It all began with the breath. An acquaintance of mine was hospitalized with a perforated lung. A few weeks later, when I met up with him at a gathering, I could hear his belabored breathing before I saw him enter the room. He was breathing so markedly that, as he took a seat beside me, I turned to him instinctively and said, “I think yoga can help you. Please come and try.”
One Case: Yoga & Severe Scoliosis
My student is a man in his early thirties. He is active and youthful, a father of two small
children who enjoys biking around Tel Aviv and hiking in the desert. He is also a software engineer and spends long hours sitting at the computer.
He has severe scoliosis. Although doctors advised braces and operations when he was in his teenage years, his parents decided against that route. He practiced Feldenkrais for many years in Europe and was an avid skateboarder. He has a natural grace, freedom of movement, and kinesthetic intelligence. When we met he was used to living with a bearable amount of pain. But if he made a wrong move, or over-exerted himself, he suffered more intensely. When I suggested yoga, he was healing from a perforation in his lung. The tissue of one lung had formed adhesions, which became tiny, closed pockets filled with air. When an air pocket burst, it perforated the tissue, forming a hole in the lung. Doctors said the condition could be related to abuse of marijuana. Yet, apparently this lung condition is prevalent among men in their thirties, and not necessarily those who smoke. If one observes his body, it is apparent that one lung has much more space than the other in which to breathe and to expand.
Cultivating Awareness Through Sitting, Pranayama, and Vayus
We began cultivating awareness through meditation. He could not lie down comfortably on the ground because one shoulder blade juts out prominently, and he could not sit comfortably on the ground in a cross-legged position. We devised a high seat of three or four blocks for a comfortable virasana. To take a break from this position, which we would also use for pranayama, as well as to open his feet and help him to connect to his inner thighs for mula bandha, I taught him a foot massage separating the toes, which we do every practice between just sitting and pranayama. This massage break creates a relaxed atmosphere, a time for him to tell me about his week and if anything is bothering him in particular. I can then direct the pranayama towards these needs.
Because his lung was still healing when we first began practice, I was extremely careful and did not assume anything. Simple observation of the nature of breath was the first step: feeling the expansion of the body with the inhale, and the in-gathering of the body with the exhale; feeling the right side breathe, feeling the left side breathe; feeling the front body and the back body; feeling the body as a single, three-dimensional, pulsating unit.
We began to lengthen exhalations in ujayi, and to allow for the inhalation to wash into the body like a wave traveling its length and width. We learned to retain the exhalation’s naturally occurring ingathering of the belly also in the inhalation, so we could feel the breath expand the back and lengthen the spine. We do not use retention or kumbhaka, but are simply aware of the four-part cycle of the breath.
Whereas his spine is very crooked, and when standing, one leg may be longer than the
other—the seated pelvis is a stable, balanced base from where to begin. Virasana allows a tactile connection to the ground through the tops of the feet and the shins, as well as through the sitting bones. From this base apana vayu allows for the mula bandha gathering of the lower parts of the body, from where the body can shoot up to the sky. He travels up the body with awareness, exhaling the vayus, which are integral to his practice. Alongside the traditional vayus practice, we also sometimes work with exhaling prana vayu into the sides of the central channel—in a kind of nadi shodana-prana vayu practice. We also use vayu breathing to unravel places of pain or tightness, directing exhalations according to need.
As with most people with severe scoliosis, one of his shoulders is higher than the other.
After consciously breathing the vayus, his shoulders become nearly level. Sometimes this happens sooner, sometimes towards the end of the breath-work, but always a lengthening of the spine occurs and he feels relief. He himself has identified breath-work, and especially the inner vayus, as his most important practice at home.
Pranic Work of Vayus with Beginners
I know that some may find it surprising that I chose to begin with a practice that requires deep awareness and concentration, such as internal vayus. But I have found that when carefully guided with intention and concentration, most people can relate surprisingly easily to the vayus. I have also found that people who have a vested interest in healing display heightened concentration and awareness, and subtle practices are more easily available to them.
Asana Practice
When my student came to me, he had undergone a very frightening experience of not being able to breathe. Because he had just undergone a hospital stay and his lung was still healing, I wanted to work with him as gently as possible, and together discover asanas that could help him feel comfortable and confident. Over time, using the principles, we were able to integrate quiet mind, breath, and movement; connectedness to the center and from the head to the toes; relaxation alongside intense alignment work; rooting and elongation; and always intention.
Shoulders
We began freeing the shoulders either seated in vajrasana with padding, in a chair, or
standing. Today he can lift his arms like wings without engaging the shoulders.
All Fours & Dog
From the beginning we also worked on cat and finding the neutral spine. We did not go up to dog pose for quite a while as this was too strenuous. I wanted his breathing to remain gentle. His neutral spine of course looks very different from a typical neutral spine. It has hills and valleys, and what looks like a very deep gorge between the shoulder blades because one shoulder blade juts out. I do not try to overcorrect his spine—we find what is neutral for him. As his understanding has grown I can place my hand between his shoulder blades and give him a contra so he can fill the area in a good way—so that he is not collapsing into his shoulder blades. As I learn his body I can understand which form is a result of his scoliosis and which is the result of collapsing. We use prana and udana vayu in elbow balance-dog pose to gain greater understanding. He has developed his own beautiful dog pose. We can even explore preparation for headstand.
Utkatasana
I want to utilize the base of pelvis, also in standing. To do so, we work on utkatasana,
connecting the feet to the groins. He stands, as if in mud, aware of his footprints. His feet are completely parallel—which is very important and helps to avoid collapsing into the lower back, tucking tailbone, and pushing out the groins. His feet become enmeshed in the ground, part of the mud floor we have imagined. These soft feet connect to a softening in the groin. Samana vayu, with an ingathering and swallowing of the groins follows, the muddy footprints become deeper and larger as the shins come forward and the knees soften. The line of the inner thigh and abdomen becomes apparent. The pelvis hangs at the correct angle, and the spine springs up from there. Shoulders are soft, the head is a continuation of the spine. This takes concentrated effort, so I remind him of maintain a soft, smooth face and relaxed breath. We neutralize the arms when needed. He pulses down with the feet and the legs elongate, carrying the body upward as if a car jack. We repeat a number of times, interspersed with shoulder openers. The legs grow strong and the connectedness of the body
is revealed again and again. I can see in his face how this work is rejuvenating and interesting even after a couple of years of practice.
Setubanda
From the beginning he practiced a very low setubandha, where the pelvis remains neutral, the feet root, and the body lifts less than one centimeter from the ground. When the lower back returns to the ground it widens and widens and widens—like when one throws a pebble in still water and concentric circles open out. This low setubanda he uses in his daily practice, and for relief when he has pain. We continue to close the class with this pose that helps put him in a good place for savasana on the back.
Savasana
In our first meeting I realized that for my student, lying on his back on a yoga mat was
exceedingly uncomfortable. But I wanted him to experience savasana. I have a straw tatami mat from Japan on to which we put the yoga mat, and at the beginning I padded his yoga mat with many rugs and blankets. After some time the practice softened his back—softening was the term he used to describe the transformation—so that he could lie down comfortably with no extra padding.
Taking it Slow, Maintaining a Safe Space
We take everything slowly and carefully. For example, we once tried three gentle rounds of three Kapalabhati breaths (9 breaths in all). He later experienced a burning feeling in the lung, so we did not try again for another half year. When we tried again and he again experienced the burning, I decided to retire Kapalabhati. The burning brings up fear for him, and honestly, also for me. I do not feel I know enough to take responsibility for someone who has experienced a lung perforation to experience a burning sensation in the lung. There are so many beneficial breathing techniques: Ujayii, Nadi Shodana, and the directed exhalations and passive inhalations of the Vayus. These various techniques answer his needs, and help him. There is absolutely no reason to insist on a practice that creates discomfort and fear. Our practice realm is first and foremost a safe space.
When we try a new thing—no matter how straightforward it may seem—I always remind him to pay attention the next few days and report back if there was some kind of change, good or bad. In that way we can continue to safely explore different ways in which to enjoy movement, cultivate awareness, and develop the musculature he needs to support his back.
Symmetry vs. Equilibrium
There is not a person reading this essay who is perfectly symmetrical. Yet when we begin yoga practice we are used to how we feel, and to our habits of posture, thus we feel quite symmetrical. When we begin to strive for more objective symmetry, we can sometimes feel strange and out of balance. At some point we gain an understanding of the right mix—the correct blend of objective and subjective symmetry for who we are at a particular stage of our development. This blend may change over time with the evolution of practice, as well as new understandings, injuries that happen living in the world, aging, etc.
Working from Within
Of course when one has severe asymmetry finding the correct blend of objective and
subjective symmetry is even more important and more delicate. Corrective work must
emerge from deep, internal work and not an external tweaking of gross muscles. When my student completes the vayus practice his shoulders line up—evening out a very visible difference. But what really has shifted is something deep within that, most importantly, makes him feels good! Yet if he would try to self-correct without the internal work—which he did for years—he would experience discomfort.
Asymmetric Work = 3 Sides
Although it may be obvious that one particular side needs a bit more elongation, and the other side needs to relax down, each side has also its less apparent qualities, such that I do not believe working certain asanas only on one side is beneficial. What we do in situations where the feeling in the asana is very different on each side, is to practice three times—we start with the comfortable side, we then do the less apparent side, perhaps in a different way such as more gently or with slightly different emphases, and then we return to the first, more obvious, comfortable side. So we end with something sweet, yet we have not ignored the special qualities that the less apparent side may offer.
Sensitivity to Feelings & Language
I am sensitive to my student’s feelings about his curvature, feelings of being out of the norm, feelings of asymmetry. For instance, when I speak about him finding the center line, I am clear about it being a subjective center. When I direct him to experience equal feelings of expansion on each side, I am clear that each side does not necessarily need to be equal in length. I can tell him to follow the line of his spine, or to draw the plumb line of an objective center. These ideas are different, and he understands this, so we can use both concepts. I tell my student that this is an exercise I do with everyone, which is true, and that absolutely no one is symmetric, which is also true. I tread lightly around this idea of equality and symmetry—objective or subjective—so he can understand that this is a universal search— not just his personal predicament.
Developing a New Way of Connecting the Body—the Power of Intention
My student was doing very well and after a year of practice, he was even able to do a high janu sirsasana. Then we had a three-month break over the summer and holidays and he returned with persistent numbness and tingling on one side. I instructed him to use intention to actively feel the left hand and the left foot throughout the day whenever he remembered. Of course, returning to yoga practice, released pressure on his spine, helping the situation. But I believe that strengthening the awareness of the numb side also helped him. Within a couple of weeks the numbness subsided.
Being Supportive and Taking Complaints Seriously
When he felt the numbness and was wondering if to go to a doctor, I told him he should
definitely go if he felt he needed to get checked. I reinforced the fact that he has the right to get checked—I think sometimes he is worried that he is too sensitive and a hypochondriac. At the same time, I also gave him exercises to do throughout the day—to empower him as his own healer.
Importance of Giving Tips for Living
One of the first things I teach therapeutic yoga students is how to get up from lying down— rolling through the side. Integrating wise movement in daily life is essential and using the principle of intention for daily tasks is helpful for integration. For instance, I remind my student not to make sudden twisting movements—such as when fastening a seatbelt in the car. I talk about practices to do when doing the dishes, and how to lift a child, or a heavy box. How to root and plant one’s weight, use samana vayu, and then to move with a rooted intention from that collected place to stay safe. I also remind parents that it is okay to kneel down before a child and explain, I cannot lift you today because I am hurt, but I can hold your hand. I suggest to people who spend long hours in front of a computer to put a reminder on one’s computer to get up and stretch.
Working Therapeutically for a Long Period
When working with someone over a number of years things shift. I allow my student to lead the direction we are going in—whether it is a period that he seems more in need of
movement, or that he is more in need of stillness. For instance, my student has really fallen in love with just sitting, so now I have him actually lead the sitting so we can sit according to the amount of time he feels he needs. But because we were sitting longer and longer, virasana, which had been a safe place, began to give discomfort. We devoted a special class to opening the hips, and he now practiced hip openers, which had been too uncomfortable at the beginning. Now he sits in virasana for meditation, and in a supported half lotus for pranayama.
Healing & Empowerment
What does it mean to heal for my student? It does not mean the curvature of his spine will go away. It means that he can function as a working father of two who enjoys physical activity without pain. Or that when he does experience pain, he will have the tools and understanding to bounce back quickly. It means that he can move with confidence in the world. And that he has developed a daily practice to maintain his back—a practice that is independent of yoga class and me. He is practicing yoga at a very deep level, enjoying the benefits of quieting the mind and integrating mind-breath-body.
Lisa Kremer
I first encountered yoga as a young child copying my father’s movements in our NYC living room. As a traveler in my 20s, I met the yoga of meditation and pilgrimage in India, Nepal, and Tibet. In Jerusalem, on a search for a dance class that could satisfy my soul, I found yoga again, and my teacher, Orit Sen Gupta. She gave me yoga as a practice, a personal experience, and a never-ending, always interesting search for oneness of body, breath, and mind.
I completed the Vijnana teacher training at Wingate (1998-2001) and continue to study. I
teach yoga in Tel Aviv, where I live with my husband and two daughters. I also write, edit, and translate professionally (BA, English Literature).
Orit taught me through example that a teacher must have an authentic experience so as to allow those practicing alongside her to have their authentic experience; that the position of the mind is paramount; that the postures are created from a deep listening; that body-breathmind are enmeshed; and that when we experience oneness we can touch upon original joy.
You are welcome to contact me at lisayoga@gmail.com or 0544733486.