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Friday Q&A: Tremors while Doing Yoga

12:19 | Labels: essential tremor, shaking, tremors

New Leaves by Melina Meza

Q: Great article on essential tremors and yoga, thanks! How might an instructor differentiate between a student experiencing tremors from over exerting a pose vs. essential tremor?

A: It may be a universal experience for new students to yoga, especially if you have been sedentary, are naturally stiff or weak, or if you are in a class beyond your level of ability to experience “shaky” muscles. This usually arises when holding poses statically for a while, versus moving from pose to pose with your breath. Even experienced yogis can have this kind of muscle quivering arise if they are moving to the next level of difficulty in the physical practices, or if they have taken a break from yoga for a while and are first returning to regular practice.

The key difference between this very common and normal challenge to tight or weak muscles resulting in a tremor like feeling and the essential tremors I wrote about previously in my post Yoga for Tremors is that they resolve immediately after coming out of the pose, and become less frequent with regular practice, even just once or twice a week in a public class. In those with essential tremor, although there might be slight improvement over time in the degree of tremor, in all likelihood, the tremors will remain and continue to arise when the arms or legs are held out in space. And, in the person with essential tremor, usually, if the hands are grounded as in Cat/Cow position, the arms are unlikely to tremor, or will at least be much less than say in Warrior 2. And same goes for the legs in standing poses like Powerful pose (Utkatasana); but hold the legs up in the air as in Shoulder Stand and the essential tremor student will likely experience visible tremor.

Don’t get me wrong, the student with essential tremor could also have shaky muscles in the legs in Triangle, too, unrelated to the essential tremor, especially if the student is tight or weak in the legs and hips. I’d emphasize that the student who does not have essential tremor should notice less and less tremor—or more accurately, muscle shakiness—from class to class if he or she is practicing regularly and doing similar poses from week to week. If there is not this expected improvement, it would be advisable to check in with your family doctor for a physical exam to make sure there is not anything unusual going on with your muscles and nervous system. And, in a more common-sense vein, always make sure you are eating appropriately, to guarantee you have adequate energy for practice, and that you are adequately hydrated by drinking water throughout the day.

—Baxter

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Yoga for Tremors

05:33 | Labels: Baxter Bell, essential tremor, tremors

by Baxter

Humming Bird by Melina Meza

On a recent teaching trip, I met with a yoga teacher from the community for a private session. She was hoping I might have some helpful suggestions for a problem she was having with her hands and arms, but also sometimes with her legs. The problem was that when she attempted to do her home practice or demonstrate poses for her yoga classes, her limbs would shake, sometimes barely noticeably, and at other times more so. This was not so worrisome to her regarding the home practice, but she was very self-conscious about it during her teaching times, feeling slightly embarrassed about what her students would think of her. The shaking, which is medically referred to as a tremor, and more specifically “essential tremor,” had also affected her hand writing negatively. It also was worse when she was tired or stressed out. She had been to the doctor, who sent her for evaluation and had determined her situation was not a mistaken case of Parkinson’s disease, which early essential tremor can mimic. Other causes of tremor had also been ruled out, medications suggested and initiated. And the meds did help a bit, which became apparent when she went off them for a bit and her symptoms worsened.

Turns out this student works with mostly seniors in her classes. We talked about the fact that some of those students might also be dealing with shaking of the limbs at times. In fact, my dad developed this kind of tremor in his 60s, and it made drinking his daily coffee quite a chore. Had I known then what I know now, I’d have suggested my dad get off the full-strength coffee, as caffeine can worsen essential tremor!

So, let’s learn a bit more about essential tremor. According to the Mayo Clinic online:

“Essential tremor is a nervous system disorder (neurological disorder) that causes a rhythmic shaking. Essential tremor can affect almost any part of your body, but the trembling occurs most often in your hands — especially when you try to do simple tasks, such as drinking from a glass, tying shoelaces, writing or shaving. Essential tremor may also affect your head, voice, arms or legs.

"Although usually not a dangerous condition, essential tremor worsens over time and can be severe in some people. Other diseases don’t cause it, although it's sometimes confused with Parkinson's disease. Essential tremor can occur at any age but is most common in people age 40 and older.”

They go on to say that the signs and symptoms of ET include gradual onset, worsens with movement, usually starts in one or both hands, can include a nodding yes or no movement of the head, and is aggravated by emotional stress, fatigue, caffeine, and extremes of temperature. Thank goodness my student lives in warm southern Florida!

As for the causes of ET, 50% of cases are due to a genetic mutation that can be passed from parent to child. As for the other 50% of cases, it is not clear what the cause is. You are at a greater risk of developing it after the age of 40. And although it is not life threatening, symptoms, like shaking when holding a cup or shaving yourself, to mention just a few, can get worse over time. And sadly, there is not specific test to diagnose ET, so you will need to rule out other conditions that mimic it and do have diagnostic tests. The western approach to treatment, if your symptoms are disruptive enough to your lifestyle and work, includes medication (such as, Beta-Blockers, anti-seizure meds, tranquilizers and Botox injections, all of which may help but also have significant side effects), physical therapy to teach exercises to improve muscle strength, control and coordination (which yoga asana could also help), and in rare severe cases a surgical procedure called Deep Brain Stimulation. Lifestyle changes are also recommended, beyond what we have already mentioned, including limiting or eliminating alcohol consumption, which may lessen tremors while drinking, but often worsen after alcohol wears off.

So what recommendations did or could I share with my student? Since the symptoms of shaking in the arms and legs typically occur when she has them out in space and not bearing weight, I suggested she play with a strap between her hands in poses such as Warrior 1 and 2, and pull outward on the strap to create some tension in the strap. This almost immediately decreased or eliminated the tremor in her arms. We discussed a similar concept for the legs when one is up in the air, as in Reclined Leg Stretch pose or Warrior 3. An 8-10 foot strap, looped, would be on the sole of the foot and around the opposite thigh or lower back, tightening it so that when your foot pushes into the strap, the strap would be tense. She still has to try this and report back on its effect.

Regular readers of YFHA know well the beneficial effects of yoga practice on stress, so you will not be surprised that I encouraged my student to vary her home practice to include other yoga practices that would help decrease her stress response, especially quieter forms of practice, such as gentle yoga, restorative yoga, and reclining guided meditations. And to assist with quieting the tremors, I suggest using sand bags on her thighs and shoulders or elbows when in Savasana or other reclining poses.

The same recommendations for stress would also help address the fatigue she says can aggravate her symptoms. And part of her yoga practice should be aimed at improving her moment-by-moment awareness of her fatigue level via setting a goal or sankalpa to do so each day, and by pausing a few times during the day and doing a simple breath awareness meditation for 5-10 minutes, after which she asks herself the question “What is my level of fatigue now?” Even setting a timer on her watch or smart phone as a reminder to assess her energy level periodically could help her identify when she needs to address her fatigue.

As for the embarrassment she is experiencing—which can be quiet distressing—I suggested she consider sharing some information about condition with her regular students at the start of one class, explaining the nature of the condition, that she is not in pain, under the influence of any substance that could cause shaking, and even talk about how her yoga practice is helping in some ways to address the challenges of essential tremor. I shared my own experience of letting my student’s know of health issues I have had, and the overwhelmingly positive responses and appreciation I have received from my students. It can help to remind them that we are all human, subject to change and illness and injury, trying our best under difficult circumstances. And, given the senior students she often works with, I suspect a few of her students will confess to the same condition and appreciate any guidance she can offer from her own experimentation with yoga.

To learn more about Essential Tremor, check out the Mayo Clinic online and also essentialtremor.org, an organization dedicated to essential tremor.

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