Author: Jeffrey Scott Craft
Chronic Fatigue Syndrome
Disease Overview (introduction and physiology, causes and symptoms, available treatments and their limitations)
Chronic Fatigue Syndrome (CFS) presents with primary symptoms of weakness, muscle pain, impaired memory or impaired mental concentration, insomnia and post-exertion fatigue that lasts for more than 24 hours.
This is not to be confused with "end of the day" or simple post exertion fatigue. This is incapacitating fatigue, despite rest or sleep, which makes it truly difficult to accomplish daily basic tasks and dramatically reduces stamina. Those with CFS are simply not able to function at the levels they were before its onset.
Because these generalized symptoms can be associated with so many different diseases, it is important that preliminary tests and multiple potential disease factors are first explored to ensure the patient is not suffering from a more common disease. For instance, we must be sure that the symptoms are not caused by metabolic diseases, such as diabetes or thyroid issues.
Once common medical disorders are ruled out, then we must explore the possibility that these symptoms are being caused by neurological disorders, or possibly psychological or mental health factors. So, we test for factors of nerve degeneration, post-traumatic stress disorder, and many other possible solutions to see if there is a likely diagnostic explanation from the neurological and mental health fields.
Once common medical, neurological and mental health diseases have been ruled out, this leaves the medical profession with a lack of explanation as to the cause(s) of these symptoms. In fact, Chronic Fatigue Syndrome is not a specific disease, but rather a collection of symptoms which operate under specified conditions. In other words, it is the name given to a set of symptoms, when there is no other explanation.
In order for someone to be diagnosed with Chronic Fatigue Syndrome, all medical, neurological and psychological explanations must be ruled out, and then the following conditions must be met, in addition to generalized severe weakness and fatigue:
1. The patient must have four or more of the following symptoms: Impaired short term memory, sore throat, tender lymph nodes, persistent muscle pain, pain in multiple joints without swelling or redness, headaches of a new type or pattern to the patient, or increased severity in headaches, increased fatigue and sickness following exertion, as well as insomnia or, sleep which produces no feeling of rest.
2. These symptoms must have been present for 6 months or longer without any other explanation.
If a patient has fewer than four of these symptoms, but all else remains true, then the patient is classified as having "Chronic Fatigue", but not the "Syndrome."
There are also some other symptoms which are commonly associated with CFS. These include Irritable Bowel Syndrome, depression or other psychological problems (such as irritability, mood swings, anxiety and panic attacks), chills and night sweats, visual disturbances (blurring, sensitivity to light, eye pain), allergies or sensitivities to food, odors, chemicals, medications or noise, as well as feeling mentally foggy and difficulty maintaining an upright position because of dizziness, balance problems or fainting.
The severity of CFS varies from person to person, with some people able to manage it well and maintain relatively active lives. However, for many it can be as disabling as many other serious illnesses, such as multiple sclerosis, lupus, rheumatoid arthritis, heart disease, or serious renal or pulmonary diseases.
CFS also comes and goes in waves for many patients, with cycles of more noticeable symptoms followed by periods of feeling relatively normal.
CFS is seen to be fairly equally distributed among ethnic groups. It is most likely to affect women in their 40s or 50s, although some men also have the diagnosis. It is rare in children, but more likely in adolescence than any age before that.
There are many theories in the medical community as to the cause of Chronic Fatigue Syndrome. Some of the most common theories include Viruses such as Epstein Barr, immune system dysfunction, Central Nervous System disorders, nutritional deficiency, and emotional stress.
Many people believe that Fibromyalgia and Chronic Fatigue Syndrome are related or perhaps even the same thing. They both share similar symptoms which are collected after ruling out other possible causes, and are labels given to a collection of symptoms when no other explanation exists.
The standard treatments for CFS vary widely due to the fact that it shows up differently in different patients. The most important thing is to find out which symptoms are most significant to the patient, and then find ways to address those symptoms. Common treatments include professional counseling, behavioral therapy, support groups, pain therapy, and various medications including antidepressants.
One of the most frustrating elements for sufferers of Chronic Fatigue Syndrome, beyond the actual symptoms, is the frustration of not knowing its cause. While it is generally approached with more awareness today by the medical community, in the beginning, many patients' pain and fatigue was dismissed by doctors as being made up or "only in their minds".
This invalidating response from the medical community in many cases made sufferers of Chronic Fatigue Syndrome feel "crazy", depressed, or extremely angry. The label Chronic Fatigue Syndrome itself came out of a need to validate the experiences of these patients. There are many theories despite the fact that there is still no clear cause, however, giving it a name helps give a structured definition as well.
Even today, the lack of a clear cause can lead to frustration and depression among its sufferers. When approaching this through Yoga Therapy, methods for treating depression and stress, as well as generalized psychosomatic disorders can be helpful for many sufferers of Chronic Fatigue.
Additionally, many are in agreement that the primary imbalance creating the symptoms is related to dysfunction of the nervous system. It has also been shown that most sufferers of CFS have reduced adrenal function which means reduced production of the hormone and neurotransmitter epinephrine (also called adrenaline).
The symptoms and clinical factors point to an overload of the sympathetic nervous system which has caused a partial shut down of pranic energy and functions related to maintaining a normal biochemical balance for a healthy, active person. Thus, a Yoga Therapy approach to strengthen and balance the nervous system is indicated.
There are also similar factors to clinical depression in many cases of CFS, and because there are no pathogens or other physiological explanations, the wisdom of Yoga points to the root of this illness as being in the mind. Therefore, using methods to calm and focus the mind, and reduce stress will be important, especially as the underlying root of the entire condition may well be linked to a maladaptive coping method for high levels of stress.
The Yoga Therapy approach for CFS should address these primary aspects:
1. Restoring adrenal function - which is responsible for healthy functioning of the sympathetic nervous system function and will increase energy levels.
This is accomplished by multiple asanas in the categories of spinal twists, forward bends, and back bends. These are postures which twist, compress and stretch the abdominal and kidney region, and focus on the adrenal glands themselves. The goal is to get a relaxed, deep stretch, which allows the stretch or other action of the asana to transfer into the adrenals, kidneys and digestive organs. As some CFS patients also present with problems absorbing nutrients from food, these practices which also help normalize the digestive system may be useful.
Additional practices, such as Agnisar, Surya Bhedan, and Bhastrika can help activate this region and improve its function both physically and energetically through the Manipur Chakra.
2. Balancing the nervous system – the parasympathetic with the sympathetic nervous system.
Deep breathing and relaxation within the asanas, as well as a focus on Nadi Shoshanna can help to balance the energy currents of the sympathetic and parasympathetic nervous systems. Also, slow movements and transitions as well as the inclusion of forward bends can be very soothing and balancing to the nervous system.
3. Addressing the underlying stress - at the mental and emotional levels which is the likely cause of the adrenal system shut down and possible related depression.
Including daily practices of Yoga Nidra can help to increase the level of relaxation in the individual which can improve recovery and the ability of the patient to actually receive the benefits of rest. Yoga Nidra also assists in the daily Omkar practice which creates powerful healing vibrations, stabilizes the mind, reduces stress and tension, and helps dissolve worry and fear.
4. Gently reintroducing physical movement -in order to increase circulation, reduce joint and muscular pain, as well as reintegrate the conscious awareness with the nervous system.
Assuming the patient is otherwise healthy, we can introduce physical practices to their comfort level with regards to energy level, pain level and mobility of joints. For many, we will need to start with the Basic Movements introduced in the Yoga Sopan Course, and then follow into Yoga Pravesh as their comfort, health and energy levels increase.
As the symptoms begins to reduce, and the pain and energy levels become more normalized, then we can encourage a wider range of Yogic Practices, with a goal of getting the patient to a yoga practice which is free of limitations.
The gentle approach of Yoga helps to calm and soothe the nervous system. It also helps to establish greater integration between the mind and body through the nervous system by increasing awareness of the body and the breath.
Additionally, the practice of yoga provides an opportunity to create discipline and regularity of routine, which supports other positive lifestyle changes as well. Yoga practice also empowers the patients with a way they can heal themselves through their own sustained effort, rather than feeling helpless and dependent on a medical community that seems to have no real answers.
It has been seen in research that 60 - 70 % of CFS suffers have neurologically mediated postural hypotension. This means that they have a reduction in blood pressure when they are in a standing position. Because of this, it appears that various inversions improve nervous function and help to restore balance to the blood pressure.
With correctly chosen practices, yoga also helps to re-energize the body, the chakras and the koshas by increasing the amount of prana and the ease of flow of prana within the energy system and the body. This increased prana and improved circulation helps to feed and restore health to the nervous system, various organs, as well as the mind. This improves overall well being, energy levels and stamina.
Various other practices also increase focus, balance the nervous system, lift the emotional state, and increase positive thoughts and mood.
If pain is increased and mobility diminished then performing ‘Basic Movements’ is the place to begin. Next you can move to the ‘Joint Freeing’ series and Shakti Chalana series. These progressively add mobility, circulation and increased levels of energy.
Once they are ready, performing Surya Namaskar will help to revitalize the energy of the body, while providing improvements in mobility and range of motion.
Introduce asanas as to their capacity, with an emphasis on the following:
Atho Mukha Swanasan, Paschimottasana, Pada Hastasana, Pawanmuktasana, Tadasana, Bhujangasana, Ushtrasana, Chakrasan, Vakrasana, Ardha Matsyendrasana, Trikonasan, Veerasana, Sharvangasana, Shirshasana, Child's Pose, and Shavasana
Nadi Shodana, Bhastrika with Kumbak, and Abdominal Breathing
Kunjal or Vaman, Neti, Kapalabhati, Laghoo Shakhaprakshala, Trataka, Jala Neti, Agnisar
Uddiyana and Moola Bandha
Meditation and Stress Reduction
Yoga Nidra, Omkar Chanting, Mantras such as Gayatri, Manipura Chakra Dharana, Mindfulness Practice
What would be generally beneficial is a simple nutritious vegetarian diet; balanced meals with good quantities of cooked vegetables, fibers and fruits.
Avoid: processed foods, sugars, caffeine, alcohol, fast foods, dairy and spicy foods.
A more relaxed and reduced stress lifestyle would be ideal. Finding ways to live and enjoy life and learning detachment. Also, regular eating and sleeping times as well as being in a natural, chemical free environment.
Avoid cooling practices, such as Chandra Bedhan, Shitali and Sitkari, which would be counter productive to the attempts to increase pranic energy and stamina.
Trying to do too much too fast. Being mindful of ones capacity will allow the individual to make progress without over exerting themselves. It is important to respect personal abilities and not worry about meeting unrealistic goals which can cause additional mental or physical fatigue.
Do's and Don’ts
The beginning practices need to be determined on a case by case basis. If a client's condition includes chronic pain, then more emphasis on restoring emotional and mental balance, and soothing the nervous system should be given to help the body and mind recover from stress. Also introducing some basic preparatory movements combined with conscious slow breathing to begin increasing circulation, mobilizing the joints, and increasing the body/ mind connection through the nervous system will bring about beneficial results.
Additionally, if the client is suffering from significant depression, then practices which create too much introversion, or too much calming of the nervous system may deepen the depressive state. In this case, we should direct the beginning practices towards restoring a balanced and positive outlook, and increasing pranic activation.
After the body and mind is better prepared for activity, or if the pain is not too great, the next step is to begin introducing Yoga Asana, as per the capacity of the client. Keep the focus on slow movement and slow deep breathing. Trying to introduce static, relaxed postures as quickly as possible will help to sooth the nervous system and reduce stress.
At the same time, it is important to introduce practices which will increase the flow of prana, and the amount of prana available to the client. This can include active movements such as Surya Namaskar to energize, as well as Bastrika Pranayama and Manipura Chakra Dharana to help the adrenal function normalize and feed prana to the nervous system.
The practices must be given to the capacity of the patient. While up to 90 minutes of practice per day is recommended as a final goal, we should start slowly. If necessary, multiple short practices sessions per day may be a better approach than a single 90 minute practice session. A way to help regulate session times is to ensure that there is no post exertion fatigue. If the individual is having hard time recuperating after a session than it is an indication to reduce the length and/or intensity.
General Program for the Patient
This is the program to work up to. Short practices only using steps 1-4 or 1-8 may be needed in the beginning if severe fatigue or muscular pain is present. The patient should never have their fatigue made worse by the practice. It should relax body and mind while they increase prana and feel more energized over time.
1. Basic Movements all types OR Preparatory Movements 1-12 OR Surya Namaskar (10 Minutes)
2. Shavasana (2 minutes)
3. Shakti Chalana Series (10 Minutes)
4. Shavasana (1 minute)
5. Bhujangasana (1 minute)
6. Dhanurasana (1 minute)
7. Artho Mukha Swanasana (3 Minutes)
8. Makarasana or Child's Pose (1 minute)
9. Ushtrasana (1 minute)
10. Chakrasana or Ardha Chakrasana (1 minute)
11. Vipareet Karani or Sarvangasana (3 Minutes)
12. Ardhamatsyendrasana or Vakrasana (3 minutes)
13. Shavasana (1 minute)
14. Pawamuktasana (1 Minute)
15. Tadasana (1 Minute)
16. Tiryak Tadasana (1 Minute)
17. Pada Hastasana (2 minutes)
18. Trikonasana (3 Minutes)
19 Veerasana (3 Minutes)
20. Shavasana (1 minute)
21. Shirshasana (3 Minutes)
22. Child's Pose (2 Minutes)
23. Anulom Vilom, Deep Breathing (10 Minutes)
24. Bhastrika with Kumbak (10 Minutes)
25. Manipura Chakra Dharana with Ujjayi Breathing (10 Minutes)
26. Prayer and Silence (5 Minutes)
90 Minutes Total
Jala Neti (Once per week)
Agnisar (100 Strokes per day in 3-5 rounds)
Laghoo Shakhaprakshala (once every 7 - 15 days)
Listening to Omkar throughout the night
Yoga Nidra for stress management
Omkar Chanting (15 - 30 minutes per day)
In a preliminary study by Dr. Hartz, he found that the use of regular yoga practice appears to help more than any other approach he tried. This came as a surprise to him, because he had not initially had any expectations about the effects of yoga for CFS sufferers. He is still researching to determine which aspects of yoga are having the greatest effects, but the initial beliefs are that the meditative aspects combined with a gentle approach to asanas which are not too intense in terms of physical exertion seems to be the key.
Yoga Vidya Dham, Kaivalya Nagari,
College Road, Nashik - 422005.
Phone - +91-9822770727 (for courses in ENGLISH)
+91-253-2318090 (For courses, in HINDI or MARATHI)
(Please call during 9.00 AM to 5 PM Indian Time)
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