Yoga with scoliosis and back pain
An article by Christine Jaureguiberry
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Back pain is often associated with poor posture. Looking too much at our phones, sitting too much, staring at the computer screen… Basically most of what we have been doing during the pandemic is really not so helpful for our back health. As yogis and yoginis we also acknowledge that we are so much more than our physical bodies and that our emotions and mental states play an important role in how we feel and when it comes to the experience of back pain.
Scoliosis can also be a contributing factor in how balanced we feel in our bodies. It’s a condition which is unfortunately sometimes dismissed by health professionals when it comes to treatment unless there is the immediate need for surgery or bracing. It’s also one of those conditions that don’t go completely away even with treatment and can cause people who are affected to feel imbalanced both physically and mentally and even experience chronic pain.
The good news is that yoga is something that can help us with both pain and imbalances! *
*Any type of back pain should always be checked out first by a health professional. I am sharing what has worked for me and my clients in this article but do make sure to speak to your doctor first if you are new to the practice and/or are worried about your pain.
My back health story
When I was a child I was diagnosed with scoliosis and whilst it wasn’t severe enough to require a brace or surgery I was told that I would always have to do something for my back. Well, that’s all great advice but what does 'do something' actually mean?
Initially I thought that meant going to see physios and chiropractors twice a week but that turned out to be pretty expensive and not sustainable. It also wasn’t particularly inspiring being told all the things that are wrong (your hips are uneven; your posture is bad) by health professionals without actually giving me a solution! The treatments themselves were very helpful of course but nothing ever had a lasting effect. At one point I started wearing a heel lift in my shoes on the recommendation of my orthopaedist but even that didn’t seem to solve the problem.
I started my yoga journey 16 years ago with my own struggles with back pain and scoliosis. I was in my early twenties which should be the time when you’re fit and healthy but I certainly didn’t feel that way. I was working in the hotel industry having just gone from standing for long periods of time as a receptionist to sitting for 9 hours a day in the marketing office hunched over my laptop.
My back was giving me problems all the time and unfortunately this was not something that I was unfamiliar with as I recognised it from my childhood. Those burning sensations in my shoulders, aching in the mid-back and sometimes lower back were very persistent and I knew that I had to do something as surely this would only get worse with age!
How yoga helped my back
When I went to my first yoga class at age 24 I wouldn’t say it was love on first sight. Not knowing much about yoga at all I found it a little too “alternative” for my liking and definitely wasn’t so keen on the 'shanti, shanti ohm' part at the end!
BUT for some reason my body felt amazing after that class so I went back! And not just once but I eventually went to classes 3 times a week because I loved it so much. I felt strong, I felt more balanced and the pain disappeared! Yes of course it would come back occasionally but I had now finally found the tools to help myself which was very empowering.
Teaching students with scoliosis
I loved yoga so much that 10 years later I quit my corporate job and did my Yoga Teacher Training to be able to help other people too! Once I started teaching the learning really began as I was now not only working with my own body but also other people’s bodies and their back pain. I also started to appreciate the aspects of yoga that go beyond the physical more and more, especially once I had children! Breathing and relaxation became all of a sudden VERY important.
The more I was teaching I found that what really made the biggest difference was not just the yoga postures themselves but also the effect that the practice has on our mental and spiritual wellbeing. People feel more connected to themselves which often helps to connect to others in their lives in a better way. My children will confirm that I am certainly a much more pleasant person to be around once I’ve done my practice!
I continued to learn more and more about anatomy and how the human body works. I researched back pain and scoliosis for hours and hours. I did all the specialist trainings I could find, always with the goal to help those that suffer from scoliosis and back pain.
The more I learned and the more I shared what I knew on my social media channels, the more I started to attract more clients with spinal conditions such as scoliosis and kyphosis who wanted to find a long-term back management solution just like what I was looking for in my twenties.
Most importantly I continued my own practice and learned more and more about what works and what doesn’t work especially with those chronic conditions such as scoliosis that don’t go away.
What is Scoliosis?
Scoliosis is a sideward curvature of the spine accompanied by rotation. The curvature is measured by a radiologist when you get an x-ray in degrees which is called the cobb angle. Anything from the cobb angle of 11 degrees and above is called scoliosis.
Types of Scoliosis
The most common type of scoliosis is idiopathic (meaning nobody knows where it comes from) and develops during teenage years. This is called Adolescent Idiopathic Scoliosis or AIS. Some types of scoliosis are congenital, meaning that they were present from birth. There is also a type of scoliosis which develops later on in life after menopause which is called Degenerative Lumbar Scoliosis or DLS.
Scoliosis curves can come in all sorts of different shapes and each curvature and rotation is absolutely unique (just like the rest of our body!). The most common curves are s curves which most often seem to curve to the right in the thoracic and to the left in the lumbar spine. The other common curve type is a c curve which is usually a longer curve that affects both the thoracic and the lumbar region – these are called thoracolumbar curves.
Treatment for Scoliosis
Treatment for scoliosis can include bracing, physiotherapy or even surgery which will usually be considered if the cobb angle is above 45 degrees.
Exercise is generally being recommended to those with scoliosis as it’s important to keep the body strong and make sure that the curve doesn’t get worse. Swimming, Pilates and yoga are all great options but really any type of movement is better than no movement! Low impact exercises are generally better especially if the scoliosis is severe and it’s harder for the body to find it’s optimal stable position.
Yoga with Scoliosis
As yoga is a low impact type of physical exercise it is generally considered to be safe and is often recommended by doctors and health professionals. The movements incorporate the whole body and movement in general is great for scoliosis which studies have shown. We keep the joints healthy by moving the spine in all directions, we move and reset the tissues and fascia. We strengthen the body and improve our flexibility.
Yoga also encourages body awareness which in turn can be very helpful to improve proprioception (how we perceive our body’s position in space) which can be compromised in those with scoliosis.
The relaxation element is important from a physical perspective as the body has to work much harder if there is a structural imbalance to resist gravity and keep us upright. Muscles can by tight and overworked on one side and underutilised on the other.
From an emotional point of view those that live with the condition and might have undergone treatment in the past can suffer from problems with body image, feelings of inadequacy and anxiety. Mindfulness, breath work and self-reflection can be very powerful during the healing process.
Potential problems with yoga
There are a few things that we must, however, consider when we practice yoga with scoliosis.
In yoga we love balance. And I don’t just mean Tree Pose I mean that we love to do everything exactly the same for exactly the same amount of time on both sides. This doesn’t work so well if you are working with an asymmetry like scoliosis. For people with scoliosis poses might feel completely different on one side than the other meaning that we might have to consider doing them differently on one side to the other!
Some poses can be problematic
As mentioned already a structural scoliosis comes with a side bend and a rotation in the spine. This often comes with what we call vertebral wedging meaning that the individual vertebrae are slightly different shaped than in a non-scoliotic spine (I’m avoiding the term “normal” here as let’s face it… what is normal anyway!).
It can also come with a condition called lateral spondylolisthesis which is when one vertebrae is abnormally slipped over to the side. This can be painful and cause instability which is why we might have to be careful with some movements like side bends or twists.
Another problematic movement can be anything that takes us into extension (back bending) as due to the rotation one side will be affected differently to the other is poses such as cobra pose or upward dog for example.
Inversions which put a lot of pressure on the neck and the thoracic spine like headstand and shoulderstand can also potentially be contraindicated depending on the specifics of the individual curve!
Beneficial poses for scoliosis
What poses you practice depends on your individual body and needs of course but generally with scoliosis we want to elongate the spine.
If you think of a garden hose and bend it to the side you will notice that it will also twist. What would you do to take the bend out? Would you bend the hose to the other side and de-rotate? No! You would just lengthen it in opposite directions!
We can apply the same principles to the spine and focus on poses that do just that: elongating. I have included a few tips for those that know which way their spine curves (which an x-ray and your medical report will show) but if you don’t know then these poses will still be beneficial for you!
I love downward dog because of all the amazing benefits you can get out of it. You’re strengthening the upper body and shoulders (very important for thoracic scoliosis especially), lengthening the muscles along the backs of the legs (great for those of us who sit a lot!) and with the sitting bones up towards the ceiling we can really work on elongating the spine!
If you know that you have one shoulder blade that sticks out more than the other (usually on the convex side of your thoracic curve) see if you can draw it in towards the midline a little more. Breathe into the concave side of your spine.
Half Downward Dog
If your wrists or shoulders don’t support the shape of Downward Dog then you can still get the benefits of elongating the spine in Half Downward Dog. Bring the hands on the back of a chair or even better something that doesn’t move like your kitchen sink! Walk the feet back and bring the hips over the ankles, lengthening the tailbone away from the crown of the head. This lengthening action should feel really good!
In yoga there are lots of fabulous standing poses to choose from but I really like Tree Pose for scoliosis. Before going into the pose notice if you have a tendency of putting more weight onto one foot than the other. This is very common with scoliosis as usually the hips are shifted over to one side. Tree Pose is a great way to notice the difference between what is going on in the right side of the body compared to the left side.
When you bring the sole of the foot to the inner leg see if you can keep the pelvis level. If you feel balanced, you can lift the arms up of the head which give you that extra lengthening and lifting of the ribcage away from the hips! If you know which areas of your spine curve out (convexity) see if you can draw them into the midline.
Dr Loren Fishmen who is both a yoga and medical doctor has done an extensive amount of research on the topic of side plank and how it can reduce scoliosis curves. Opinions in the scoliosis specific treatment world are quite divided on this but Dr Fishman has certainly seen good results for his patients! He suggests practicing the pose for as long as you can on the convex side of your lumbar curve at least once a day.
This requires a lot of discipline and strength of course. As scoliosis curves are so individual and there are so many compensations going on (above and below the main curves) I would recommend practicing the pose on both sides (as they both need strength and support!) but really focusing on keeping the concave side open.
This is a type of breathing practice where we close one nostril to breathe in and then breathe out through the other. We then breathe in through the same side and out through the opposite always closing one nostril.
The nostril on one side is connected to the same side of the brain but opposite side of the body. Breathing in this way can be really helpful when dealing with asymmetries which have an effect on the whole body and probably also the brain (research studies on this topic are still limited right now).
The pose that I would never skip in any yoga practice is Savasana. The difficulty I have found for those with scoliosis is to get completely comfortable. The “bumpiness” in the back can make people feel really uneven. With lumbar scoliosis is might feel like we are rolling more to one side than the other. It is therefore important to set up well with blankets and bolsters and anything additional you might need.
When scoliosis curves get too large and progress too rapidly spinal fusion surgery might be necessary. This is a major surgery where rods are attached to the curved part of the spine to both straighten it and fuse the vertebrae together which means loss of movement in certain parts of the spine to halt the progression.
Yoga is still very much possible and beneficial for those with spinal fusion but needs to be approached with care so I would always recommend working with an experienced teacher if you’re new to yoga and have undergone surgery in the past. They can then help you adapt yoga poses and choose the ones that are most appropriate.
My top tips for yoga with scoliosis and back pain
- Do your own body research. Knowledge is empowering getting a proper diagnosis is really important when you deal with any type of pain or condition. Get it checked out, get all the advice that you can get but also do your own research.
- Get to know your curve! After the diagnosis really get to know your body and how it feels in both movement and static positions. How does it feel in this yoga pose? How does it feel in that yoga pose? How does it feel on the right compared to the left? How do you feel during the yoga practice but most importantly how do you feel after the yoga practice?
- Find a good teacher! Seek out teachers who are comfortable in working with those who have scoliosis, who are nurturing and allowing you to explore rather than impose their idea of what a pose should look like!
Tips for yoga teachers working with students with scoliosis
- Choose poses to elongate. Elongation is your best friend when choosing yoga poses for your student. Whilst twists and bends might be absolutely fine for anyone with mild and stable scoliosis it might not be for someone with more moderate or severe curves.
- Focus on breathing and body awareness. The best give you can give someone with scoliosis is to guide them to breathe into the less accessible areas of their body which are usually the concave sides of the curve. Very often those areas will feel “disconnected” so using light touch (with the permission of the student of course) might be really helpful to the student to direct their breath and ultimately become more aware of those areas.
- Assist and guide, don’t diagnose! As Yoga Teachers we are trained to observe our students and notice misalignment. It can be tempting to point out imbalances because we want to help. Don’t mention scoliosis unless the student mentions it to you first though. We are not there to diagnose. We also don’t know what their scoliosis journey has been like and the last thing you want to do is bring something up that they are not ready to deal with.
Any type of back pain should always be checked out first by a health professional. Yoga should never be a replacement for medical treatment or advice. It can be, however, very beneficial for those who are seeking a more longer-term back management approach which is often needed especially by those who suffer from scoliosis.
Scoliosis can come without any symptoms at all, but it can also come with a huge amount of discomfort and pain, physically and emotionally.
In yoga we acknowledge that we are so much more than just our physical bodies. We are also encouraged to go that little bit deeper to connect with that part of ourselves which is beyond any identification with physical conditions or limitations.
Christine Jaureguiberry is a fully qualified Yoga Alliance Professionals (UK) Yoga Teacher, a Registered Children’s Yoga Teacher, Yoga for Scoliosis (Adelene Cheong & Elise Browning Miller) and Restorative Yoga Teacher (Judith Hanson Lasater).
She is passionate about helping people who suffer from back ache, scoliosis or other back related conditions to learn about their bodies and how to use yogic postures and techniques so they can feel in control, empowered and improve their quality of life.
Christine teaches online and in person classes, workshops and trainings to students from all over the world. She is the creator of Yogaberry, an online Yoga for Scoliosis community, YouTube channel and resource for all things back care and scoliosis.
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