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A self-management model for Fibromyalgia Syndrome (FMS) Chronic Fatigue Syndrome (CFS). Fibromyalgia Syndrome (FMS) 3 months of fatigue and pain over a widespread area of the body with numerous sensitive points. Chronic Fatigue Syndrome (CFS) • Myalgic Encephalomyelitis • Persistent exhaustion for six months or more. • 60% following glandular fever, Ross River virus or severe flu. Common features • • • • • • sleep disturbance, environmental sensitivity with allergies, depression, muscle weakness and tightness, deconditioning poor posture. fibromyalgia chronic fatigue syndrome PAIN FATIGUE ================================= Causal factors for FMS and CFS. • Autoimmune diseases, such as lupus and rheumatoid arthritis. • Chronic pain. • Traumatic injuries. • Chronic stress. • Sleeping disorders. • Viral or bacterial infections. • Major hormonal events • develop without any apparent cause. • sensitisation of the central nervous system Following an eight-week yoga program. • In the Journal of Pain (November 2010) • a randomised controlled study of fibromyalgia sufferers showed significant improvement in: • pain, • fatigue, • mood • coping strategies The self-management model. • complex, chronic conditions • gradual improvement in symptoms over months or years.. • treat as an individual. • the chronic pain or fatigue end of the spectrum, • a mixture of both. Yogic Approach • disturbances in the energy flow and balance in the body. • symptoms of increased sensitivity to touch. • increase in vital physical pranic energy (sympathetic output) • a decrease in mental pranic energy (parasympathetic) . Yoga physiology • prana in a muscle or joint is blocked or deficient • the supply of blood and lymphatic fluid becomes sluggish • muscles and joint circulation grow stagnant. • cellular metabolism build up, • Acidic wastes and toxins irritate the sensitive nerve fibres, causing pain and stiffness. • the structure of the muscle and joint itself begins to degenerate. Ida • • • • • • Ida represents, parasympathetic nervous system activity, right brain, mental activity, the left nostril, introversion and calmness. Pingala • • • • • • Pingala represents, sympathetic nervous system activity, left brain, physical activity, the right nostril, extroversion and dynamism. Brain physiology • The more you use a body part • the larger the representational area in the brain will become Brain physiology • With disuse, the area of the brain representing parts of the body can become smaller . • nerve is injured and your brain computes that more sensitivity is required to protect the body, • more stress sensors are made by the nerve cell and put into its membrane. • stress states can increase nerve sensitivity. • Research has shown that practising normal pain-free movements normalise the input from the brain. Yoga treatment • Yoga asanas, regularly practised, begin to normalise body movements, therefore re-establishing normal brain physiology. Yoga treatment • With pranayama practices we experience a greater sense control over the nervous system allow it to become stronger and more balanced. Telencephalisation • Breathing controlled from the primitive brain stem. • pranayama, we shift control to the more highly evolved cortex. • This shift of control from unconscious to conscious levels will have profound effects on our well-being. kumbhaka (breath retention) • train the nervous system to tolerate higher levels of carbon dioxide in the body • blood capillaries in the brain lie dormant • increased carbon dioxide levels stimulate capillaries to dilate. • improves cerebral circulation. Hyperventilating pranayama techniques • bhastrika is a vitalising pranayama and can be used effectively in chronic fatigue. • The rapid muscular effort and increased metabolic rate • purifying and healing effect on the body and mind. Lack of awareness • In FMS and CFS thoughts are often scattered and there is difficulty in focusing the attention on the present moment Thoughts focused on the past • individuals often keep thinking of the golden past, prior to their injury. • This makes it difficult to move on, • a complete cure is the only way of reclaiming the past. Thoughts focused on the Future • Expectations of the future can also cause pain, anxiety and fear. • they may never work again, • that their condition will worsen • they will lose the support of friends and family. • Swami Niranjan states that “expectations in life are bondage”. Physiological effects of thoughts • thoughts can activate alarms signals inside the brain which can augment the experience of pain. • The thoughts trigger the release of stress chemicals such as adrenaline • leave the person feeling anxious and fatigued. Yoga psychology. • Awareness • In the practice of yoga we seek to intensify our conscious experience. • Awareness is recognising our experiences. • Yoga practices aim to increase our awareness, to focus our consciousness and allow us to be in the present moment. The positive effects of focusing the mind • someone competing in a world championship may be unaware of the pain of an injury. • mind is focused, a powerful internal pain control system kicks in. • Pathways coming down from the brain meet the rising pain impulses and damp down the pain signals. • This is approximately 60 times more powerful than any drug you can inject or ingest. It allows a flood of chemicals (happy hormones) such as endorphins (opioids) and serotonin to be released. Simple practices for focusing the mind • Simple practices such as abdominal breathing (vertical breathing) have been shown to release endorphins into the bloodstream, these are potent neuromodulators which help us to cope with pain and anxiety. Physiological effects of diaphragmatic breathing • improves circulation to the heart and lungs on top of the diaphragm, and the liver, spleen, stomach and pancreas immediately beneath it and attaching to it. • The vagus nerve, a parasympathetic nerve, connecting to the abdominal organs heart and lungs to the brain is also said to be massaged and toned. Treatment • If there is low energy and lethargy, • stimulating practices • full yoga breathing and yoga energy locks (bandhas). Fatigue Paradox • In chronic fatigue some people can suffer the paradoxical situation • they feel fatigue • also feel agitated and anxious reflecting heightened sympathetic response. Physical effects Deconditioning and muscle weakness Muscle tightness and tension Poor fitness, less endorphins Poor posture or postural pain Strategies strengthening postures Yoga stretches and relaxation Aerobic activity Postural reversal exercises, ergonomic assessment and advice. Weight gain or weight loss Diet and exercise Sinus congestion and Yoga sinus cleansing (Neti) allergies Abdominal bloating and Nauli (abdominal massage), nausea stomach locks Psychological effects Stress, confusion anxiety Strategies yoga relaxation, breathing and and meditation Depression and Psychology counselling. mood swings Training in the practices of being in the moment, and witnessing. Functional consequences Strategies Unable to perform paid work Work conditioning, pacing strategies Return to modified part-time duties Begin small and easy tasks at home. Pacing strategies Unable to perform house work Socialising, friends relationship Intimate relationships with Expand networks. Visit the ashram. Family counselling and support. Yoga practices • • • • • • • • Yoga Nidra Pranayama Meditation Hatha Yoga kriyas Bandhas Asanas Diet Fasting