As someone who has lived with scoliosis, and dedicated much of my life to teaching students with scoliosis, I can attest to the power of yoga to help manage and treat this condition. If you are interested in working with students who have scoliosis, you'll need a basic primer on the condition as well as some specific asana suggestions to treat it.
What is Scoliosis?
Perhaps the most dramatic of spinal aberrations, scoliosis appears in cave paintings of prehistoric man and was first treated with braces by the Creek physician Hippocrates in the fourth century B.C, Not only does it create spinal deformity and rib displacement, it twists the shoulders and hips and shifts the body's center of gravity. Its most obvious symptoms are cosmetic, but pain and cardiopulmonary complications (due to compression of the heart and lungs) are also common. The word "scoliosis" is derived from the Greek word skol, which means twists and turns. In scoliosis, the spine forms an S curve (or reversed S) from side to side down the back, and at the same time the back of the spine rotates toward the concave side of the S, twisting the rib cage and making the sides of the back uneven. (To observe this effect, bend a hose into an S shape and observe how it rotates at the same time.) Particularly when this curvature occurs in the mid-back region, the ribs compress on the concave side of the spine and spread apart on the convex side. On the concave side, the attached ribs are pushed sideways and forward, while on the convex side, they collapse toward the spine and move back, thus forming the characteristic rotation of the rib cage. The ribs on the convex side often protrude posteriorly, and over this protrusion there frequently develops a tense, painful mass of muscle tissue.
Four Major Scoliosis Curves
Curvature can take place anywhere in the spinal column but generally follows four common patterns. In a right thoracic scoliosis, the major scoliosis is concentrated in the thoracic (mid-back) region, and the spine curves to the right. (There may also be a counter curve to the left in the lumbar region, but this curve is less severe.) In a left lumbar scoliosis, the major curve is to the left and is concentrated in the lumbar (lower back) region, though, as shown in the diagram, there may be a less extreme counter curve to the right in the thoracic region. A third type of scoliosis is the right thoraco-lumbar, where the major curve is to the right in the thoracic and lumbar region. The last type of curvature is the right thoracic-left lumbar combined curve, where the major curve is to the right in the thoracic region, with an equal counter curve to the left in the lumbar region. For unknown reasons, 90 percent of thoracic and double curves are right convexity (curve to the right); 80 percent of the thoraco-lumbar curves also are right convexity; and 70 percent of the lumbar curves are left convexity. Seven times as many women as men have scoliosis.
Structural and Functional Scoliosis
Scoliosis can be either structural or functional. The structural variety is much more serious and develops as a result of unequal growth of the two sides of the vertebral bodies. It usually appears during adolescence, and its causes are not well understood--approximately 70 percent of all structural scoliosis are idiopathic, meaning doctors do not know why they develop. Functional scoliosis only affects the back muscles and does not structurally alter the body. It can result from such things as poor posture or repeated unbalanced activity, such as always carrying books on one side. It is much more common than structural scoliosis, usually much less noticeable since the degree of curvature is less, and almost always reversible.
To determine whether a scoliosis is functional or structural, have your student bend forward from the hips. If a lateral (side to side) curve visible in standing disappears in this position, the scoliosis is functional; if the curve remains, it is built into the ribs and spine, and the scoliosis is structural.
Yoga or Surgery?
When I was 15, my family physician informed me that I had a severe structural right thoracic scoliosis. He recommended a brace and threatened me with a possible fusion of the spine, an operation in which metal rods are inserted next to the spinal column to prevent the curvature from growing worse. Appalled, I consulted a top orthopedic surgeon, who suggested that instead I try a regimen of exercise and stretching.
I exercised regularly throughout high school and college, but although 1 experienced little discomfort, I noticed that my posture was becoming worse. I was rounding my shoulders, particularly on the right side; and when I wore a bathing suit, I noticed that the right side of my back protruded more than the left. After graduation, while working with the Peace Corps in Brazil, I began to experience spasms and acute pain in my back. Guided by a fellow Peace Corps volunteer, I turned to hatha yoga.
When I stretched in the yoga poses, the numbness on the right side of my, back went away, and the pain started to dissolve. To explore this path further, I returned to the United States, where I studied at the Integral Yoga Institute with Swami Satchidananda and learned about the importance of love, service, and balance in life and yoga practice. Then I turned to the Iyengar system to explore in depth the way the therapeutic use of yoga postures could help my scoliosis.
Since that time, I have been exploring and healing my body through the practice of yoga. By teaching students with scoliosis, I have learned how to assist others with their own explorations. I have found that although every scoliosis is different, there are certain philosophical guidelines and practical yoga postures that can be helpful to yoga students with scoliosis.
The decision to do yoga to remediate a scoliosis entails a lifetime commitment to a process of self-discovery and growth. For many people, this kind of commitment is intimidating. It's tempting to turn instead to an orthopedic surgeon, who will "fix" a back by fusing it and get rid of the pain forever. Unfortunately, this operation results in a virtually immobile spine and frequently fails to alleviate the pain. I taught one teenage student with an extreme scoliosis who, weary of struggling with her yoga practice, gave up and had her back fused. To her dismay, her pain persisted, and she had even less mobility than before. When the rod in her back broke, she had it removed rather than replaced, and she returned to her yoga practice with a renewed and deeper commitment.
Choosing the path of self-discovery rather than surgery requires not only commitment, but inner awareness. While your guidance will be helpful, your students must develop an awareness of their own bodies--no famous teacher can fix their backs for them, any more than an orthopedic surgeon can. Only through their constant awareness and loving attention can they transform discomfort into a guide that helps them get in touch with their bodies.
The goal of yoga practice should not be to straighten their backs; they must learn to accept them as they are, not deny them or judge them. Instead, they must work to understand their backs and to relate to them with sensitivity and awareness. Healing is much more than straightening a scoliosis, or curing a disease. It is learning to love and nurture ourselves and trust our inner knowing to guide us to a vibrant state of being.
Yoga for Scoliosis
When the body is balanced and aligned with gravity, a yoga posture will be almost effortless. Before doing yoga, my body did not know what "balanced" felt like. Through yoga, I have learned that I can have a curved spine and still be balanced and graceful--and so can my students.
There are six major areas of the body to focus on while teaching yoga poses for scoliosis. These areas are very important in creating proper alignment, decreasing pain, and minimizing further curvature of the spine.
1. Feet and legs. When standing and walking, it is very important that your students place equal weight on both feet and become aware of any imbalances. Strengthening the legs creates a solid foundation from which the spine can stretch and become freer, and it enables the legs, rather than the spine, to carry the weight of the body.
2. Spine. Since this is where the scoliosis is located, it is important to help your students focus on lengthening the spine, which tends to reduce the S curve.
3. Psoas (Major and Minor). These two muscles (a pair on each side of the body) are the principal flexors of the thigh. They arise from the iliacus muscle and along the vertebral column and join to insert on the lesser trochanter of the femur. Together with the iliacus, they form a structural and functional unit called the iliopsoas. Besides flexing the thigh, the iliopsoas is an important postural muscle. During sitting it balances the torso; in standing it counteracts the tendency of the torso to fall behind the line of gravity, which passes just in back of the hip joints. Keeping this muscle well toned aligns the lower limbs with the torso and frees the spine.
4. Scapula. To prevent the upper back from rounding (a common problem in people with scoliosis), it is important to have your students drop the shoulder blades down from the ears and draw them in toward the front of the body. To facilitate this movement, they must develop increased flexibility of the muscles surrounding the shoulder blades.
5. Abdominal Muscles. Your students must work to strengthen their abdominal muscles. If the abdominals are weak, the back muscles overwork and therefore tighten. In extreme cases, this may cause lordosis or an extreme curve of the lower back particularly on the concave side of the lower back.
6. Breath. Awareness of the breath is perhaps the most important thing to teach your students to cultivate while doing the yoga poses. Usually very little air enters the lung on the concave side of the spine. Sending the breath into the collapsed rib cage on this side can actually stretch the intercostal muscles and create more lung capacity. This creates more openness and evenness on both sides of the chest, from the inside out.
Yoga Poses For Lengthening the Spine
Here are some specific asanas that will help your students alleviate discomfort and realign their spines.
When your students begin to practice yoga, the most important movement is lengthening the spine. This movement will create more evenness in the spine and ribs and release tension in the muscles of the back.
Cat/Cow Pose. At the start of a practice period, have your students loosen the spine with the breath to prevent injury, particularly at the apex of the scoliosis. Instruct them to kneel with the hands below the shoulders and the knees below the hips. Have them inhale and lift the head and tailbone, making the lower back concave. Then instruct them to exhale and tuck the tailbone, rounding the back and releasing the neck. Repeat at least 10 times.
Vajrasana (Child's Pose). After they have completed the exhalation in
the Cat/Cow Pose, have them stretch the hands out in front. Ask them to inhale deeply into the back, particularly the concave side where the ribs are compressed. Then instruct them to exhale and move the buttocks back halfway toward the heels. When they inhale, ask them to stretch the arms and the pelvis away from each other, with the upper back following the arms and the lower back following the pelvis. Let them breathe into this position, feeling the intercostal muscles stretching between the ribs and the spine and back muscles lengthening. To help stretch the compressed ribs on the concave side, ask them to move the arms toward the convex side, keeping the arms shoulder-width apart. Let them notice how this movement makes the back more even. After letting them breathe into this position for a minute, ask them to move the buttocks all the way back to the heels and relax the arms by their sides, relaxing the entire body.
Three-Part Bar Stretch. Your students may practice this pose at a dance bar or at home on a porch railing, sink, or wherever they can grab onto something and pull.
- Ask your students to grab onto the bar with hands shoulder-distance apart and walk the feet back until the spine is parallel to the floor and the feet are directly under the hips. Now instruct them to bring the heels forward to the position where the toes were and hang backwards, bending from the hips and stretching the buttocks away from the bar. Make sure they keep the neck in line with the spine, not allowing the chin to lift up. Ask them to feel the entire spine being lengthened by the pull.
- Now have them bring the feet in a few inches toward the bar and bend the knees into a right angle, with the thighs parallel to the floor and the knees directly above the heels. Ask them to continue to stretch the buttocks down and backwards. This particularly stretches the mid-back below and to the sides of the shoulder blades.
- Next, instruct them to walk the feet forward a few inches farther to allow the heels to remain on the floor. Tell them to let the buttocks move down toward the floor in a squat. Now have them pull back, keeping the buttocks down, and feel the lower spine being stretched.
Trikonasana (Triangle Pose). In Triangle Pose, the feet are separated while the torso stretches to the side. Because of your students' scoliosis, your emphasis should be different when you ask them to stretch to each side. When stretching toward the side of the concavity, emphasize lengthening the spine to open up the compressed ribs on the underside of the body and decrease the protrusion of the ribs on the opposite side. When stretching to the convex side, emphasize twisting to create more evenness on the sides of the back.
For example, someone with a right thoracic scoliosis would stretch to the left to create length in the spine. Have that student separate the feet about one leg's length. Ask her to turn the left toes out to 90 degrees and the right toes in to 45 degrees, and stretch the torso to the left, bending from the hips and stretching the arms away from each other. Then have her place her left hand on the back of a chair in order to spread out the ribs on the concave side. Ask her to drop the right ribs in medially towards the spine so both sides of the body are parallel to the floor. Let her notice how dropping the right ribs spreads out the compressed left ribs. You can also have her press the right outer heel of the foot into a wall to give stability and strength from which to stretch. If you are teaching in a studio that has wall ropes, a rope attached to the wall and wrapped around her right thigh is an excellent way to create this stability, particularly for someone with a lumbar scoliosis.
It is also important to stretch to the opposite side to decrease the bulge in the back on the convex side of the spine. Ask her to place the left outer heel at the wall or use a rope attached around the left leg. Have her lengthen out from the hip as she did on the left side. Instruct her to place her right hand on the leg and bring the left heel of the hand to the sacrum. As she inhales, instruct her to draw the base of the right shoulder blade down from the ears and into the body, opening the chest. Then tell her to exhale and twist from the navel, drawing the left elbow back to align the shoulders with each other. Let the neck and head follow.
Virabhadrasana I (Warrior Pose). This pose strengthens and stretches the legs, psoas, and back muscles. For students with scoliosis, this pose is best practiced with the support of a doorjamb or pillar, to keep the torso upright and balanced. Have them bring the back groin to the edge of the door jamb with the front heel about two feet ahead and the front leg hugging the side of the wall. Then ask them to place the back toes about two feet behind the left hip. They should square the two hips so they are parallel to each other and point the tailbone to the floor, lengthening the sacrum.
Instruct them to inhale and bring the arms overhead parallel to the shoulders, palms facing toward each other, and lift from the upper back, lengthening the ribs and spine out of the pelvis. Then let them exhale and bend the right leg, creating a right angle, with the thigh parallel to the floor and the shinbone perpendicular to the floor. Their right knee should be directly over the right heel, with the left leg fully extended and the left heel descending to the floor. Ask them to keep lifting the spine and at the same time press into the floor with the back leg. If they have difficulty bringing the back heel to the floor, place a sandbag under the heel for balance. Pressing it back and down to the floor helps to penetrate the deep psoas muscle.
For additional standing poses helpful for scoliosis, consult B.K.S. Iyengar's Light on Yoga (Shocken Books, 1971). Utthita Parsvakonasana (Lateral Angle Pose) , Ardha Chandrasana (Half Moon Pose), Parighasana (Cross Beam of a Gate Pose) are three excellent lateral stretches to do for scoliosis that follow the same guidelines as Trikonasana. Parivrtta Trikonasana (Revolved Triangle Pose) , and Parivrtta Parsvakonasana (Revolved Lateral Angle Pose), two twisting standing poses, are highly recommended for intermediate yoga students.
Even in a healthy spine, the continual pull of gravity can compress the intervertebral disc and eventually cause nerve damage or disc herniation. In a spine with scoliosis, the problem is even more pronounced. Your student will tend to feel the uneven pressure of gravity constantly but have no understanding of how to create alignment to alleviate it. Inversions create a freedom in her body to experience alignment without the usual distortions caused by gravity. As a result, it is often easier, particularly for students with scoliosis, to feel what alignment is upside down than while standing on the feet. The inversions also develop strength in the back and arms; increase circulation to the vertebrae, brain, and other organs, and encourage lymphatic circulation and venous blood return.
Ardha Adho Mukha Vrksasana (Half Handstand). Handstand is generally one of the first inversions students learn. It helps to develop arm and shoulder strength, preparing them for other inversions such as Headstand. By learning to lift up in Handstand, they also learn to lengthen the spine against gravitational force, a movement that is particularly important for those with scoliosis. If your students are new to Handstand and afraid to try it, Ardha Adho Mukha Vrksasana (Half Handstand) is an alternative that can help them build confidence and strength. To warm up, ask your students to do Adho Mukha Svanasana (Downward-Facing Dog Pose) with their heels at the wall. Have them lift the right leg and extend through the heel with the ball of the foot pressing against the wall. Then ask them to reverse this, bringing the right leg down and lifting the left leg. This movement helps build upper body strength, often lacking in practitioners with scoliosis; it also teaches students to lengthen both sides of the body evenly, despite the distortion in the spine.
Have your students rest in Child's Pose. Now ask them to go back into Adho Mukha Svanasana and lift both legs onto the wall, hip-width apart and parallel to one another. The feet should be at hip level, no higher, and the arms, shoulders, and torso should be in a straight line. Have them press actively into the wall with the heels. Ask them to spread the shoulder blades away from each other and draw them away from the ears. Instruct them to press into the inner hands, draw the elbows in and keep the arms straight. If this is difficult, let them use a belt around the arms, just above the elbows.
Salamba Sarvangasana (Shoulderstand). Shoulderstand releases the chronic tension in the neck and shoulders so common among people with scoliosis. If your students are beginners, they should have as much support as possible to encourage the chest to open and to prevent the weight of the body from descending on the neck and shoulders. Suggest that they begin by using a chair, a bolster, and the wall. Place the back of the chair approximately one foot from the wall. Place a nonslip mat and thin blanket on the seat of the chair and a blanket over the back. Place a bolster or several blankets on the floor in front of the chair. If they are on a wooden floor, place a folded towel in front of the blankets for placing under their heads. Have them sit in the chair facing the wall and roll backwards into the pose, bringing the shoulders onto the bolster and head on the floor. Ask them to hold on to the chair's back legs and lift their legs, resting their feet against the wall. If any students' chin is higher than his forehead, place a folded towel under his head. Ask him to relax the eyes, turning them inward and down toward the chest. Let your students stay in the pose for 5 to 10 minutes. To come out of the pose, have them slide the chair away and lower their buttocks to the floor.
As they progress, suggest that they begin to do Shoulderstand at the wall without the chair and bolster. Place four folded blankets at the wall; have them lie on the blankets with the buttocks close to the wall, the shoulders at the edge of the blankets, and the legs stretched up the wall. Ask them to bend the knees, lift the buttocks, and shift their weight onto the shoulders. Have them interlace the fingers with the elbows straight and roll the shoulders under. Make sure they support the back with the hands and lift up through the knees. Have them straighten one leg at a time, until they are strong enough to straighten both legs and balance. If they get tired, suggest that they stretch the legs back to the wall, keeping the legs straight. Ask them to hold for a minute in the beginning and gradually increase to 5 to 10 minutes. To come out, instruct them to release the hands from the back, and continue to extend through the heels as they slide to the floor, pressing the tailbone toward the wall.
As their practice progresses, they might wish to try Pincha Mayurasana (Forearm Balance). When the arms, shoulders, and back have been strengthened through regular inversion practice, they may be ready to practice Salamba Sirsasana (Headstand).
The backward bends have been the most powerful poses in releasing my back tension. Backbending has given me freedom and mobility, particularly on the more developed right (convex) side of my back.
Passive Backbend Over a Bolster. With a scoliosis your students may experience periodic muscle spasms. Thus, even though backward bends are helpful, you should ask them to approach these postures with softness rather than force. In order to open up, the muscles in the back must learn to release rather than tighten, allowing the heart to open like a lotus blossom from the inside out. Beginning with passive backbends encourages this approach.
Roll a firm blanket into a cylinder or use a bolster. Have your student lie back on the folded blanket or bolster so that her shoulder blades are resting on the roll. Her head and shoulders should rest on the floor. Ask her to stretch the legs out through the heels to prevent lower back compression, and lift the breastbone. Instruct her to bring the chin down toward the chest and lengthen the neck. Now let her extend the arms straight overhead and rest them on the floor, if possible. Suggest that she feel the breath evenly expanding the rib cage. Ask her to try to breathe into and expand the compressed side of the rib cage. If she feels the convex side of the back protruding onto the roll more than the concave side, place a small hand towel or tie under the concave side so that the back touches the blanket evenly. She can also do this passive backbend over the edge of her bed.
Salabhasana (Locust Pose). This backbend is very important for scoliosis, because it strengthens the erector spinae muscles and the hamstring muscles of the legs. This strengthening helps to ensure adequate support of the spinal column in all back bending poses.
Ask your student to lie face down and extend the arms out to the side, in line with the shoulders. On an exhalation, have him lift the head and upper chest off the floor, keeping the buttocks firm and pressing the thighs strongly down. Ask him to lengthen the arms out to the side so the shoulder blades stretch away from the spine, keeping the hands below the level of the shoulder blades. Instruct him to exhale as he
releases. Repeat three to five times.
Now have him stretch the arms overhead and feel the muscles of the back lengthening from the pelvis. Ask him to lift the arms and place the palms on the seat of a chair in front of him. Then have him stretch the arms out once again and move the chair farther away to lengthen the spine. Suggest that he gently lift the abdomen and floating ribs to support the front of the spine. Ask him to press down strongly with the palms on the chair as he presses the thighs downward and lifts the spine further. Instruct him to exhale as he releases. Repeat this three to five times. He can also do this pose with the legs lifted as well as the arms.
As your students become more advanced, they may wish to attempt more advanced backbends, such as Dhanurasana (Bow Pose), Ustrasana (Camel Pose), and Urdhva Dhanurasana (Upward Facing Bow Pose) .
Twists are very important for scoliosis because they help to derotate the spine. Caution should always be taken to lengthen the spine before twisting.
Chair Twist. Ask your student to sit on a chair with her right side to the back of the chair and her hands placed on each side of the back of the chair. Have her place her feet firmly on the floor, knees and ankles together. With an inhalation, ask her to lengthen the spine; with the exhalation, instruct her to gently rotate from the navel, stretching the ribs away form the pelvis. Have her press with the right hand into the back of the chair to create more twist, and with the left fingers pull on the back of the chair, drawing the left shoulder blade away from the spine. Ask her to continue to breathe into the pose and twist further with each exhalation. With an exhalation, let her slowly release the pose. For a right thoracic scoliosis, emphasis should be put on twisting in this direction. Twist both ways twice, but instruct her to stay longer on this side.
As she progresses, she will be able to add several other seated twists that are beneficial to scoliosis, including Blharadvajasana, Maricehyasana, and Ardha Matsyendrasana.
Forward bends help your students release deep tension in the back and shoulders. The longer they can stay in these poses, the deeper the release will be.
Janu Sirsasana (Head to Knee Pose). Ask your student to sit at the very edge of a folded blanket with both legs straight, and pull the flesh of the buttocks away from the sitting bones. Have him bend his right knee and bring his right heel into the right groin, letting the knee fall gently to the side. Instruct him to bend forward from the hips over the left leg. In this forward bend, he should first lift the spine and draw the shoulder blades down and into the back, opening the chest. This movement counteracts the tendency of people with scoliosis to hunch their backs and round their shoulders. To achieve this opening of the chest, he might pull gently on a chair, or on a tie wrapped around the ball of the left foot. You can also place a sandbag on the protruding (convex) side of the spine. If he can come farther forward, place a bolster or blanket across the straight leg and rest the forehead on the bolster. Repeat on the opposite side.
Paschimottanasana (Seated Forward Bend) and other seated forward bends can also be practiced in a similar fashion, with the aid of a chair, a sandbag, and a bolster.
Savasana (Corpse Pose) with Breathing Awareness
Relaxation is crucial to allow the body, mind, and sprit to receive the fruits of the practice. Especially for scoliosis sufferers, relaxation is difficult, for the muscles have been clenched to support the uneven spine. Ask your students to lie down on their backs on the floor, stretching both sides of the body evenly. If their backs are uneven due to the scoliosis, place a tie or small towel in the concavity of the back. Instruct them to close their eyes and breath deeply, becoming especially aware of the spine and expanding both sides of the rib cage evenly. Ask them to move their awareness through their bodies, noticing and releasing any areas of tension. Let them stay in the pose at least 10 minutes.
As the body relaxes in Savasana, the mind becomes quiet, and true healing can take place. Healing is not just a physical activity, but involves deep awareness of the mind and sprit as well. In the course of their lives our students encounter many hardships that, like their curved spines, may initially appear to be painful handicaps. By helping them learn to take responsibility for healing their backs and treating them with awareness and sensitivity, we can help them also learn to respond this way to other emotional, mental, and physical traumas.
Elise Miller, M.A. in Therapeutic Recreation from the University of North Carolina, is a Senior Certified Iyengar Yoga teacher from Palo Alto who has been teaching yoga throughout the United States and internationally since 1976. As a founding director of the California Yoga Center in Mountain View, CA, Elise teaches classes and workshops specializing in back care and sports-related injuries and is a faculty member at the Iyengar Yoga Institute of San Francisco. For more detailed information on Yoga for Scoliosis, including Elise's video, please visit her website at http://www.yogaforscoliosis.com