The dull aching on the right side of my mid-back was familiar. Sitting at my desk all day working on income taxes was not only dulling my mind, it was creating a pain in my body that I could no longer ignore. It occurred to me, “Not only am I in pain, I’m downright depressed!” I hadn’t realized that my whole psyche was besieged by negativity. Was my attitude affecting my already vulnerable back or was it the other way around?
I knew of only one solution for my spasmed back and negative attitude: yoga. For years, yoga had helped me cope with the pain I had lived with almost all my life. I was just over a year old when I fell down a steep flight of basement stairs. Initially, the family physician thought I had only broken my nose. Years later, I found out that my ribs had been knocked out of position, which gradually created a lateral curvature of my spine called scoliosis.
What is scoliosis?
In the simplest terms, scoliosis is a curvature of the spine. It appears in prehistoric cave paintings and was first treated with braces by the Greek physician Hippocrates in the fourth century B.C. In fact, the word “scoliosis” derives from the Greek word skol, which means twists and turns. Not only does scoliosis create spinal deformity, it displaces the ribs, twists the shoulders and hips, and shifts the body’s center of gravity.
In scoliosis, instead of following a straight line along the length of the back, the spine forms an S curve (or reversed S) from side to side down the back. 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.) When this curvature occurs near the middle of your back, the ribs compress on the concave side of the spine and spread apart on the convex side.
On the concave side, the attached ribs push sideways and forward, while on the convex side, they collapse toward the spine and move back, forming a rotation of the rib cage characteristic of the condition. The ribs on the convex side often protrude to the back; frequently, a tense, painful mass of muscle tissue develops over those bones.
The most obvious symptoms of scoliosis are cosmetic—your body is visibly crooked—but pain and cardiopulmonary complications (due to compression of the heart and lungs) are also common.
The 4 major scoliosis curves
Curvature can take place anywhere in the spinal column but generally follows one of four common patterns.
- Right thoracic scoliosis: The major curve 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 it is less severe.)
- Left lumbar scoliosis: The major curve is to the left and is concentrated in the lower back. There may also be a less extreme counter curve to the right in the thoracic region.
- Right thoraco-lumbar scoliosis: The major curve is to the right in the thoracic and lumbar region.
- Right thoracic-left lumbar combined curve: 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 curve to the right. Eighty percent of the thoraco-lumbar curves also are right convexity; and 70 percent of the lumbar curves are left convexity. Up to 10 times as many women as men have scoliosis.
The 2 types of scoliosis
Scoliosis can be either structural or nonstructural (otherwise known as functional). The structural variety is more serious, developing 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.)
Nonstructural scoliosis only affects the back muscles and doesn’t structurally alter the body. It can result from poor posture or repeated unbalanced activity, such as always carrying heavy bags on one side. It is much more common than structural scoliosis—and usually much less noticeable since the degree of curvature is less. Nonstructural scoliosis is almost always reversible.
To determine whether a scoliosis is functional or structural, bend forward from the hips as if in Uttanasana (Standing Forward Bend). If a lateral (side to side) curve visible in standing disappears when you bend forward, the scoliosis is functional. If the curve remains, it is built into the ribs and spine, and the scoliosis is structural.
There’s no quick fix for scoliosis
When I was 15, I was diagnosed with a severe structural right-thoracic scoliosis. Rather than wear brace or have an operation that involved putting metal rods along my spine, I turned to exercise and stretching on the advice of a top orthopedic surgeon. I saw with little improvement. In fact, I noticed that my posture was becoming worse, and I began to experience spasms and acute back pain. That was until a friend directed me 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. I studied at the Integral Yoga Institute. The Iyengar system allowed me to explore in depth how the therapeutic use of yoga postures could help my scoliosis. Since that time, I have been taking care of my body through the practice of yoga.
Before I began my yoga practice, my body didn’t know what “balanced” felt like. Through yoga, I have learned that I can be balanced and graceful, even with a curved spine. When your body is balanced and working with gravity, a yoga posture will be almost effortless.
It’s tempting to turn to an orthopedic surgeon who will “fix” your back by fusing it. Yes, that can stop the curve from progressing. But the operation makes your spine virtually immobile and it 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.
I’ve found that although scoliosis is different for everyone, yoga’s philosophical guidelines and practical postures can help most yoga students with scoliosis. But the decision to do yoga to remediate scoliosis entails a lifetime commitment to the practice—and to the process of self-discovery and growth. For many people, this kind of commitment is intimidating, as it involves building a deeper inner awareness. Yes, guidance from a competent teacher is helpful, but it can’t fix what ails us. Awareness of our own bodies is crucial.
Ultimately, the goal of yoga for scoliosis should not be to straighten our backs. We must learn to accept them as they are. We must work to understand our bodies 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.
The body with scoliosis
If you have scoliosis, there are six major areas of the body to focus on to create proper alignment, decrease pain, and minimize further curvature of the spine.
Spine: Since this is where the scoliosis is located, it is important to focus on lengthening the spine, which tends to reduce the S curve.
Feet and legs: When standing and walking, 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. A strong foundational stance enables the legs, rather than the spine, to carry the weight of the body.
Psoas (major and minor): These two muscles (a pair on each side of the body) are the principle flexors of the thigh. Together with the iliacus, they form a structural and functional unit called the iliopsoas, an important muscle for proper posture. When you are sitting, it balances the torso. In standing positions, it keeps the torso from falling 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.
Scapula: To prevent your upper back from rounding—a common problem in people with scoliosis—it’s important to drop your shoulder blades down from the ears and draw them in toward the front of the body. To facilitate this movement, practice poses that help develop increased flexibility of the muscles surrounding the shoulder blades.
Abdominal Muscles: Strong abdominal muscles are very important for people with scoliosis. Weak abdominals cause the back muscles to overwork and become tight. In extreme cases, weak abs may cause lordosis or an extreme curve of the lower back particularly on the concave side.
Breath: Awareness of the breath is perhaps the most important thing to focus on while doing the yoga poses. The concave side of the spine leaves less space for air to enter the lung. 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.
How yoga helps with scoliosis
If you have been diagnosed with scoliosis—or simply notice imbalances in your back and your body—you can benefit from yoga’s physical postures, breathing techniques, and relaxation techniques. A regular practice may help create more symmetry in your body, redevelop structural alignment and reduce tension in your muscles.
Before you begin a yoga practice, it’s important to know how your spine curves. Your doctor—and an x-ray—can tell you whether it is an S curve or a C curve, where the curvature happens along your vertebrae, and how your ribs are shaped. Understanding your particular imbalances will help you make adjustments as you practice.
No matter what kind of curve you have, the most important part of your asana practice is lengthening your spine. Any movement that creates space between the vertebrae will create more evenness in the spine and ribs. Stretching your back can also release tension that may build up in the muscles that hold you erect. The breath is another important part of the expansion of your torso, so pay careful attention to your breathing in the poses.
While yoga may not cure scoliosis, it can help lengthen the spine, strengthen the muscles, de-rotate spinal twisting, and re-align your posture. Addressing these spinal issues does not rely only on the physical (asana) part of yoga. It involves deep awareness of the mind and spirit, as well.
The best yoga poses for scoliosis
As you begin your practice, it’s important to loosen your spine to prevent injury, particularly if your scoliosis is acute or severe. Be gentle and pay attention to your body and breath.
Kneel in Tabletop position with your hands below your shoulders and your knees below your hips. Inhaling, lift your head and tailbone, making the lower back concave. Exhale and tuck your tailbone, rounding the back and releasing the neck so that your head is down. Repeat at least 10 times, breathing with the movement.
Balasana (Child’s Pose)
After the exhalation in Cat–Cow, walk your hands forward. Inhale deeply into your back, particularly the concave side where your ribs are compressed. Exhale and move the buttocks back halfway toward the heels. Inhale, and stretch the arms and the pelvis away from each other, with the upper back following the arms and the lower back following the pelvis. Breathe into this position, feeling the stretch of the intercostal muscles between the ribs, as well as the lengthening of your spine and back muscles. To help stretch the compressed ribs on the concave side, walk your arms toward the convex side, keeping them shoulder-width apart. Notice how this movement makes your back more even. Breath in this position for a minute, then move the buttocks all the way back to the heels and release your arms by your side. Relax your entire body.
Standing yoga poses for scoliosis
With scoliosis, the emphasis of the stretch should be different on each side. When stretching toward the side that is more concave, 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.
Trikonasana (Triangle Pose)
From Tadasana, separate the feet about one leg’s length. Turn the left toes out to 90 degrees and the right toes in to 45 degrees. Bend from the hips and and stretch your torso to the left. Reach the arms away from each other. Placing your left hand on the back or seat of a chair helps to spread out the ribs on the concave side (the underside). Drop the right ribs in medially towards the spine so both sides of the body are parallel to the floor. Notice how dropping the right ribs spreads out the compressed left ribs. You can also press the right outer heel into a wall to give stability and strength to your stretch. To come out of the pose, reach your right hand toward the ceiling and allow lift yourself out of the pose.
It is also important to stretch to the opposite side to decrease the bulge in the back on the convex side of the spine. Place the left outer heel at the wall. Lengthen your body away from your hip as you did on the left side. Place your right hand on your leg and bring the heel of your left hand to the sacrum. Inhale and draw the right shoulder blade down from the ears and into the body, opening the chest. Exhale and twist from the navel, drawing the left elbow back to align the shoulders with each other. Let the neck and head follow.
Forward bend yoga poses for scoliosis
Forward bends help you release deep tension in your back and shoulders. When you bend forward, you can feel your spine lengthening, and the longer you can stay in these poses, the deeper the release of your back and spine.
Janu Sirsasana (Head-to-Knee Pose)
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. Bend your right knee and bring your right heel into the right groin, letting the knee fall gently to the side. Lift and lengthen your spine, and draw the shoulder blades down and into the back, opening the chest, then fold forward from the hips over the left leg. This movement counteracts the tendency of people with scoliosis to hunch their backs and round their shoulders. To achieve this opening of your chest, you may pull on a tie or strap wrapped around the ball of your left foot. If you have a heavy sandbag, place it on the protruding (convex) side of the spine. If you can come farther forward, place a bolster or blanket across your straight leg and rest your forehead on it. 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.
Inversions for scoliosis
Even in a healthy spine, the continual pull of gravity can compress the intervertebral discs and eventually cause nerve damage or disc herniation. In a spine with scoliosis, the problem is even more pronounced. You will tend to feel the uneven pressure of gravity constantly, but you may not understand how to create alignment to alleviate it. Inversions free your body to experience alignment without the usual distortions caused by gravity. As a result, it is often easier to feel aligned when you are upside down than while standing on your 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 you for other inversions, such as Headstand. By learning to lift up in Handstand, you also learn to lengthen the spine against gravitational force, a movement that is particularly important for those with scoliosis.
If you are new to Handstand and afraid to try it, Ardha Adho Mukha Vrksasana (Half Handstand) is an alternative that can help you build your confidence and strength. To warm up, do Adho Mukha Svanasana (Downward-Facing Dog) with the heels at the wall. Lift the right leg and extend through the heel with the ball of the foot pressing against the wall. Reverse, 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 you to lengthen both sides of the body evenly, despite the distortion in your spine.
Rest in Child’s Pose. Now 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 no higher than hip level, and your arms, shoulders, and torso should be in a straight line. Press actively into the wall with your heels. Spread your shoulder blades away from each other and draw them down away from your ears. Press into your palms, draw your elbows in, and keep your arms straight. For more support, loop a belt around your arms, just above the elbows.
Relaxation is crucial to allow the body, mind, and spirit to receive the fruits of the practice. Especially for scoliosis sufferers, relaxation can be difficult because the muscles have been clenched to support the uneven spine.
Savasana (Corpse Pose) with breath awareness
Lie down on your back on the floor, stretching both sides of the body evenly. If your back is uneven due to the scoliosis, place a small towel under the concave part of your back. Close your eyes and breath deeply, becoming especially aware of the spine and expanding both sides of the rib cage evenly. Move your awareness through your body, noticing and releasing any areas of tension. Stay in the pose at least 10 minutes. As your body relaxes in Savasana, your mind becomes quiet, and true healing can take place.
Yoga backbends for scoliosis
Take cues from Restorative Yoga, which tends to rely on bolsters and blankets to support the body. For example, backward bends over a bolster can be a powerful pose for releasing tension in the back. Backbending has given me freedom and mobility, particularly on the more developed right (convex) side of my back.
Salabhasana (Locust Pose)
This backbend is very important for scoliosis, because it strengthens the erector spinae muscles that run along your spine from the sacrum to the base of the scull. Locust also strengthens the hamstring muscles of the legs. Having strong muscles in these areas helps to ensure adequate support of the spinal column in all back bending poses.
Lie face down and extend the arms out to the side, making a T-shape in line with the shoulders. On an exhalation, lift your head and upper chest off the floor, keeping your buttocks firm and your thighs pressed down strongly. Lengthen your arms out to your sides so your shoulder blades stretch away from the spine, and move them toward the sides of your body, wherever feels comfortable. Exhale as you release. Repeat three to five times.
As you become more practiced, you may wish to attempt more advanced backbends, such as Dhanurasana (Bow Pose), Ustrasana (Camel Pose), and Urdhva Dhanurasana (Wheel or Upward-Facing Bow Pose).