Editor's note: The below are intended to be general recommendations for yoga practitioners and teachers. They are not a replacement for the personal advice of a health professional.
For yoga students with scoliosis (an abnormal lateral curvature of the spine) whose doctors have given them permission to practice and helped them understand their curvature, a mindful asana practice may serve a beneficial role in the prevention and treatment of common symptoms like back pain and breathing difficulties.
According to physical therapist Bill Reif, author of The Back Pain Secret: The Real Cause of Women’s Back Pain and How to Treat It, yoga’s power to help can be heightened if yogis with scoliosis and their teachers keep a few things in mind. This article offers general tips for how best to work with scoliosis in any kind of a yoga practice. Below is a specific sequence, with movements culled from both yoga and physical therapy, that puts many of those tips into play.
“Yogis with scoliosis will want to bring the spine closer to neutral alignment using mirrors for visual feedback. Holding this more neutral position, which requires muscle engagement, through increasingly challenging movements will help to build strength on the convex side of their curvature, and poses like side bends will help to lengthen the concave side,” Reif summarizes.
He admits that remembering which side is concave (shortened and inward-curved) and which side is convex (lengthened and outward-curved) can be confusing for students and teachers alike, especially in the case of double or S curves. Sometimes students and teachers may not be clear on the exact curvature or its specific effects; at other times, a curvature can be hard to keep in mind amidst other cues. For these reasons, rather than instructing a pose one way on the left side and one way on the right, Reif finds that it makes sense to do an asymmetrical pose on both sides, and then repeat it a second time on the more challenging side.
That method is employed in many of the poses in the practice below, though once you have determined which side of a pose is the more challenging side for you, instead of repeating the pose an additional time on that side, you could simply stay there an extra five breaths to allow for additional strengthening or mobilizing.
The entire sequence may take about an hour, depending on how many breaths you choose to hold in each pose, how many repetitions you do, and how many breaks you take.
How often would someone with scoliosis benefit from such a practice? According to Reif, it depends on many factors: “A student who spends a lot of time sitting, standing, or doing physical labor and has symptoms—like pain or difficulty breathing—will benefit from a fairly long practice, like this one, daily. Someone who is more active, but does less heavy lifting, and experiences fewer symptoms, may only need an extended practice a couple times a week. But some sort of daily practice is important. I’d recommend that even those students who aren’t feeling pain aim to do at least one or two poses that seem to work the best for them every day. If you have a longstanding spinal curve, it may need a regular ‘reminder’ of the spinal position you are working toward. Otherwise the body has a ‘memory’ of the older, abnormal curve, and may revert to that more familiar asymmetry.”
Because a right thoracic C curve, or right thoracic (primary) and left lumbar (secondary) S curve, is most common, many, but certainly not all, practitioners with scoliosis may find that their left side benefits from additional lengthening and their right from additional strengthening.
Note that the asymmetrical poses that follow are instructed with this curvature in mind: First you lengthen the left side (or strengthen the right), then you go to the other side, before being asked to repeat the pose on the side that was more challenging. Presumably, this will be the first side. If you know that you have the opposite curvature, you may want to reverse the instructions so that you begin with the challenging side, move to the easier side, then repeat the pose on the challenging side. If you don’t know your curve type, it may be helpful to have a physical therapist or physician evaluate you so you’ll know which adjustments are necessary to bring you to a more neutral position.
You will need a mirror (positioned so you can see yourself through as much of the practice as possible), a block (for pose 6), and perhaps a strap (for poses 16 and 17). For the final pose (19) you will need a bolster and perhaps a blanket or towel.
To make the sequence more intense, instead of speeding it up, feel free to increase the time you stay in the poses, or to repeat them (always spending longer on the more challenging side). To make the sequence less intense, try practicing poses 1 to 5 in a chair, then moving to the hands-and-knees poses described in 9, 10, 12, and 15, before giving yourself a generous savasana.
1. Mountain Pose Explorations in Self-Correction Facing a Mirror
“Standing or sitting in front of a mirror must be first because one must see the alignment to understand it best,” Reif says.
Stand in front of a mirror with your feet hip distance apart and parallel. Elongate your spine by rooting down through your feet and lifting up through the crown of your head. How tall can you grow? Check the alignment of your hips, shoulders, and head in the mirror. How much can you level your hips and shoulders? Can you center your head instead of letting it tip to the right or the left? Are both the right and left sides of your rib cage facing forward evenly? Observe what happens when you intentionally swivel your torso slightly to the right, then to the left. Does twisting to one direction in fact seem to help “untwist” you? (And perhaps make it easier for you to level your shoulders as well?)
When you find a position that makes you more “even” in the mirror, “tense your trunk muscles and hold the new position for several breaths,” says Reif. Do your best to remember how this alignment feels: It is one you will want to recreate at various points in this practice, sometimes without the help of a mirror.
2. Deergha Swasam
This pranayama encourages full, diaphragmatic breathing, important since scoliosis can impinge upon lung capacity. In this version, the hands are placed on the belly and the upper chest. “Though the upper chest doesn’t move nearly as much as the belly, having the hands in this position will help you find the correct order for the actions of a diaphragmatic breath,” Reif says.
While standing in the more neutral alignment you created in pose 1, place one hand on your abdomen and one hand on your chest. Keep your eyes open, watching your alignment in the mirror as you breathe.
On an inhale, imagine filling your right and left lungs from bottom to top: Expand the belly and lower rib cage, then the middle of the rib cage, and finally the upper chest. On an exhale, imagine emptying your right and left lungs from the top to the bottom: Empty the upper chest, then the middle of the rib cage, and finally the lower lungs and belly. Pull in the belly slightly at the end of the exhale.
Repeat five to ten times, paying special attention to any restricted areas: Work to inflate any places where the ribs may have drawn very close together, often the concavity of the thoracic curve. Even on your exhales, try not to collapse here. Take a break—breathing a shallower breath or two—at any time you notice any strain.
After familiarizing yourself with this pranayama, resolve to keep some semblance of deergha swasam in every pose.
3. Upward-Reaching Mountain Pose
This pose will help you lengthen your spine.
Still standing in mountain in front of a mirror, reach both arms up overhead, making them as straight and as high as you comfortably can. If, looking at your reflection, you notice that one hand is not as high as the other, aim to reach up more with that hand, but not so much that you feel strain.
Hold here for five or so breaths, filling the right and left lungs from the bottom to the top, emptying the right and left lungs from the top to the bottom.
4. Standing Side Bend
This gentle side bend will help you begin to find length in the concavity by stretching the paraspinal muscles along your spine and the intercostal muscles between your ribs.
Standing in mountain pose, place your right hand on your right hip. Reach your left arm up, then overhead to the right, allowing your hips to move to the left as much as they can without sacrificing stability. Gaze up toward the ceiling or down to the floor at the outside of your right foot. (Or turn your head to look up then down.)
Hold here for five diaphragmatic breaths. Then return to mountain and switch sides. Repeat on whichever side was most challenging and hold there for another five breaths.
5. Standing Side Glide
This “side glide” will help you continue to lengthen the concave side of your spine and torso.
Place your left hand on your left hip, and your right hand on the lower part of your right rib cage, your fingers facing forward. Press your hands toward the midline of your body to move your hips slightly to the right and rib cage slightly to the left, keeping your head and shoulders level (and feet well grounded).
Hold here for five breaths, making each one as full as possible. Then switch sides. Repeat on whichever side did not move as easily.
6. Standing Side Bend and Twist With Block
This pose offers a route to lengthening, de-rotating, and leveling the pelvis that might help you create a more neutral spine.
1. Stand in mountain pose facing a mirror, with your feet about hip distance apart and a block, on its lowest setting (like a step), positioned about a foot behind your left foot.
2. Raise your left arm overhead, then bend to the right. Hold here for two breaths. 3. Keeping the side bend, reach your right arm across your chest as if you were trying to shake the hand of someone standing just to your left. Allow your rib cage to turn slightly to the left as well. Hold here for another two breaths.
4. Slowly nod your head forward and back 10 times, then center your head.
5. Now, while maintaining your arms in position, step the ball of your left foot onto the block behind you, noticing if this has any leveling effect on your pelvis. Hold here for about five slow, deep breaths.
6. Lower your arms and return to mountain pose.
Then move the block about a foot behind your right heel, and switch sides. Repeat on the more challenging side.
7. Wall Climb
This exercise will help you lengthen the concavity of your curvature. “The greater your curve, the less likely it is that the tips of your fingers will attain the same height when you walk them up a wall,” Reif says. “But be patient: Forcing the lengthening to happen too fast could strain the limits caused by your spinal curvature.”
Below, in step 5, you are asked to level your hips. Reif admits that this is difficult without a mirror, but encourages you to look at your hands: “If you notice that your reach has become more even, that is positive feedback which we may assume is improving your spinal curves,” says Reif. A teacher might also be able to help you assess the levelness of your hips.
1. Standing in mountain pose with your toes and nose very close to a wall, place both palms flat on the wall alongside your chest, as if you were setting up for a vertical version of cobra pose.
2. Slide your left hand up the wall a few inches. Hold for a couple of breaths.
3. Now slide your right hand up a couple of inches, pausing for a couple of breaths.
4. Keep alternating sides, noticing any feelings of lengthening, however slight, along your spine, until you’ve walked your hands up the wall as far as you comfortably can.
Notice: Do both hands reach the same height? See if you can reach a bit higher on the side that has a shorter reach.
5. Lift the heel on the side with a shorter reach by pressing the ball of the foot down, and hike that side of the pelvis up a bit higher, toward the shoulders, until both hips (and maybe even shoulders and hands) are closer to level.
Hold here for about five diaphragmatic breaths.
6. Now re-ground your lifted heel and slowly walk both hands down the wall back to chest height, trying to keep your shoulders as level as possible.
8. Wall Fall
Through this exercise, you will build strength on the convex side of your spinal curve by working to hold a more neutral position through a push-up-like movement adapted from the Scientific Exercises Approach to Scoliosis. This fairly challenging movement should be undertaken only by strong practitioners who have acquired a facility with the preceding exercises as well as with plank pose.
You may want to check your alignment in a mirror before practicing this “fall,” but ideally, over time, you will memorize what a more neutral alignment feels like, and be able to come close to it without the help of a mirror.
1. Stand a bit more than an arm’s length away from a wall and facing it, self-correcting to come to the more neutral version of mountain pose you found in the first pose. (Your goal is to keep this spinal alignment throughout the following movements.) Reach your arms out in front of you, palms facing the wall and fingertips about in line with your shoulders. Inhale here.
2. Slowly “fall” toward the wall on an exhale, catching yourself by bending your elbows and landing on your palms, your hands alongside your chest. (Note that initially you should be close enough to the wall that your heels stay on the ground. If this movement proves to be fairly easy, then step further away from the wall, and as you fall forward, your heels will lift slightly.) Inhale here.
3. Exhale as you push yourself away from the wall, returning to mountain pose with your arms outstretched. Inhale here.
Repeat ten times, or until fatigue.
9. Slow Cat-Cow
This familiar spine-limbering sequence is slowed down here to allow the effects of your full, diaphragmatic breaths to help unravel any tightness along your back.
From standing, make your way down to the mat by forward folding (with bent knees if that is more comfortable for you), then bending your knees until your hands can touch the ground. Walk your feet back and lower your knees to the floor.
Place your palms on the mat about shoulder distance apart. Arrange your shoulders right over your wrists and your hips right over your knees.
Round your back on an inhale, and hold here in cat pose for two breaths. Next time you exhale, arch your spine slightly to come into cow, and hold this gentle backbend for two slow breaths.
Repeat each pose at least five times.
10. Side Bending Tabletop
This side bend from hands and knees will help lengthen the concavity.
From hands and knees, walk your left hand about six inches forward, and bring it to the midline of your mat. Turn your head to the right, looking toward your right hip. Now bend your right elbow and bring your right hip toward your right shoulder, trying to shorten the right side of your waist (and lengthen the left).
Hold here for five breaths.
Return to tabletop, then switch sides. Repeat on whichever side felt more challenging.
11. Tabletop to Plank
“Once you have learned how to correct the asymmetry, start to emphasize your core muscles in order to get your corrections to ‘stick,’” Reif says. “The core muscles that will help keep your torso better aligned, and may help relieve back pain, are strengthened here: the obliques, the rectus and transverse abdominis, and, in the back, the multifidus and erector spinae.”
Come to tabletop, doing your best to create your most neutral spine through the self-corrections you made in pose 1: elongating, leveling the hips and shoulders, centering the head, and de-rotating.
Hold here for five deep breaths, or…
…For more intensity, step one foot back, then the other, coming to plank pose. Hold here for several deep breaths, drawing the belly in at the end of every exhale, before lowering the knees back down.
12. Thread the Needle, Child’s Pose Variation
For a twist, Reif favors this variation of thread the needle for those with scoliosis because it allows you to feel the rib cage better than many other twisting poses while encouraging elongation. “The downward pressure of the torso’s weight may help to lengthen the compressed area of the spine, a benefit that you don’t get when vertical in sitting and standing.”
From hands and knees, move your feet toward each other and sink your buttocks back to your heels as far as you comfortably can to come into an extended child’s pose.
Thread your right arm under your left shoulder and let the right side of your head rest on the mat (or a block). Hold here for at least five diaphragmatic breaths, reaching through your right fingertips, and pressing down with your left hand to spin your chest slightly to the left.
Release the twist, returning to extended child’s pose, then switch sides. Repeat on the more challenging side.
13. Forearm Side Plank
Side plank is one of the poses touted as being beneficial for the reduction of scoliosis curvature. Here we suggest doing the pose on your forearms, since your wrists may be taxed by spending so much time on hands and knees and in plank.
From hands and knees, lower to your forearms. Step one foot back, then the other, coming into forearm plank. Adjust your right forearm so that it is parallel to the front of your yoga mat and your fingertips are touching your left elbow. At the same time, stack your left ankle on top of your right, reaching powerfully through both heels.
For less intensity, keeping your left leg straight, step your left foot to the mat immediately behind your right.
Bring your left hand to your left hip or reach up toward the ceiling with your left arm. Work to lift your hips away from the mat.
Hold here for five breaths, drawing the belly in at the end of the exhale. Then lower to forearm plank (or forearm tabletop, or child’s pose), and switch sides. Repeat again on the more challenging side.
14. “Superman” Exercises
“Strong back muscles, like the multifidus, are important for stability and posture, and provide a solid foundation for movement of your arms and legs,” Reif says. “These superman poses, especially the twisting version, will help to strengthen the multifidus.”
1. Ease your way down onto your belly, with your arms straight out in front of you and shoulder distance apart, palms facing each other, legs straight, toes pointed, and feet about hip distance apart. Hover your nose just above the floor.
2. On an exhale, draw your belly toward the spine and lift your head, your left arm, and your right leg. Hold for three to five breaths.
3. Lower down, then switch sides.
4. Lower down, then repeat on the harder side.
5. Lower down, then lift both legs and hold for three to five breaths.
6. Lower down, keeping your legs on your mat, now lift both arms and hold for three to five breaths.
7. Lower down again, then keeping your legs down, lift both arms again, but this time twist your upper body slightly to the right, as if you were holding a large ball you’d like to pass to someone on your right. Hold here for three to five breaths.
8. Lower back down, then switch sides.
9. Lower back down and repeat on the harder side.
10. Lower back down, then lift your arms, head, chest, and legs for three breaths.
15. Extended Child’s Pose With Side Bend
This version of extended child’s pose will lengthen the concavity of your curvature and counterpose the strengthening backbends you just performed.
From your belly, press back up to tabletop. Walk your hands to the right, bringing your left hand on top of your right hand with your arms straight. Then sink your buttocks back as far toward your left heel as you comfortably can.
See if you can reach farther forward and to the right (without strain) and hold for five breaths. Walk your hands back through center, then to the left, to switch sides. Repeat on the more challenging side.
16. Seated Wide-legged Forward Fold Variation
In this side bending, twisting version of seated wide-legged forward fold, you provide traction for your own spine. If you cannot easily grab hold of your foot, ankle, or shin, loop your foot with a strap.
Come to a seated position and open your legs out to about 90 degrees. Root down with both heels and flex your feet so that your toes point toward the ceiling.
Walk your hands to either side of your right thigh, turning your chest to the right.
While continuing to root down with your left sitting bone, fold forward to bring your left hand to your right outer shin or ankle or to the top of your right foot.
Press down into your right hand—still alongside your right thigh—to turn your chest to the right.
Hold for five breaths. Then return to upright and switch sides.
Repeat on whichever side you found most challenging.
17. Easy Pose or Hero Pose With Cow Face Arms
“This pose stretches the rhomboids, subscapularis, teres major and minor, infraspinatus in the scapulae, and the paraspinal muscles—especially on the concave side,” Reif says. It is instructed with a strap, but if you can easily bring your hands together, you don’t need to use one.
Sit in a comfortable cross-legged seat facing the mirror. You can sit on a block or bolster to make this pose more comfortable, or you can kneel in hero pose if sitting cross-legged bothers your knees. Re-establish your more neutral spinal alignment.
Holding on to a yoga strap with your left hand, reach your left arm toward the ceiling.
Bend your left arm, pointing your elbow toward the ceiling, and dangling the strap down your back. Bend your right arm and bring your right hand to your back, palm facing out. Swim your right hand up along the inside of your right shoulder blade, taking hold of the strap with your right hand and even trying gently to pull the strap longer. Hold for at least five deep, diaphragmatic breaths.
Release your arms, change the crossing of your shins if you're sitting cross-legged, then switch sides. Repeat on the more challenging side.
18. Deergha Swasam
Returning to the pranayama you explored toward the beginning of practice will give you a chance to notice if it has become any easier to breathe deeper, fuller breaths.
Pick a position that allows you to relax while concentrating on your breath: Sit cross-legged or in hero pose, or lie down on your back. Come to the more neutral spinal alignment you explored in the first pose and again place one hand on your chest and one hand on your belly.
Now close your eyes, feeling your breath, and your alignment, from the inside. Inhale, envisioning that you are filling both your right and left lungs from bottom to top—expanding the abdomen and lower rib cage, then the middle of your rib cage, and finally the upper chest. Exhale, imagining your right and left lungs emptying from top to bottom, emptying the upper chest, then the middle of the rib cage, then the lower lungs and belly. Pull in the belly slightly at the end of your exhale.
Notice any differences between sides. Attempt to avoid any “collapse” on your more restricted side as you exhale.
Repeat for a total of five to ten rounds.
19. Side-Lying Savasana
“This passive pose can help you find symmetry without effort and may help alleviate pain,” Reif says. You will need a bolster. You may also want a folded blanket or block under your head. If you have a double curvature, you may want an additional rolled-up blanket or towel.
Place the bolster horizontally across your mat. You will want it to support the part of your rib cage that is most convex (outward-rounded). So if your thoracic spine curves to the right, place a bolster where it will support the right side of your rib cage as you lie on your side. (If you have an S curve, and your lumbar spine is curved to the left, you may want to roll over part of the way through savasana and lie on your left, with the rolled-up blanket or towel under the left side of your waist, so that both curves receive gentle pressure.) If you would like to have something other than your bottom arm to support your head, place the block or folded blanket near the top of your mat.
Arrange yourself so you are lying on your convex side and the gentle support of the bolster is encouraging your spine to move toward its centerline. Place your head on your bottom arm (or folded blanket or block), and stretch your top arm overhead.
You can also keep your top arm bent in front of you if that is more comfortable. Bend your knees as much as you like. Close your eyes if it's comfortable to do so.
Stay here for five to ten minutes, breathing easily, allowing gravity and time to move you toward symmetry.