How to Access Whole Body Alignment in Scoliosis and In Yoga Therapy

What is alignment? How can we create it in all areas of our lives? 

energetic alignmentScoliosis (curvature of the spine) can be easy to notice in our clients, but it can be harder to notice the more subtle vertebral malalignments. Our medical system names several types of scoliosis. There are Structural curves, which are true spinal curvatures. They can be further divided into “C” curves (one long lateral curvature) or “S” shaped (2 separate lateral curves-one in the thoracic spine usually and one involving the lumbar spine). There are also functional curvatures, which are compensatory curves in the spine cause by a structural problem somewhere else, say for example, a true longer leg. That longer leg would obviously cause pelvis asymmetry and a compensatory or functional curvature in the spine. There is adult-onset scoliosis and the more common adolescent “idiopathic” scoliosis (implying no known cause). Sometimes there is a physical trauma initially that seems like a non-event. The spine then adapts and grows to compensate for the original dysfunction…at least that’s the theory. All physical theories. That’s our medical system, though. We have a Physical problem, our system is designed to look only for a physical solution. As Physical Therapists, we are trained to only search for and deliver a physical-only solution through physical manipulation of the vertebra, soft tissue techniques, a lift in the shoe on the short side (if appropriate), dry needling muscular trigger points. Osteopaths and Chiropractors will use physical manipulation in a similar way. For the vast majority of clients, there will be only partial effect, if any at all. Why? If we forcefully open closed energetic places in the body, is this really the way to go? What if we could teach the client to open those places as it felt right and safe to do so?


Addressing scoliosis only through the physical lens of manipulation, exercise, bracing and surgery will always only provide partial correction, if any, because this young man pictured above is not just his spine.

You could appreciate from looking at this image that breath excursion of the left lung might also be significantly restricted. The lung is not smaller physically as some might think, but the capacity for breath seems smaller because of the physical compression. With breath restriction, we become not only a smaller container for breath, but also for aliveness. We FEEL small. Confidence diminishes. The spine is designed to be the support system for our entire body. So what happens when we perceive a failure of that support system? I find it interesting also that most of these “idiopathic” curves are discovered during adolescence. This is not only a time where friendships are changing rapidly, but the child is leaving the child body and moving into their future adult body. It is a time where we expose certain aspects of ourselves only to be ridiculed for who we really are..and so because every one of us has been there and has had that direct experience, we can understand what that might feel like inside the body…how we might learn to close off those aspects of ourselves deemed unworthy by our peers. The friends made in elementary school might no longer be around to support us. There are many ways the external support system of our world can suffer. What goes on OUTSIDE the body is also going on INSIDE the body. You could see how a perceived lack of support, diminished breath and “kinks” along the more subtle energetic channels of the body might cause a scoliosis. You could also see how a scoliosis might cause some of those feelings too. We could go 10 rounds over what came first, but wholeness of alignment will need to address all of these areas. Ganthis

We have 3 main energetic channels (nadis) of the body. If I were explaining this to a 4 year old, I would describe these subtly felt channels as unseen to the naked eye. We have one on the right side of the body called Pingala, one on the left side called Ida and the great central sushumna nadi running up and down the center of the spine. 

From the image above you can see that Pingala (shown in red) and Ida (shown in blue) cross the body in several main areas, called Granthis. Other energetic models out there would list these places as Chakras. The Granthis are just the 3 main areas where these energies cross. They are also Chakras.

GranthisWhen I’m working with a client on alignment, there are absolutely physical cues that are a significant part of our practice (hip/knee/ankle alignment, tailbone to crown alignment), but even more important is helping the client to free the breath from the belly. If the client can get breath moving into the belly, aliveness comes and through that aliveness, the client can be taught to direct the energy as if it were aligning and moving through that central, vertical sushumna nadi. True energetic movement through sushumna nadi can take a lifetime of practice, but that doesn’t mean we can’t imagine it happening. If I said nothing to this client, no attempt to “fix” anything and just guided the breath, alignment would begin to happen from the inside out through aligning with the subtle energetic pathways of the body.


As the Yoga Therapist, I am choosing asana (postures) initially that are very grounding. I’m teaching the client to be mindful of sit bones touching, the back of the heart if that is touching, hands, feet, crown of the head. I’m choosing asana that will highlight those places. I’m then layering asana that focus opening where the client might need it (the left side body for our model in the first image) with the understanding that direct opening in the most closed places can leave the client quite vulnerable (joints can feel unstable as a result of too much opening too soon).

imagesI’m bringing in many tools to free the belly in breath (vital for the client who is braced) in combination with visualization of sushmna nadi and bringing in mindfulness to the more subtle energetic channels of the body.

This client’s spine moves exactly as mine does. It flexes. It extends. It side bends and rotates. As long as there is no surgical correction with a rod and wires, there are no contraindications, nothing to avoid. If there has been surgical correction, that might certainly affect my choice of posture, but it’s doesn’t at all effect the breath work (pranayama) and the energetics of the posture. The client might be surgically “fused” with a rod holding them at a 20 degree curve, but they can still feel whole and aligned from the inside.

harrington rod

One of my favorite asana for bringing in all 3 ways to incorporate “alignment” in practice is Yastikasana or Stick pose. If you were to imagine a kinked bicycle chain. I see Yastikasana as a way for the client to remove the kinks through the very shape of the asana, through the breathwork done in this shape and through the firm support of the ground beneath them. The pose translated is “Pencil” and I’ve never seen a malaligned pencil.


In Yastikasana, the palms are pressed together, the inner seam of the legs are pressed together, the feet are flexed with the heels leading away from the body, the fingertips are reaching away from the body and the lower back is being pressed to the floor. All of this is going on while you are BREATHING fully in and out through the nose in 3 parts-belly, ribcage, collarbones. All of this is going on as you are imagining sushumna nadi clearing on exhale and filling with aliveness. Maybe a round or two of Kapalabhati would feel great as well, if the client already knows this breath work. Teaching and exploring bhanda locks can add grounding or distraction, where needed. After release from the posture, ALLOW the release to go wherever it needs to go in order for the client to FEEL the after effects of Yastikasana. If there is rotational dysfunction at the ribcage or tight shoulders limiting the ability for the hands to come together, you will want to prop under the arms so there is support there.

Alignment in all areas of our lives requires mindfulness. If we seek this for our physical bodies, we must first learn to bring breath into the closed spaces, to align with the subtle energetics of the body, and to be mindful OFF the mat of other areas of our lives where we might feel unsupported or out of alignment. Just notice. Without judgement as good or bad, we can just notice the connection. If we notice it, we can begin to change the lie we tell ourselves. As a Yoga Therapist and a Physical Therapist, it is not my job to bring out story. Whole body alignment has very little to do with the wound and everything to do with the thoughts, beliefs and perceived truths around the wound. It has nothing to do with where one places the foot. 

Bringing in ways to cultivate the feeling of support from the inside through meditation is also very appropriate. Even if we feel that no one out there is holding us up, we can teach our clients how to create the feeling of support from the inside. Fake it ’til you make it, I say. Draw all the nay-sayers in to your shavasana anyway. Imagine they are all there. Imagine forgiving them. Imagine all of them holding you up. What would it feel like inside to have ALL of that support? What would it look like?




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About No Boundaries Yoga Therapy

LISA Z. HUGHES, BS, PT, C-IAYT, Certified GYROTONIC Instructor, CPI Lisa Hughes is a licensed Physical Therapist, having received her degree from Northeastern University in Boston, MA. She is an Internationally Certified Yoga Therapist through the International Association Of Yoga Therapists. In 2014, Lisa completed her Yoga Therapy training through the Pranakriya School of Yoga Healing Arts under the direction and tutelage of Yoganand Michael Carroll, E-RYT500, Dean of The Kripalu School of Yoga and Marlysa Sullivan, MPT, E-RYT500, Director of The Center for Integrative Yoga Studies in Atlanta. She is the owner of No Boundaries Yoga Therapy, LLC in Alpharetta, GA., where she sees private clients for Yoga Therapy. In 2015, Lisa founded an Adaptive Yoga class for students with Spinal Cord Injury and other neurological deficits. She has taught "Adapting Yoga for Disability" for Doctoral Physical Therapy students at Emory University and regularly assists Yoga Teachers in opening yoga to all students. Lisa has thirty years of clinical experience as Licensed Physical Therapist, specializing in pain science, sports medicine, and rehabilitation medicine. While working with the head of the American College of Sports Medicine at the Sports Medicine Clinic in Children’s Hospital Boston, Lisa has rehabilitated professional football players from the New England Patriots and Cincinnati Bengals, dancers from the Boston Ballet Company, and many elite level gymnasts, runners and cyclists. She has worked with cancer survivors as well as organ transplant recipients and specializes in adapting Yoga for all disability and for the medically fragile. Lisa treats the whole client, integrating the traditional Physical Therapy modalities of neurophysiological manipulation and myofascial release with the ancient healing tools of Yoga Therapy for clients with chronic medical conditions, the medically fragile and the able-bodied new student. It is her vision to open Yoga to every body, regardless of age or medical condition. Lisa is married and has three children. In her free time, she is dedicated to a zerowaste lifestyle and educating others in living sustainably. She is avid hiker, wilderness adventurist and practices Yoga and Meditation daily. She is a volunteer with the Paralyzed Veterans of America and the Challenged Athletes Foundation (, whose mission it is to provide opportunities and support to people with disabilities so they can pursue active lifestyles through physical fitness and competitive athletics.

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