Each client is unique, but a lot of scoliosis patterns are a version of the ‘three-curve’ scoliosis pattern described by Christa Lehnert-Schroth. In her seminal book on scoliosis treatment, Lehnert-Schroth describes how torsion relationships create overly strong muscles on the convex side of the curve and short tight muscles on the concave side. Discussing her model she explains that “left lumbar spinal erectors muscles are overly strong, thus the right thoracic group becomes stronger as well, and finally the left cervical group, resulting in a typical three-curve scoliosis posture” (Lehnert-Schroth 2007, 50).
This model informs my seeing and interventions. I find that discomfort often shows up in the overly strong convex regions (i.e., painful left trapezius and left low-back/sacroiliac regions). When working in these areas, my intention is predominantly to differentiate and ease hypertonic tissue. I find I get better results when I devote more of my efforts to freeing and ‘waking up’ the shorter, weaker, less embodied areas around concave spinal curves. For clients with scoliosis, this often means focusing structural and functional interventions around the right lumbar, left thoracic, and right cervical spine. Of course, this is a generalized observation and interventions need to be customized to the individual.
To address concave curves, I often work with the client sidelying, bolstering at different locations on each side (see images below). By placing a bolster at the left waist, I can more effectively free the right iliac crest and lift the lower ribs. This is also a good time to address shortness in the right anterior neck and shoulder. When the client turns to the opposite side, I bolster under the convex left thoracic curve to facilitate right rib expansion. Bolstering each side differently facilitates creating space, increasing breath, and refining perception on the concave curves of the spine.
Clients with scoliosis tend to be tighter, weaker, and less embodied on the concave side of the spinal curve – often sections of the right lumbar, left thoracic, and right cervical spine. Bolstering the convex side facilitates interventions that increase span, breath, and perception in concave areas. With common scoliotic patterns, bolstering under the left waist assists freeing the right iliac crest (A) and lengthening the waist and lifting the lower ribs (B). When the client switches sides, a more superior placement of the bolster (under the rib cage just inferior to the armpit) assists compressive rib release (C) and educates the client to breathe into the left posterior thoracic cavity.
Figure 3: Bibiana Badenes working with a teenager.
Do you teach movement to these clients?
BW: Totally! Although I believe all clients benefit from Rolf Movement Integration, it’s essential for working with scoliosis. We’re working with a functional spiral as much as a structural one. While movement work can create appreciable shifts in curvature patterns in young people whose spinal curves are still developing, I think working with perception and coordination is just as critical for those of us whose spines have already adapted at a boney level. We can still find fluidity, support, and balance through significant curvatures. This is where embodiment through somatic awareness and imagination come in.
BB: Absolutely. Over the years, my functional and structural sessions have merged until now I cannot separate the two. Working this way has had a personal benefit as well. Since I do the experiential exercises when I teach them, I continue to enhance my own embodiment. I continue to work full time because the work contributes to my own self-care.
I do not teach anything that could be interpreted as ‘how the body should be’. Instead, I try to help my clients learn to feel and sense without judgment. Developing acceptance is very important. I teach a sequence to people with scoliosis that works on the following concepts:
Could you speculate about where or how you think idiopathic (not neuralgic or from a degenerative disease) scoliosis starts?
BW: I suspect it’s a combination of nature and nurture. Research suggests that most adolescent scoliosis has an inherited, or at least genetic, component. Rolfer Larry Koliha and I were teaching a class on working with scoliosis to bodywork practitioners in Iceland several years ago. When we asked participants about their experience working with scoliosis, we were stunned to learn that only one person had worked with a client with scoliosis, and none of the participants had the condition themselves. Such lack of exposure is never the case in
U.S. classes. Larry hypothesized it was because everyone in Iceland learns to swim, and because this was a common exercise in the culture, young people grew up using their bodies bilaterally. My theories tended more toward the ‘nature’ side of the equation. Until the 1940s Iceland was pretty isolated with a highly homogenous gene pool. I hypothesized that there was less of a genetic predisposition in the population. I suspect both points are valid: genetics creates the opportunity, but how we live in our bodies has a lot to do with whether a predisposition is realized.
BB: I always wonder why scoliosis is so much more prevalent in girls than boys.
Some of the things I’ve read suggest cultural differences. Perhaps boys are more likely to be involved in spatial activities such as ball games (baseball, soccer, etc.), which allow them to remap and release neural patterns before long- term compensations set in. But we just don’t know. Scoliosis is a symptom of the whole neuro-myofascial-skeletal system – not just the spine. So we have to teach clients to rebuild this system via their sensing and not focus on form.
What about homework? Do you want parents to be more or less involved?
BW: You can’t cram functional learning – it takes time. Homework is useful only if it gets done, so I like to give clients things they can do when they’re waiting in a line (play with perception in standing), or sitting at a stoplight (notice ‘backspace’), or talking on the phone (keep a ball nearby for foot mapping). I also encourage clients to do somatic exercises on the floor before retiring for the night; it makes a nice transition to sleep. Adults and adolescents alike are more likely to do homework if they understand how it might benefit them. So the most important thing is to get to know your clients and what motivates them. This is especially important for kids who may not have asked to get bodywork therapy. I once had a client bring in his son to address a spinal curvature and an extremely tight chest. Initially the boy had no interest in our sessions. So we just talked. As he began to open up, I learned he was an avid swimmer. When I mentioned that Rolfing work might facilitate fuller breathing, he wanted to try it. Clients need to be invested for the work to be effective.
Parents can help or hinder. I worked with one mother/daughter pair who each had scoliosis. It was wonderful to see them support each other in practicing homework and moving more. But I have also seen parents who are overly involved or critical. On several occasions, I have made time to talk with parents separately about their use of language. Descriptions such as ‘bad posture’, ‘crooked’, and ‘lazy’ have no place in our sessions, but often creep into the vocabulary of well-meaning parents. I acknowledge that they probably don’t even realize that they’re using these words, but owe it to them to highlight how these terms shape their child’s body image. Parents are usually receptive.
Whenever possible, I prefer to interact directly with adolescents and create the expectation that they are responsible for doing their homework and giving me feedback. It’s about creating self- sufficiency and ‘internal support’ – a metaphor that goes a long way when working with scoliosis.
BB: I also educate parents about how to better support their child. I often see a pattern of young girls with scoliosis whose mothers place very high expectations on them. I can’t help but wonder if these girls respond to this pressure by compressing physically. It’s just an observation.
Some parents think that scoliosis is only an aesthetic condition. Unless their child is in pain, they don’t think it’s something they need to address. But I find that working with these patterns not only results in straighter spines but also improves attention and academic performance, develops greater self- confidence, and increases social interaction. I tell them, “Hands on the body are hands on the nervous system.” I think somatic coaching plays a big role. It’s important to motivate clients and make them part of the equation.
One more thing – some parents think that we can complete this work in a matter of weeks. This is a learning process. As a result, I only take children whose parents commit to a longer period of time, and I tend to space my individual and group sessions so they don’t feel burdensome.
What about non-idiopathic scoliosis? Have you had any success with that?
BW: In cases of scoliosis that result from things like a disease, a neuromuscular disorder, a tumor, or spinal malformation, our work is less effective in terms of changing spinal curvature or lessening pain. That said, one of the most startling spinal changes I ever observed occurred with a client in her early sixties who presented with a dramatic scoliotic pattern. She was a nurse who told me that she hadn’t had the scoliosis until a couple years prior. At that time, she’d been in a significant car accident and she attributed her alignment to the event. Although I tend to rely on client input, when she told me she’d never had scoliosis as a young person, I was skeptical. Perhaps, like myself, she’d had the condition but never realized it. The pattern was similar to the idiopathic adolescent scoliosis I commonly see, which often becomes more pronounced with age. I couldn’t help but think the accident had simply hurried the process. I’m glad I kept silent. We did a pretty traditional Ten Series with only a moderate amount of functional work. When she showed up after her seventh session, her spine was straight. It was as if something sprung loose and the spine unwound. She was thrilled and I was speechless. I am humbled by what the body can accomplish when we take obstacles out of its path.
BB: In my opinion, we always can help people with scoliosis (through movement, awareness, and manual therapy) to avoid future compensations. If it is related to pathology, especially neurological, we have to be aware that we are part of a multidisciplinary team and that we need to work together. I love this work! It’s amazing what can happen when we help people find simultaneous stability and mobility.
BW: It can change everything.
Bibiana Badenes is a physiotherapist, Certified Advanced Rolfer, and Rolf Movement Practitioner in Spain. She organizes the BodyWisdom Spain Congress, teaches internationally, and serves on the board of ISMETA.
Bethany Ward, MBA, is a member of both the Rolfing and Rolf Movement Integration faculties at the Dr. Ida Rolf Institute™. She is a member of ISMETA’s Leadership Council and past president of the Ida P. Rolf Research Foundation.
Bibiana and Bethany became friends in 2016 teaching a gait workshop while walking the Camino de Santiago in Spain, which Bibiana organized with colleague Til Luchau and Advanced-Trainings.com. At a second workshop last year, each shared how living with scoliosis had brought cherished insights as well as challenges.
Frank, K. 2012 Dec. “Rolf Movement® Faculty Perspectives: Differentiating Categories of Embodiment: An Educational Rationale for Rolf Movement Integration within Rolfing® SI.” Structural Integration: The Journal of the Rolf Institute® 40(2):3-6. Available from https://bit. ly/2QpijBa.
Lehnert-Schroth, C. 2007. Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine, 1st English edition. Palo Alto, California: The Martindale Press.
Keen, L.K. 2009 Dec. “Embodiment and Grace.” Structural Integration: The Journal of the Rolf Institute® 37(4):27-30.