By Elise Browning Miller
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. So I got up and headed for the kitchen. Stuffing my face was always a quick solution for the pains and problems of life.
As I grabbed for the food, it occurred to me, "Not only am I in pain, I'm downright depressed! "Though I knew taxes were not always an enlightening task, I hadn't realized that my whole psyche was besieged by negativity. Was my negative attitude affecting my already vulnerable back or was it the other way around? Either way, eating was not going to solve the problem.
I knew of only one solution for my spasmed back and negative attitude. For years, only yoga had helped me cope with the pain I had lived with almost all my life. At 16 months, I had fallen 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 from the accident, which gradually created a lateral curvature of the spine called a scoliosis.
What is Scoliosis?
Perhaps the most dramatic of spinal aberrations, scoliosis appears in cave paintings of prehistoric man and was first treated with braces by the Creek physician Hippocrates in the fourth century B.C, Not only does it create spinal deformity and rib displacement, it twists the shoulders and hips and shifts the body's center of gravity. Its most obvious symptoms are cosmetic, but pain and cardiopulmonary complications (due to compression of the heart and lungs) are also common. The word "scoliosis" is derived from the Greek word skol, which means twists and turns. In scoliosis, the spine forms an S curve (or reversed S) from side to side down the back, and 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.) Particularly when this curvature occurs in the mid-back region, the ribs compress on the concave side of the spine and spread apart on the convex side. On the concave side, the attached ribs are pushed sideways and forward, while on the convex side, they collapse toward the spine and move back, thus forming the characteristic rotation of the rib cage. The ribs on the convex side often protrude posteriorly, and over this protrusion there frequently develops a tense, painful mass of muscle tissue.
Four Major Scoliosis Curves
Curvature can take place anywhere in the spinal column but generally follows four common patterns. In a right thoracic scoliosis, the major scoliosis 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 this curve is less severe.) In a left lumbar scoliosis, the major curve is to the left and is concentrated in the lumbar (lower back) region, though, as shown in the diagram, there may be a less extreme counter curve to the right in the thoracic region. A third type of scoliosis is the right thoraco-lumbar, where the major curve is to the right in the thoracic and lumbar region. The last type of curvature is the right thoracic-left lumbar combined curve, where 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 are right convexity (curve to the right); 80 percent of the thoraco-lumbar curves also are right convexity; and 70 percent of the lumbar curves are left convexity. Seven times as many women as men have scoliosis.
Structural and Functional Scoliosis
Scoliosis can be either structural or functional. The structural variety is much more serious and develops 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. Functional scoliosis only affects the back muscles and does not structurally alter the body. It can result from such things as poor posture or repeated unbalanced activity, such as always carrying books on one side. It is much more common than structural scoliosis, usually much less noticeable since the degree of curvature is less, and almost always reversible.
To determine whether a scoliosis is functional or structural, bend forward from the hips. If a lateral (side to side) curve visible in standing disappears in this position, the scoliosis is functional; if the curve remains, it is built into the ribs and spine, and the scoliosis is structural.
Yoga or Surgery?
When I was 15, my family physician informed me that I had a severe structural right thoracic scoliosis. He recommended a brace and threatened me with a possible fusion of the spine, an operation in which metal rods are inserted next to the spinal column to prevent the curvature from growing worse. Appalled, I consulted a top orthopedic surgeon, who suggested that instead I try a regimen of exercise and stretching.
I exercised regularly throughout high school and college, but although 1 experienced little discomfort, I noticed that my posture was becoming worse. I was rounding my shoulders, particularly on the right side; and when I wore a bathing suit, I noticed that the right side of my back protruded more than the left. After graduation, while working with the Peace Corps in Brazil, I began to experience spasms and acute pain in my back. Guided by a fellow Peace Corps volunteer, I turned 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. To explore this path further, I returned to the United States, where I studied at the Integral Yoga Institute with Swami Satchidananda and learned about the importance of love, service, and balance in life and yoga practice. Then I turned to the Iyengar system to explore in depth the way the therapeutic use of yoga postures could help my scoliosis.
Since that time, I have been exploring and healing my body through the practice of yoga. By teaching students with scoliosis, I have learned how to assist others with their own explorations. I have found that although every scoliosis is different, there are certain philosophical guidelines and practical yoga postures that can be helpful to yoga students with scoliosis.
The decision to do yoga to remediate a scoliosis entails a lifetime commitment to a process of self-discovery and growth. For many people, this kind of commitment is intimidating. It's tempting to turn instead to an orthopedic surgeon, who will "fix" a back by fusing it and get rid of the pain forever. Unfortunately, this operation results in a virtually immobile spine and 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, and she returned to her yoga practice with a renewed and deeper commitment.
Choosing the path of self-discovery rather than surgery requires not only commitment but inner awareness. Guidance from a competent teacher is helpful, but awareness of our own bodies is crucial--no famous guru can fix our backs for us, any more than an orthopedic surgeon can. Only through our own constant awareness and loving attention can we transform our discomfort into a guide that helps us to get in touch with our bodies.
The goal of yoga practice should not be to straighten our backs; we must learn to accept them as they are, not deny them or judge them. Instead, we must work to understand our backs 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.
Yoga for Scoliosis
When the body is balanced and aligned with gravity, a yoga posture will be almost effortless. Before doing yoga, my body did not know what "balanced" felt like. Through yoga, I have learned that I can have a curved spine and still be balanced and graceful.
There are six major areas of the body to focus on while doing the yoga poses for scoliosis. These areas are very important in creating proper alignment, decreasing pain. and minimizing further curvature of the spine.
1. Feet and Iegs. When standing and walking, it is very important to place equal weight on both feet and to be aware of any imbalances. Strengthening the legs creates a solid foundation from which the spine can stretch and become freer, and it enables the legs, rather than the spine, to carry the weight of the body.
2. 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.
3. Psoas (Major and Minor). These two muscles (a pair on each side of the body) are the principal flexors of the thigh. They arise from the iliacus muscle and along the vertebral column and join to insert on the lesser trochanter of the femur. Together with the iliacus, they form a structural and functional unit called the iliopsoas. Besides flexing the thigh, the iliopsoas is an important postural muscle. During sit ting it balances the torso; in standing it counteracts the tendency of the torso to fall 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.
4. Scapula. To prevent the upper back from rounding (a common problem in people with scoliosis) , it is important to drop the shoulder blades down from the ears and draw them in toward the front of the body. To facilitate this movement, we must develop increased flexibility of the muscles surrounding the shoulder blades.
5. Abdominal Muscles. To strengthen the abdominal muscles is very important with a scoliosis. If the abdominals are weak, then it causes the back muscles to overwork and therefore tighten. In extreme cases, it may cause lordosis or an extreme curve of the lower back particularly on the concave side of the lower back.
6. Breath. Awareness of the breath is perhaps the most important thing to focus on while doing the yoga poses. Usually very little air enters the lung on the concave side of the spine. 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.
Read more about this article in Sequences for Scoliosis here.
Elise Miller, M.A. in Therapeutic Recreation from the University of North Carolina, is a Senior Certified Iyengar Yoga teacher from Palo Alto who has been teaching yoga throughout the United States and internationally since 1976. As a founding director of the California Yoga Center in Mountain View, CA, Elise teaches classes and workshops specializing in back care and sports-related injuries and is a faculty member at the Iyengar Yoga Institute of San Francisco. For more detailed information on Yoga for Scoliosis, including Elise's video, please visit her website at http://www.yogaforscoliosis.com.
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