our-yoga

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

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.

There's a discussion going on over at the Confluence Countdown about "holding students back" in the Ashtanga system. The blogger, Bobbie, makes some very interesting points about the system from a philosophical / psychological perspective, the discussion of which I'll leave to her blog. I'm outta that relationship, remember? ;)

What is interesting to me is the question of whether it's good for students to practice exclusively the primary series for too long. Bobbie and many of the commenters come to the same conclusion that I did, that practicing exclusively the primary series for years on end does not give your body a healthy or balanced practice. And since the system seems to have developed rules over the years about when/how students are "given" (I agree with Bobbie, I also dislike that word!) the next pose or series, e.g. being able to bind in Marichyasana D or being able to stand up from and drop back to Urdvha Dhanurasana, many students find themselves practicing primary for years.  Many, like myself, don't have regular access to a teacher who can "give" them the next pose or teach them 2nd series. Nonetheless, we are told not to do other yoga, to "pick a system and stick with it," that doing other yoga will somehow dilute the transformational power of the practice.

Bobbie and many commenters on the post feel what I felt, deep inside my body, and what led me to "break up" with Ashtanga and start practising other poses - that the primary series is not, IN ITSELF, a balanced practice. And quite possibley it wasn't intended to be that way, but that is another conversation. In any case it's good to hear that many of the senior teachers seem to agree.

Essentially the points made in the post and the comments, which may not be experienced by everyone, but which me and my body agree with wholeheartedly after practicing Primary for 3 years:

[NB: In response to a comment left on the blog, I realised that my original post used language that was a bit too absolute, so I've edited the original wording a bit to emphasise that what I'm talking about is relativity within the sequence. I've also added some more anatomical precision.]

• Primary has a relatively greater emphasis on forward bending, stretching the muscles of the  back (in particular the erectors spinae and the quadratus lumborum) more often than it strengthens them (one of the best poses for that is shalabasana). In some people, an overemphasis on forward bending can be destabilising for the SI joint. Sciatica or SI pain, anyone?
• It develops relatively more upper front-body strength (pec minors) without developing the corresponding upper back-body strength (rhomboids and rotator cuffs). My yoga therapy teacher believes that this is why many Ashtangis (and others who practice vinyasa-based yoga) develop shoulder injuries, because those crucial muscles that stabilise the shoulder blades can become relatively weaker on the back than the front. Another effect of this is that the front body, especially the front of the shoulders, while getting very strong, may become tight and "closed", as there are relatively fewer poses to open it up (the best stretches for here are back-bends with the arms extended behind the body, e.g. purvottanasana, ustrasana, shalabasana, dhanurasana).
• While Primary certainly stretches the hamstrings, it doesn't provide space for deep hip-opening in certain directions. There is a lot of external rotation and flexion of the hip joint, but relatively little extension or internal rotation. The sequence also strengthens the psoas, the quads and the external rotators of the hip (the glutes, the piriformis) relatively more than it stretches them. These muscles are key muscles for postural stability and the health of your spine, and balanced hip-opening (internal and external) is important for maintaining the safety of the knees and the lower back.

Since I stopped practicing Primary about 6 months ago and moved to a more balanced practice, I am feeling my body in a whole new way. Most noticeable is that my back body is much stronger as a result of the targeted postures I have been doing, and this has significantly reduced the shoulder pain I used to often experience (which was also related to my scoliosis). This has also made my posture better and I've made some progress towards reversing the forward-hunch that my shoulders had developed through a combination of too much computer time and too much emphasis on forward-body strengthening (in particular the pec minors). No thanks, kyphosis, not for me!

The moral of the story, for me at least?

• Listen to your body and think about finding balance in your long-term yoga practice. 
• If you stretch a muscle, strengthen it. It doesn't have to be the same day, but overall!
• If you stretch/strengthen somewhere, be sure to also stretch/strengthen its opposite (antagonist).
• If you feel like your body is imbalanced from a practice you are doing (chronic pain or recurring injuries are a good sign), listen to those feelings and find a teacher or yoga therapist who will help you identify what's going on.

And above all, remember, it's only asana!

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I just read David Garrigues' latest post. I think I'm becoming a big fan of his. Maybe I will try to go study with him if I don't make it to Mysore soon. Anyway, in this post, David answers some questions from students about the practice. One student's question--and David's response--really jump out at me. This student was recently diagnosed with mild soliosis and carpal tunnel syndrome. The doctor told the student to quit Ashtanga as it places a lot of pressure on the wrist, and doing inversions "will only make... scoliosis worse." This student decided to write David to ask him if there is a way to continue practicing Ashtanga with these conditions.

David responds by suggesting various modifications for practicing with these conditions. He then concludes by saying:

"The essential ingredient is a love of ashtanga and in maintaining a steady devotion and trying to do the practice as accurately as your given circumstances allow... there will always be someone to tell you that you can’t do ……….. the list of possible things or activities or dreams is endless and so is the list of people who will tell you can’t do that something. Sometimes they may be right but equally sometimes they are wrong. And ultimately you have to decide how important something is to you. And when you’ve decided on that something that is important enough to you, you may need to guard and protect the heck of it in order to for it to remain a strong, positive force in your life. As people we can tend to be suspicious of what we don’t know about, and if on the surface something looks strange or exotic or very different from what we know or are used to, we can tend to form negative impressions of that thing. But our own fear and unwillingness to be open to new or different things can us cause to make wrong assessments of things and to unfairly judge what we don’t have enough information to be judging. I believe it would be a true waste for you to stop developing the ashtanga yoga practice that you have begun and love. If you practice properly there is a strong chance that ashtanga can help correct or at least minimize the negative effects of both of your problems better than any thing else that you will try. I have found that ashtanga applied properly, has huge potential for transformation and healing. Om! David"


David's response really speaks to me. For one thing, I also have mild scolosis. I've been diagnosed with it since I was in elementary school. And at least a couple of my yoga teachers have also spotted it: Eddie Modestini and Nicki Doane spoke to me after one of the sessions at their asana intensive on Maui in 2007 (which I attended), and asked me if I knew I had mild scoliosis (I said I did). They had spotted the curve in my spine while I was in Sirsasana. They didn't really suggest anything much more beyond that (they didn't ask me to stop doing inversions, which is why I'm still doing them today :-)), although Eddie did say that doing more backbends will help my condition in the long run. Anyway, I have this suspicion that if anybody had told me at any point that I needed to stop doing Ashtanga because of the scoliosis, I probably would have gone ahead and continued doing it anyway, knowing the sort of person I am.

But David's response also spoke to me because it highlights something I have been feeling very strongly for a while now. It seems to me that very often, expert knowledge and specialized training (in this case, medical training) have the effect of closing the mind of the individual who has received that training, accentuating the very human tendency to be suspicious of and form negative impressions of things we are not familiar with. It is probably not an exaggeration to say that many highly-trained experts operate from a place of fear rather than openness, automatically rejecting that which is strange or counter-intuitive to them.

But perhaps we can't blame people for having this attitude. After all, seen from many angles, the daily practice that Ashtanga requires is very strange and counter-intuitive to many people. This morning, for example, I had to wake up earlier than usual in order to do my practice and make it to campus for a meeting at 8:30 a.m. As I sat in the conference room waiting for the meeting to begin, I couldn't help wondering what the reactions of the other people present at the meeting would be if I had told them that I had spent two hours breathing, bending myself into certain shapes and standing on my arms as well as my head before I came to the meeting... I guess what I'm trying to say is that doctors are ultimately ordinary people plus some specialized training. And that specialized training may or may not prepare them to deal productively with things in their patients' lifestyles that they find unfamiliar or strange. So it is perhaps natural that many doctors, when confronted with such unfamiliarity and strangeness, would default to that "if it puts you in an unfamiliar or uncertain place, it's probably bad for you, don't do it" mindset.

Please don't get me wrong: I'm not telling anybody to stop seeing doctors. But David's student's encounter with the doctor brings up a feeling I have been having for a while now: It seems to me that, more often than not, the medical establishment in this country tends to disconnect and dis-empower individuals from their bodies. Rather than helping the patient to find out how best to work with a particular condition given his or her lifestyle choices, values, and things he or she holds dear, doctors often seem to just default to saying something along the lines of, "Take this pill or undergo this procedure, and you will be better. And don't do this or that." For instance, some time ago, I had a diabetic friend who was taking medication daily for his condition, as prescribed by his doctor. When I asked him what that medication was supposed to do, he said he didn't know! Which strikes me as very strange: If you had a particular condition, and somebody was asking you to put a certain substance into your body, wouldn't that person at least have a responsibility to tell you what that substance was supposed to do in your body? Or maybe it didn't occur to my friend to ask. Yeah, I suppose that's possible too. In any case, if my friend's experience is indicative of the state of physician-patient relationships in general in this country, then it seems to me that medicine as practiced in this country suffers a serious flaw: There does not seem to be any attempt to further engage patients as people, and help them to better understand and care for their bodies and minds given who they are as individuals. Doctors just see patients as machines that can be fixed with this or that drug or procedure. Which leads to a state in which people feel more disconnected from and dis-empowered with regard to their own bodies, and become ever more dependent on supposed health experts to tell them what is right and wrong and good and bad. I don't think this is a good way to go.      

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This is a guest post by the lovely Rachel of Suburban Yogini.  As a fellow scoliosis-sufferer, I asked Rachel, with her experience at therapeutic yoga, to put together a short-but-sweet sequence for the spine that could be practiced daily to help relieve some of the discomforts caused by scoliosis.  You can read a bit more about her own experience with scoliosis here.

Yoga teacher Elise Browning Miller is one of the most recognized experts on the subject of yoga and scoliosis.  You can visit her website here for lots of helpful information on the different types and origins of scoliosis.  She has also written a number of articles for Yoga Journal on the subject: here is one about yoga and scoliosis, and here is one about teaching students with scoliosis.

So, on to our sequence, with a few wise words from Suburban Yogini's blog: "Yoga practice for back problems of any kind, or scoliosis specifically, should always be undertaken with a qualified teacher who understands the back problem and in conjunction with advice from a physical therapist. This said, yoga practice by its very nature will strengthen and stretch the back muscles and focus the mind on lengthening the spine."

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