t om Vee TTT eT eee wvlvy yee dive by Elise Browning Miller and nancy DL heratyVEU VU UUUUUUUTUUARUNMA ROU UU UUUVUULUDULUDULUUY YOGA FOR MN il J Dedicated to the late B.K.S. Iyengar and his children Geeta S. Iyengar and Prashant Jyengar. With gratitude to my beloved teachers who taught me to heal myself and share that gift with others, Else Browning MilerYoga for Scoliosis: A Path for Students and Teachers Copyright © 2016 by Elise Browning Miller and nancy DL. heraty Copyright © 2016 Illustrations by Stephanie McCann All rights reserved. This book may not be reproduced or transmitted in any form whatsoever without written permission from the authors, Elise Browning Miller (www.ebmyoga.com) and nancy DL heraty (www yogajourneystotheheart.com) Library of Congress Cataloging-in-Publication Data available upon request. First Printing, June 2016 Printed in New Brighton, Minnesota Printed by Printeraft ISBN: 978-0-9964963-0-8 For more information about Yoga for Scoliosis, go to www.yogaforscoliosis.com. ‘Authors’ Note ‘This book offers a program of exercise recommendations for the reader to follow. You should consult with a medical professional before beginning this or any exercise program. As with any exercise program, if you feel any pain or discomfort, stop immediately and consult a medical professionalVDIVIVVVVVVUVLUUUUULVULVUUUU UV UUUUUUUUUUUUUUUUUULU contents at 42 2 8 110 118 131 145 148 149 151 ‘About the Authors ‘Acknowledgments Forewords Introduction All About Scoliosis, Benefits of Yoga for Scoliosis Four Major Structural Curve Patterns Getting to Know Your Curve Pattern Yoga for the Fused Spine Beginning Your Own Home Practice How to Use This Book ‘Asanas & Pranayama Standing Poses Seated Poses Back Poses, Backbends, and Back Strengtheners “Twisting Poses ‘Supine and Side-Bending Poses Core Strength Poses Inversion Poses Breath Awareness for Scoliosis, Sequences, Seven Yoga for Scoliosis Practice Sequences ‘Yoga for Scoliosis for Yoga Teachers Resources Index Notesabout the authors Elise Browning Miller, sa inmerapeuic Recre ation from the University of North Carolina, is a senior certified lyengar 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 and Palo Alto, California, Elise teaches classes ‘and workshops specializing in therapeutics and is a faculty member at the Iyengar Yoga Institute of San Francisco. Elise has successfully used yoga to manage the effects of her own scoliosis and she sees clients with scoliosis and other back related problems privately. She has published numerous articles on scoliosis and other yoga-related subjects in Yoga Journal and other print and online magazines. Elise has studied with B.K.S. lyengar and Geeta S. Iyengar in India on numerous occasions. She has produced the Yoga for Scoliosis DVD and booklet, Yoga for Back Care booklet, Intermediate Yoga in Fiji DVD, and a new edition of her book Yoga: Anytime, Anywhere. Elise’s joyous personality, ese of communication, and down-to-earth, precise, and rurturng teaching ate endear hr to students nancy DL heratty teaches cissic hatha yoge with an ‘emphasis on alignment and specializes in yoga therapeutics for those with specific issues and ailments. She is based in the Chicago area, Therapeutics forthe spin, and specifically scoliosis are where her expertise shines. DL trained with Ese Browning Mille to become aYogs for Scoliosis trainer. She continues to study and assist with renowned master teacher Gabriel Halpern at Yoga Circle in Chicago, where she has trained in therapeutic and restor- ative yoga based on teachings from the Iyengar tradition, DL continues to study with senior teachers to maintain a current, informed, and fresh ap- proach to yoga, She has led retreats and vison quests with her late soulmate Kevin RED BEAR Dubrow, MSW, in Arizona, Michigan, and Wisconsin. DL is an artist and a potter, and that creativity shines throughout her teaching. She has been published in Yoga Chicago Magazine on several occasions and authors and self-publishes her own workshop manuals. This is her first book. 4. Yoga for Scoliosis - About the AuthorsVVUVVUVUVUVUVUUUUUUUUUUN OU UU UU UU acknowledgments ~~ Be Many wonderful people contributed to compiling the knowledge and wisdom in this book. The major players are to the right. Each of you gave brillance and professional- ism, making this book beautiful, informative, and full of experiential learning. Many thanks! FROM ELISE I dedicate this book to my beloved yoga guru, the late B.S. Iyengar, who brought light to my body and soul through the practice of yoga, who taught me to explore and inquire deep within, who guided me with his teachings for forty years to find more balance and symmetry with my scoliosis A heartful thanks to his daughter, Geeta Iyengar, for her inspirational teaching and her dedicated and innovative work in the field of therapeutics and women’s yoga. ‘To Judith Hanson Lasater, for being my first yoga teacher in the Iyengar tradition and my dear friend ‘To Patricia Walden, my friend and teacher, who has taught and inspired me through her magnificent teaching and has set an example of how to live the life of a modern but true yogi encompassing all aspects of yoga. ‘To Lois Steinberg, my friend and teacher, who has unconditionally shared with me and many others, teachers and students alike, her knowledge and deep understanding of the therapeutic approach to Iyengar yoga. ‘To my father, G. Tyler Miler, who always encouraged me to follow my dream and taught me to live life with an open heart. ‘To my soulmate and husband, Tony Ornellas, who inspires, supports, and loves me for who I am. To DL, who has been the backbone of this book, I could not have done this without you. You made the process so much more fun, To my students throughout the years, who have taught me to listen, to learn how to pay attention to individual needs, and to trust my intuition. FROM DL. | dedicate this book and my vocation in yoga to my late husband and soul- mate Kevin RED BEAR Dubrow (May 8, 1953-February 15, 2016), One of the greatest and most loving men I have ever met, he brought me to my soul, He was my major cheerleader. He helped me find the chutzpah to begin writing this book, and always loved me forall that I am, Meegwetch RED BEAR! ‘The synchronicity of meeting my mentor and teacher Gabriel Halpern was written in the stars. He guided me to the path of yoga therapy, and supported me on the journey into Yoga for Scoliosis with Elise. To Elise, who started with her Yoga for Scoliosis manual and then joined me on the bandwagon to bring this book to fruition! This process has given me a dear friend in Elise, a beacon of light that guides me to becoming an amazing older woman, To Barbara Armbruster, another amazing woman, yoga teacher, and soul seeker, who has taught me to be grand in all that Ido. Ihave been gifted with an amazing community of friends and seekers of soul, family, fellow yoga teachers, and courageous students who have supported me in this amazing vocation of yoga and who have listened to my ideas and given me feedback and support for this book. I love you all! ‘We would like to thank Dr. Sigurd Berven for his contribution to the chapter on the fused spine and for providing X rays for this book. KBY PLAYERS ‘Authors ise Browning Miller ‘nancy OL heraty Editor Jenifer Rodrigue Designer Chat Ornett Mustrator Stephanie McCann © Stephanie McCann 2016 stephaniemecann.com Photography Tony Ornelas Copy Editor ‘Shannon Waite Yoga Clothing Graciously donated by Marie Wright Yoga Wear. mariewright.com Models Else Miller Gaby Diskin nancy DL heraty Readers Barbara Armbruster Gabriel Halpern Carol Melamed ‘Ann Merlo Syivia Thanas ‘Acknowledgments - Yoga for Scoliosisforewords Geeta S. lyengar os Geeta S. Iyengar is the lise Browning Miller has been a longtime student of BKS. Iyengar since eldest daughter of B.KS. E 1976 and a student of mine since I first began to teach intensives at Rama- lyengar and the director of mani Iyengar Memorial Yoga Institute (RIMY1). She has assisted in the (of the Ramamani lyengar ‘medical classes at RIMVI since the 80s and has helped many people with scoliosis en Memorial Yoga Institute. cover the years. Having scoliosis herself, Else has a unique insight to be able to of She started teaching in | teach yoga to those with scoliosis. Tis is a comprehensive book giving great 1962 and continues to | detail of how to address one’s scoliosis with different modifications for different oP teach around the world. patterns of scoliosis. It is an invaluable guide and reference tool for teachers. (s ‘She isthe author of Yoga: A Gem for Women. May this book hep ll those who suffer from scoliosis. GE Gs Gp GE Gs (6 Yoga for Scoliosis. Forewords3 2 5 2 > > 3 - 2 2 2 ACARI UU DU UU UU IN Judith Hanson Lasater E ndorsing Yoga for Scoliosis isa triple delight. First, it allows me a way to honor my decades-long personal and professional friendship with Ms. Miller. Next, 1 am so pleased to see such a thorough book presented in this competent ‘manner. Very few yoga teachers have Ms. Miller's depth of knowledge and experi- ence in the field of therapeutic yoga practice for those living with scoliosis, ‘You will find that the text is clear and the advice sound. This is the ultimate textbook for understanding the benefits yoga offers to those with scoliosis. It educates and inspires both the yoga teacher and yoga student alike. Finally, | am delighted when | think of what this book offers to those who need it so desperately. Yoga for Scoliosis is nothing short ofa gift of practical hope for a better and more pain-free life. Highly recommend. Judith Hanson Lasater has taught yoga since 1971 and isthe author of eight books, including 30 Essential Yoga Poses for Beginning Students and Their Teachers and Relax and Renew: Restful Yoga for Stressful Times, Forewords - Yoga for Scoliosis 7Lois Steinberg Lois Steinberg is an lise Browning Miller, an early adopter of yoga. took to the practice with a stoves scavied’ | Apne hte tt a orn Iyengar Yoga teacher have started her Iyengar Yoga journey with BX S. Iyengar himself on one of and is director of lyengar|_his trips to the United States. That class lit a fire in Elise and established her sure Yoga Champaign-Urbana. footing on a lifelong path as a student and teacher of yoga She is the author of | ‘numerous books and She writes an important book on Yoga for Scoliosis that contributes to the a articles on tyengar Yoga. science, and philosophy of yoga asana and pranayama practices. Elise has learned | that her yoga practice ia not only a way of Wie, but has also helped her overcome Gt pain associated with her scoliosis, a spinal curvature condition she was diagnosed Gt with as a teenager. As a fellow Iyengar Yoga practitioner, | have come to know Elise. I have been impressed with her passion to share her knowledge of yoga and Gr of how those living with scoliosis can use yoga to help their condition. Gt Elise presents an extensive and eaty-o-nderstand description of scoliosis for Gr those who have this condition and for those who teach students with scoliosis. This Gy book guides the reader to understand this spinal condition. Elise provides a Gr valuable service to students ranging from the raw beginner to the experienced c practitioner, explaining how they can use Iyengar Yoga to do asana and pranayama a to work with bringing balance to the asymmetries of their body. Gy Herlove ofan decision to yoga shies throughout this book. The bok cy interactive and inspirational. Elise relates her experiences to encourage novices, Cy even those who may be hesitant, to use Iyengar Yoga for scoliosis. She shares her e joy with meaningful statements made by BK. Iyengar and Geeta S. Iyengar and c! with personal stories of her experiences in her studies with them. ec! ‘Throughout the book, she reminds the reader about the four curve patterns c! ‘and shows how to work in each pose with them in mind. She lays a good founda- e! tion to go deeper on the path of yoga when one has scoliosis. Certified Iyengar t ‘Yoga teachers can also use this book to understand the needs of their students c with scoliosis. She depicts hands-on adjustments for the teachers. The photos are ec! clear and accompanied by easy-to-follow instructions. el Read this book cover to cover and continue to use it as a reference guide, el either as a yoga student with scoliosis or as a yoga teacher. In the case of the latter, el when a student with scoliosis attends your class, you will be well prepared to guide B them in their practice. e al a al ae 8 Yogs for Scoliosis -Forewonds eeVUVUBYVLVUVUYLLULUUUL UU UU LULU LULU UU UU UU UU Patricia Walden ‘ve worked with people who have scoliosis in my yoga classes for years, and I although it’s not my area of expertise, I've been able to help them by applying ‘what I've learned from watching my teacher, BS. Iyengar, and by referring to ‘an old spiral bound copy of Elise Browning Miller's Yoga for Scoliosis teaching, manual, Now when I want to know how best to guide a student with scoliosis, Il reach for this book Elise and her co-author and student DL describe in detail what scoliosis is and the complications that can result when it reveals itself through different patterns in different people. They've also included instruction on how to map out your student's pattern or your own pattern if you have scoliosis. Finally, they explain how to address its many unique physical challenges through adjustments in the poses that offer the best potential for improving balance and well-being ‘Something I've come to understand about my students with scoliosis is that ‘many, especially women, feel shamed by the experience. The diagnosis can feel like a separation from others, a stigma. In the yoga teachers’ chapter, Elise and DL. give guidelines on how to work physically and psychologically with scoliosis students. Also, the chapter on pranayama is invaluable for the basic instruction it offers on the inner journey of the breath, which is like medicine for the heart. All of the insight and knowledge specific to breathing, alignment, and adjust- ‘ments comes from Elise’s own experience and the guidance she received directly from our teacher, Mr. Iyengar, and his daughter, Geeta S. Iyengar. Elise was blessed to be their student. And the spark of their meeting, the spark of that blessing, shines its light throughout this book From my perspective, this is a book that Elise has been working on her entire life. This is the work she is meant to do. Through the rare alchemy of wisdom and delight that comes through her teaching, she leads us to explore our bodies, appreciate joy, and be inspired to taste and savor our own process of healing ourselves. The knowledge contained in this book is essential for yoga teachers and for all yoga students who have scoliosis. What Elise and DL. are offering in Yoga for Scoliosis will benefit so many. Patricia Walden is one of two North Americans to hold & senior advanced cerucate in the lyengar method. She teaches weekly classes in Cam bridge, MA. and at Downtown Under Yoga in Newton, MA She is the | corauthor of The Woman's | Book of Yoga and Health, Forewords- Yoga for Scoliosis 9introduction “There is beauty in curves. There is beauty inan oak tree as well as a palm tree.” Elise Browning Miller 10. Yoga for Scoliosis - Introduction ‘mately 20.4 million people practicing yoga in the United States alone. The "National Institutes of Health is now conducting research to show the many therapeutic applications of yoga, ranging from back issues to stress reduction Using yoga to manage the effects of scoliosis, an asymmetrical curvature of the spine, is also becoming more recognized by prominent doctors, chiropractors, and physical and massage therapists as a means to reduce pain and find more symme- try and balance in the spine. Previously, doctors would say there was nothing that could be done for scoliosis unless the curve was s0 severe (at least fifty degrees or ‘more) that surgery to fuse the spine was recommended. In the past, the prevailing belief was that exercise did not have any benefits for those with scoliosis. Even now, for a moderate curve, doctors often prescribe a brace for the spine. Often parents of teenagers with scoliosis or adults with scoliosis look for alternatives to surgery and instead choose to be proactive before having a rod or rods surgically inserted along the spine. Although scoliosis is generally thought of as a problem for adolescents, the condition is actually becoming far more prevalent older adults. An article ran in the New York Timesin October 2013 called “Scolio- sis Can Hit Well Past Adolescence,” and it reported that, “In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees.” The article also spoke of a physiatrist, Dr. Loren Fishman, who, after reviewing the author's X rays, prescribed 1 yoga pose, Vasisthasana (or Side Plank Pose): “Because of the core and back muscle strength required to maintain symmetry in the body while balancing on one hand and one foot, he believed this pose would strengthen the muscles on the [right] and exert enough of a tug on her spine to keep it from protruding farther to the right, He suggested that the exercise might even lessen the curve.” On October 30, 2014, the Wall Street Journal reported on research published in the September issue of Global Advances in Health and Medicine. The research revealed that practicing Side Plank for a few minutes a day reduced spinal curva- ture by almost 50 percent in teenage practitioners and 38 percent in adults. Imagine then, what a full yoga practice could do for those with scoliosis! ‘Yoga for Scoliosis is a practice that is empowering both physically and mentally for those who live every day with the effects of a spinal curvature. By gaining experience through a daily practice, skills in self-reflection, and awareness of patterns that have developed from imbalances, each person becomes his or her own healer. Y (ga is now in the mainstream. According to Yoga Journal, there are approxEli: Personal Journey hen | was fifteen years old, | found out that | had scoliosia My pediatrician ‘examined me one day and saw that when he had me bend forward at the ‘waist my right back ribs were protruding He told me I had scoliosis, « Jateral curve of the spine with vertebrae that rotated. | was sent to an orthopedic surgeon specializing in scoliosis. He took X rays of my back that revealed right | thoracic forty-nine degree curvature with a compensating left lumbar curve. He recommended surgery immediately was a very athletic teenager, I played on the varsity tennis and basketball teams and was alarmed when I found out that ! wouldn't be able to play sports for the rest of ‘my high school years, Instead, if I had surgery. 1 would be in the hospital for a long period of time and could plan on at least a year’s recovery. My brother was doing his residency in pediatric cardiology at Boston's Children’s Hospital, and he recommended that I get a second opinion from a well-known orthopedic surgeon who specialized in scoliosis, Dr. Harris. After Dr. Harris, who was in his sixties, examined me, he told me that my growth spurt had ended and he felt sure that the increase in my curve would subside, He said that too many young surgeons were recommending surgery for too litle a degree of curvature and that there was much I could do to stabilize my curve. He recommended that I wait a year, continue to be active in sports, and start swim- | ming regularly with @ focus of the backstroke But it was the next thing he said to me that changed my life. He told me he had ‘But it was the next recently read a book on yoga and he believed that its breathing, stretching, and thing he said to me that strengthening could be good for those with scoliosis, He was going to research it | changed my life. He told further, and would examine me again in year to see if my curve had stabilized. fit me he had recently read had increased, then we might consider surgery, In the meantime, he said I should swim | q book on yoga and and continue my other athletic endeavors. | Took back at that meeting with the late Dr. Harris in 1964 and realize how far “<*> ‘ahead of his time he was. This was the diagnosis I wanted to hear, and that small breathing, stretching, ‘mention of yoga had left an impression that would bring me to yoga years later. and strengthening could I began to swim regularly. | completed high school while excelling in varsity sports | be good for those with ‘and then went on to swim throughout college on the varsity team. After graduating, I scoliosis.” Joined the Peace Corps and was assigned to Brazil. While serving in the Peace Corps, | lise Browning Miller T was more sedentary than I had been before and did not get the opportunity to swim. I started to have back pain. It was then that a fellow Peace Corps volunteer introduced me to yoga, and I immediately felt a release of my pain, ‘After returning to the United States, I lived in a yoga ashram for several months and became a yoga teacher with the Integral Yoga Institute in New York City. Part of the practice involved long periods of sitting meditation and chanting, and I found this Wa. very difficult to do without pain. | started to notice the asymmetry in my body when | practiced the yoga asanas (poses), but I had no clue how to correct the imbalances. | Sometimes when I did my yoga asana practice, I would feel more balanced; other times, I would actually have more back pain eventually moved on to graduate school at the University of North Carolina, ‘where I specialized in therapeutic recreation. | took many anatomy and physiology classes with physical therapists, and I started my research into the many physical therapy approaches to scoliosis. Soon after obtaining my master’s degree in 1973, a friend handed me Light on Yoga, the now-famous book by BS. Iyengar. My friend told ‘me, “This is the book you need to read.” How right he was. In the summer of 1975, my then-husband and I moved to the West Coast and eventually settled in the Bay Area. I was fortunate enough to meet Mary Dunn, Judith Hanson Lasater, and Rama Jyoti Vernon, who are all now internationally respected as ‘yoga teachers and practitioners influenced by Iyengar. We would practice yoga to- | gether when we were preparing for BK S Iyengar’ visit to the Bay Area in 1976. I felt very fortunate to be able to attend the workshop with Mr. Iyengar, and it changed my VUVUUUUA UU UU Uv Introduction - Yoga for Scoliosis 11IMfe's direction. One of the areas he focused on during his visit was alignment of the body. | remember while | was practicing standing poses, he would often adjust my right ribs forward (they were protruding back) and bring my right shoulder blade my back (it was winging out away from my ribcage). In all the yoga that I had done previously, no one had adjusted me or given me a sense of what alignment felt like His adjustments and instructions on alignment in the poses gave me tremendous relief from the pain | had been experiencing. This opened my consciousness to the idea that it might be possible to stabilize my curve to keep it from getting worse and even & = possibly to decrease the curvature with yoga practice. | came out of the workshop (el . feeling more balanced than I had ever felt in my life, and I decided to dedicate rny life ‘In all the yoga that 1 to yoga. I started to practice from the sequences Mr. Iyengar includes in the backot (I had done previously, no Light on Yoga, and | attended classes at the newly founded lyengar Yoga Institute of (al one had adjusted me ‘San Francisco. | graduated from the Institute in 1978, and then from December of that (ol orgiven me a sense of year to January 1979, | attended a yoga intensive with Mr. lyengar at the Ramamani 9 what alignment felt like. Hyeng Memorial Yoga esate (RUM) ln Les or ‘or me tom . (el experience made me a ues come up for me from living wit His adjustments and scoliosis. | had always felt that I was handicapped with a crooked spine and that { (s instructions on align- ‘would never be a balanced human being. The time at the Institute made me confront. (9 ‘ment in the poses gave ‘my limitations and, atthe same time, Mr Iyengar gave me the guidance to go beyond (@ me tremendous relief those limitations with a new awareness of how to adjust both my body and conscious- (4 from the pain I had ness to a more balanced state. been experiencing. This opened my conscious- From Student to Teacher ness to the idea that it | ver the past forty years, I have traveled many times to India to study with the might be posible O itr engur hs dagher Geta and his Prashant. conn to al stabilize my curve, to con my understanding of how to work with my own scoliosis and have also keep it from getting assisted in the medical classes atthe Institute to help others learn how to use yoga to worse and even possibly ‘work with their scoliosis. I am now a senior certified Iyengar Yoga teacher, and since I decrease the curvature 1980, Ihave owned Calfornia Yoga Center in Mountain View, California, where I teach. I give Yoga for Scoliosis workshops around the world and have a private practice where I see students with scoliosis and prescribe a program that addresses their particular curve. ‘Through my personal practice, my many visits to RIMYI in Pune to study with the | tyengars, and the help of many of my teachers—including Judith Hanson Lasater, Patricia Walden, Manouso Manos, John Schumacher, Ramanand Patel, Lois Steinberg, | with yoga practice.” Elise Browning Miler Joan White, and many more—I have lessened the degree of my right thoracic curve ‘and have avoided the surgery to fuse my spine that was fist mentioned to me when I was fifteen. | am very grateful to my teachers and my yoga practice. I feel it is both my passion and my duty to pass on what I have learned over the past forty years to all children, adolescents, and adults with scoliosis. ‘Throughout the years, my personal practice has been the key to addressing my scoliosis. | tell my students that it’s a daly yoga practice that will make the difference of how you cope with your scoliosis, even if it's just twenty minutes a day—though an hour a day or more is ideal. It’s not enough to just go to a class once a week. Instead, ‘you need to imprint balanced alignment into the body by addressing your asymme- ‘ries daily and then refining your practice to meet your needs. From my personal | experience, not all yoga styles adapt the poses to address the needs of a person with | scoliosis. Some methods of practice could even make spinal curvatures worse, | especially if you are extremely fiexible and unaware of your curve pattern. Without an | experienced teacher to offer guidance, you could actually reinforce your asymmetrical curve pattern in the poses. Having scoliosis has been a blessing in disguise. If I did not have scoliosis, perhaps | {wouldnt have beens dscptined with my yoga practice or maybe 1 would have discovered yoga at all. Yoga has led me to meet and assist those with scoliosis on their 1.2. Yoga for Scoliosis Introduction DRIDDDD DHA HPAP PPPMRIVVPIPIAAAAGHDDJUUUUU UU PU Z 2 5 5 5 a ray 3 a > o - roy roy o > J Journey to address the imbalances and the myriad effects of living with an irregular curvature of the spine, In this book, I hope to guide many more of you who live with scoliosis on how to develop a practice. I have also designed this book for teachers who want to learn to help their students with scoliosis (especially if attending one of my teacher training programs is not a possibilty) If more people understand how to use ‘yoga as a practice to address their own scoliosis and how to assist yoga students with ‘scoliosis, more people will be empowered to decrease their pain and perhaps even prevent unnecessary surgeries ‘One of my Yoga for Scoliosis teacher trainers is nancy DL. heraty. She has agreed to assist me in writing this book. Very rarely do I meet teachers who do not have scoliosis themselves but have an innate understanding of how to work with students who live | with scoliosis, DL is one of those teachers. She not only has the ability to understand scoliosis but also relates to her students with scoliosis as if she were living with scolio- sis herself. | experienced this same quality with B.K.S Iyengar. Though he did not have scoliosis, it was as if he was able to separate from his own body and experience from the inside out how to help those with severe spinal curvature. DL has the passion, the desire, and the intuitive sense to help those with scoliosis. ‘Through her process of self-healing through yoga, she has developed the strength of will to help others heal themselves through yoga. | recognized this quality in her | immediately when we started to work together, which made me feel we could collabo- rate well in writing a book on scoliosis. She has been the driving force in helping me write this book, and I am very grateful for her input and contributions. ! have loved every minute of our collaboration, DL’s Personal Journey and two pregnancies and births. | am also a potter. Lifting heavy boxes of clay and the asymmetrical, twisted, leaning, and seated postures I put my body into to throw pots on the wheel also caused an increase in back pain. I learned that Ihave a very flexible lumbar spine, also known as lordosis, and this particular physical characteristic served to increase the pain in my lower back as well as bring on bouts of sciatica pain. I lived in a swayback position with my belly protruded, my shoulders rounded, and my hhead jutted forward. I had pain bending over. I had great pain from backbending. My back and legs were so tight that I could barely touch my knees if my legs were straight. Thad shooting pain along my outer left leg down to the knee that would keep me up at night. I tried going to a chiropractor, which helped for short periods of time, but I felt I needed to do more as the effects of the adjustments would not last and the pain would eventually visit again. Then | found yoga. My first classes were so hard to keep up with. I constantly compared myself to the other students, who all seemed to be much more flexible and appeared to know what they were doing. I kept going though, and some- how I was drawn in. I suppose I was hoping to improve myself to what I saw as the other students’ abilities. It helped to have a good teacher who continually encouraged me and gave me suggestions, one being to practice at home. | was a ceramics teacher at that time, and so I was naturally drawn to the idea of teaching. As I practiced yoga more and more, I became interested in sharing what I loved to do. Following in my first teacher's footsteps, I started teaching Vinyasa Flow ‘Yoga. Vinyasa (as i's sometimes called) is a style of yoga that often instructs students to move quickly, flowing from one pose to the next while synchronizing their move- ments with their breath, After years practicing in this way—with litte or no attention to alignment—my sciatica pain became aggravated, and I realized I needed a new direc- tion. This style of yoga was not serving me well. I was actually being served up to it. ‘Ten years later, when I was forty-five, | met Gabriel Halpern, an lyengar-trained I found yoga when I was thirty-five and suffering from back pain due to poor posture teacher in Chicago. He taught me about proper alignment in poses, careful sequencing “Then I found yoga. My first classes were so hard to keep up with. I constantly compared myself to the other students, who all seemed to be much more flexible and appeared to know what they were doing. T kept going though, and somehow I was drawn in.” nancy DL heraty Introduction Yoga for Scoliosis 13| 9 Poses. and important teaching oil He eacowraged ma to sow down and sdy my body as | held myself in yops poses for longer periods of time. As a result of practicing this way, | beyan to feel less pain. | also had an increased awareness of how | was standing, sitting. and carrying my body in other ways. whether | was at : Computer driving, or standing and cooking Instead of aggravating old injures. ‘He encouraged me 10 practice started to help me become aware of how my posture. patterns. and habits slow down and study my | ere contributing 10 my back pain ‘open in my chest, much more flexible in all positions, and, in my mid-fifties, better able to participate fully in an active teaching and home life. Bending forward and ‘backward, twisting, inverting, and reaching my toes without pain are all among the benefits that I enjoy now. Without yoga, I believe I would be in great pain and unable to participate fully in my life. 1 gravitated naturally to helping those with back pain in Gabriel's therapeutics classes. I began to see in my own general-public classes that students with back pain also gravitated toward me. When I attracted several students with scoliosis in my | classes, I did not know how to help them, and in fact I was alittle afraid of teaching them. Gabriel encouraged me to study more and to research and glean information | about anatomy, physiology, and how yoga is used to heal scoliosis. He also encour- aged me to look into Elise Browning Miller's work. In 2009, Elise traveled to Chicago to teach a weekend workshop at Gabriel's | studio. After the first half of the first day in that workshop, I felt called to work with | her. After attending two levels of workshop trainings and completing her practicum | course, I joined her group of Yoga for Scoliosis trainers. Now I offer classes in Yoga for Scoliosis and Yoga for Back Care in the Chicago area. When I approached Elise about writing a book together that would take her Yoga for Scoliosis manual into greater depths, we agreed that our students and teachers were ready for more. It is important for me to share all that I've learned in my yoga practice so that others can find freedom from back pain and feel more at home in their bodies, with all their curves and twists. I have seen in my students and experi- enced in my own personal practice the beauty of alignment and of wellness in body and mind, May your path be enlightened by yoga! body as I held myself Gabriel taught me to bepin to understand the potential of yops as therapy in yoga poses for longer | ventualy, he invited me to work alongside hien in his therapeutics clauses. assisting periods of time. Asa students with various aliments of the body | worked with him for seven years ax an result of practicing this Apprentice in his therapeutics classes and then for five years as his ansiatant in his way, [began to feel less | ditlonal classes and workshops This training was invaluable 1 my development as pain.” nancy DL heray | YRS Feacher and yop therapy apectaliat. Most importantly, has taught me how to care for my own back issues, which in turn has fostered my compassion for others Who suffer from back pain. Moving Away from Pain ; ; | rom the work | did with Gabriel and in my own practice to heal my spine and ‘ok Priston yore hao pan aa (ob patience and practice were the keys to releasing pain. | developed several sequences for myself that contributed to renewed health and freedom from pain (ob Active strength-building practices, practices that elongated my spine and released (ob tension in my tight muscles, relaxation, deep breathing. and supported restorative let practices were all in my play book. | installed a rope wall in my home and used many props for my poses. Developing these sequences and practicing them daily, being (at ‘aware of my own patterns in daily life and then correcting and realigning those (oh patterns, and taking time to rest are still to this day, a great relief. | fee! taller, more os f 14 Yoga for Scoliosis Introduction WIIIIVIIANANANDAAAHATSJVVUVUV UU UU UU VIVIVIVVVVVUU ‘ VIIIVVIVIV all about ~ SCO When Iwas diagnosed as a teenager, the orthopedic surgeon had not explained hich side my curve was on, why my spine went tothe side, or why my ribs were rotating and creating a hump. | started practicing yoga and wanted to address my scoliosis but I did't havea clear image of what my back looked lite For years, Thad forgotten about it, since I wasnt in pain. But when I started to have pain in ‘my twenties, I came out of denial and wanted to understand everything about my scoliosis. At this point, Ihad done a litle yoga, but Iwas not sue which poses were helping my back and which were making it fel worse or making the curve increas, Understanding the way in which my spine was misaligned and why [elt rotated seemed crucial to understanding how to practice yoga to counter my curves and lessen the pain, Elise Browning Miller Definition and History of Scoliosis ‘component. The word scoliosis is derived from the Greek word skolios, which means “crooked” or “twisted,” and from the Germanic root skel, or “a bent or curved part of the body.” Scoliosis was a term frst used by the ancient Greek physician Galen more than eighteen centuries ‘ago, and Hippocrates treated scoliosis with bracing in the fourth century BC. Scoliosis has been discovered in cave paintings, so we know it has existed in humans since before recorded time. A spine with scoliosis has shifted laterally, forming an S- or C- shaped curve, and with that curve, the spine rotates at the same time. S== is an abnormal lateral curve of the spine with a rotational Structural and Functional Scoliosis or nonstructural, scoliosis A structural curvature isa structural misalignment of the bones of the spine in which vertebrae are stuck in a rotated position and the disks between the vertebrae become compressed, causing the verte- brae to become wedge shaped. In most structural scoliosis cases, another part of the spine curves toward the opposite side to compensate forthe initial lateral curve. This secondary curve results in what is referred to as functional scoliosis. A compensating curve helps the body stay upright rather than leaning completely into the structural curve. In cases of structural scoliosis, there T= are two types of scoliosis: structural scoliosis and functional, |OSIS HOME PRACTICE If you are planning to have an at-home yoga practice, iis essential to understand the anatomy and physiology of scoliosis and your pattern ‘of scoliosis. In other words you will need to be able to answer these questions: * Does the curve move to the left or right of center? + In what part of your back does it appear, the upper or lower back? * Do you feel that one side of the back is protruding further back like a hump? + Do you notice if there is more than one curve? Let's explore more about scoliosis and see if we can paint a picture that will sive you a clearer understanding of your scoliosis ANOTE FOR TEACHERS Its essen- tial for you to have this understanding so you can identify the pattern of your students’ scoliosis and then be effective in guiding them into the right poses and showing them how to adjust themselves in the poses. Understanding the terminot- ay presented in this chapter will help you understand physician reports and X ray analyses and speak knowledgeably to professionals All About Scoliosis: Yoga for Scoliosis 15Facts Structural scoliosis affects 2 to 3 percent of the population or an estimated seven million people in the United States while functional scoliosis has been estimated to be evident in 80 to 90 percent of the population. It has been estimated that ap- proximately 75 to 85 percent of scoliosis cases are idiopathic, approximately 10 to 15 percent are congenital, and approximate- ly 10 percent or less are second- ary to a neuromuscular disease. Figure 1 is usually a higher degree of curvature, and the degree of curvature is ‘much more likely to increase. Functional scoliosis is caused by an imbalance of the functioning of, muscles associated with the back and does not usually alter the structure of the bones or body Sometimes, functional scoliosis is seen without structural scoliosis being present. This is when the spine takes on a lateral curve as a result of everyday tasks that repeat and create an imbalance in the body. Functional curvatures can be caused by actions that repeatedly ‘stress or shorten one side of the body, including poor postural habits, movements that involve only one side of the body, and carrying a heavy object on one side of the body (such as carrying a heavy book bag on one shoulder or carrying a baby on one hip). Leg length discrepancy is another cause of functional scoliosis. Functional scoliosis of this type is not considered trué medical scoliosis and can usually be reversed by yoga and ‘ther modalities that lengthen the spine, strengthen the back muscles, and develop proper posture. Ergonomic principles may also help bring the ‘spine back into alignment Causes of Structural Scoliosis coliosis is typically classified as either idiopathic (cause unknown, S subclassified as infantile, juvenile, adolescent, or adult according to when onset occurred), congenital (caused by vertebral anomalies present at birth), or neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, polio, cerebral palsy, spinal muscular atrophy, or physical trauma) ‘Adolescent idiopathic scoliosis has no clear causal agent, and itis generally believed to be multifactorial, although genetics are believed to play a role. Various causes have been implicated, but none of them have consensus among scientists as the cause of scoliosis, though the role of ‘genetic factors in the development of this condition is widely accepted, as evidenced in multiple cases of scoliosis found in family lineages. Still, (according to a study released by the American Society of Human Genet- ics in 2007) at least one gene, CHD7, has been associated with the idio- pathic form of scoliosis. Structural idiopathic scoliosis impacts infants, adolescents, and adults worldwide with little regard to race or socioeco- nomic status. The primary age of onset for idiopathic scoliosis is ten to fifteen years old during the adolescent growth spurt. Females are eight times more likely than males to progress to a curve magnitude that requires treatment, A hormonal component seems to be evident for ‘women since the degree of curvature often increases during adolescence, pregnancy, and menopause. ‘As stated in the Introduction, a recent study published in the New York Times in October 2013 showed that 67 percent of adults over the age of sixty were diagnosed with adult idiopathic scoliosis. Some cases of scoliosis identified in adulthood could have begun in childhood or adoles- ‘cence without being diagnosed. Scoliosis can also develop spontaneously. Unlike other forms of scoliosis that are found in children and teens, adult onset scoliosis is often ‘caused by changes in the spine due to a type of arthritis known as spon- dylosis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to a curvature of the spine. The spine can also be affected by osteoporosis, vertebral compres- sion fractures, and disk degeneration, which is sometimes called degen- erative scoliosis,VVUVVVVVVVVVUUVVUUUUU UU UU OU UU UU UU UU UU UU UU Congenital scoliosis (Figure 1) can be traced to a malformation of the spine during weeks three to six in utero. It is a result of either a failure of formation, a failure of segmentation, or a combination of both, This type of scoliosis is much more severe and needs more aggressive treatment than other forms of scoliosis, Anatomy of Structural Scoliosis ‘all have curves in our spine, But the structural curves that, Wier the healthy workings of the spine are the natural, sagittal curves that move from front to back in the median plane (Figure 2). When a baby is born, the spine isin flexion, also known as the fetal position, This is a convex curve. As a baby learns to raise his ‘or her head, a secondary curve develops where the neck or cervical spine hhas a concave curve going inward, When a baby begins to crawl and then ‘walk, another concave curve develops in the lumbar region of the spine, or the lower back. The sacrum, made up of five fused vertebrae in the center of the pelvis, is a convex curve like the mid-back. These four impact, and prevent compression of the disks. Structural scoliosis is created when the growth and movement of the vertebral bones shift the spine out of its natural vertical plumb line, The vertebrae deviate to the side and sometimes rotate on their axes (Figure 3). This rotation distorts the alignment of the ribs (since they are con- nected to the spine) and creates the more noticeable physical characteris- tic of arrib hump. ‘The ribs are connected to the spine and follow its lateral and rota- tional alignment (see Figure 4, page 18). With idiopathic scoliosis, the sides of the vertebrae grow unevenly, causing the lateral and rotational ‘components of the scoliosis. The vertebral body distorts toward the ‘convex side, and the spinous process deviates toward the concave side (Figure 3). ‘When scoliosis occurs, the lateral curve (the right side of the thoracic area in Figure 4, page 18), causes the ribs and intercostal muscles between the ribs to move sideways, spread apart, and rotate backward. This is called the conver side of the back. On the opposite side of the lateral curve (in this example, the left side of the thoracic area), the intercostal muscles are atrophied and the ribs are compressed, With the rotation of the spine, the ribs on the left are pushed forward toward the front of the body, forming a flat back. This is called the concave side of the back. As a result of these lateral and rotational movements, there is postural misalignment: the ribs are rotat the shoulders can be at different heights, with one shoulder blade more prominent than the other; and one hip may be higher than the other resulting in an uneven waist (see Figure 4, page 18). The head is sometimes not centered directly above the pelvis and the entire body can be leaning to one side. The most obvious symptoms of tural curves provide shock absorption on the spine, reduce gravitational ‘These are the four natural curves of the spine, The seven vertebrae of the cervical spine are concave, the twelve vertebrae of the thoracic or dorsal spine are convex, the five lumbar vertebrae create a concave curve, and the fused sacrum and tailbone are conver. Al! Avot Scoliosis. Yoga for Scoliosis 17Figure 4 Figure 5 Erector Spinae Muscles 18 Yoga for Scoliosis - All About Scoliosis scoliosis are cosmetic, but pain and discomfort are also common, In extreme cases of people may experience cardiopulmonary and digestive complications as well Muscles Affected by Scoliosis you have structural of functional scoliosis, the muscles are greatly affected by this imbalance To be strong, every muscle in the body needs to have the ability to contract and stretch Even a tight muscle is not necessarily strong if it does not have the ability to stretch. I's not uncommon for the same side to always tighten and become ‘controlling side in every activity, including ‘simply bending over to pick up an itern off the floor. That isthe side that does all the work. It is important not to overindulge that tendency. On the convex side of the curve in the thoracic area where the hump is located, the intercostal muscles (Figure 6a) between the ribs are overstretched. This can also create a weakness of these muscles. Muscles overlapping the ribs and intercostal muscles often become tight and overdeveloped, resulting in a gnawing sensation of tension and dull pain. These are often the erector spinae muscles (Figures 5 and 6a), or paraspinal muscles. You might feel a sensation similar to a clamping down on the ribs as a defense to keep the intercostal ‘muscles from overstretching and prevent the ribs rotating further. In addition to a daily yoga practice, massages and deep tissue work can help to release the tightness of these muscles. (On the concave side of a thoracic curve, the intercostal muscles between the ribs become underdeveloped and even atrophied. As a result, the ribs compress together and breathing capacity is limited. On an inhalation, the breath will go mainly to the convex side, where the inter- costal muscles are stretched. As a result, they expand the ribs more easily and bring more oxygen into the lungs on the convex side. On the concave side, the breath will not move as easily into the lungs because the inter- costal muscles are weak and not able to fully stretch. Often, muscles on the concave side are weaker. Breathing in this pattern can actually pro- mote the progression of the scoliosis. Other muscles that are affected are the erector spinae muscles (Figure 5 and 6a), which are often weaker. and the exterior latissimus dorsi muscle (Figure 6a), which attaches from the pelvis to the shoulder girdle and may also be weaker. ‘Another muscle that often becomes tight in the upper thoracic and neck area is the trapezius muscle (Figure 6a). The trapezius muscle is @ broad triangular-shaped muscle originating from the center of the back, extending from the lower thoracie spine to the base of the skull, and inserting on the scapula and clavicle, Because the rotational component of the ribs and mid-back form a hump on the convex side, the shoulder on that side may be higher and round forward, causing this muscle to tighten. ‘This may also cause neck tension since there may be a tlt of the head from the thoracic curve or a compensating curve in the neck and upper thoracic area. In the lumbar area of the spine, or lower back, the erector spinae muscles (Figures 5 and 6a) will also be affected. On the convex G DPPPPO PAPA PM PPMMAIDINANAKS f; \\ SET / | All About Scoliosis - Yoga for Scoliosis 19 ' NT Quadratus Lumborum —_—_— Figure 6a DONO NON AAA AAA AA AAAI NA DONO OOOO OOO. OO. 0.0. 0.0.6 6,Figure 7 | Examples of Adams Forward Bend Test | Spine with Scoliosis, Straight Spine At times, both sides of the psoas can be tight, and I have seen cases where the convex side is tighter or as tight as the concave side, The psoas can also be weak, particularly if someone is sedentary. Else Browing Miller 20. Yoga for Scoliosis All About Scoliosis side where the curve is moving laterally, there is a rotation posteriorly in the lumbar area. Often muscles on this side become very tight. including, the quadratus lumborum muscle (see Figure 6b, page 19), also known 4s the QL, which attaches from the posterior iliac crest of the pelvis to the transverse processes of the lumbar spine and the twelfth rib. When muscles become tight, their strength is diminished. On the concave side, the muscle shortens and becomes weak. In some cases, the pelvis will even ride up close to the ribs, with little muscle development. In essence, the muscles on each side of the back may be weaker than # normal back ‘result of the rotation and lateral aspect of the scoliosis. ‘A significant postural muscle group called the itiopsoas muscles (Figure 6b, page 19), also known as the psoas and iliacus muscles, are ‘greatly affected by scoliosis. The iliopsoas are actually a combination of three muscles: the psoas major, psoas minor. and the iliacus. The psoas major in particular has its origin from the first through fifth lumbar verte- brae and the twelfth thoracic vertebra and inserts at the inner trochanter of the femur or thighbone. It is a hip flexor, and its job, along with the quadriceps, or front thigh muscles, is to lit the leg, When the leg lifts. these three muscles contract and when the front of the thigh is stretched, the quadriceps and psoas muscles are stretched. With scoliosis, the spine is moving laterally and is rotated in the lower back, with one side of the pelvis lied higher (as in lumbar and thoraco-lumbar curves), and the psoas muscles will often contract or tighten more on the concave side of the scoliosis. ‘The diaphragm (Figure 6b, page 19) is important in addressing respiratory dysfunction caused by scoliosis. This is a dome-shaped muscle like an umbrella, with radiating fibers located between the thoracic and abdominal cavities. This muscle plays a primary role in breathing capacity. ‘When it contracts, it draws downward into the abdominal cavity, increas- ing the volume of the chest cavity. When this happens, the air pressure in the chest cavity decreases relative to the air pressure around the body, and since nature abhors a vacuum, air rushes into the nose or mouth to balance out the pressures. Voila, you have inhaled! Conversely, when the pressure within the lungs is greater than the atmospheric pressure, exhalation occurs. On the exhalation, the diaphragm releases and ascends toward the thoracic cavity, moving air out of the lungs. Using diaphragmatic breathing rather than shallow breathing is vital to those with scoliosis. Because there is potentially less breathing capacity for those with scoliosis, utilizing the diaphragm to expand the lungs will increase breathing capacity and cardiopulmonary functioning by decreas- ing cardiac workload. It also increases digestive functioning by massaging the internal organs and allowing for more effective oxygen delivery and ‘waste removal at a cellular level. Lastly, it maintains equilibrium in the autonomic nervous system. Made up of two divisions, the autonomic nervous system is divided between the sympathetic nervous system and the parasympathetic nervous system. The sympathetic nervous system helps you respond to emergency situations and, as a result, increases heart rate, constricts blood vessels, and increases blood pressure. The parasympathetic nervous system regulates the body's natural processes during periods of rest and relaxation. When it’s activ, it slows down the heart rate and increases intestinal peristalsis and gland activity. When you take shallow breaths or have irregular breathing, this will only stimulate the autonomic nervous system, eventually creating an imbalance. With scoliosis, it is especially important to breathe consciously into the dia~ phragm so that the breath will expand into the lungs as fully as possibleVVUVUVVUVUUVUUUUUUUU UU UU UU UU UU UU UU UU UU and expand the ribs, particularly where itis needed on the concave side. Also, by focusing on releasing the breath from the diaphragm. the exhala- tion will be smooth, deep, and slow, creating more balance between the ‘sympathetic and parasympathetic nervous system. Testing for Scoliosis ollosis but that practice has fallen off since 2004 when a federal ask force said thatthe screenings weren't effective. As a result of the National Scoliosis Foundation supporting the education of school nurses, physical education teachers, and other professionals to screen pre-teens and teenagers in schools and other locations, there are now {twenty-four states that conduct such screenings (Adams Forward Bend Test, Figure 7), This organization is committed to encouraging other states to participate in these early detection screenings. Scoliosis is also often detected during regular medical checkups and sports physicals Medical doctors, particularly orthopedic surgeons specializing in scoliosis, will give a full examination of your back. chest, fet, legs, pelvis, and skin. ‘The doctor will also check to see if your shoulders are level, your head is centered, and the opposite sides of your body appear even Doctors will perform the Adams Forward Bend Test to determine if you have a structural scoliosis by having you bend forward with a rounded spine. If there is any significant asymmetry between opposite sides of the bbody where one side of the ribeage is higher than the other or there is a bulge in the lumbar area, then itis defined as a structural scoliosis. If there appears to be asymmetry with shoulders, back muscles, or hips while you are standing yet when you are bending forward the spine appears aligned in the center of the body with little or no rotation, then itis functional, or nonstructural, scoliosis. Should your medical history or physical examination suggest possible structural scoliosis, a series of two X rays willbe taken: one X ray from the back and the other from the side. Each X ray captures the entire spine. Occasionally the doctor may need additional tests if there are other issues. If you require an X ray evaluation, the doctor will measure the curve on the X ray by the Cobb Angle Measurement (Figure 8), named after the American orthopedic surgeon John Robert Cobb. This method is used to measure the amount of curvature in the spine. Lines are drawn paralel to the end plates of the vertebral bodies at the beginning and the end of the curve. A second line is drawn perpendicular to each of the first lines, and the angle between these two lines is equal to the Cobb measurement. Itis important to realize that the Cobb measurement is never exactly the same each time the spine is X rayed since the measurement is affected by the position of the patient, the way the X ray is taken, and the way the lines are drawn. As a result, there isa standard measurement error of three to five degrees. Therefore, major treatment decisions should not be made upon single measurements and small changes. ‘Computers are now commonly used to measure the degree of curva- ture, so measurements have been more reliable in recent years. The Cobb ‘measurement should be in the radiographic report (part of a patient's chart) and therefore, will last far longer than the radiographs, which are often recycled after five years or so. Scoliosis is diagnosed as a mild scoliosis if it measures below twenty degrees. In this case, treatment is not recommended but regular checkups are encouraged. A moderate degree of scoliosis is clasified from twenty S chools in the past have regularly tested for adolescent idiopathic All About Scoliosis- Yoga for Scoliosis 21degrees to forty-five or filty degrees approximately, and often bracing is recommended. Fifty degrees and above, where the severity of the lateral rotation of the curve may increase more rapidly and may cause cardiopul- monary or digestive dysfunction, or both. is classified as a severe scoliosis. For cases this severe, surgery is often recommended. Bracing Options ‘ou may have a brace prescribed for your scoliosis in adolescence cg 1 an example of a brace in Figure 9). The type of brace that i 6 recommended is determined by the type and severity of your o ccurve pattern. Braces can be custom-made from a mold of your body Bracing options range from hard plastic that wrap the torso to more flexible elastic bands that are ited to a pelvic pant. The brace stabilizes the body, bringing it back into alignment and preventing the curve from progressing Braces should be worn every day for the prescribed time unt = (@ BE ‘you stop growing. Some bracing options include specific exercises to ‘ab practice while in the brace ‘ab Fusion Surgery (ad Figure 9 (ok ‘ome of you may have had spinal surgery to correct the curvature ; (Figure 10). It is recommended for patients to undergo fusion <6 surgery to either correct a severe curve or prevent it from getting Gf worse, Fusion surgery involves attaching rods, hooks, wires, or serewsto (yw the curve with small pieces of bone placed over the spine, The bone pieces will grow together with the spinal bone, fusing it in the proper Position. This surgery will correct the degree of curvature and rotation by Og approximately 50 percent but will not cure the scoliosis, In fact, the surgery prevents the patient from their full range of motion. Students need to be aware of this limitation when practicing yoga or any type of aT exercise. Backbending and twisting are very limited, and forward bending will only happen by bending or folding from the hips. Bending at the waist is not possible. But i’ still important to exercise and yoga can help by reducing pain and keeping the body strong and flexible, even with the decreased range of motion. Each year, scoliosis patients make more than 600,000 visits to private physician offices. An estimated 30,000 children are put into a brace for scoliosis, and 38,000 patients undergo spinal fusion surgery. A scoliosis patient's life is subject to many unknowns. Consequently, treatments are often ineffective, invasive, and as a result, an unnecessary expense. Scoliosis, patients also have increased health risks due to frequent X ray exposure. Scoliosis can impact the quality of a person's life by limiting activity, increasing pain, reducing respiratory function, and diminishing self-esteem. No matter what your curve pattern or degree of curvature, yoga can help man- age, address, and counter the negative effects of scoliosis. Emotions can be tamed and confidence renewed with a consistent practice. Overall, a sense of harmony and balance can be achieved with yoga. 22 Yoga for Scoliosis All About Scoliosis PRPIIIIIIIAIADNAADNNOSVUVUVUVUUYUUUUUVUUUU UU UU UU UU UU UU UU UU UU benefits of Yoga spiritual practice with its roots going back 5,000 years to India. The practice of hatha yoga, which includes physical postures, breathing techniques, and relaxation, has many physical benefits, including improved posture and increased flexibility and strength, ‘A body with scoliosis develops a highly sophisticated compensating “act” but with proper instruction it can also learn a more refined symmetrical “act.” By combining yoga postures with awareness of your breath you can redevelop structural alignment and create more symmetry in the body. By stretching the muscles that have tightened and strengthening the muscles that have become weak from the asymmetrical imbal- ance of scoliosis, realignment of the body is accomplished, When asymmetry is reduced in spinal alignment, the body can rely more on its bone structure to hold itself up, rather than overworking the muscles, and the effect is a more effortiess posture, By developing a regular yoga practice, corrected proprioception and muscle ‘memory come into play, and the muscles begin to move the bones into a more symmetrical, aligned position. In turn, once the bone alignment is improved, the muscles become more efficient and require less effort to maintain that alignment. A regular yoga practice can help you find that balance point that allows the scoliosis curve to coexist with gravity and activates the body's natural plumb line. The result for most people with scoliosis who commit to a regular yoga practice is better posture and less pain. Vs which means “yoke” or “union,” is an ancient physical, mental, and Iyengar Style of Yoga who created a therapeutic approach to the practice of yoga. The Iyengar system of yoga emphasizes body awareness, postural alignment, and a balance of muscular strength and flexibility. Classic asanas (yoga postures) are modified with props—such as blocks, blankets, and belts—to allow for a deeper penetration into the posture and longer holds, or to make a pose accessible to someone with a limited range of motion. Iyengar Yoga is also based on Patanjali’s Yoga Sutras and includes a philosophical component that focuses on the eight limbs of yoga (Ashtanga Yoga). Iyengar's focus on Patanjali’s teaching brings the element of spiritual guidance to the practice, T= book is based on the teachings of B.KS. Iyengar, the renowned yoga master for Scoliosis “Healing is much more than straightening a scoliosis curve or curing ca disease. It’s learning to love and nurture our- selves and trust our inner knowing to guide us toa vibrant state of being.” Elise Browning Miller Benefits of Yoga for Scoliosis. Yoga for Scoliosis 23My journey with practic- ing yoga for my scoliosis has been a blessing in disguise. If I didn’t have scoliosis, I'm not sure that I would be doing ‘yoga every day or be living a healthy life. I have to do yoga every- day and that is a bless- ing, Elise Browning Miller revealing a path of how to live life more consciously. This focus also introduces the Practice of mind consciousness in the yoga postures, an awareness of the senses, and/ ‘meditative state that leads to a balance of mind, body, and spirit. Psychological Benefits of Yoga for Scoliosis psychological feelings may be realized within the framework of a yoga Practice. For cosmetic reasons, teenagers may feel distressed because they want to be “perfect,” as fashion magazines portray, and yet see themselves as “erooked.” They may suffer from self-conscious feelings and low self-esteem. They don't want to be singled out as different and, in an effort to self-protect, may become introverted, preferring to hide their bodies—especialy if they are encased in a brace 24/7. If there is no pain involved, young adults often will go into denial, telling thern- selves, “I's behind me, therefore it doesn't exist!” If pain is involved later in life or even as a young adult, emotions such as anger, frustration, or depression may manifest. Also feelings of being scatter-brained, imbalanced, or disoriented may have been experi- enced in the past or perhaps are still being felt Fear is also an emotion that may surface, particularly if an orthopedic surgeon implies that the curve will only get worse with time and recommends surgery to fuse the spine. If there are prolonged periods of pain, chronic or acute, a person with scoliosis may fear that the rest of their life will revolve around pain. Parents of teenag- cers may face the difficult decision of whether or not they should put their child through surgery to fuse the spine. There is the fear of the surgery, which is invasive and in- cludes a long recovery period. Or if they choose not to proceed with the surgery, there is the fear that their child's scoliosis might worsen and they will be deformed or in chronic pain throughout their life. W osestesnt mee eet How Yoga Can Help Psychologically you are taking personal responsibility for your well-being and addressing the physical and emotional effects of your scoliosis. You are choosing to not depend solely on drugs, doctors, chiropractors, acupuncturists, or other professionals to heal you. By developing a personal yoga practice, you are investing and participating in your own healing process. Yoga gives hope that you can do something to improve your condition and your quality of life. ‘Yoga is a journey of self-awareness, By taking the time and energy to focus on your body and find more alignment and balance, you are giving yourself a gift. By directing loving attention to your breath while you align yourself in yoga postures, you can transform the pain or feelings of imbalance into self-acceptance and freedom. To be in the present is a “present” to your self. Yoga is a practice that can bring health and well-being, With a yoga practice, you are doing something positive and healthy for yourself. This may even affect how you eat, move in your body, interact with others, and make other choices to develop healthful habits. ‘Yoga helps you to find balance, physically and mentally. Often with scoliosis, you either ignore the fact that you have it or are thrown into self-pity. A regular yoga practice will help you understand your body's limitations and stay open to the transfor- ‘mation and freedom that are possible, both physically and mentally. With this balance, you are able to honor yourself and enjoy a fulfilling life with an openness to exploring ‘ew horizons. Choosing to practice Yoga for Scoliosis requires commitment and inner awareness. With scoliosis, itis important to not expect perfection, but instead accept ‘yourself and find your own optimal alignment and center. As there is beauty in the straight alignment of a palm tree, there is also beauty in an oak tree, with its many twists and turns, D eveloping a yoga practice is empowering. By committing to a regular practice, 24 Yoga for Scoliosis - Benefits of Yoga for ScoliosisVUVUVVUVUUUVUUVUUUUU UU UU UU UU UU UU UU UU UU UU UUs Key Components of Yoga for Scoliosis how deepening the breath invites relaxation and calmness. You'l start by focusing your attention on breathing through your nose. In time, you'll learn how to breathe into areas of discomfort throughout the body and into the side of the lungs and ribs where the breath does not flow easily, Focusing on your breath will remind ‘you to keep breathing throughout your practic. 1 DEVELOPING BREATH AWARENESS From the start, you'll come to experience lengthening the spine to create more space between the vertebrae and assist in 2 LENGTHENING THE SPINE You'll begin your practice by elongating or bringing it back to center, This is also a key factor in reducing pain, a result of imbalances that occur as a result of scoliosis. You'll strengthen your Jeg muscles in order to support the back and spine. Standing poses give you that focus. You'll also experience through your practice how building strength in your abdominal muscles, core muscles, and the muscles that run along the spine can help prevent the lateral curve in your spine from increasing. 3 STRENGTHENING You'll learn how to strengthen the muscles that are weak as DE-ROTATING In all poses, especially twists, itis possible to de-rotate some of the abnormal rotation caused by the scoliosis and thereby gain more align- ‘ment and balance. When a spine is fused through surgery, the rotation of the spine is fixed, and twisting will be very limited those with scoliosis. But, like an oak tree, you can find your center with all your beautiful twists and turns. In a way, you are learning to remap your body's, alignment from within. You'll also learn how to maintain the four natural curves of the spine (cervical, thoracic, lumbar, and sacrum/tailbone) when standing in daily life and when practicing standing poses. Flattening or overarching any of the four natural curves leads to discomfort and pain. 5 REALIGNING YOUR POSTURE Finding your center is quite a challenge for scoliosis, your body's center of gravity shifts. As a result, you lose height as the spine collapses, and you are constantly fighting against gravity’ pull. By hang- ing in inverted positions and allowing the spine to stretch upside down and into gravity itis possible to realign your centerline, release tension in overworked muscles, create more space between the vertebrae, and center the body. In more advanced inversions, you can strengthen the arms and legs as well 6 DEFYING GRAVITY AND CENTERING THE SPINE When you live with Choosing to practice Yoga for Scoliosis requires commitment and inner awareness. With scoliosis, it is important to not expect perfection, but instead accept yourself and find your own optimal alignment and center. T have found that it's helpful to begin my practice with breath awareness. If you know that you hold your breath unconsciously, have stress or tension in the body, or are not familiar with yoga breathing techniques (pranayama), then I suggest that you begin with the chapter “Breath Awareness for Scoliosis” on page 118. This will help you address your scoliosis with more ease throughout your asana practice. Blise Browning Miller Benefits of Yoga for Scoliosis - Yoga for Scoliosis 254. major structural Curve patterns FINDING YOUR PATTERN To be able to use yoga effectively for your scoliosis, you'll need to find out your scoliosis pattern. This process is discussed in the next chapter, “Getting to Know Your Curve Pattern.” You can also consult a medical professional in | this field or a Yoga for Scoliosis trainer to assess your curves. (See the “Resources” chapter ‘on page 148 for infor- mation on how to find a qualified teacher) column, However there are four major structural curve patterns for structural idiopathic scoliosis, the most common form of scoliosis. When there are other causes of a scoliosis if it is linked to an injury, for example, or your scoliosis is congeni- tal or due to a neurological disorder), the curve patterns may go in the opposite direc- tion from the curve patterns shown here. In order to be able to use yoga effectively for ‘your scoliosis, you'll need to know your curve pattern. (See “Getting to Know Your Curve Pattern,” page 29.) \ scoliotic curvature can take place anywhere along the length of the spinal (or major curve) is concentrated in the thoracic (mid-back) region and curves to the right. In a right thoracic scoliosis curve, there may also be a counter curve (compensating curve) to the left in the lumbar (lower back) region, but this is a less severe curve. There also may be a less severe curve going to the left in the cervical spine (neck). 1 Right Thoracic Scoliosis describes the curve pattern where the major scoliosis, trated in the lumbar region. There may be an opposite less extreme curve (com- pensating curve) to the right in the thoracic region and to the left in the cervical spine (neck). Often with lumbar scoliosis, the curve will start in the last few thoracic vertebrae (T11 or T12) and involve the lower floating ribs. 2 Left Lumbar Scoliosis indicates that the major curve is to the left and is concen- where the major curve is to the right in the thoracic region with an equal major counter curve to the left in the lumbar region. Both are structural curves of less than ten degrees differentiation. This is commonly known as a double major curve. There also may be a compensating curve going to the left in the cervical spine (neck). 3 Right Thoracic/Left Lumbar Scoliosis. This curve pattern is a combined curve curve is to the right in the thoracic and lumbar region. There may be an opposite, less extreme curve to the left in the upper thoracic and cervical region of the spine as well as in the lower lumbar. Note that this curve is different than a right thoracic curve in that it is a longer curve than a right thoracic and extends down into the lumbar. 4 Right Thoraco-Lumbar Scoliosis is a scoliotic curve pattern where the major 26 Yoga for Scoliosis - Four Major Structural Curve Patterns continued on page 28Four Major Structural Curve Patterns - Yoga for Scoliosis 27 AAAAAAAAANNANVAANAAIAAAAAAAAANANANARAKRARARKARKAFacts With idio- pathic scoliosis (and for unknown rea | sons), 90 percent of thoracic curves go to the right with only 10 percent going to the left. The same is true for a right thoracic/ left lumbar curve. Seventy percent of lumbar curves have left convexity, and thoraco-lumbar curves have right convexity 80 percent of the time, There can also be triple curves, with an addi- tional lateral curve in the cervical orneck | region. Also, there may be two or more lateral curves in the thoracic region of the back with a ma- jor lumbar curve. Typical Postural Effects and Muscular Imbalances within the Four Scoliosis Patterns ‘or thoracic spine) are affected. Often the neck will be tilted 10 one side the right shoulder will be higher and more forward than the other with posterior protrusion of the right shoulder blade and ribs. It may cause severe kyphowis (a rounded hump or extreme convexity) as a result of the rotational component. pecially on the same side of the back as the curve. For example, with a right thoracie curve, the ribs and intercostal muscles are spread apart, forming the rounded hump on Wrist wn So ea the right side. Because the spine itself may lose its natural convexity, the mid-back may ‘appear flat at times, particularly on the opposite side of the curve. Also, with the ribs rotating back on the right convex side, the ribs on the left side will rotate forward and ‘compress toward each other, creating a left concave side. The left shoulder may drop lower than normal as a result of the compressed ribs on the concave side. If there is a ‘compensating curve going to the left in the upper thoracic and cervical spine, the head ‘may tlt tothe right. Muscles that may become imbalanced and create tightness, ‘weakness, or both are the trapezius, erector spinae, rhomboids, serratus, and latissimus dorsi muscles. The intercostal muscles that facilitate the expansion of the ribs on inhalation and contraction on exhalation are also imbalanced. On the right convex side, the intercostal muscles are overstretched, and on the concave left side, they're underde- ‘veloped. In order to increase breath depth, focus must be given to stretching the intercostal muscles on the left concave side and contracting the intercostal muscles on the right convex side to create deeper and more balanced breathing, With a left lumbar curve, the pelvis and muscles in the lower back will be affected. ‘The right hip will often be higher and rotated forward with the left waist rotating back on the convex side. The hips may sway either right or left from the plumb line. Muscles that may become weak and tight are the erector spinae muscles, quadtratus lumborum (it will most likely be tight on the left side and weak on the right side), and the hip flexors (specifically the quadriceps and iliopsoas muscles). The psoas muscle affects the curve when the left and right psoas muscles are imbalanced. It is very important to strengthen the abdominal muscles when there is weakness in the lower back muscles, since the abdominals often become weak as a result of imbalances in the back muscles or pelvis, With a right thoracic/left lumbar curve, imbalances will occur in both the tho- racic and lumbar areas as indicated above in each of the right thoracic and the left lumbar patterns. Though attention needs to go to both areas to create better postural alignment and muscular balance, it’s the most balanced scoliosis to have since the curves are more equal. Also, there may be better plumbline symmetry (the head may be better aligned over the center of the pelvis). With a right thoraco-lumbar curve, similar patterns of postural and muscle imbalance occur as with a right thoracic curve, but since there can be a significant curve on the left side in the upper thoracic and neck area, the left shoulder may be higher and more forward. The major curve to the right is a long curve that starts in the thoracic spine and continues down into the lumbar area and affects the muscles of the ‘mid-back and lower back. There will aso be a posterior protrusion and rotation of the right ribs, shoulder blade, and waist, forming the convex side, whereas the left side will rotate forward. Because the curve continues on the right side down into the lumbar or lower back region, the left hip may be higher and more forward. 28 Yoga for Scoliosis - Four Major Structural Curve Paterns PIPPPPRPIPIIBAIAAAANAAANAS