February 25, 2019

Yoga and scoliosis – should scoliosis patients do yoga?

Over the years, yoga has been branded as a methodology and popular trend for scoliosis management and treatment. Today, yoga and scoliosis are commonly and positively associated with each other.  At first glance it would make sense that stretching and strengthening could have a positive impact on the spine, especially with a yoga instructor that has in-depth knowledge of anatomy. It is important to remember that yoga as it is practiced today, was developed about 100 years ago (influenced by British colonies in India and Swedish gymnastics) for physical fitness – not for an asymmetric/scoliotic spine.

There are a variety of yoga poses that may be adapted to be safe for patients with scoliosis. However, this requires the patient to have an advanced understanding of their unique scoliosis, a knowledge of proper exercise principles and the physical capability to maintain good spinal alignment during exercises. However, there are healthcare treatments (i.e. Schroth method exercises) that are far more effective, safe, and designed specifically and individually for scoliosis and its multitude of complexities. 

Yoga as a practice, is well-rounded to target and interweave the spirit, mind and body. It has been proven to have many benefits for health and wellness for those across the age continuum. Yoga is great because it can be adapted in so many ways to be tailored to a person’s individual style and needs. The problem with yoga and scoliosis treatment is that scoliosis is so complex that not even an advanced yogi working at a highly adapted practice would be able to provide a completely side-effect free training.

To understand why yoga and scoliosis do not mesh well together, it is important to have a basic understanding of the principles of scoliosis. According to the Augmented Lehnert-Schroth classification system, persons have either a 3-curve or 4-curve scoliosis. This system divides the body into 3 or 4 “body blocks,” respectively.  When looking at a person from the back, those body blocks (the spinal segments) are shifted away from the midline (creating the curves). In addition, those body blocks are twisting in opposing directions. Refer to figure 1. for clarification. The narrow parts (concavities) of the blocks pictured below are rotating forward, and the thicker parts (convexities) of the blocks are rotating backwards. 

augmented lehnert schroth classifications, schroth classifications, scoliosis body blocks
Figure 1. demonstrates the different body blocks associated with scoliosis. It also demonstrates how the blocks are shifted and rotated in both a 3-curve and a 4-curve scoliosis.

In addition to each body block shifting away from the midline, and rotating in opposition to adjacent body blocks, the alignment of the spine from the side view also needs to be taken into account. With scoliosis, a “flatback” appearance is common (hypolordosis/hypokyphosis). The opposite is also possible with an increased curve backward in the upper back (hyperkyphosis) and an increased curve forward in the lower back (hyperlordosis). In addition, any combination of these can happen anywhere along the spine. Refer to figure 2.

sagittal plane of scoliosis
Figure 2. demonstrates the body blocks from the side view or sagittal profile of a person with scoliosis.

The problem with yoga and scoliosis

It is true that certain yoga poses can have a positive effect on one of the 3 or 4 curves at a time. For example, in a 3-curve scoliosis with primary thoracic (upper back) curve to the right, triangle pose (as performed as pictured below) would help shift the thoracic curve in the correct direction. However, the lumbar curve would worsen in shift and rotation. Depending on the flexibility of the person, their sagittal plane may also be compromised. 

yoga and scoliosis, yoga poses for scoliosis
Figure 3. Triangle pose to the right performed by a person with a 3-curve scoliosis and a thoracic curve to the right. In this pose, the lumbar curve worsens.

When performed on the opposite side – triangle pose (as performed below), the lumbar curve improves in shift and rotation, but worsens in thoracic shift and rotation. And again may worsen the cervical curve, depending on head position.

yoga and scoliosis, yoga poses for scoliosis
Figure 4. The same patient performing triangle pose on the left. In this pose, the thoracic curve worsens.

A thoracic (upper back) curve may not extend through the entire thoracic spine. Simply twisting in opposition of the rotation in the thoracic spine is not specific enough to help “fix” scoliosis. A much more specific method is taught in Schroth Best Practice called RAD (rotational angular breathing) which allows a person to unshift and untwist only the portion of the spine effected by the curve. It is specific to each person and their individual curve and must be taught by a certified practitioner. See Figure 5. 

a 3 curve scoliosis x-ray showing body blocks
Figure 5. The above x-ray demonstrates a 3-curve scoliosis labeled by the red and blue lines. This view is looking at the person from the back. Each body block is outlined in white. Only the approximated area of the ribcage highlighted in pink, needs to be unshifted and untwisted backward. This can be accomplished with RAD. In a yoga pose such as seated twist with the whole ribcage twisting back on the left, the upper curve (curve 1) is worsening in rotation. The thoracic curve (curve 2) could worsen or improve with seated twist, depending on elongation of the torso. The lumbar curve (curve 3) could worsen or improve depending on the placement and flexibility of the hips.

When treating or managing scoliosis, all curves should be addressed at the same time and in all planes (shift, rotation and sagittal alignment). This is to discourage increased flexibility in the so-called “wrong” direction for any of the curves. Because the spine already has a tendency to move in the wrong direction- you wouldn’t want to practice a pose (e.g. triangle pose) that encourages increased flexibility/strength in the wrong direction for one or more of the curves. Flexibility and strength should only be encouraged in the “correct” directions for all curves in all planes simultaneously. This is achieved through scoliosis-specific exercises that use isometrics (i.e. Schroth 3D exercises).

Movements that may worsen one or more curves at a time (even when promoting alignment of one of the curves) include side bending, twisting, forward flexing/folding of the trunk, hyper extending of the trunk (i.e. backbending), and side shifting to the wrong side. Many of the movements just mentioned are included in a majority of the most commonly used yoga poses. It is important to correct all curves in all planes at once and isometrically strengthen them there (not just gain flexibility). When strengthening of all core and back muscle groups that are effected by the scoliosis at once, you get optimal spinal alignment with neurological rewiring that maintains during daily life (i.e. static and dynamic movements).

Yoga may appear to be correcting one curve in one plane at a time, but the adverse effects on the other curves outweigh the “benefits” of the yoga pose all together. It does not correct for all curves in all planes at once which, is necessary to create the best and most correct change to the bony structures, overlaying musculature and neurological systems. Yoga also does not include RAD – which is necessary to make the specific spinal changes, specific to an individual’s curve pattern. Yoga is fine for a symmetrical spine – but simply put – it is not specific enough for the treatment or management of scoliosis. Unfortunately, for this reason – yoga and scoliosis do not pair well together. 

Kimberly Kruzel, MS, OTR/L, RYT 200, Schroth Best Practice® certified 

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