Friday Q&A: How to Practice Side Plank Pose (Vashithasana) for Scoliosis

A reader left the following question as a comment on Nina’s post Side Plank Pose Could Reduce Spinal Curves in People with Scoliosis, which described a study in which Side Plank pose was practiced to help improve scoliosis:

Q: I'm wondering if the pose should be done on only one side to correct the imbalance. If so, advise on how to determine which side would be useful to me.

A: The yoga world is all a buzz about the newest study for Loren Fishman, MD on yoga for scoliosis. Dr. Fishman, an Iyengar yoga practitioner, physiatrist, and yoga researcher, has just completed at study looking at the effect of one pose, Side Plank (Vasithansana), on scoliosis. (By the way, Fishman has already written two books on yoga, one on yoga for arthritis and one on yoga for osteoporosis, and is also conducting a large study on yoga for osteoporosis.)

For those interested, you can see the study itself at www.gahmj.com. I tend to like to look at the whole thing, as reports about the study are often incomplete in painting a good picture of what was done! Note: when I first visited this site, I could view the entire study, but now only the abstract appears. If you have information on how to access the full study, please let us know and we'll revise this post.

In the study, Fishman’s team noted a particular trend in the modern treatment of scoliosis that often involves muscular stretching and relaxation to address the sometimes painful curvature of scoliosis.

“Non-surgical techniques for treating scoliosis frequently focus on realigning the spine, typically by muscular relaxation or muscular or ligamentous stretching. However, such treatments, which include physical therapeutic, chiropractic, and bracing techniques, are inconsistently supported by current evidence.” (Emphasis is mine.)

They therefore choose an opposite approach, utilizing a single pose to strengthen the side of the chest and spine the scoliosis curves toward (or bows toward). The majority of scoliosis cases curve towards the right side in the thoracic or rib cage part of the spine. There are other less common varieties, but I’d like to use this one as the example. Of the 25 subjects enrolled in the study, 19 did a good enough job following the study’s recommendation to be included for the final results: once a day practice Side Plank pose, initially for 10-20 seconds for the first week, then increasing the hold for as long as they could after that, most days of the week. With the curve to the right side, they would only do Side Plank with the right hand on the floor. They also were taught to do a important variation of Side Plank that may be different than the alignment often taught in public classes, with the hips and side body bowed up a bit towards the sky instead of keeping the two sides of the torso parallel.

X-rays were taken at the start of the study and again between 3-22months later. The average time practitioners held the pose was 1.5 minutes, and the frequency was six out of seven days a week for a bit over six months. Again, the practitioners did this one pose, once a day only, on the one side. The change in the curve of the spine was impressive: in the compliant group, the mean change in the angle of curve (known as the Cobb angle) was over 40%. This is quite a lot! But there is also a lot we don’t know:

• If the participants suffered chronic pain from their scoliosis and if their pain improved at the end of the study. 
• If the participants had trouble with secondary issues in doing the same pose over and over for six months, such as wrist, elbow or shoulder soreness or pain, even though the authors stated somewhere that these were not an issue.
• While the study included a few different variations of the pose, such as forearm version vs. full version, it was not clear how many participants required modifications to participate. 
• Whether the improvements in the curve would remain if the participants stopped doing the pose after six months and were six months after stopping practice, for instance. Do they have to do this indefinitely to keep the straighter spine? 

To summarize, this is a small study of 25 people with scoliosis, doing Side Plank pose for an average of 1.5 minutes once day for just over six months, with significant improvement in the spinal curve of scoliosis using strengthening instead of stretching. Despite what we don’t yet know, it seems reasonable to try this pose out if you have scoliosis and want to see if you can improve your spinal alignment. Because there are different kinds of curves, I’d recommend you discuss this with your doctor, your physical therapist if you have one, and the most experienced yoga teacher you can find. From your MD and PT, make sure you are clear on which kind of curve you have. From your yoga teacher, learn all the variations of Side Plank you can to find a way to gradually learn to do it in the best way possible for your body. 

One question I have also heard from a few different readers is: what do you think of only doing it on the one side? Before I answer that, I am wondering if the study author Dr. Fishman thinks these folks should only do one yoga pose each day and not have a balanced yoga asana practice in addition to this special practice? I’d hope not, but don’t know his thoughts on this. However, if a person with scoliosis wanted to have a regular practice, too, I’d use this new info to inform certain poses.

Personally, if I had scoliosis, I might consider:

1. Doing the convex side of Side Plank pose first with the hip/side body arch as in the study.
2. Then doing the Pose on other side, but without the lift, focusing on keeping the two sides of the chest as parallel as possible.
3. Then repeating the first side again with the study lift variation. 

I would then apply this body arch idea as well to other side bending poses, such as, Triangle pose (Trikonasana), Extended Side Angle pose (Utthita Parsvakonasana), and Half Moon pose (Arda Chandrasana). And I would be very interested in not only the improvement in physical appearance of the vertical alignment of my spine, but just as or more importantly in the functional improvement of my body and the subjective improvement in how my body is feeling. 

The study is a first, exciting research step in using yoga to improve scoliosis. I hope there is a larger and broader look at it in the near future. And for those in our reading audience, let us know if you have tried anything like this and what results you found. If you start practicing with this new information, give us a report back periodically on what you are finding personally!

—Baxter

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Yoga for the People (and Healthy Bones)!

by Shari

With the recent passing of BKS Iyengar (the teacher of my teacher, Donald Moyer) and the exponential growth of yoga inspired by Mr. Iyengar, I have been thinking a lot about health outcomes and why yoga is such a powerful self-help tool. You see, in my day job as a home health physical therapist, health outcome is measured very differently than it is in a complementary alternative health care model that yoga falls within.

My patients too often don't get better. My job in aiding their recovery often feels like I am trying to put a small Band-Aid on a gaping wound. I can’t change the situations that lead to their poor health. They suffer from the chronic life challenges of poverty. Years of poor health management, from an uncaring overworked, depersonalized, underfunded health care delivery system, and the chronic stress from living marginalized lives lead to chronic health issues. To often these patients are living in polluted urban environments, where walking is not done by choice because it is unsafe. They also are victims of poor health from years of eating processed, nutritionally void meals. The places where they live are commonly food deserts, where fresh food is unavailable without having to take public transportation via circuitous routes. Many of my patients don’t have cars. My care often feels inadequate because I can’t change their life circumstances even when they are doing all they can do to regain their health.

For example, J was in her early 80's when I met her. She was a homemaker, a long-time smoker who had remained physically inactive though very slim. She had been diagnosed with osteoporosis in her 60's and her family started a walking program with her. They also enrolled her in a senior exercise class at the near by senior center. She was pretty stabile for about 15 years and maintained independent living in her own home. But then her husband became ill, and she couldn't care for him any longer, so he was institutionalized. He died approximately one year later. After that she had a bout with pneumonia and her long history of smoking finally caught up with her; she was diagnosed with chronic obstructive pulmonary disorder and became oxygen- and steroid-dependent for respiratory management. She was also placed in an assisted living facility by her family because of frequent falls due to leg weakness. I was her home health PT. She was compliant with her exercises but wasn't really walking more than a couple of steps because of extreme fatigue. Also, she suffered from several osteoporotic fractures from "hugs" from her family. She was really upset by this because she felt like she was crumbling from the inside out. The pain from the osteoporotic fractures and the immobility from not walking and being pushed in her wheelchair by staff further eroded her overall health. She died in her sleep—with no major medical cause—several weeks after I discharged her. 

So you might be wondering, could yoga have helped J? I believe that if it had been a part of her activity regimen when she started her walking and exercise class that it would have. Yoga could have helped J with her sense of physical and emotional loss as she lost her independence and her home. Guided strength training for specific bone strengthening positions might have slowed her progressive osteoporosis. Unfortunately I will never know for certain because her care was limited by her HMO insurance company and I was only given four visits and told to "get her back onto her feet." 

In my more cynical moments I am disgusted by the public degree of privilege that American yoga seems to support. The visual images of perfect woman and occasionally men shine from the glossy covers of popular mainstream yoga magazines, with headlines urging pursuit of the “perfect yoga body” and touting delicious organic recipes, not to mention hyping over-the-counter supplements for “health” or lovely yoga fashions to enhance your practice of yoga.

So when the accolades of the wonders of yoga are constantly cited sometimes I can’t take it. But then I remember B.K.S. Iyengar and how he really did bring yoga to the people and how he did make it accessible to everyone. I also remember that yoga is more than asana—that it truly is a credo on how to live your life for the greater good.

So in this spirit of inclusivity and my own belief that the best way to deal with health challenges is through personal empowerment, I am starting a new beginner-level yoga class focusing on bone health called Yoga for Healthy Bones, both to honor J and to support my general yoga students who, as they are aging, are being diagnosed with bone loss from either osteopenia or osteoporosis. This class will provide camaraderie, creating a community of mutual support as well sharing, which the class members can engage in if they so desire. There is nothing better in self care than learning what worked or didn't for individuals with similar diagnosis. And, most importantly, this will be a venue where people can practice yoga without fear of hurting themselves.  

I am personally very impressed with the work and level of dedication that Dr. Loren Fishman has provided for his patients through his ongoing medical study on the efficacy of yoga in building bone density. This class will incorporate some of his basic principles of bone stimulation as well as focusing on many of the safe beginner level standing and seated poses for osteoporotic individuals. If you live in or are visiting the San Francisco Bay Area, come and join us on Sunday afternoons from 4:00-5:30pm at the Yoga Room in Berkeley, California (see yogaroomberkeley.com).

Namaste.

Shari

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