I suffer from a congenital C-shaped scoliosis. The curve is convex to the left with the apex of the curve between T3 and T4 thus making a thoracic curve which is not compensatory. I was not diagnosed until adulthood, by which time I had reached skeletal maturity and no amount of surgery or bracing would help. Whilst yoga cannot change my skeletal structure a combination of asana, pranayama, meditation and chiropractic have released the muscles that have become tense over years of trying to «stay upright», thus giving me a much wider range of motion and more comfort as well as helping me to accept the curvature of my spine as part of who I am.
Below is an x-ray of my spine taken in early 2007 and an article on Yoga and Scoliosis which was published in Yoga and Health magazine in July 2008.
A Journey Along the Curvatures of the Spine
Scoliosis is a «C» or «S» shaped curvature of the spine which can have a known cause such as connective tissue disorders, rickets or the result of an accident when the spinal curve develops after the ribcage, pelvis or shoulder girdle have been knocked out of alignment. Congenital scoliosis with no known cause is referred to as «idiopathic». Idiopathic scoliosis often presents with other bony abnormalities. In my personal case of idiopathic scoliosis this occurs in my sternum which is described as pectus excavatum or more commonly as funnel chest. This is where the sternum dips in towards the chest cavity, forming a concave surface on the chest.
The lateral curvature of the spine rotates not only from side to side but back on itself, rotating the affected vertebrae towards the concave side, twisting the ribcage and making the sides of the back uneven. The results of this can be seen clearly in the yoga asana Setu Bandhasana; once the back has lifted from the floor to its full extent in that particular person a direct line of sight down the middle of the front torso will clearly show one side of the ribcage is substantially higher than the other.
Not only does the scoliosis sufferer have spinal deformity and rib displacement, but the shoulders and hips can become twisted and the body’s centre of gravity shifted. While one of the most obvious symptoms is a cosmetic one; severe pain and heart and lung compression, due to reduced space in the thoracic cavity, are common as well. As the body works to maintain an upright posture over the years, muscles will begin to tighten and painful masses of muscle tissue will develop in the ribcage, shoulders and neck.
Conventional treatment of scoliosis has varied over the years. Braces and spinal fusion (an operation in which metal rods are inserted next to the spinal column, similar to the idea of a runner bean growing straight if tied to a beanpole!) were common 20 years ago to prevent the curvature worsening. It is slowly becoming a more widespread belief that posture training and exercise are important for scoliosis prevention (when a scoliosis curve may occur due to the result of a misalignment after an accident) and treatment of idiopathic scoliosis.
My own scoliosis was not diagnosed until my late 20s, only a few years ago, well into my journey along the yoga path, and so I was able to see the results of yoga, physical therapy, passive relaxation exercises and a philosophical mindset on the curvature of my spine. As a child my parents had shown some concern as to the malformation of my breastbone but were told that it was merely a congenital defect of only cosmetic importance. As I grew older, however, I realised that my lung capacity and stamina were much less than those of my peers. My posture was also unusual; one shoulderblade protruded more than the other and my ribcage seemed very asymmetrical.
I was a relatively active child and teenager, training hard in ballet and other forms of dance from the age of four and also practicing yoga to some degree with my parents and brother.
Unusually for a teenage girl, I was never particularly concerned with the shape of my body. I was always prone to slenderness, was short and easily blended into the background when I needed to, so my increasing round shouldered-ness never particularly concerned me, and at this point I was not in any pain. After leaving college at 18 and going to university my practice of dance and yoga went out of the window and my posture became worse. It wasn’t until I started to work in an office in my mid-20s, however, that I began to notice a severe pain and numbness on the right-hand side of my back and discomfort in my right ribcage. It was at this point in my life that I returned to yoga to find some relief from the discomfort I thought simply to be the effect of a deskbound career.
As I began to practice yoga asanas again I noticed a lot of tightness in my upper back, neck and shoulder girdle that had not been there as a teenager. I decided to consult a chiropractor, recommended to me by a yoga teacher as being «yoga sympathetic», who subsequently diagnosed my scoliosis. After the initial shock I began an intensive course of physical treatment and therapy to help to reverse the muscle development which had occurred as a result of my scoliosis causing pain, numbness and tightness.
As I incorporated the physical exercises into my daily asana practice I noticed the pain beginning to dissolve. My yoga practice was allowing me to let go of my pain both physically and mentally. And so I began to explore and heal my body with yoga, a course of action which led to yoga teacher training and beginning to teach yoga to others.
Veda Scaravelli, in her book Awakening the Spine, likens the backbone to the trunk of a tree. The spine moves in two opposite directions, from the waist down into the earth and from the waist up into the air. If the spine is not straight, there is a feeling of not being grounded. Scoliosis sufferers often complain of a feeling of not being balanced. Whilst the spine is growing in two opposite directions from the waist it is not in a direct way.
We must re-educate the spine and release tense muscles. Chiropractors and massage therapists can help with this re-education, but so can the concept of breath and movement that is yoga. It is extremely important therefore for scoliosis sufferers to practice a feeling of lengthening and elongating their spine.
A simple asana for practicing symmetrical alignment and spinal awareness is Tadasana, or mountain pose. Stand with the feet hip distance apart, rotating the thighs slightly away from each other, lifting the arches of the feet whilst making sure that the big toe joints remain on the floor. A good way of grounding the feet in Tadasana is to think about three points on each foot, the big toe joint, the little toe joint and the heel, drawing down into the floor. Then draw the navel gently into the spine, make sure the shoulders are drawn back and down, away from the ears, the shoulder blades are drawn in towards the back and the back of the neck is long. It is important to take some time to come into this posture correctly.
Now notice if you are leaning to one side, if there is more weight on one foot than the other. If there is try to evenly distribute the weight between the two feet. Use a mirror or have partner observe whether the shoulders and hips are at even height. Spend some time now trying to re-align your «plumbline», evening up the shoulders and aligning the head over the pelvis. At first this re-alignment may feel crooked! This is because you are starting to break an habitual stance.
As you learn to re-align the «plumbline» of your body you are re-aligning bones, muscle and tissue. This will help you gradually learn to relax in a standing posture instead of gripping or overworking to remain upright. You may find that you are gripping on to the floor with your toes rather than allowing the feet to be soft. Lift the toes, place them gently on to the floor without gripping and re-align yourself again.
Bring your awareness to your breath and with each exhalation feel that the spine is stretching and elongating. Some yoga students with scoliosis find that visualising the breath travelling up and down the spine helps. There is no better way than being aware of the internal flow of energy than watching the path of the breath within our bodies.
We are not working towards a mythical day when suddenly the scoliosis sufferer’s spine is straight, but instead towards a feeling of ease within the body. A revolution within the body occurs as we focus on remediation rather than cure. We must begin to release the muscles that have become so tight and painful over years of making so much effort to stand up straight and use the extension of the exhalation to open the body and bring new life to the spine.
When it comes to asana practice there may be the need for modification in some of the postures for a student with scoliosis to get the most out of yoga. However, it is important to remember that a modified posture is no less beneficial than practicing the full posture and postures should never be regarded with a sense of hierarchy. Just as a very able, strong and flexible student should not look down upon those unable to do full posture, a student with postural or skeletal difficulties (or indeed any other injury or weakness) should not feel inferior in any way in the presence of those to whom asana practice comes easily.
We must remember that asana practice is only one aspect of yoga; it is just as important to cultivate stillness, compassion and deep yogic breathing. It is also important to release the temptation of rushing ahead into a posture we are not ready for but instead to listen to our bodies and work within our limitations and capabilities.
A «step by step» approach to asana practice is key; breaking each posture down into stages, ensuring that we remember that each stage of the posture is as important as the full posture itself. A good example of this breaking down technique can be seen in the practice of Adho Mukha Svanasana or Downward Facing Dog, a posture which crops up in most styles of yoga and is vital for the Surya Namaska (sun salutation) sequence.
Some students, including those with scoliosis, may find that they do not have the strength or the postural stability to hold this pose for very long, and in some practices they may be required to hold it for up to 10 breaths. If practiced incorrectly, without alignment and breath focus, trying to hold Adho Mukha Svanasana for this long can lead to areas of tension developing in the shoulders, back, arms and legs. This is not beneficial!
Instead the posture can be broken down into stages, getting to know the feel of Adho Mukha Svanasana before coming into the full posture. Firstly it can be practiced lying down with our legs up the wall, making sure the buttocks are as close to the corner of wall and floor as possible. Flex the feet as though standing on the floor and raise the arms over the head so they are lying on the floor shoulder width apart, keeping the shoulders relaxed away from the ears. This is Adho Mukha Svanasana. Then the posture can be practiced standing. Begin by standing in Tadasana as detailed above. On an inhale raise the arms alongside the ears, making sure you do not hunch the shoulders up. As you exhale bend forward to a ninety degree angle, trying to keep the back straight. This is Adho Mukha Svanasana. When you are happy with the sensation of the posture you are ready to practice the full asana.
There are of course many yoga asana that are beneficial to students with scoliosis. I find that many asymmetrical standing postures such as Trikonasana (Triangle pose) and modified Parsvakonasana (Extended Angle pose) help the student to become aware of the asymmetry in their spine and body as they notice the differences between one side and the other. Balances such as Vrksasana (Tree pose) assist with distributing the weight evenly between the two feet and elongating the spine to maintain balance throughout the postures and standing and seated forward bends help by allowing the spine and the muscles around it to relax. I find holding forward bends for some time (10-15 breaths) very beneficial; exhaling to feel the spine elongating and visualising the crown of the head drawing away from the bottom of the back.
Breath practice (or pranayama) is also of great benefit to the scoliosis sufferer. Not only does a limited thoracic capacity lead to short, uneven breath, usually up in the chest rather than down in the belly where the diaphragm is engaged, but the pain that scoliosis causes can lead to breath retention. Holding the breath during asana practice is counterproductive as it can block the movement of pranic energy and lead to exhaustion.
Donna Farhi suggests in The Breathing Book that holding the breath in an attempt to relieve pain will not get the sufferer anywhere. Instead she recommends using the breath itself as pain relief.
She goes on to suggest exhaling as soon as painful stimuli is anticipated, as our natural impulse is to inhale and hold the breath. We must refrain from dwelling on possible outcomes of the pain if it increases and instead direct our breath into the area that is causing us pain. Once again we are practicing breaking lifetime habits in order to attain ease.
To bring the practice of yoga into the everyday life of a person with scoliosis (or indeed without scoliosis!) we must re-align our «plumblines» and breath. Whilst washing the dishes, for example, think about standing in Tadasana. Whilst out walking, draw awareness to the breath. Ask yourself if you are breathing into the chest or the abdomen, if your breath is even or uneven, smooth or ragged and begin to allow yourself to breathe with more ease. With practice and positive focus on the spine we can overcome lifelong bad habits.
Choosing the path of yoga to remediate scoliosis is a lifetime commitment. With guidance from a good teacher and by developing awareness of our own bodies; our movement, our muscles, our structure and our breath, we can use our pain and discomfort to guide us into an awareness and understanding of the curvature of our spines.
The practice of yoga is a continuous journey where the practitioner, whatever their experience, is constantly re-treading the same ground as they come to realise their own bodies, their capabilities and limitations. Through my practice and my teaching I have come to learn that every person has a body as individual as their fingerprint – postures that work in an asana practice for one person may be painful and unbeneficial for another. A yoga practice helps each of us to learn and read our own breath and bodies from day to day, begin to learn what we need and, as Desikachar says, «to attain what was previously unattainable» (The Heart of Yoga p. 5).
Whilst for some this may be attaining full Astanga Vinyasa Primary Series, for others it may be attaining the ability to sit in stillness with a straight spine for 10 minutes, overcoming discomfort. Neither of these attainments are more or less beneficial than the other in themselves, and yoga practitioners should not feel any pressure to attain what another person has attained – we should instead let go of our ego and be comfortable with our own achievements and our own bodies.
In many ways I look upon my scoliosis as a blessing. Rather than it being an obstacle to my yoga practice I have come to understand the curvature of my spine as a lesson in self-observation and self-acceptance. This is the body I have been given and I will work with it to attain what, to me, was previously unattainable. My scoliosis helps me, as I develop my yoga teaching, to understand to a greater degree the limitations and abilities of my students.
Yoga practice is for back problems of any kind, or scoliosis specifically, should always be undertaken with a qualified teacher who understands the back problem and in conjunction with advice from a physical therapist. This said, yoga practice by its very nature will strengthen and stretch the back muscles and focus the mind on lengthening the spine.
For me, however the most important part of the yoga practice is its ability to lead the practitioner towards acceptance of themselves and their bodies, to be happy with the skin they are in and to love themselves just the way they are.