Side Plank Pose for Scoliosis Challenge: Conclusions

by Nina

 In the fall, I read some compelling about Dr. Loren Fishman’s study on using Side Plank Pose (Vasithasana) to improve scoliosis (see Side Plank Pose (Vastithasana) Could Reduce Spinal Curves in People with Scoliosis!) . Because I myself have mild scoliosis, I decided to experiment by doing the practice myself and I issued the Side Plank Pose for Scoliosis Challenge on November 17, 2014. I said that I was going to be doing the pose as Baxter recommended: twice on my convex side (the left side for me) and once on my concave side (the right side for me). I asked you to join me and report back on the results of your experiments.

On December 11, I wrote an update on my experiment so far Honestly? Progress Report on the Side Plank Pose Challenge. At that time I said that because the pose was causing me wrist and hand pain and that I had come to dread practicing the pose every day that decided I would no longer practice it six or seven days a week. I said that because I knew that practicing a strength building pose three or four times a week is often enough to build strength, I decided to go for a more modest strategy of practicing only every other day, which felt much safer to me. And when I told Baxter about the modifications I was making, he wrote me:

“I agree that doing the same pose every day is going to produce some problems for students in the wrist, elbow or shoulder on the weight bearing side, although Loren denies that was a problem in their study.”

Are you wondering what ever happened to me since then? Unfortunately, things got worse for me. Before I go into it, I want to say that I learned that the type of scoliosis I have, low lumbar scoliosis, is very rare (only about 5 percent of all types of scoliosis) so I have a feeling that the people in Loren Fishman’s study did not have the same type of scoliosis that I do. And the feedback I’ve gotten so far from our readers showed that none of them developed the problems that I did. But the truth of what happened to me—despite my hopes and best efforts—is that this practice did not work for me.

Basically what happened was my low back pain got worse. And the last time I did Side Plank pose, I felt a terrible twinge just as I was going into it. So I used common sense and stopped practicing the pose entirely. Then I went to see my favorite MD/yoga teacher for an assessment to see if he thought I was having any serious back problems. After running me through the usual medical tests, checking for disc problems, etc., Baxter (yeah, it was him—I’m lucky, right?) concluded I had no serious problems. But he recommended that I should give up the Side Plank pose experiment permanently as it did not seem to be helping me.

Since then I’ve gone back to practicing Side Plank pose the way I used to do it, about once a week, once on each side, for upper body strength building. And it now feels fine. 

Of course, I’m a bit disappointed I didn’t find an easy yoga solution for my scoliosis, but I’m also realistic to know that everyone has a unique body, and that works well for one person might not work for another. 

How about you? Are you still practicing? If so, how are you doing? And, if not, why did you give it up?

By the way, if you'd like to listen to Loren Fishman and Ellen Saltonstall discuss the original study, Yoga U Online now has a free download of there discussion here. And since we now have good photos of all four versions of Side Plank pose, I thought I'd include them all in this post. For information on practicing them, see Featured Pose: Side Plank Pose (Vasithasana).

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Honestly? Progress Report on the Side Plank Pose Challenge

by Nina

Truth Rescued by Time, Witnessed by history by Francisco Goya

How’s the Side Plank Pose for Scoliosis Challenge working for you? I’m still practicing the pose as promised, but to be honest the experiment is not turning out the way I’d hoped.

I started out practicing the pose every single day, two times on my convex side and one time on my concave side. After several days, I started feeling wrist and hand pain in the pose. So I decided to start practicing the low version of the pose on my forearm on alternate days, just to give my hands and wrists a break. I also started doing wrist flossing on the days when I practiced the full version of the pose as a prevention strategy to try to ward off wrist problems. 

But even with all these modifications, I started feeling like this pose wasn’t agreeing with my body. I’d been having some lower back pain and stiffness before I started practicing Side Plank Pose every day, and it felt to me like the pose wasn’t helping that in any way. In fact, I began to develop a kind of dread about doing the pose. In my home practice, I really try to listen to my body and not just power through things because they are supposedly good for me. So finally I took a few days off from practicing the pose.

The next time I returned to practicing the pose, it felt a lot better to me. And I made a decision that I would no longer practice it six or seven days a week. Because I knew that practicing a strength building pose three or four times a week is often enough to build strength, I decided to go for a more modest strategy. Maybe this way of practicing would take me longer to improve my curve (if that happens—I learned that the type of low lumbar scoliosis I have is very rare) but it felt a lot safer. And I have continued as well to do my wrist flossing after doing Side Plank Pose. I’m happy to say that while I still don’t know what’s happening with my curve (I will be checked soon), my body is feeling better and my dread of doing the pose is over.

When I told Baxter about the modifications I was making, he wrote me the following:

“I agree that doing the same pose every day is going to produce some problems for students in the wrist, elbow or shoulder on the weight bearing side, although Loren denies that was a problem in their study.”

So how’s it going for you? Please let me know in the comments. Are you still practicing the pose? How does it feel to you? And how does your back feel? Did you decide to change anything about how and when you are practicing the pose? If you want to add wrist flossing to your practice as a preventative measure, we have a post on it Featured Sequence: Wrist Flossing.
 
For those of you who are not taking the challenge, do you follow your intuition in your home practice?

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More on Side Plank Pose and Scoliosis: Double Curves, Explanations, Cautions

by Baxter

Standing Female Nude Seen from the Back by Vincent van Gogh

Since I wrote about the new study on using Side Plank pose (Vasishtansana) to improve scoliosis in my post Friday Q&A: How to Practice Side Plank Pose for Scoliosis, Nina has launched the Side Plank Pose Challenge, encouraging those with simple, one-sided scoliosis to join her in doing Side Plank pose every day, twice on the convex side of the curve (for example, if the scoliosis bows out to the right side, convex is to the right) and once on the concave side (left side, in this example). I’d remind folks that in the study just completed, the variation of the pose done on the convex side includes bowing the convex side of the body up towards the ceiling, away from the floor. Here is what I recommended last Friday:

1. First, do the convex side of Side Plank pose with the hip/side-body arch used in the study.
2. Do the pose on other side, but without the lift, focusing on keeping the two sides of your chest as parallel as possible.
3. Repeat the first side again, with the lift variation used in the study.

Let’s go into a little more detail today to help clear up any confusion you might have on how to approach this at home. The muscles on this convex side of the ribs and waist are lengthened and typically weaker then the concave side, so you will be employing concentric or isotonic muscle contraction to get into the pose. This means that the muscles that are located on the convex side of the torso and abdomen grossly shorten and tighten while you move into the pose, the idea being to strengthen these muscle while affecting the amount of the curve in your spine. Once you are in the pose and holding it for as long as you can (the average in the study was around 1.5 minutes), those muscles are then maintaining your position via muscle contraction known as isometric contraction, meaning the muscle is still actively contracting, but not grossly changing length. This can also contribute to strengthening those weaker, longer muscles on that convex side.

When you are doing the concave side, those side body muscles are already stronger and somewhat shortened compared with the convex side muscles. So we don’t want to encourage them to shorten any more with full concentric contraction as you did on the first side. I suggested above that you come into the more classic alignment of keeping the sides of your torso and waist parallel, which is really mimicking where you would like to see the spinal alignment end up over time. Going even further, I suppose one could argue that allowing the left side of the torso and waist to slightly bow toward the floor, then engaging the left side body muscles in isometric contraction to maintain that position might further the goal of gradually changing the curves of the scoliotic spine. I’d caution those that try this last idea out to make sure to keep the concave-side shoulder and shoulder blade areas strong and avoid sagging around the shoulder area.

If scoliosis—or life itself—were only so simple! As it turns out, some people with scoliosis will have a “double curve,” pictured as the variation on the far right of the illustration Nina shared last week (although the lower curve to the left is kind of subtle). 

In this situation, there will be a primary curve (typically on the right), and a secondary curve, often below the primary curve (typically on the left). Sometimes (could not find data on how often) this second curve is considered “compensatory,” meaning it is the spine and brain’s way of trying to balance out the top curve through the entire length of the spine. The obvious question arises, and several readers asked this: how should I approach the Side Plank pose practice if I have a double curve?

First off, since this condition has not been studied using Side Plank, anything I say about applying this particular pose to double curves is merely conjecture on my part. So keep that in mind! And it would be helpful for you to be evaluated or re-evaluated by your doctor or health care provider to document where your curvature is at the start of any experimentation you might undertake (even those of you joining Nina for her Side Plank Pose Challenge!). (When her chiropractor reviewed her old X-rays this week, Nina learned that what she thought was a right-sided curve was actually a low lumbar, left-sided curve!) And then you could return to have the angle of curve rechecked after some reasonable amount of time practicing Side Plank Pose.

Here are two possible ways to address the double curve:

• Since the secondary, lower curve may be compensatory, focusing on the primary, larger curve could positively affect both curves, bringing the double curve closer to vertical alignment. So you might just do what those with single curve to one side are doing.
• It could also be argued that when doing the Side Plank Pose on the convex side of the primary upper curve, you would accentuate the lift in the mid-ribcage area, and when doing it on the convex side of the lower curve, you would bow at the side-waist area.

Obviously, since no one has yet studied the double curve scientifically, you are on your own here. So go slow, make sure that you get good guidance on doing the pose correctly as to your arm and wrist positions, your bottom shoulder joint activity and the positioning of your feet. From there, make sure that if your double curve was causing pain prior to starting the Side Plank pose practice, that your practicing of the pose does not increase your baseline pain levels. That is an obvious indication to re-evaluate the safety of the pose for your unique scoliosis.

One of our readers and a student of mine, a graduate of the Piedmont Yoga Teacher Training, went so far as to email the author of the scoliosis study, Dr. Fishman, and received quite helpful information back. He acknowledged to her that double curves are more complicated to apply the Side Plank pose prescription to. And he actually offered to send her a yoga Rx if she ever has another spinal X-ray done and can send it to him. Wonderfully generous!

If those of you out there with a double curve decide to give this pose a try to see if it improves the curve of your scoliosis, please report your findings back to us—who knows, you might end up planting the seed for a new study on yoga for scoliosis!

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Take the Side Plank Pose for Scoliosis Challenge!

by Nina

After reading Baxter’s post on Friday (see Friday Q&A: How to Practice Side Plank Pose for Scoliosis?) and talking with my chiropractor, who is also a yoga teacher, I decided to practice Side Plank pose (Vasithasana) every day for six or more weeks. My chiropractor strongly agreed with Baxter that for the long term, practicing Side Plank pose on just one side was not a good idea and said that to maintain the benefits, a person would need to practice indefinitely. So I’ll be doing it exactly as Baxter suggested in his post, twice on my convex side (the left side for me) and once on my concave side (my right side). And I’m hoping that some of you will join me in taking this challenge, and will report back.

Because I was assessed by my chiropractor on Friday, she’ll be able to see what happens to my curve (and the rest of my spine) when I go back in a month, and in the visits that following after that (if I decide to continue the practice). I’ll report back to you with her observations as well as my own. If you want to join me in the challenge and don’t have someone assessing your curve, you could simply report in on any reduction in pain you are experiencing or any other differences you are noticing—or not—on a week-by-week basis.

Obviously since I’m writing this, I have scoliosis. I briefly mentioned it in my post Late-Onset Scoliosis is Common in Older Adults because I had myself had developed late-onset scoliosis. But I didn’t say much more than that. (By the way, if you haven’t read that post and are having back problems—or even hip or leg problems—and have never been tested for scoliosis, please do read it because there is a possibility you might have the condition.) So I’d like to take a few moments to tell you more about it, so you’ll understand why I’m motivated to take on this challenge, and also why I see a chiropractor regularly.

Although my scoliosis is fairly mild and doesn’t cause me back pain (it is a levoscoliosis, in my lumbar spine, rotating to the left), it does cause my right hip to be higher than my left and also causes that hip to rotate in more than the left hip. The result is my legs are imbalanced, with one leg being shorter than the other. If left untreated, I develop leg pain, outer knee pain, and eventually a limp. I have also developed mild arthritis in my right hip as a result of imbalance, which has limited my mobility in my right hip joint (see Goodbye, Lotus Pose).

Although I cannot reverse the scoliosis or my arthritis, I do work on strategies for maintaining my physical health. I keep exercising all my joints through their range of motion to keep them as healthy as possible (I’d like to delay as long as possible the need for a hip replacement). Yoga has been an immense help to me in this because it is so multi-dimensional in the way you are able to move your body in the asanas (see Range of Motion: Yoga's Got it Covered!). I also get regular chiropractic adjustments from a chiropractor who is also a yoga teacher. After an adjustment, my legs are the same length, my leg pain is gone, and I can walk well. The adjustment is only temporary, as the scoliosis is still there and my hip returns to its original imbalanced position over time, but regular adjustments keep me walking well and pain free.

So it was in this context that my chiropractor and I decided together that it would be a great idea for me to practice Side Plank pose, twice on the convex side and one on the concave side, to see what would happen. We’re so curious and excited! Will this practice help reduce my curve and keep my leg and hip in a healthier alignment? And it’s wonderful for me to be able to do this experiment with a health professional I trust—and who also knows a lot about yoga—assessing me through the process, Dr. Claire-Marie Holman. 

So who wants to join me? If you’re interested, please leave a comment on this post stating your intention to practice. Or, you can leave a comment over on our Facebook page  on the post there that links to this one. See Friday Q&A: How to Practice Side Plank Pose for Scoliosis? for details about how to practice the pose. Although I won’t post weekly on the blog about my experiment, I will post and update in another four weeks after my first assessment. However, I will post weekly on Facebook to report in that I have practiced, so if you join me on Facebook, you can report in there weekly as well, and we can all chat in the comments about how the experiment is going. (And, of course, if you do start practicing regularly and Side Plank Pose causes you pain or any bad side effects, please do stop.)

I look forward to hearing from you!

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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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Side Plank Pose (Vastithasana) Could Reduce Spinal Curves in People with Scoliosis!

by Nina

Side Plank Pose (photo "borrowed" from Wall Street Journal)

I’ve been hearing for some time that a single yoga pose, Side Plank pose (Vasithasana), is particularly beneficial for people with scoliosis (see Friday Q&A: Scoliosis). In my post Late-Onset Scoliosis is Common in Older Adults, I wrote about a New York Times article that said that late-onset scoliosis, a condition I have myself, is actually more prevalent in adults than it is in adolescents. The author of that article, Jane Brody, is not a regular yoga practitioner, but she described a “yoga exercise” that was recommended to her after she found out about her late-onset scoliosis.

"Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat. And I myself had the same pose, Side Plank pose (Vasithasana) recommended to me by my chiropractor (yes, I have a chiropractor for my scoliosis—I don’t believe that yoga is the answer to everything), so I have incorporated this wonderful strengthening pose into my regular yoga practice."

Now a recent scientific study, which was reported in the Wall Street Journal article Study: Doing the Side Plank Reduced Spinal Curving in Scoliosis Patients, found that for a small group of patients with scoliosis (21 women and four men ages 14 to 85) practicing this one pose resulted in a curve reduction of almost 50 percent among teenage practitioners and 38 percent for adults. Yes, they studied just this single yoga pose!

"In this study, we assess the possible benefits of asymmetrical strengthening of truncal muscles on the convex side of the scoliotic curve through a single yoga pose, the side plank pose, in idiopathic and degenerative scoliosis."

For this particular study, they advised the participants to do the pose on one side only, "with the convexity downward." For information on the original study, see Serial Case Reporting Yoga for Idiopathic and Degenerative Scoliosis.

While this study of Side Plank pose is, like so many other scientific studies of yoga, limited by the small number of participants being studied and the lack of control group, there is no question in our minds that this is an excellent strengthening pose. In his post Friday Q&A: Yoga for Surgically Repaired Scoliosis, Baxter mentioned Side Plank pose as one of the strengthening poses that he recommended for strengthening the muscles at the front, back, and sides of your body. Shari says the pose strengthens the serratus anterior, the obliques, the latisimus, quadratus the lumborum, the gluteus muscles, the fasciae latae, hamstrings, scapula stabilizers, teres minor and major, and then all the paraspinal muscle stabilizers. Wow that’s a lot of muscles! That's why we recommend this pose for anyone who wants to build upper body strength. And I’m betting that strengthening those paraspinal muscles (the muscles all along the spine) is particular beneficial for people with scoliosis.

So today seems like a good day to review our instructions for how to practice this pose. For people who don’t yet have the strength to do the pose on the floor, we provide the option of doing the pose with one hand on the wall. You can practice the wall version regularly until you build up the strength to do the floor version.

Side Plank Pose on the Floor

1. Start by taking Downward-Facing Dog (Adho Mukha Svanasana) pose.

1. From Downward-Facing Dog, swing your shoulders forward almost into Plank position while keeping your hips lifted.

3. Make your right arm stronger by contracting the muscles of the arm to the bone, and tip your heels to the right, bringing the outer edge of your right foot and the inner edge of your left foot to the floor, with your feet slightly apart.

4. Turn your chest away from the floor and bring your left hand onto your left hip. Since this takes a lot of strength, stay just few breaths at first, and gradually add more time with more practice.

5. To come out, swing back into Downward-Facing Dog pose

6.  Unless you are practicing on one side only as in the study, repeat the pose on the second side. Afterward, rest in Child’s pose a few breaths.

Side Plank Pose on the Wall 

1. Start with your right side to the wall. 

2. Reach your right arm out to your side, parallel with the floor, and place your palm on the wall with your fingers pointing up. Engage your right shoulder blade into your chest wall and down slightly towards your right waist.

3. Step both feet out away from the wall, until your right foot is positioned directly under your left shoulder.

4. If your balance is good, try bending your left knee and bringing your left foot into Tree pose (Vrksasana).

5. Take your left arm up and overhead, reaching strongly towards the wall with your left arm and shoulder blade, aligning it like the top arm in Extended Side Angle pose (Utthita Parsvakonasna). 

6. Unless you are practicing on one side only as in the study, repeat on the second side. 

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Friday Q&A: Yoga for Surgically Repaired Scoliosis

Q: I have a new student in my basic class who has a rod in her back due to scoliosis.  Has anyone had this experience and have any suggestions? She is young and healthy.

A: Some of our readers might think that this is an uncommon occurrence in a yoga class, but I myself have had several students over the years with scoliosis who had undergone a “fixation” procedure to try to improve the straightness of their spine, to try to prevent the abnormal curves of their scoliotic spine from getting any more dramatic, or to reduce the pain from the scoliosis. 

The first successful procedure of this kind was the placement of a “Harrington rod”—named after the doctor who pioneered the technique—along the length of the spine, usually from the upper chest (thoracic spine) down into the area of the lower back (lumbar spine). The rod is then “fixed” to the spine via wires and screws. The rod essentially immobilizes the part of the spine it is connected to from moving in any direction (see All About the Spine: Anatomy and Movements). Since the introduction of that surgical technique, several others have also been developed and are used today.

So, once a person with scoliosis (see Friday Q&A: Scoliosis) has had this procedure done, how would that affect their yoga practice? The section of the spine that is fixed to the rod is now not likely to change shape over time, but has very little movement possibilities. It turns out that the joint at the top of the spine directly above the last fixed vertebra and the joint at the bottom of the spine just below the last fixed vertebra are now the spots where the spine can still move. That means that these two areas are where forward bending, back bending, side bending, and twisting movements might be able to actually take place. But this puts an excessive burden on those two areas, and they run the risk of being overworked and becoming a future source of dysfunction and discomfort!

Fortunately for me (and you!) I ran into a local expert on yoga and scoliosis, Sandra Razieli, at the farmer’s market the other day and we talked for a while about her approach to working with this situation. I should mention that Sandra herself has scoliosis, and has used yoga to address her own challenges with the condition, as well as teaching specialty classes on scoliosis for many years. She stressed the following four goals in working with scoliosis when there are rods attached to the spine: 

1. Work on lengthening the spine. Although the practitioner should focus on lengthening the spine in all poses, I’d particularly recommend practicing poses such as Mountain pose (Tadasana), Downward-Facing Dog pose (Adho Mukha Svanasana) or variations, Plank pose (Phalakasana), Triangle pose (Trikonasana) that encourage internal lengthening via imagining lengthening from the tailbone to the crown of the head actively while in the pose. In addition, partial inverted poses where the spine lengthens with gravity, such as Standing Forward Bend (Uttanasana) and Wide-Legged Standing Forward Bend (Prasarita Padottanasana), if done without allowing the force of gravity to round the spine into forward bending shape, may also be beneficial. For Uttanasana, consider reaching the arms out to a chair seat, and for Prasarita Padottanasana, consider lengthening forward with the torso and hands, as in Downward-Facing Dog pose.

2. Stress the “strengthening” aspects of the poses. Strengthening the muscles of the front body, back body and side body enables these muscles to assist in keeping the spine long and in its neutral curves. I’d say that some of the same poses I just mentioned for lengthening will also promote strengthening, and you could add in any version of Side Plank pose (Vasithasana), Hunting Dog pose, and Reclined Leg Lowering pose (Urdhva Prasarita Padasana) as well.

3. Focus on directing your breath into the area of the rib cage where there is still compression. Breathing into compressed areas in all yoga poses can help to widen and open up the chronically narrowed spaces between the ribs that result from the curved and twisted spine.

4. Minimize twisting actions. Twisting actions can stress the two mobile spinal joints at the top and the bottom of the fixation, and can also stress (and potentially loosen) the fixation of the rods to the spine. 

Sandra also recommended looking up her good friend from NYC, Debra Wolk, who has a studio dedicated to yoga for those with scoliosis Yoga Union Center for Back Care. Debra offers classes, trainings and workshops for those with scoliosis, both with and without rods in place. This New York Times article Yoga Classes, Even With a Fused Spine features her studio and the wonderful work she is doing. 

—Baxter

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Late-Onset Scoliosis is Common in Older Adults

by Nina

Reclining Nude, back by Henri Matisse

A recent New Times article Scoliosis Can Hit Well Past Adolescence by Jane Brody confirmed something I have been observing in the yoga community: late-onset scoliosis is quite common in older people. I developed the problem myself in my fifties, so I’m quite aware of the condition, and I’ve noticed a large number of other older yoga practitioners with the same problem. Here’s what Jane Brody said about this:

"Although scoliosis is generally thought of as a problem of adolescents, who often require bracing or surgery to correct the curvature, the condition is actually far more prevalent in older adults. In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had spinal deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees."

Even a mild version of scoliosis can result in chronic pain of different types. While your pain could be in your back, it might also be in your hip (because scoliosis can make your hips uneven) or even your leg and/or knee (because scoliosis can make one leg “virtually” shorter than the because that hip is higher).

Baxter, who teachers Yoga for Back Care, has already written about scoliosis (see Friday Q&A: Scoliosis). But I decided to write about it today because I think it’s important for us all—students and teachers alike—to realize what a common problem this is. And if you (or a student of yours) are having mysterious back pain, hip pain, or leg pain, it’s worth being checked out to see if this is causing the problem. Some people just don’t think of it! I personally know of two cases of women with pain who didn’t realize they had scoliosis. In one case, the yoga student’s teacher casually mentioned, well, of course, you have scoliosis, because it was visible to his sharp eyes. She had no idea! And in another case, it was I myself who noticed it while I was assisting a fellow student doing a backbend. I just asked her, “Do you have scoliosis?” She was surprised I had asked, but we when talked afterward, it turned out she was having quite a lot of pain, including in her hip. So I encouraged her to get checked out by a health professional, and sure enough, she did have scoliosis.

Getting checked out is not necessarily a big deal. A health professional can do a visual test that is quite simple (he or she will watch your spine as you come bend into a forward bend), although in same cases, if your scoliosis is very mild, you may need an X-ray to detect it. But it is worth knowing the source of your physical problems because, yes, yoga can help. Even Jane Brody had a yoga pose recommended to help her:

Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat.

That pose sounds like Vasisthasana (aka Side Plank pose) to me! And there are whole lot of other yoga poses you can do to strengthen your back and balance your curve. So if you’ve been diagnosed with this condition, seek out a yoga for back care teacher who understands scoliosis, take a Yoga for Scoliosis workshop, or check out Elise Browning Miller’s web site (she’s a long-time yoga teacher who uses yoga to manage her own scoliosis) for info on her books and DVD and other resources.

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Friday Q&A: Scoliosis

Patterns in the Sand by Michele McCartney-Filgate

Q: Scoliosis. I have a mild case of it and find that twists and side bends make my back feel good. Any other advice? When I look at my students doing forward bends, it seems that a lot of them have one side of the back of the rib cage that protrudes higher than the other side. Just how common is scoliosis anyway?

A: The conventional wisdom when working with scoliosis is to apply some therapeutic principles to the spinal structural changes. They include to lengthen the concavity, strengthen the convexity, and to try to neutralize the curvature in asana. This isn't as easy as it sounds because most scoliosis patterns that are in an "S" shaped curve will have a more pronounced primary curve and then a compensating secondary curve.

To successfully work with your own scoliosis you need to first know if the curve is from postural imbalances or from structural changes. The quick way for this to be screened is to have someone watch you as you bend into Standing Forward Bend (Uttanasana). If the curve worsens, then it is structural. If the curve evens out, then it is most probably postural overlay. But the only conclusive way to know if you indeed have scoliosis is to have an X-ray of your spine from head to tail. A skilled radiologist needs to read it to measure the curve.

That said, your observation that twists and side bends make it feel better are reinforcement that you are probably stretching your concavity. There is a way that spines move that is unconscious (meaning it just occurs) and that is the law of side-bending and rotation. In a neutral spine (like Mountain pose or Tadasana,  side bending and rotation occur to opposite directions (we are talking about how the vertebra individually are moving. So, that is why in Triangle pose (Trikonasana) you are asked to rotate your torso over a fixed pelvis. But in forward bends or backbends, spinal movement changes. In this case rotation and side-bending occur to the same side (picture One-Legged Forward Bend or Janu Sirsasana). So this is where the confusion comes in because you need to move the spine differently depending on the asana you are practicing. Also the scoliotic spine is not symmetrical and there are elements of side-bending and rotation already present so when you bend forward in Standing Forward Bend (Uttanasana), you are increasing the spinal rotation; this is why the curvature worsens.

So it depends on how much information you want or need to apply to your yoga practice. Some teachers recommend doing your poses three times, starting and end a pose with the problematic side, that is, the side for which twisting is more difficult. I would recommend you obtain Elise Browning Miller's yoga DVD on scoliosis, and, if you live in the Bay Area, try to take her workshops on yoga and scoliosis because they are excellent. See http://www.ebmyoga.com/.
—Shari

A: Regarding the prevalence of scoliosis, out of every 1000 children born in the US, 3-5 will develop an abnormal curvature of the spine serious enough to require intervention. The scoliosis usually first shows up during growth spurts, especially around puberty. In 80-85% of the cases, the cause is unknown, and so it is labeled “idiopathic scoliosis.” Most of these students will not require serious intervention, and yoga could be a great way to address the spinal curve and twist.

Recently loss of bone density has been shown to cause lateral deviations in the spine that may contribute to the onset of scoliosis in postmenopausal women. Estrogen hormones are very important for the maintenance of bone mineral density, and during menopause, the normal levels of circulating estrogen decline. So there is increased risk for losing bone density, and therefore an increased risk for degenerative scoliosis. Recent evidence also suggests that the development of scoliosis in postmenopausal women is much higher than in juveniles and adolescents. One has to wonder if there was a mild scoliosis present, perhaps undiagnosed, that becomes more apparent at menopause. Also, kyphosis, or dowagers hump, is well know to arise at this time as well, and is likely a combination of posture and osteoporosis.

Other stats on scoliosis:

• Scoliosis curves measuring at least 10° occur in 1.5% to 3.0% of the population
• Curves exceeding 20° occur in 0.3% to 0.5% of the population
• Curves exceeding 30° occcur in 0.2% to 0.3% of the population
• Small spinal curves occur with similar frequency in boys and girls, but girls are more likely to have a progressively larger scoliotic curve that will require treatment

And I agree with Shari's insights on scoliosis and also recommend Elise Miller's DVD and workshops around the US on yoga for scoliosis. One example of how one approaches this would go like this: if the main curvature is to the right side of your thoracic spine, that is, the convex bulge is easily seen in Standing Forward Bend (Uttanasana) as a skyward prominence on the right side of the back rib cage, you would likely approach asymmetrical poses like Triangle differently going to the right side and to the left side. When going to the right side, focus on spreading from the spine around the side of the ribs toward the front of the chest, something Elise calls "de-rotation."  When going to the left side, focus on lengthening the left side of the waist and torso, from the left hip crease to the left armpit. No specific attention would be directed at the right-side prominence on this side. This same principle could be applied to other poses such as Extended Side Angle, Warrior 2 pose, and Half Moon pose. The principle may change with symmetrical poses, as Shari said.

Another good East Bay resource is Sandra Safadirazieli, who trained with Elise, has been working with her own scoliosis, and offers classes at Piedmont Yoga Studio on an ongoing basis. Teachers from other parts of the country should chime in with recommendations for other teachers and workshops.

—Baxter

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