Back to Back
For three years the aching rarely subsided. Dee McCandless, 56, of Austin, Texas, felt constant twinges in her lower back. They came as she washed dishes, while she drove her car, even when she tried to sleep at night. A yoga teacher and longtime dancer, Dee grew frustrated and desperate as she searched for an explanation. Then her own yoga teacher, Devon Dederich, took a closer look at her back and suggested that Dee might have scoliosis, or curvature of the spine.
Soon afterward, Dee sought out one of my Yoga for Scoliosis workshops and learned how to use yoga to work with the reverse-S curve of her spine. For the next month she took time off to devote herself to healing. In addition to her morning yoga practice, she began to hone moment-to-moment awareness of how she was holding herself throughout the day. "About 8 to 12 times a day I would make adjustments to the way I sit, stand, sweep the floor, brush my teeth, you name it." Her work paid off. "Within four weeks I was sleeping without pain, and the daily pain wasn't as dominant. About a month after that, the daily pain ended." Not only that, Dee believes that the curve in her lower back is lessening. These days if Dee's pain returns, she knows that yoga can bring her body back into balance.
Dee has been amazed by how quickly her body responded to yoga practice, but the changes she underwent don't surprise me. I experienced similarly dramatic shifts when I started doing Iyengar Yoga for my own scoliosis. During a routine physical when I was 15, my doctor noticed that my spine curved to the right in my upper back and to the left in my lower back. I was diagnosed with a 49-degree structural right thoracic curve with a compensating left lumbar curve. (See The Four Common Curves). The news came as a complete shock. I'd never felt any pain. (I later learned that most teenagers don't experience pain until they're older.) I went from being a normal kid who played basketball and tennis to having my doctor tell me he was going to surgically fuse my spine and insert a metal rod into it.
I was willing to do anything but have surgery. I sought a second opinion from a well-known orthopedist who specialized in scoliosis. Thankfully, he felt surgery was necessary only if the curvature continued to increase. He recommended swimming and mentioned that he had just heard that yoga could be helpful too. I took his advice and joined the swim team during college, but it wasn't until my 20s that I took up yoga.
By that time, the pain had set in. My right shoulder was higher than my left and rounding forward. A hump was beginning to appear on the right side of my back. I was motivated to make a change and started taking classes at the Integral Yoga Institute in Dallas, where I was living at the time. Yoga decreased my pain and helped me feel more aligned right away. The more yoga I did, the more balanced I felt. A few years later I met B.K.S. Iyengar, a master at working with therapeutic conditions, and I knew I'd found my calling as a yoga teacher.
Now, after more than 30 years of working with my own scoliosis, my curve has decreased significantly and is barely noticeable. I'm not necessarily the norm—I've devoted countless hours to my yoga practice every day for more than 30 years—but I've seen tremendously positive results in my students too. The key is to be consistent and patient.
Drawing from my own experience, I've created a yoga program that helps people of all ages with scoliosis, whether or not they've had surgery. My approach is to lengthen the spine, stretch muscles that have become tight, and strengthen muscles that have grown weak. I also focus on de-rotating the spine and ribs to create more balance in the body. Almost every day I receive emails from students who express how this yoga practice has brought balance and ease to their life.
The word "scoliosis" is derived from a Greek word that means twists and turns. Scoliosis was first treated with braces by the Greek physician Hippocrates in the fourth century BCE. Today, it's much more prevalent than people realize, affecting more than 6 million people in the United States alone. It typically begins in adolescence and progresses at its most aggressive rate while a teenager is still growing. But even after the growth spurt and into adulthood it can continue to worsen by about one degree per year. It can also get worse in women who are pregnant more than once. But beyond that, many facts about the disease remain a mystery. In 85 percent of the cases, the cause of scoliosis is idiopathic, or unknown. (The other 15 percent of the cases are caused by a variety of disorders such as cerebral palsy or muscular dystrophy.) "It's a multifactorial disease. It goes hand in hand with growth, but we don't know exactly why," says Joseph O'Brien, president of the National Scoliosis Foundation. "Genetics plays a role, but hormones or physiology may too." O'Brien adds that it's also not known why the disease more often progresses in girls to a degree where treatment is required than it does in boys, at a rate of eight to one. Perhaps most troubling is that when a teen is first diagnosed, doctors can't predict if the curve is going to progress beyond 30 degrees (the point at which the bones can become deformed), so it's difficult to recommend the best course of treatment.
In scoliosis, the spine curves to one side, forming a reverse-S or a reverse-C shape up and down the back. (Most of the time the spine curves to the right in the upper back and to the left in the lower back, but, again, no one knows why.) The spine also twists, which causes the ribs to push forward on one side and back on the other. So, if the spine curves to the right, the right ribs will bulge backward, creating a convex shape as the left ribs push forward, creating a hollow, concave area. When this happens, the right ribs also spread, causing the intercostals (the muscles between the ribs) to overstretch and the left ribs to become compressed.
These twists and turns—whether extreme or minor—can create a domino effect that knocks the rest of the body out of whack. The shoulders may be off kilter, causing one shoulder blade to be more prominent than the other; or one hip may be higher than the other, resulting in an uneven waist. The head often either leans to one side or hangs forward instead of being centered directly over the pelvis. All these imbalances can add up to a long list of pains and other infirmities. Since the head and shoulders are constantly out of alignment, headaches often occur. Having uneven hips can lead to lower back pain and sciatica. Constant compression on the concave side of the curve can wear away the tiny facet joints between the vertebrae and cause the disks to degenerate. It can also lead to bulging or ruptured disks. Aching pain on the concave side is often so relentless it leads to insomnia. In extreme cases, cardiopulmonary complications can occur due to compression of the heart and lungs. Not surprisingly, the stress of these physiological complications can cause depression and low self-esteem.
Structural Versus Functional
There are two types of scoliosis: structural and functional (also called nonstructural). In structural scoliosis, the vertebrae form a lateral curve. In functional scoliosis, a structurally normal spine appears curved because of a structural problem in another part of the body, such as a difference in leg length. A functional curve is usually much less noticeable than a structural curve, since the curvature and rotation are less severe, and in many cases it is reversible. Often it corrects itself on its own, once adolescents have finished growing. But if a functional curve doesn't right itself, it can lead to a structural curve.
A simple way to determine whether someone has structural or functional scoliosis is to look at the spine while he or she stands in a forward bend. This is the standard screening test given to schoolchildren. If a curve is visible when the person is standing, and it then disappears in a forward bend, the scoliosis is functional. If the curve remains and the rotational component becomes more obvious, it's structural scoliosis.
With scoliosis in teenagers, an orthopedic surgeon will typically take x-rays and recommend braces if the curvature is more than 20 degrees. If the curve advances to 45 degrees or higher (in teens or adults), doctors often recommend surgery, according to O'Brien. Orthopedists have been operating on people with scoliosis for decades. Unfortunately, surgery is not a guarantee that the pain will disappear. But whether or not someone chooses to have surgery, developing a consistent yoga practice will help increase breath capacity, decrease the pain, and perhaps even prevent the curves from worsening.
Awareness Brings Hope
When I first meet people with scoliosis, they're often discouraged. Many of them have been told by their doctors that only surgery will relieve their pain or stop the progression of their curves. They often have low self-esteem and try to hide their scoliosis with baggy, loose-fitting clothes.
When they do yoga all this begins to change. Once they start to feel better, my students realize that they can do something to improve their posture, relieve their pain, and feel more centered. As they build their awareness of their bodies, they begin to take what they learn in class and apply it to their activities throughout the day, just as Dee did. When they realize that they have some control over making themselves feel better, they begin to have hope.
I can certainly attest to this. Before I started practicing yoga I had been told by doctors that I shouldn't have children. They were worried that being pregnant could make my curvature worse. My husband and I were both sad and disappointed by this news. But when I found yoga I felt as if I were unraveling layers of tightness that I had developed as a protective shield. As I developed more awareness of the alignment of my spine, I began to feel more energy throughout my body as well as more openness from deep within.
I started to feel more and more confident that getting pregnant wouldn't make my scoliosis worse. Once I felt ready to welcome in new life, I became pregnant within a few weeks. I did yoga every day for hours during my pregnancy and had a home delivery without complications. My curve didn't worsen; in fact, I had never felt happier or more balanced than I did during those nine months.
The Power of the Breath
When I work with students, I always start with simple breath awareness, because learning about my own breathing patterns made such a difference for me. In the early stages of my practice, I soon discovered that I wasn't breathing into the left side of my back because my ribs and intercostal muscles were compressed. I began to focus on expanding them by breathing into this area. After several months, I noticed that it had made a significant difference in my lung capacity. What's more, by expanding the ribs on the compressed side, I began to feel that my spine was gradually shifting back to center.
Once you understand where your breath is going and where it's restricted, you can direct it into the underused areas during asana practice. The next time you come to your mat, try this simple exercise: Stand in Tadasana (Mountain Pose) and inhale as you sweep your arms overhead into Urdhva Hastasana (Upward Salute). Pause there and exhale completely. Take another deep breath and take notice of where your breath is full and where it's restricted. Does it differ from the right side to the left? From front to back? How about from the top of the lungs to the bottom? Keep breathing as you lengthen both sides of your waist evenly. Now exhale and bring your arms back by your side, but keep your side waist long and your chest lifted. Repeat this a few more times and try to hone your awareness of where the breath flows.
Find Your Vertical Line
The next step is to work on your alignment by finding the vertical line of reference that runs from the crown of your head all the way down to your feet; this is also known as your plumb line. Finding it might be tricky at first. Over the years, your body has probably developed a highly sophisticated system to compensate for its abnormal curves. If there's a major curve to the right, for example, the head often lists to the left. Also, one hip may lift higher than the other, which can bring on pain in your lower back.
Practicing a pose as simple as Tadasana can help you find a more symmetrical alignment. Begin to notice if you're leaning more to one side than the other and try to bring equal weight into both feet. Have your teacher or a friend observe whether your hips or shoulders are uneven. Finally, align your head so that it's perched directly over your pelvis. Don't worry if you feel completely crooked after all these adjustments—your body has been off kilter for a while, so you will need to relearn what it feels like to be on your plumb line. When you learn to align your bones, the surrounding muscles and connective tissue can relax instead of gripping or overworking, and your posture will begin to feel effortless. In each pose you do, remember that the goal is not to imagine that one day your spine will be absolutely straight, but to find a place where there is ease in your body.
Lengthen, Strengthen, De-rotate
In addition to finding your alignment in Tadasana, you'll need to practice poses that enable you to maintain it in your everyday life. A well-balanced practice for scoliosis should include poses that lengthen your spine, poses that stretch tight muscles and strengthen weak muscles, and poses that help counteract the rotation in the spine and rib cage.
Adho Mukha Svanasana (Downward-Facing Dog Pose) is the ultimate spine-lengthening pose. Imagine how good a dog feels when it spontaneously does this stretch. That's the feeling you want to create in your Downward Dog. If your hamstrings are tight, a great alternative is Puppy Pose (see below).
The next thing to work on is building strength. I emphasize this with my teenage students because they're often still growing and their joints are very flexible. Locust Pose and its variations strengthen the muscles in the upper back that surround the vertebrae and can perhaps prevent the scoliosis from progressing. I also find that menopausal women who've experienced muscle loss need to bolster their strength. In addition to the upper-back work, I encourage all of my students to consistently practice standing poses to strengthen their legs. Try incorporating poses such as Trikonasana (Triangle Pose), Utthita Parsvakonasana (Extended Side Angle Pose), Virabhadrasana I (Warrior Pose I), and Virabhadrasana II (Warrior Pose II) into your practice. Virabhadrasana I is therapeutic for two reasons: It strengthens the back, and it stretches the psoas muscle. When you lift your arms overhead in the pose, draw your tailbone toward the floor and imagine lifting your torso out of your pelvis to stretch your psoas.
Since scoliosis rotates the spine, I incorporate poses that actively de-rotate it. Doing simple twists such as Chair Pose can be effective if you work correctly. Remember that your spine is asymmetrical, so the way you approach the pose will be different from one side to the other.
The Four Common Curves
There are four common patterns of curvature in scoliosis, although lateral curves can appear anywhere along the spinal column. To use yoga effectively for your scoliosis, find out what pattern you have from an orthopedic surgeon or knowledgeable health care practitioner.
1. Right thoracic scoliosis In this type, the major scoliosis is concentrated in the thoracic (upper or midback) region and curves to the right. There may also be a less severe countercurve to the left in the lumbar (lower back).
2. Left lumbar scoliosis The major curve is to the left in the lumbar. There may be a less extreme curve to the right in the thoracic.
3. Right thoracolumbar scoliosis The major curve is to the right in both the lower thoracic and the lumbar. This is commonly known as a C curve. (It looks like a C from the front, a reverse C from the back.)
4. Right thoracic-left lumbar scoliosis The major curve is in the thoracic region, with an equal countercurve to the left in the lumbar region. This is commonly known as an S curve. (It looks like an S when viewed from the front.)
For unknown reasons, most curves in the thoracic bend to the right and most curves in the lumbar arch to the left. There can be more than one compensating curve anywhere along the spine, even in the cervical spine (neck).
Sequence for Scoliosis
Uttana Shishosana (Extended Puppy Pose)
Come onto all fours. See that your shoulders are above your wrists and your hips are above your knees. Walk your hands forward a few inches and curl your toes under. As you exhale, move your buttocks halfway back toward your heels. Keep your arms active; don't let your elbows touch the ground. Drop your forehead to the floor or to a blanket and let your neck relax. Keep a slight curve in your lower back. To feel a nice long stretch in your spine, press the hands down and stretch out through the arms while pulling your hips back toward your heels. Breathe into your back, feeling the spine lengthen in both directions.
If you have a right thoracic curve, a right thoracolumbar curve, or significant double scoliosis (right thoracic-left lumbar curve), move your arms toward the right (convex) side. Keep your arms shoulder-width apart and really reach through your left arm. Breathe into your intercostal muscles and lungs on the left (concave) side to create more space between the ribs. Maintaining that evenness in both sides of the rib cage and waist, slowly bring the arms back in line with the hips.
If you have a left lumbar curve, keep the arms stretching straight ahead. Focus on pulling both hips back evenly to stretch the compressed area—the right side of the lumbar. (If your scoliosis goes to the left in the thoracic region, then walk your hands to the left.)
Trikonasana (Triangle Pose), Right Side
Stand with your feet four feet apart and parallel to each other. Turn your left foot slightly in toward the midline of your body. Turn your right leg out 90 degrees, and place the ball of your foot onto a block. Line up the right heel with the instep of the left foot. Stretch your arms out at shoulder level. Pull up through your thigh muscles and straighten your knees without locking them back. Take a breath in, and on an exhalation, reach out to the right and place your right hand onto your right shin.
If you have a left lumbar or double curve, lengthen your right waist away from your hips and drop the left waist parallel to the right. Placing your foot on the block will help you to hinge from the hips (as opposed to the waist), so that you can focus on lengthening your side body.
If you have a right thoracic or right thoracolumbar curve, reach out toward an imaginary chair and then bring your right hand down to your shin. Bring your left hand to your sacrum. Inhale and draw the right shoulder blade away from the ears and in toward your body as you open the chest. Exhale and twist the right ribs forward while keeping the right shoulder blade on the back. This action de-rotates the right rib cage and decreases the bulge that often appears on the right side. Reach the left arm up to the ceiling with the palm facing forward. Gaze straight ahead. After a few breaths, inhale and slowly come out of the pose. Turn the feet parallel and try it on the left side with a chair.
Trikonasana (Triangle Pose), Left Side
If you have a right thoracic or right thoracolumbar curve, place a folding chair a few inches past your left foot. Reach out to the left and place your left hand on the back of the chair. Extend your torso away from your hips and lengthen the left side waist. Bring your hand to your right ribs and press them down so that they drop toward the spine. Bring your right hand to your waist and breathe. Reach your right arm up toward the ceiling with your palm facing forward.
If you have a left lumbar or double curve, the left side of your lower back will collapse back into a convex shape. To counteract that, focus on rolling the left waist and lower back area clockwise. Press the outer side of the right foot into the floor to lengthen the lower back and hip area on the right side.
Salabhasana (Locust Pose), variation
This pose strengthens the rhomboids (the small postural muscles near the spine in the midback) and the lower trapezius muscles, which often become weak with scoliosis. Spread a blanket out on your sticky mat and lie on your belly. Stretch your arms in front of you, shoulder-width apart. Inhale and lift the left arm and right leg off the ground as you keep the crown of the head reaching away from your body. Try to keep the arm and leg lifting at the same height. Turn the left palm in to face the center and press down through your right palm to help lift you up. Continue to breathe and hold the pose for 5 to 10 breaths. On an exhalation, slowly release from the pose and relax for a few breaths by bringing the forehead down to the floor. When you repeat the pose on the second side, notice if one side feels weaker than the other, and if so, do that side an additional time.
Side-lying on a Bolster
Lie on the bolster on the side where your major curve is. (The side where your ribs or waist protrudes.) If you have a double curve, start with the upper one. Keep your legs straight or bent as you reach your upper arm overhead and grab with the opposite wrist. Feel the compressed ribs and waist stretch and open. Breathe into this new space. For a double curve, do both sides. Stay for up to 5 minutes, then slowly come up.
Chair Twist Right
If you have scoliosis, it's important to do twists because they help counteract the rotation in the spine. Sit sideways with the right side of your body toward the back of the chair. Place one hand on each side of the chair back. Place your feet firmly on the floor, with a block between your thighs. Inhale and lengthen the spine. Exhale and press your right hand into the back of the chair as you twist to the right. Turn from the navel, letting the ribs and head follow. Press the tips of the shoulder blades in toward your spine as you twist.
If you have a right thoracic or right thoracolumbar curve, press with the right hand and rotate the left lumbar area forward.For a right thoracic curve, press with the right hand into the back of the chair as you move the right shoulder away from it. Press the shoulder blade onto the back and feel the right side of the chest expand. Bring the right ribs in toward the midline of your body. At the same time, lengthen the left side of your body by breathing into and stretching the left ribs. Stay for 5 breaths, and on an exhalation, slowly come out of the pose.
Chair Twist Left
If you have a right thoracic or right thoracolumbar curve, or double curve, the right side of your rib cage will push back into a convex shape. To counteract this, press your left hand into the chair and push the right rib cage in toward the front of your body.
If you have a left lumbar or double curve, push with the left hand to bring the left side of the lower back and waist back toward the midline of your body.
Passive backbends counteract kyphosis (a condition where the head drops forward and the shoulders hunch), which is common in thoracic curves. Take a round bolster and lie back so that your shoulder blades are resting on the roll and your head is on the floor. If this feels too intense, roll a blanket into a cylinder and use that instead of the bolster. If your midback is concave on one side, place a hand towel or washcloth underneath that side so that your back is more even on the bolster. Stretch out through the heels to counteract compression in the lower back. Extend the arms straight overhead and toward the floor. Stay for up to 5 minutes, keeping the muscles in your back soft. To come out, bend your knees, roll to your right side, press your left palm into the floor, and slowly come up.
Supta Padangusthasana A (Reclining Hand-to-Big-Toe Pose)
This pose safely stretches your hamstrings, lower back, and hips. It's particularly helpful for a left lumbar, right thoracolumbar, or double curve, where the hips are often uneven. In a reclined position, you can focus on making the hips level.
Lie on your back and make a large loop in a 10-foot strap and a small loop in a shorter strap. Place one end of the long strap around your right thigh and the other end around the balls of both feet. Bend your right knee to your chest—the strap will wrap around the very top of your right thigh, in your groin crease. Take the strap with the smaller loop and place it around the ball of your right foot. Straighten your right leg and reach through the heels and balls of your feet. Stay for 5 breaths.
Supta Padangusthasana B (Reclining Hand-to-Big-Toe Pose)
With the strap in your right hand, exhale as you move the right leg out to the side. Keep the left side of the body firmly on the floor. If the left side lifts up, raise the right leg slightly and press the left palm onto the front of your left hip. It's OK if your right leg doesn't go very far toward the ground. Stay for 5 breaths. Repeat Supta Padangusthasana A and B on the other side.
You Are Unique
One day as I was looking out the window, I saw a group of beautiful palm trees reaching straight up toward the sky. It dawned on me then that an oak tree, with its many twists and turns, can be just as beautiful. As one of my students, Jeanie Schwab, told me, "Not only have I relieved my pain, but I no longer compare myself to all those other people out there with perfect spines. I've learned to accept my body the way it is, but at the same time be open to change." This acceptance is the final tool that I try to convey to my students. Every time you begin your yoga practice, remind yourself that the goal is not to find perfection, but to find your own optimal alignment and center.
I believe that having scoliosis was a blessing in disguise. It brought me to my life's biggest passion—yoga. It forced me to find more balance not only in my spine but in my whole life. My student Dee agrees. "My pain is now my inspiration. It reminds me to sit up and pay attention to what's going on in my life," she says. "So lately, I've been thanking the pain, too."
Elise Miller has been teaching Iyengar Yoga with a focus on back care for more than 25 years and is the founding director of California Yoga Center in Palo Alto and Mountain View, California. Her DVD Yoga for Scoliosis is available at yogaforscoliosis.com. She lives in Palo Alto, California.