Scoliosis affects 6 million Americans. Chances are you or someone you know has it. Either way, it’s likely you’ve heard of it. And if you’re an asana teacher, you’ve probably encountered this condition in at least one of your students. In fact, you may have spent countless hours trying to understand scoliosis in order to help empower your students to alleviate their symptoms. But if you’re not familiar with it, light online research will provide a wealth of information. The Mayo Clinic's website states that “Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular dystrophy, the cause of most scoliosis is unknown.”
Scoliosis affects 6 million Americans.
According to The National Scoliosis Foundation, scoliosis affects both genders, and its onset typically occurs between the ages of 10 and 15. Treatment includes bracing, and in more advanced cases, surgery. Though mild scoliosis often presents few symptoms, severe forms may limit lung capacity, place pressure on the heart, and reduce overall range and quality of physical movement.
When I was asked to write an article about a recent scoliosis study for Yoga International (more on that later), I immediately thought of my friend Amanda. Amanda was diagnosed with a 45-degree S-shaped curve when she was 14. Her doctors concluded that much of her growth was finished, and that bracing was not an option. As she puts it, “My movement would be severely compromised from the base of my neck all the way down.” The conclusion she and her family drew was to hold off on surgery for the time being. “We decided to wait," she says, "but there's a lingering fear that my ribs could eventually collapse into my lungs."
Amanda has since developed a regular asana practice. And when I asked her for her personal reflections on what it's like to live with scoliosis and how yoga aids her symptoms, this is what she had to say:
“Everything is crooked when the spine is crooked. And it requires mindfulness to pull it together. I find that asana alleviates pain in nooks that would otherwise hold it. And when I'm not practicing, I feel the pain return to certain parts of my back that feel pressure (the uneven jutting of my spine into muscle, and that muscle pain not being alleviated). Eventually I become used to the pain, and it becomes less noticeable over time. But in many ways that’s worse, as it gradually builds and stores itself within my body."
“Everything is crooked when the spine is crooked. And it requires mindfulness to pull it together. I find that asana alleviates pain in nooks that would otherwise hold it."
Many of us can relate to Amanda’s story in our own way. We too came to asana and wanted to alleviate a little pain, whether emotional or physical, and we stick around because it works. Yet, while yoga has been a valuable therapeutic resource for thousands of years, it’s only within the past several decades that scientific studies have been conducted to measure its efficacy. And the more I read the findings of these reports, the more I see that our intuitive inclination to the mat is spot-on.
Side Plank for Scoliosis
In one of the most recent studies, published in “Global Advances in Health and Medicine,” a team of researchers set out to study the side effects of side plank on reducing spinal curvature in scoliosis patients. The study, conducted by Dr. Loren Fishman and the Columbia College of Physicians and Surgeons in NYC, included 25 participants, each diagnosed with idiopathic scoliosis. "Idiopathic" refers to the fact that the causes of the scoliosis are unknown—which is often (85% of the time) the case.
The study was conducted to demonstrate the effects of asymmetrical strengthening, and appears to focus primarily on C-curve scoliosis (a C curve refers to a single curve, as opposed to an S shape where there is an upper curve and a lower curve facing in opposite directions). Each participant was instructed to hold the posture on the convex side of their spine—the side that's rounded outward—daily, and for as long as possible. According to the study, this averaged about 1.5 minutes a day for 6.1 days a week.
For 19 of the 25 participants, the reduction of curvature averaged 40.9%.
The results of their practice were measured in three ways: individual reports, radiographic assessment (taken before and after), and Cobb measurements (Cobb Angle is a standard measurement used to gauge the development of scoliosis). Over a 6.8-month period, pre- and post-Cobb measurements indicated an overall significant reduction within primary scoliotic curves. Furthermore, for 19 of the 25 participants, the reduction of curvature averaged 40.9%.
Initial write-ups on the reports have circulated across social media and the yoga biosphere, with glowing reviews from the yoga community. For the most part, many are simply glad that a study was conducted at all.
For Roger Cole, a Stanford-educated scientist and certified Iyengar yoga teacher, the research is validating. “This is exciting work because it provides the best scientific evidence I know of to date that a simple yoga technique may provide a powerful means to help correct scoliosis. Up until now, we have had to rely on anecdotal success stories." He adds that, “While the study does not definitively prove that yoga is an effective treatment for scoliosis, it looks promising and should certainly grab the attention of the medical community. It justifies larger clinical trials that could one day put yoga treatment of scoliosis squarely in the mainstream of modern, evidence-based medicine.”
What about S-curve scoliosis? And why are we focusing on asymmetrical strengthening alone?
It’s true. Studies such as this prove that we no longer have to rely on our hunches, though that’s not to say that a lack of scientific research would have deterred most of us from our practices. Perhaps the most powerful draw to yoga is the feeling of the practice. We just know it works. Again, we feel it. Yet evidence such as this provides direction for practitioners—in this case, a specific pose. But there are a few lingering questions which arise after reading the study: What about S-curve scoliosis? And why are we focusing on asymmetrical strengthening alone?
Yoga teacher Ellen Saltonstall, who has collaborated with Dr. Fishman on two books (“Yoga for Arthritis” and “Yoga for Osteoporosis”), puts the intricate nature of scoliosis into context: "I have been using this technique in my scoliosis protocol and I find it to be very helpful. Educating the student or patient is crucial, since each person's scoliosis is very specific and often confusing to them. It is important to know whether the curve is a C curve or an S curve, which was not addressed in this study. Students need to identify (either on their own or with professional eyes) exactly where their curvature is convex (rounded outward) and where it is concave (hollowed inward), and whether they have multiple curves, which is common. Once they know that, they can do the appropriate actions on the appropriate side in this pose."
And as for asymmetrical strengthening, Cole brings up another valid point:
"An important question left unanswered is whether people should also practice the pose on the other side. Yoga technique generally seeks symmetry, and it is possible that working one side to the complete exclusion of the other over the long term could lead to new imbalances (at the very least, an imbalance in shoulder strength, but perhaps also other complex imbalances between spinal muscles). On the other hand," he adds, "practicing the pose on the second side could theoretically slow or even negate therapeutic benefits on the first side. Only further study can resolve the issue."
I contacted Dr. Fishman for his expertise about these quandaries, but also, I couldn’t help but wonder: Out of over 8,000 yoga postures known to asana, why did he choose side plank as the point of focus?
He also confirmed that practicing asymmetrically could pose a few risks, but that practicing side plank on both sides would negate its therapeutic effects.
In regard to Cole’s statement, Fishman agreed that further study was needed, and expressed sincere interest in conducting further research. He also confirmed that practicing asymmetrically could pose a few risks, but that practicing side plank on both sides would negate its therapeutic effects. “Reversing this asymmetrical condition requires an asymmetrical means. Muscle strength seems to be the key. It is true that doing the side plank on one side only could cause new or other asymmetrical problems to develop in the wrist and the shoulder or rarely in the sacroiliac joint. But doing the pose on both sides would utterly nullify the process of asymmetrical strengthening that vasisthasana (side plank) initiates. The side plank should be done daily on one side, only with the convex side of the lumbar curve downward, for as long as possible each time.”
As for specific practices for S-curve scoliosis, Fishman had this to say:
“That depends on the individual. Sometimes the upper curve is compensatory, and by straightening the lower part of the spine, the upper part straightens itself. I’ve seen that happen. Sometimes the upper curve may be independent or may even have come first. With the help of other yoga experts I’ve figured out a number of other effective asanas for reducing and correcting the upper curve, including, but not limited to, ardha chandrasana (half moon pose).”
So why did Dr. Fishman choose side plank after all? He expressed that in many ways, the pose chose him—that it was through trial and error, and noticing how effective the pose was within his own practice. But for those who want to try these methods for themselves, Fishman cautions that certain measures are necessary for safety. “I believe the people practicing this method must be monitored every month or so because the process is so strong that if unmonitored and done too long, it may actually reverse the process and produce a curve on the other side. When the curve gets down near zero or is negligible, then the pose should be done on both sides to keep the spine straight.”
Fishman concluded our interview stating that he truly believes this treatment could help patients forego braces (which are sometimes worn for as much as 23 hours a day) and better yet, surgery, which is often extremely painful and debilitating.
Would you try side plank as a treatment for your scoliosis?
How do you feel about the study? Many have thought scoliosis to be incurable. However, research such as this certainly leaves one wondering. Based on the results of Dr. Fishman’s research, would you try side plank as a treatment for your scoliosis, or suggest it to your friends? Please leave your comments below.