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