while you dispair over having Parkinson's.

Flexing Exercise

Take a look in the mirror and say a few words to yourself. Loss of facial muscle tone
can affect your your ability to communicate fully as well as affecting the way you are perceived. So keep those facial muscles exercised too.

There are plenty of stretching and flexing exercises which you can find in the form of facial isometrics. You can also try singing or reading aloud. For fun and exercise, go back to the mirror and make faces at yourself. You'll be able to see and/or feel which muscles need to be worked. Continue to make those funny faces but hold each pose for at least 5-10 seconds.

And don't forget that simply chewing your food energetically will not only help your digestion but also exercise muscle groups of your face and neck. As an added benefit, spending more time chewing may decrease your caloric intake. and reduce swallowing difficulties.

Mental Exercise

Try doing a cross word puzzle each day or sudoko if you are a numbers person or even computer gaming. Don't be afraid to open yourself to new experiences, to make new friends. Even if you can't get out of the house that easily, you can expand your world of interest.
Checkout some brain exercises at: http://www.neurobics.com/exercise.html