Step by step...

A step by step approach to asana, breaks down both the hierarchy and the posture itself and is beneficial to all yogis, regardless of limitations or capabilites. It is important never to forget the roots from which the posture grows. Remember, each step of the posture is as important as the posture itself.

A good example of this breaking down technique can be seen in Adho Mukha Svanasana or Downward Facing Dog, a posture which crops up in most styles of yoga and is vital for the Surya Namaska sequence.

Some students, including those with scoliosis, may find that they do not have the strength or stamina to hold this pose for very long and in some practices they may be required to hold it for as long as 10 breaths. If practiced incorrectly, without alignment and breath focus, trying to hold Ahdo Mukha Svanasana for this long can lead to areas of tension developing in the shoulders, back, arms and legs. This is not beneficial!!

Instead we can break the posture down, getting to know the feel of Adho Mukha Svanasana before coming into the full posture. Firstly we can practice lying down with our legs up the wall, making sure the buttocks are as close to the corner of the wall and floor as possible. Flex the feet as though standing on the floor and raise the arms over the heads so they are lying on the floor shoulder width apart, keeping the shoulders relaxed away from the ears. This is Adho Mukha Svanasana. Then we can practice the posture standing. Begin by standing in Tadasana as detailed in a previous post. On an inhale raise the arms alongside the ears, making sure you do not hunch the shoulders up. As you exhale bend forward to a ninety degree angle, trying to keep the back straight. This is Adho Mukha Svanasana. When we are happy with the sensation of the posture we are ready to practice the full asana.

There are of course many yoga asana that are beneficial to students with scoliosis. I find that many asymmetrical standing postures such as Trikonasana and modified Parsvakonasana help the student to become aware of teh asymmetry in their spine and body as they notice the difference between one side and the other. Balances such as Vrksasana assist with distributing the weight evenly between the two feet and elongating the spine to maintain balance throughout the postures and standing and seated forward bends help by allowing the spine and the muscles around it to relax. I find holding forward bends for 10-15 breaths very beneficial; exhaling to feel the spine extending and visualising the crown of the head drawing away from the bottom of the back. Backbends, twists and shoulder openers are also helpful.

Various asana sequences helpful for scoliosis will appear in this blog in due course.

Asana and Hierarchy

By practicing yoga, we are not working towards some mythical day when suddenly the scoliosis is gone and the spine is perfectly straight, but instead towards a feeling of ease with our bodies. A revolution within the body occurs as we focus on remediation rather than cure. We must begin to release the muscles that have become so tight and painful over years of making so much effort to stand up straight, and use the extension of the exhalation to open the body and bring new life to the spine.

When it comes to asana practice there may well be need for modification in some of the postures for a student with scoliosis to get the most out of yoga. However, it is important to remember that a modified posture is no less beneficial than practicing the full posture. Too much emphasis is often placed on achieving the "perfect" asana at all costs, with no thought to the fact that all our bodies are different and what may be good for one person may be nigh on impossible for another. The asana practice itself is merely one of the eight limbs of Patanjali's yoga and a stepping stone to achieving Samadhi, it is not so much the posture itself as the mindset behind the posture, getting into the posture and leaving the posture (all of which aspects including Samadhi will be examined later in this blog). It is therefore important to remember not to regard yoga asana with any sense of hierarchy. Just as a very flexible, strong student should not look down upon those unable to do full posture, a student with postural or skeletal difficulties should not feel inferior in any way in the presence of those to whom asana practice comes easily.

It does not matter what kind of shape your body is in when you start your practice. Just having a body - being alive - is sufficient qualification for doing yoga.
-- Total Yoga - Tara Fraser (Duncan Baird Publishing 2001 - p.28)

Asana practice is one step of yoga; it is just as important to cultivate stillness, compassion and deep yogic breathing (which I will discuss further at a later stage). It is also important to release the temptation of rushing ahead into a posture we are not ready for, but instead to listen to our bodies and work within our own personal limitations and capabilities.

...if we are to be complete human beings we must incorporate allaspects of ourselves, and do so step by step
-- The Heart of Yoga - TKV Desikachar (Inner Traditions International 1999 - p.7)

Scaravelli, Tadasana and the breath

One of the most influential books I have read about yoga and the spine is Veda Scravelli's Awakening the Spine. Her most powerful metaphor is likening the human back to the trunk of a tree. A tree grows in two opposite directions - the roots are pulled deeply down to the centre of the earth whilst the trunk grows up towards the sky, elongating and spreading into branches. The deeper the roots grow, the stronger and taller the tree.

Likewise the spine moves from the waist up into the air and down into the earth.

If the spine is not straight, however, there is a feeling of not being grounded. Scoliosis sufferers often complain of a feeling of not being balanced. Whilst the spine is growing in two opposite directions from the waist it is not in a direct way. Scoliosis sufferers commonly simultaneously suffer from conditions such as Chronic Fatigue Syndrome. From a physical perspective this is not suprising as their chest capacity is limited. However from a more metaphysical point of view we can liken the spine to a fibre optic cable, such as that used for an internet network; to work correctly the fibre optic needs a clear line of sight, the energy it carries cannot move around corners. In the same way the path of energy that travels up the scoliatic spine finds limitations in its movement. By working on a feeling of lengthening and elongating we can help the energy within us to flow more freely.

As we grow older our skeleton becomes more rigid and heavy, and so if a skeletal problem is not diagnosed until adulthood (as with my scoliosis), there is very little chance of being able to fix the problem with bracing and surgery. Instead we have to re-educate the spine and release tense muscles. Chiropractors and massage therapists can help with this re-education, but so can the concept of breath and movement that is yoga. it is extremely important therfore for scoliosis sufferers to practice a feeling of lengthening and elongating their spines.

A simple asana for practicing symmetrical alignment is Tadasana or mountain pose. Stand with the feet hip distance apart, rotating the thighs slightly away from each other, lifting the arches of the feet whilst making sure the big toe joint remains firmly on the floor. A good way of grounding the feet in Tadasana is to think about three points on each foot, the big toe joint, the little toe and the heel, drawing down into the floor. Then draw the navel gently in towards the spine, make sure the shoulders are back and down and the shoulderblades are flat. It is important to take some time to come into the posture correctly.

Now notice if you are leaning to one side, if there is more weight on one foot than the other. If there is try to evenly distribute the weight between the two feet. Using a mirror or a partner notice and observe whether the shoulders and hips are at even height. Spend some time now trying to re-align your "plumbline", evening up the shoulders and aligning the head over the pelvis. At first this re-alignment may feel crooked! This is because you are starting to break na habitual stance.

As you learn to realign the "plumbline" of your body you are realigning bones, muscle and tissue. This will help you gradually learn to relax in a standing posture instead of gripping or overworking to remain upright. You may find that you are gripping on to the floor with your toes rathern than allowing your feet to be soft. Lift the toes, place them gently on to the floor without gripping and realign yourself again.

Bring your awareness to your breath with each exhalation feel that the spine is stretching and elongating. Some yoga students with scoliosis find that visualising the breath travelling up and down the spine helps.

...yoga encourages us to focus our minds and be aware of the internal flow of energy."

-- Total Yoga - Tara Fraser - Duncan Baird Publishing 2001 (p.13)

There is no better way to practice this awareness than watching the path of the breath within our bodies.

The Practice Begins

As I began in earnest to practice yoga asana again I noticed a lot of tightness in my upper back, neck and shoulder girlde that had not been there as a teenager. It was amazing to me how quickly and easily we can allow our bodies to fall into disrepair and neglect. Just a few short years seemed to have set me back a lifetime. I hadn't put on weight, I still swam and walked everywhere but a lack of full body movement exercise combined with sitting at a desk all day had exacerbated the tightness and immobility that the curvature of my spine caused.

I decided to consult a chiropractor, recommended to me by a yoga teacher, and my scoliosis was officially diagnosed for the first time. The subsequent Xray and chiropractic report can be seen in the first post of this blog. On seeing the evidence and, to my mind, severity of the Xray and hearing the report I was initally in shock. But luckily my years of yoga practice had done more than help my scoliosis physically. The philosophical and inward reflecting nature of yoga had helped me to understand that we are all here for a reason, we are all different and we have to love the bodies that we are given.

I will go into the concepts of letting go of our material nature and emotion at a later date, but for now suffice to say that my yoga practice helped me to come to terms with my spine and I soon began an intensive course of physical therapy to compliment my asana practice and to help reverse the muscle develompent which had occurred as a result of my scoliosis causing pain numbness and tightness. As my neck and shoulders started to release, I began to release a lot of emotion. I had been holding that tension in my back neck and shoulders for years. Because that is the part of me that is "made wrong" it's where all the negative emotions had gone and I finally started to let stuff go. I rode the wave of these emotions for weeks and veered from crying to giggling uncontrolably often!

And so I began to explore and heal my body with yoga, a course of action which led to yoga teacher training and beginning to teach yoga to others.

I have come to love my Xray. It still takes my breath away but for quite different reasons. It is something I can't change. It makes me unique. It reminds me of the uniqueness and indivicuality of all the bodies in the universe. It reminds me that our physical bodies are temporary. This is the body I've been given and I must love it for it houses my Spirit. Crooked spine and all. It's also made me more aware in my yoga practice and what my body was created to do. I can translate my own weaknesses into those of my students too and really try and understand their bodies, their areas of tension and weakness. In many ways, my spine is a blessing.

Yoga practice teaches us and gives us the tools to let go.
Developing this ability to let go builds inner strength and helps relieve suffering.

-- Yoga Therapies - Jessie Chapman - Ulysses Press 2003 (p.11)

My scoliosis

My own scoliosis was not diagnosed unil relatively recently. I was well into my journey along the yoga path by this time so I was able, upon diagnosis, not only to understand the difficulties and limitations I had been finding in my asana practice but also to understand what my yoga practice, relaxation and meditation exercises and philosophical mindset had done to prevent even more severe problems relating to the curvature of my spine. I can't begin to imagine the state I may have been in if, say, I had taken on the life of a couch potato in my teens and stuck to it!

When I was born the only noticable structral malformation of my scoliosis was my breastbone which showed a classic example of funnel chest. This is where the sternum dips in towards the chest cavity, forming a concave surface on the chest (example picture attached, I'm not quite ready to publish a picture of my own chest. Give it time!). My parents showed some concern about this but where told that it was merely a congenital defect of only cosmetic importance. This misdiagnosis has, in many ways, done me a favour in that at least I have never had to endure spinal fusion or bracing, as such things are thought futile on a mature skeleton.

As I grew older I began to realise that my lung capacity and stamina seemed much less than that of my peers. This was, for many years, incorrectly diagnosed as asthma and while an asthma inhaler does assist in times of shortness of breath, none of the other symptoms of my breathing are particularly in line with the symptoms of asthma. As I grew I also became aware of my posture being quite unusual' one shoulderblade protuded mroe than the other and my ribcage seemed very assymmetrical.

I was a relatively active child and teenager, traning hard in ballet and other forms of dance from the age of four and also practicing yoga to some degree with my parents and brother. Interestingly, my mother first sent me to ballet class because she was mildly concerned about my lack of co-ordination. In hindsight, knowing what I do now about my spinal curvature, it is really a wonder I wasn't falling over sideways (I have no compensatory curve - which I will explore in more detail at a later date), never mind slightly unco-ordinated!

Unusually for a teenage girl, I was never particularly concerned with the shape of my body. I was always prone to skinnyness, was short and easily blended into the background when I needed to, so my increasing round-shoulderedness never really bothered me, and at this point it didn't cause me any physical pain. After laving colleage at 18 and going to university, my practice of dance and yoga went out of the window and my posture became worse. It wasn't unitl I started to work in an office in my 20s, however, that I began to notice a severe pain and numbness on the right-hand side of my back and discomfort in my right ribcage. It was at this point in my life that I returned to yoga to find some relief from the discomfort I thought simply to be the result of a deskbound career.....

What is Scoliosis?

Scoliosis is a “C” or “S” shaped curvature of the spine, its name derived from the Greek “skol” which means twists. Pictures of people with scoliosis appear in Prehistoric cave paintings and the first recorded treatment of the condition with braces was in the fourth century BC by the Greek doctor Hippocrates.

The condition can have a known cause and is common in connective tissue disorders such as Marfan Syndrome, homocystinuria and Ehlers-Danlos for example, it can be a feature of rickets, when the bones become soft due to decalcification, or the result of an accident; the spinal curve developing after the ribcage, pelvis or shoulder girdle has been knocked out of alignment.

Scoliosis with no known cause is referred to as “idiopathic”, although some researchers say that this term is becoming outdated as studies are beginning to show a clear link between congenital scoliosis and low bone densities. My own scoliosis is “idiopathic” and both my mother and maternal grandmother suffer from osteoporosis, but I think that to try to find a singular genetic cause for "idiopathic" scoliosis is simplifying the problem. Bone density, for example is influenced by a wide variety of overlapping factors such as hormone levels, nutrition, exercise and medication. The causes of "idiopathic" scoliosis are still far from clear and is is illogical to presume that they are the result of a single gene factor alone.

The lateral curvature of the spine rotates not only from side to side but back on itself as well, rotating the affected vertebrae towards the concave side, twisting the ribcage and making the sides of the back uneven. The results of this can be seen clearly in the yoga asana Setu Bandhasana; once the back has lifted from the floor to its full extent in that particular person a direct line of sight down the middle of the front torso will clearly show one side of the ribcage (usually the convex side of the spinal curvature) is substantially higher than the other.

Not only does the scoliosis sufferer have spinal deformity and rib displacement, but the shoulders and hips can become twisted and the body’s centre of gravity shifted. While one of the most obvious symptoms is a cosmetic one, severe pain and heart and lung compression, due to compression on the thoracic cavity, are common as well. As the body maintains the upright posture it is comfortable with over the years, muscles will begin to tighten and painful masses of muscle tissue will develop in the ribcage, shoulders and neck.

Spinal curvature can take place anywhere in the spinal column. For unknown reasons 90 per cent of thoracic and double curves curve to the right, 80 per cent of thoraco-lumbar curves also curve to the right whilst 70 per cent of lumbar curves curve to the left. Seven times as many women as men have scoliosis, a statistic that brings us back to the question of bone density.

Conventional treatment of scoliosis has varied over the years. Braces and spinal fusion (an operation in which metal rods are inserted next to the spinal column, similar to the idea of a runny bean growing straight if tied to a beanpole!) were common 20 years ago to prevent the curvature worsening. Browning Miller, in her article Yoga and Scoliosis describes herself as feeling “appalled” (Yoga Journal November 1999) by the idea of such treatment and instead consulted an orthopaedic surgeon who advised “a regimen of exercise and stretching” (ibid). As a young graduate she turned to hatha yoga and noticed that when stretching in yoga asanas “the numbness on the right side of my back went away, and the pain started to dissolve” (ibid).

While the medical profession still tend to accept the premise that exercise does not have a place in scoliosis treatment, it is slowly becoming a more widespread belief that posture training and exercise are important for scoliosis prevention (when a scoliosis curve may occur due to the result of a misalignment after an accident) and treatment, as it had been prior to the popularity of surgery and bracing in the 1940s.

As part of my purpose for writing this blog/journal/book, whatever you would like to call it, I hope to put forward enough evidence of both my own personal journey and that of other people to prove that exercise, especially a subtle exercise like yoga, has every effect on the curvature of the spine, both physically, spritualy and emotionally. That by changing our attitudes towards our spine we can change our lives.

Chiropractic Report and X-ray

The scoliosis is congenital and appears to be a failure of formation, genetic aberration that prevents full ossification and results in a hemi vertebra type abnormality. This appears to occur in the lower one third of the left T2 vertebra and continues over the T3 and T4 and the upper one third of the T5 vertebra. The curve is convex to the left with the apex of the curve between T3 and T4 thus making a thoracic curve which is not compensatory. It is an adult presentation which is any curve presenting after skeletal maturity. There is a mild left cervico-thoracic rib hump. There is a +1 apical rotation of the pedicles, this is mild. Congenital scoliosis often presents with other boney abnormalities in your case the sternum which is described as pectus excavatum or more commonly known as funnel chest.