I followed the recent exchange of articles between Jeff Maitland and Robert Schleip with great interest. I became a Rolfer last year, and part of their discussion was on a subject of crucial interest to me, but over which I had neither conceptual nor practical mastery. My urgency of understanding increased when a woman with a mild scoliosis similar to the one discussed by Maitland and Schleip became my client.
I am persuaded that Jeff has mis-read Robert’s article’ and misconstrued his intent. But this, it seems to me, is an excellent example of the merely secondary importance of being right; it has been highly profitable, for me at least, to puzzle through the issues raised by Jeff’s dissent.
The problem arises with a misreading. Maitland says, “…Schleip says that the fibers of the short psoas rotate the ‘vertebrae more anteriorly [sic; this is a misquotation 2] and that the vertebrae rotate ‘away from the side of the short psoas3. He concludes by saying, “Schleip thinks that he has described the opposite of what Freyette’s first law says when in fact he is describing the very same situation.”4 Neither of these statements is accurate.
Maitland understands Schleip to be saying that a short left psoas generates a spine that is inconsistent with Freyette’s First Law. However, Schleip’s point is not that it is not, but rather that the typical scoliotic spine (Figs. 1, p. 24 and 1a, p. 25) is not likely to have been caused by a short psoas. Schleip says, for instance, “In terms of rotation one would suspect the psoas fibers attaching at the lateral sides of the vertebrae to rotate this side more anteriorly… “.5 He says “would,” meaning that he does not assume that that is what happens, rather that that is what is being tested: given Freyette’s First Law, he is asking, is it likely that a short psoas has caused the scoliosis?
Is this why Maitland thinks Schleip has not understood Freyette’s First Law?
Maitland says, “let’s imagine that the lumbar spine is being side bend left by a left short psoas” which of course illustrates a right side bend and right short psoas, as Netter imagines it would be); but in starting from the other end of the argument Maitland has missed what for Schleip is the essential problem. That is not whether a scoliotic spine behaves according to Freyette or not (Schleip thinks that it does6), but that its orientation does not imply a unilaterally short psoas. Schleip says that his illustration might lead us to suspect a short left psoas, but that it is not entirely consistent with it (he says that it would be “partly in conflict”). Why does he say that? Isn’t this a straightforward matter of inspecting the illustration, and then determining which way the lumbar spine is side bent? It is not.
Two points will be raised here; the first is interesting, perhaps persuasive, and the second is more decisive.
If the rotated vertebrae in the lumbar spine here were the result of a left short psoas, we would expect their left costal processes’, to which the deep psoas fibers attach, to be rotated more anteriorly. Since that is patently not the case, we should rule out shortness in the left psoas as the cause of rotation. This will not surprise Maitland.
However, these vertebrae are not only side bent and rotated, but also translated laterally from the median axis (sagittal plane) – to the left (Figure la, p. 25). For this reason, it also seems unlikely that shortness in the right psoas is the root cause of this scoliosis, because the centers of the lumbar vertebrae are displaced further from the presumed distal iliopsoas insertion on the right femur8.
That is the first point.
In his comment on the illustration (Figure 1, p. 24), Schleip says that, “the explanatory theory of an unilateral psoas shortness (e.g. on the left here) would be partly in conflict with the direction of rotation shown.”9 Two things are striking here. The first is that he is speaking of a presumably left short psoas. This is odd; isn’t the lumbar spine left-rotated as a group here, and in a right side bend? The second is that he says that the theory is “partly in conflict” – why only partly? There is one answer to these two questions: namely, that this lumbar spine is only partly left rotated. Greenman explains the matter in this way:
“The vertebral motion segment consists of the superior and inferior adjacent vertebra [sic] and the intervening disc and ligamentous structures. By convention, motion of the superior vertebra is described in relation to the inferior.”10
This means that, in this spine, L2, L1, and T12 are plainly right-rotated, not left-rotated, and indeed it is evident from the illustration that their left costal’1 processes are progressively more anterior, as compared with those of L3.
So Schleip is right on this point. The entire lumbar spine here assumes a single arc, and each of its vertebrae is rotated left, to a greater or lesser extent, with respect to an imaginary midline; but they are not on that account all left-rotated, at least not according to the accepted terminology.
It might be argued that the psoas doesn’t care what the osteopathic conventions for describing things are, and that the fact that Dr. Greenman would call L2, L1, and T12 right rotated does not change the fact that they are in fact left-rotated with respect to “what would be normal for this body.” There might be a possible counterargument in this point, but it is probably worth considering first how odd the psoas orientation – on either side – has to be for the spine to take the shape that it does. L3 is the vertebra that is furthest translated left; but it is also the vertebra that is most left-rotated! – that is, with respect to “what would be normal for this body,” not with respect to osteopathic convention. The problem is inverted on the right side, so the psoas there is, of course, not less oddly oriented. Indeed, the idea that a right short psoas is the root cause of this scoliosis is even more difficult to entertain, since (as noted above) the lumbar vertebral bodies are also all translated left (left of “what would be normal for this body,” that is).
Figure 1 might occasion some misgivings. It is not obvious from it that L2 and L1 are left side bent, though T12 appears to be. Since this is an admittedly schematic illustration, it is probably better to reserve judgment about whether or not this spine respects Freyette’s First Law. Its rotational component, on the other hand, is quite clear. Indeed, in his analysis Schleip refers only to rotation: “partly in conflict with the direction of rotation shown” (my emphasis); so perhaps in preparing the illustration he did not concern himself with the side bend component. It would be helpful for him to comment on this.
The reductionist view of the scoliosis problem that seeks to isolate its cause in a single muscle is the sort of thing that has led to drastic measures like the surgical severing (horribile dictu) of the psoas that Schleip mentions;” but reductionist approaches do sometimes have success. Likewise, maps like Figure 1, p. 24 are a useful way to distinguish and isolate aspects of a problem; but they are not the same (so it is said) as the territory they represent.
This discussion, like Schleip’s, leaves out the question of whether either psoas is actually short. Part of the problem in that question is that “short” can mean more than one thing to Rolfers. Perhaps the reader will be forgiving of the need in this discussion for awkward substitute locutions (and of their inconsistent application). Shortness is characteristic of random bodies; as Ida Rolf said, “it is not possible to put in a compensation that lengthens; every compensation shortens”13. The present argument (and Schleip’s) addresses only the issue of whether or not a “short” psoas is likely to be the root cause of a scoliosis.
1. That is, “Lecture Notes on Psoas and Adductors,” in Rolf Lines, Nov. 1998; pp. 21-22.
2. What he actually says is this: “In terms of rotation one would suspect the psoas fibers attaching at the lateral sides of the vertebrae to rotate this side more anteriorly…” Ibid, p. 21. My emphasis. To “rotate the vertebrae more anteriorly” would mean to rotate the tops of the vertebrae more anteriorly.
3. Maitland, J.: “The Backbone of Structural Integration,” in Rolf Lines, Winter 2000; p. 18.
5. Schleip, op. cit., p. 21, and quoted in Maitland, op. cit., p. 18; my emphasis.
6. “Walking on Solid and Less Solid Grounds: Reply to Jeff Maitland,” in Rolf Lines, Winter 2000; p. 20: “At least for the very common type of idiopathic scoliosis all the books seem to support Freyette’s First Law…”
7. Some readers will find this expression strange, or even perverse, and will prefer “transverse processes.” But cf. Locomotor System, by Werner Platzer (Thieme Medical Publishers, New York, 1992); p. 42.
8. “Further” meaning something like, “further than what would be normal for this body.” “Shortness” is an admittedly imprecise term in this context, or at any rate not a simple one. Both Schleip and Maitland appear to mean not only “short with respect to what would be normal for this body,” which is already not simple, but also something like “chronically contracted,” since the question has to do with the root cause of the scoliosis. We are of course handicapped by not knowing where the distal iliopsoas attachments are.
9. “Meaning and Grounds…,” p. 20.
10. Greenman, P. E.: Principles of Manual Medicine, 2nd Ed. Lippincott, Williams, and Wilkins, 1996; p. 60.
11. Or, if you prefer, “transverse processes.”
12. “Lecture Notes…,” p. 22, and pointing out that the procedure has proven ineffective in improving scolioses.
13. Rolf, I. P.: Ida Rolf Talks about Rolfing and Physical Reality. Rolf Institute, 1978; p. 204. Also attributed to her: “The psoas meanders, and anything that meanders gets in trouble.