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.
Back Basics
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.
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.
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."