Scoliosis: What to Do?

"A Rolfer's first goal is to restore symmetry, and symmetry, in the last analysis, is a synonym forbalance.1""In all Rolfing work, we are involved in a lengthening process?that´s the only way you can straighten a body.2"

Author

FULGENZI, Miita Mazzali

Translator

Pages: 5-13

Year: 2000

Dr. Ida Rolf Institute

ROLF LINES, Vol XXVIII nº 04 FALL 2000

fall

2000

Volume: 28

It is in light of these declarations by Dr. lda Rolf that we can give effective support to our clients who have scoliosis. Rolling is the most powerful tool available to align a body that is unbalanced by scoliosis, provided that we are able to put everything “where it belongs.”

This article is for Rollers who, fearing to make a mistake, are reluctant to treat scoliotic clients. It is impossible to discuss in a single article what has been written about in hundred, kit books. ‘Therefore only a few cues, together with some manipulation keys that 1 personally have found effective, will be given. If these cues arc gin en analytically, it is not in order to underestimate the whole, but so that each Roller has more tools to use when they are necessary. The aim is to sharpen our body reading in order to employ a more definite strategy.

DESCRIPTION OF SCOLIOSIS

True scoliosis is idiopathic – or of unknown origin – and is characterized by the presence of a misalignment of some or all vertebrae creating a helicoidal shifting of the spine. The back develops a gibbus (or more than one), meaning that at the same level, one side (if the bark is more posterior relative to the other side. This can easily be seen by asking the client to bend forward (Figures A and B). If a gibbus is not present it is not true scoliosis, but rather scoliotic behavior a condition much easier to change.

In the scoliotic spine, one or more curvatures in the frontal plane may be seen – the primary curve and the compensation curves. The vertebrae an, rotated on the horizontal plane. these rotations as a whole create the gibbus and are formed by transverse processes shifted posterior on one side and by the ribs following this shift (Figures C and D). At the same level on the other side of the spine, the transverse processes go forward and we see a depression, or concavity. In the sagittal plane, the two sides of the body have different curvatures. This means that, in profile, one side of the spine is lordotic, while at the same level die other side is kyphotic.

Every scoliosis has its own conformation and evolution, linked to the personal history of the person affected by it. Scoliosis can he caused by illness, such as bone tuberculosis or paralysis, as well as by a bone anomaly such as a shorter leg or an extra half-vertebra. Ill these cases, if you don’t have a specific background, it is better to ask a teacher or a doctor who knows Rolling for advice regarding the initiation and extent of your intervention.

Scoliosis affects females to a larger extent than males, and it advances during periods of bone growth. This means that it the scoliosis appears at an early age (childhood scoliosis), it can become severe it not treated. Sculiosis worsens far quicker one rear before and one year after puberty, but when it is discovered it must be treated every time the child becomes talker. Once we have finished the ten Rolling sessions, we should ask the parents to measure their child’s height and to bring them in for another session every time they notice as increase.

To understand what the body needs during periods of rapid growth, just imagine that a very deep tension prevents the myofascia from spread ing correctly during bone growth. This “pin” blocks a few segments, and the body is forced to twist at several locations. This is true because when two bodies are compressed together. they tend to react by rotating.’ Soft tissue shortening goes together with increasing scoliotic curvature. There flore the first important concept to remember is: to straighten a scoliosis it is necessary to create more space by lengthening the fascia.

Other parts tit the body have to compensate when the spine becomes scoliotic. The head, which orients itself in space through the eves and keeps the body balanced through the inner ear, must be level. Compensation curvatures are in fact an adaptation to maintain the body in an upright position. Even it in the sagittaI plane the shoulder girdle partially absorbs the imbalance of the lower spine, there are always compensations in the neck.

In a scoliosis, shortening involves, first of all, the inuscles joining vertebrae. If we consult Kapand)i’s hooks autd considc r the physiology of joint movement ill the spine. we notice that flexion movement has a larger range at the lumbar level, while rotation is greater at the thwaric level. Consequently, thoracic scolioses are more dangerous because then have a favorable ground on which even more rotation maybe allowed. When scolins,is is in an advanced stage, some vertebrae can actually degrade to a cone shape that can no longer be modified. In spite of this, we can work to release compensations anal let the body be more at ease.

STRUCTURE EXAMINATION

In observing the client standing, the triangle formed by the waistline and the arm (Figure E) is an obvious indication: people with scoliosis have one triangle smaller than the other. On one side we may also see the socalled (at least in Italy and France) “hatchet stroke” adjacent to the spinal concavity (Figure F). On the side where the hand doesn’t touch the body or is more distant, we will find a major shortening of the psoas (Photo 1).

In the pelvis there are many factors that we will consider one at a time:

1) One ilium will be in anterior tilt, one in posterior till. The lies of force will therefore he very different in each leg. 1Ve can put our hands on the iliac crests to see which is higher; the higher side will be the One with an anterior tilt (Photo 2). At the lumbar level a lordosis goes together will) the anteriorly tilted ilium, a kvphosis with Ow ilium in posterior lilt.

If you are supporters of precision, You ran do a test: put one of Your fingers on the anterior superior iliac spine (ASIS) of the client and another on the posterior inferior iliac spine (three fingers of the person you are measuring below the posterior superior iliac spine). If the finger in Iron) is lower, the ilium is unleriorly tilted, and vice versa (Photo 3).

2) One ilium will be in out-flare, the other in in-flare. To evaluate that, we can trace two lines starting from the umbilicus to each ASIS. The longer line will be the side of the out-flare (Photo I).

3) The pelvis as a whole can have rotation in the horizontal plane. lip evaluate this, instruct the’ client to stand in a relaxed manner, and rotate their pelvis right and left. The direction the pelvis relates more easily is the direction of rotation.4

The sacrum can seem difficult to understand, because it moves in all three planes and there is an oblique component that creates difficulty for the beginner. The base of the sacrum follows the lumbar segment, so in the frontal plane it will have the same inclination of the lumbar vertebrae. In the horizontal plane, the base of the sacrum will be posterior on the same side as the lumbar kyphosis. Working on these two variables allows us to also influence file third, and so the obliquity.

The legs are aflected by imbalance in the pelvis, and sometimes there is a sacroiliac joint blocked.’1i check if one leg really is shorter than the other, we may ask the client to lie down supine, with legs bent. This will show if one of the femurs is longer (Figure G). To check it the lower legs are different lengths, ask the client to sit on the edge if the table with the lower legs hanging down. (Figure H).

Regarding the back, electromyography studies have shown that muscle activity on the concave side of a scoliotic curvature is almost zero. If scoliosis creates more than one curvature, to recognize which is the main curvature and which are compensations, we can ask the sitting client to bend to the side. The “cord’ curvature is where we find very little closure movement on the convex side during the side-bend. The other curvatures can be modified much more easily.

In a body that has a scoliosis, the shoulder girdle will be lower on one side (Figure If the best evaluation of this is obtained by looking at the clavicles. If they are slanting as a whole, but in tine with each other, it is due to scoliosis photo 1). If only one clavicle is inclined, it is caused by other factors such as a shoulder raised to carry a handbag, poor posture while studying or writing, or a previous trauma.

The ribs are fixed open where the convexity of the curvature is (where we see the gibbus) and are closer together on the concave side (Figure J). Shortened rhomboids also pull the scapula mediallly on the concave side. The scapula slides laterally on the convex side with a corresponding shortening of serratus anterior and all the muscles between the scapula and the arm including teres major and minor infraspinatrus (Figure J). If we place our thumbs on the inferior angle of the scapulae, we can evaluate their position with respect to the spinae and the torso more clearly (Photo 5).

Lumbar and thoracics vertebrae follow type-1 motion, meaning that whem there is a lateral bending of the spine, every vertebra that has free joint facets moves rotating its transverse process downward and forward on the same side as body bending. Cervical vertebrae always compensate. On one side, between the atlas and occiput, there will be a greater compression (Figure K).

The cranium and viscera are also forced to adapt to the scoliotic spine. As both evaluation and treatment in these areas are highly complex, i suggest that specific training be obtained.

HOW TO WORK

Premise: all Rollers are trained to work with every kind of structure. What follows are indications for working more accurately. All suggestions can be added to the normal work routine, or can be substituted by something more specific or efficient. An overall view must be kept; while working in a specific way we must not neglect integration of the whole.

I want to stress that ia person who has scoliosis, it is the “core” which is affected. As we create connections and give support from the ground, a sense of deep balance is increased. It is important to work not only with the client lying down, but also With her sitting and standing. Even if Rolling sometimes induce’ only a limited decrease of scoliosic rotations (mainly in ad tills), easing; the imbalances associated With compensations make the client more comfortable.

1) Legs. A piece of advice from Michael Salveson’ has proved very useful to me: treat scoliosis starting from the client’s legs. Although we did l have enough time to discuss how he works, this idea guided me in treating a severe scoliosis (’15’ in the main, more rigid, curvature, and 55″ as compensation curvature) in a little girl 11 years old. Her spine was very soft and looked extremely unstable, while her leg muscles were stiff and short. Everything I did to help her legs had a positive influence on her spine and created a more homogeneous tonus. Very often legs have tensions because of the need to support and compensate for instability, in the “core.” Intervening in the fascial arrangement of the legs modifies the arrangement of the pelvis, and because of the attachment of the psoas, the spine.

In addition to working along the lint-, of force considered in Jan Sultan’s internal/external model (and, if you like, the way of working considered in the article “Remarks About Structure Starting From an Aesthetic Point of View”), I recommend performing the following test. Place the client on her side with her legs flexed open and one leg bent to stabilize the lumbar area (Photo 6). Passively straighten one leg at a [line, backward and forward, to test the range of motion; you will easily realize if full extension is inhibited and where the major tensions are. The same test should be performed on both sides. In this position, we can also work by asking the client to gently lengthen her leg. A good image to use, drawn from Hubert Godard’s way of working, is to tell her to slide her leg, caressing, the table with her skin. In the, way we induce a tonic movement from the “core”.

2) Sides. The side where the triangle formed between the waist and arm is smaller is the side where the weight of the trunk burdens more. This triangle has to be opened and lengthened in order that the weight of the upper body in be shared more evenly on the pelvis. For instance, we can work erector spinae and quadralus lumburmn while the client exhales and glides her arm upward and leg downward, thinking of creating space in between (Photo 7). It is very useful to ask that her movement have a tangible direction7. Giving space to the shorter side also reduces the inclination of the shoulder girdle.

3) Pelvis. Balancing the pelvis requires sonic patience.

A) Hip rotators must be treated: if shortened they contribute to asymmetry of the pelvis.

B) On the side of iliac crest posterior tilt we find short hamstrings; where there is an anterior till it is the quadriceps that works and shortens more. We have to work as required.

C) Closing the iliac crest in out flare: we ask the client to bend the leg on the side of the out-flare and bring it toward the opposite side, then we ask her to push her knee against our resisting hand for a few seconds, then release (Photo 8). We then exaggerate movement of the leg downward until we feel resistance in the tissue, hold her leg for a while in that position, and repeat the cycle two more times. The obturator internus will also be short on the side of out-flare. Where the iliac crest is in in-flare, we ask the client to bend and open her leg outward (like a frog) and to push up against our hand, then we open her leg even more and we keep it in this position for a few seconds (Photo 9). This is also done three times.

To further balance the pelvis and release any tensions in the pubic, symphysis, we can make both legs work against resistance in opening and in closing for a few seconds (Photos 10 and 11)

D) To counteract the pelvic rotation in the horizontal plane, I find it useful to work with the client sitting, making sure she is silting in a well balanced way on the bench before starting any movement. We can hold her iliopsoas tendon, from her groin, resisting her movement while she attempts to rotate hex pelvis further in to its rotational pattern (Photo 12). We must remember that appropriate work on the viscera also helps to decrease pelvis rotations.

E) Major pelvic ligaments (sacrotuberous, sacroiliac) have to be balanced: we palpate to determine which side is more rigid and lean on them with the client in the sixth session position.

4) Sacrum. As I’ve already written, when we work to give balance in two planes of space, the third will also be modified. When we work to put anterior the lumbar kyphosis (it’s always easier to push anterior a vertebra or transverse process than to pull it posterior) we are also balancing the sacrun. To straighten a little the sacrum inclined on one side (following the inclination of the lumbar vertebrae), we ask the client. who is sitting on the bench and bending forward. to meet our hands by pushing tier feet on the floor the knuckles of our hands are put beside the first (on one side) and the fifth (on the other side) sacral vertebrae spinous processes. When we feet the client pushing, we transmit a little force as if we wanted to screw, or unscrew, the cap of a jar, depending on which direction we want to move the sacrum (Photo 13).

If the sacroiliac joint is blocked (when the client walks there is aberrant or little movement in that area) and you haven’t received any specific training on this topic yet, you can use a very, effective and safe trick. With the client supine, place a little foam rubber ball as big as a tennis ball but much softer under the center of the sacrum (you can ask your client if she feels it’s central). Leave it there while you work somewhere else. The weigh) of your client and the craniosacral rhythm will release the tight ligaments and the joints. A few minutes ones later the client will feel much better and you will see more movement. This is also very good for people who have chronic problems in that area, and for the Roller after a tiring day.

5) Thorax. It is important to give elasticity to the ribcage, chiefly in adults who have mote rooted rigidities. One strategy is working while flit client is breathing against resistance. especially where the sunken parts of the sternum are set. In my experience. working against resistance (which is not a strength test, either for the client or the Roller) can help people with scoliosis feel they aren’t as weak as they thought or have been It’d to think. We ask the client to exhale deeply and then to breathe in so .e. to push away our hands that arc pre>sing a little on her thorax (Photo 14).

6) Back. As I have written before, it is easier to push forward transverse processes that are posterior than to do the opposite. In my advanced training’ I observed Jeff Maitland using type-I vertebral motion in a very effective way. While seated, the client bends to the side where the gibbus is. Vertebra after vertebra we invite the client to come from her feet toward our hands while we press on the gibbus-side transverse processes, encouraging their movement forward.

For the concave side, we ask the client to bend to the same side and to come ruin her feet, lengthening the arts over her head so as to open the costal girdle where it is closed, and to breathe in while our fingers work to curate space between the ribs (Photo 15).

If a rotation of the trunk in the horizontal plane is present it is possible In ask the client to exaggerate it (awhile maintaining connection with the ground) while the Roller counteracts her rotation. This effective trick can be applied to several areas such as the pelvis, shoulders, and psoas.

7) Scapulae. The scapula slipped medially (on the concave aide) can be brought outward by lengthening the rhomboids attached to it. I would like In remind everyone that the superior medial angle of the scapula becomes a nixed point for many movements and is in trouble in many people.

The shoulder blade slipped laterally (on the gibbus or convexity side) has tissues tied up on the lateral holler; definition and fluidity of movement are needed. The serratus anterior is very important, a big tonic muscle that plays a major role in positioning the shoulder blade. We can help matters by releasing the insertion below the medial border of the shoulder blade (Photo 16). We can also lengthen it while the client, lying on the opposite side, breathes out (the costal girdle doses and the shoulder blade moves closer to the spine) and gently slides her arm backward toward the spine (Photo 17). The frontal part the humerus is usually pushed forward, and tissues between it and the clavicle are thickened; everything must be addressed to restore space and definition.

8) Costal girdle. In the more opened side (gibbus side) we can give elasticity to intercostal muscles by accompanying them inward with the client breathes out, i.e. while the ribs get closer together. We can work on the side opposite the gibbus while the client is prone with her torso side hunt so as to open the ribcage. We ask her to slide her arm laterally over her head, caressing the Rolling table (tonic movement) while she breathes in (opening the ribs more) toward our lingers that work to give more space (photo 18).

9) Psoas and viscera. All though they are in the territory of the fifth session, these areas should be treated earlier, perhaps by doing a little work at the end of the earlier sessions to adapt them to what has been done in other parts. Activating the psoas creates connection, which is very important for people who have scoliosis. If not adjusted the viscera can be badly affected by structural work done elsewhere Visceral restrictions can also prevent a release of the structure.

10) Cervical vertebrae. There is always a compensation curvature in the neck that should be integrated at the end of each session. The side that has little or no space between atlas and occiput is an area that can cause pail and dizziness as the years go by, if not treated. We have to give space and freedom of movement in this area.

11) TMJ and cranium. Dr. Rolf taught us that the sphenoid hone is the keystone of the human body. In people with scoliosis the sphenoid is conditioned by underlying asymmetries even mono. To be more specific, as is required in these cases, it is advisable to attend specific workshop.

A few words about the temporal muscle: like all fan-shaped muscles (deltoid, gluteus minimus and medius), its fibers can act in different ways, following completely different lines of movement and force. Its anterior fibers can become antagonist to the posterior ones (or vice-versa). inhibiting its action. This is what occurs in people with coliosis, because there are strong asymmetries in their structure. Releasing the tighter fibers in this muscle will release tensions in facilitating movement in the cranial Sutures, giving more balance.

I would like to Finish by remembering a very effective trick used by Hubert Godard 8. At the end of a session he invited his client to get on the Rolling table and walk a little on it. The movement on a soft surface removed many rigidities and once hack on the around, a fluid and harmonious movement was induced, a beautiful sight to see.

REFERENCES

1) Ida Rolf: Ida Rolf Talks About Rolfing and Physical Reality. Healing Ails Press, 1990, p.187.

2) Op. Cit.. p.203.

3) Hans Flury: “Theoretical Aspects and Implications of the Internal-External System.’ Notes on. Structural Integration. Nov 1989,

4) Hans Flury: ‘Normal Function” Workshop.

5) Advanced Training. Rome, 1996.

6) Roll Lines, Vol. XXVII No.3, Summer

7) Hubert Godard’s Movement Workshops.

8) Movement Training. Rome 1997.

BIBLIOGRAPHY

Ida Rolf. Ida Rolf Talks About Rolfing and Physical Reality; Arts Press, 1990.

Ida Rolf Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being, Harper & Row, 1978

Alain Bernard: Trattato di osteopatia strutturale. Vol. I. II, Marrapese. 1986.

Marcel Bienfait: Fisiologia della terapia manuale Editore Marrapese 1990.

Marcel Bienfail, Scoliositerapia manuale Editore Marrapese 1990

Léopold BusquetLe catene muscolari, Vc1. I,II,III,IV. Marrapese. 1992.

I.A.Kapandji: Fisiologia articolare. Marrape se, 1983.

Jeffrey Maitland The Art of Rolfing. Principles, Taxonomies, Techniques, distributed in advanced training, Rome 1996

A, Mancini, C. Morlacchi: Clinica ortopedica, Piccin, 1977.

Patrick Michaud: L’esame morfologico in ginnastica analitica Marrapese,1989.

René Perdriolle: La scoliosi, Ghedini Editore, 1982.

Vincenzo Pirola La chinesiterapia nella rieducazione della scoliosi, Sperling & Kufer. 1993.

(Drawings used in this article are taken from these books.)

Scoliosis: What to Do?

FULGENZI, Miita Mazzali

ROLF LINES, Vol XXVIII nº 04 FALL 2000

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