According to Stephen Pare1 not only did I misunderstand Schleip’s original intent, but I also misread his article and misquoted him in way that misled me in my original criticisms. While I appreciate Pare’s desire to enter into the discussion, I am not certain that he managed to defend Schleip’s understanding of rotation from the criticism I originally raised in “The Backbone of Structural Integration” and then reiterated in detail in “Meaning and Grounds.” Although I will suggest a shortcoming in Schleip and Pare’s discussion of the effect of the psoas on scoliosis at the end of this reply, let me emphasize that I am primarily concerned with showing how my original criticism of Schleip’s mistaken description of rotation has neither been answered nor shown to be wrong by either Schleip or Paré.

I will begin with Pare’s claim that I misquoted Schleip. Although I can respect why Pare thinks I misquoted Schleip, his suggestion that I did and his supposition that this so-called misquotation misled me is incorrect. In “The Backbone of Structural Integration”‘ I began the second paragraph with a somewhat lengthy quotation. Pare points out that I left out the phrase “this side” and that this omission is important. But the quotation in the second paragraph actually contains the disputed phrase. It is in the third paragraph that I omit “this side.” The second paragraph reads, “In terms of rotation one would suspect the psoas fibers attaching to the lateral sides of the vertebrae to rotate this side more anteriorly…” In “Meaning and Grounds,”3 which was written and submitted many months before Pare wrote his article, I also used the same quotation and again included the phrase, “this side” (sixth paragraph). It is true that in the third paragraph of “Backbone” I omitted this phrase just as Pare says. But I omitted “this side” and put quotes around “vertebra more anteriorly” for a reason. I was attempting to draw attention to a problematic description of rotation, which is the point at issue – “the point, by the way, that Schleip never addresses in his reply. Although I think it is clear from the context that my device for focusing attention on the issue of rotation was not a misquotation, I can see how one might want to quibble over this point But whether this is a misquotation or not, the important issue concerns whether my criticism of Schleip’s point is correct and whether Schleip and Pare understand my criticism.

In footnote 2, Pare seems to suggest that leaving out the phrase “this side” is problematic. Although I don’t fully understand the point Pare is making, he says, “To ‘rotate the vertebrae more anteriorly’ would mean to rotate the tops of the vertebrae more anteriorly.”‘ Since Pare quotes Greenman on the convention for describing the motion of a vertebra, he is probably also aware of what Greenman has to say about the osteopathic convention for describing rotation. In the very next sentence following the text quoted by Pare, Greenman says, “In describing rotation the anterior surface is used rather than the elements of the posterior arch.” And then six paragraphs later Greenman says, “Rotation of a vertebra is described as rotation around the y axis with translatory movement being dependent on the vertebral segment involved.”‘ To state the point with a little more precision, we can say that rotation of a vertebra is defined as “movement of the anatomical vertical axis (y axis) of the vertebra; named by the motion of a midpoint on the anterior superior surface of the vertebral body.”6 From these established conventions for describing rotation of a vertebra, it is clear that omitting “this side” from the description of rotation makes little difference; saying that it is rotated this way or that is sufficient. Hence, given this convention for describing rotation, omitting “this side” does not imply that the phrase “rotate the vertebrae more anteriorly” means “rotate the tops of the vertebrae”, “unless of course “tops of the vertebrae” refers to the “midpoint on the anterior superior surface of the vertebral body.” But if that is what “tops of the vertebrae” means, then it is just another way of saying the same thing and the phrase “this side” adds nothing useful to the description of rotation.

Paré comments on the schematic drawing of a neutral type I rotoscoliosis that Schleip appropriated and simplified from Mitchell, Moran, and Pruzzo and concludes that Schleip is correct in saying that the “explanatory theory of an unilateral psoas shortness would be partly in conflict with the direction of rotation shown.” (For the sake of consistency I reproduced Schleip’s attenuated version rather than Mitchell, Moran, and Pruzzo’s original in “Meaning and Grounds”) Taking up Schleip’s position in this way and claiming that he is correct only occludes my criticism once again. My point does not depend on my grasping the fact that Schleip is critical of the unilateral short-psoas theory of scoliosis. My criticism concerns Schleip’s claim that the vertebrae rotate in a direction opposite from the way Freyette’s first law would describe it. The problematic phrase in question is “the direction of rotation shown” and the problematic conclusion is that the “direction of rotation shown” is in conflict with Freyette’s first law.

Without properly preparing the reader for his point, Pare correctly points out that by following the convention quoted from Greenman (that the motion of the superior vertebra is described in relation to the inferior), one can conclude “in this spine L1, L2, and T12 are plainly right-rotated, not left-rotated, and indeed it is evident from the illustration that their left costal processes are progressively more anterior, as compared with those of L3.”‘ If you are familiar with Freyette’s first law, you know that it would correctly describe L2 and L1 as left rotated and describe their transverse process as progressively less prominent or posterior. If you are looking at Schleip’s schematic drawing of the spine through the lens of Freyette’s first law, you might be completely flummoxed by Pare and Schleip’s assertion. How can they reasonably claim that L1 and L2 are right rotated when Freyette’s first law clearly and correctly describes all five lumbar vertebrae as left rotated (and right side bent)?

Believe it or not, there is no conflict between the Pare/Schleip description and Freyette’s description of rotation; both descriptions are true. The apparent contradiction arises because there are two different osteopathic conventions for describing rotation being used and Pare has not clearly understood or informed his reader that he is using a convention different from, but not in conflict with, Freyette’s. One convention for describing rotation, the one at work in Freyette’s first law, leads to the conclusion that L1 and L2 are left rotated and the other convention leads to the conclusion that L1 and L2 are right rotated. Thus, if you were to use the convention that describes L1 and L2 as right rotated, and you did not realize that both descriptions designate the same situation, you might conclude that Schleip is correct, as Pare does. What at first glance seems totally weird vanishes when you realize that the points of reference in terms of which the rotation of vertebrae is described are different for each convention. With this understanding, it becomes perfectly obvious that you are reading two equally correct ways of describing the same thing. If both descriptions are true, then Freyette’s first law correctly describes the illustrated spine; “Schleip is wrong and my original criticism stands: “Schleip thinks he has described the opposite of what Freyette’s first law says when in fact he is describing the very same situation.”

Notice that both Schleip and Pare consistently misunderstand my criticism. Notice also that the confusion about rotation in Pare’s article is different from the one in Schleip’s article, “Lecture Notes on Psoas and Adductors.”8 However, it is very curious that both confusions result from Schleip and Pare’s thinking that they are describing the opposite of what Freyette’s first law says when in reality they are describing the very same situation.

The mistake that Pare and Schleip make can be more easily understood by means of a simple analogy. Imagine that someone asks two different people, A and B, how to get to the Institute for Advanced Fingernail Reflexology. A says take a left at Spinal Lane and B says take a right at Spinal Lane. Since you cannot both turn right and left at the same point in the same intersection, it sounds like one of these well-intentioned people must be wrong. But the conflict in description vanishes once you are informed that A is imagining that the traveler is driving north while B is assuming that the traveler is going south. Since the point of reference, whether you are traveling south or north is different, there is no contradiction and both instructions are correct. In a similar manner Pare uses a convention that describes rotation in a way that seems to contradict Freyette’s way of describing rotation, but in fact rests on using a different point of reference. By not realizing that he is using a convention that is compatible with Freyette’s law, Pare mistakenly thinks he is describing rotation in a way that supports Schleip’s contention. Since both descriptions are correct and compatible with each other, the support Pare constructs for Schleip’s position evaporates.

In order to explain the two conventions in a way that clearly shows that they come from osteopathy and that they are two equally correct ways of describing the same situation, I will quote Mitchell, et al. in detail. Using the language of Freyette, Mitchell, et al. say the following about their drawing of a rotoscoliosis: “the lower five vertebrae, representing the lumbars…are side bent to the right (forming the left convexity), and as a group, rotated left.”9 Notice that they say that the five lumbars are rotated left. They do not say that L2 and L1 are right rotated. The point of reference in terms of which rotation is being described in this case is the prominence or posterior displacement of the left transverse processes in relation to the right transverse processes, which can be easily palpated, and the sacrum (see below) Thus, a few paragraphs later, after describing what they call the “theoretical and inspectional aspects of a rotoscoliosis exam,” Mitchell, et al. add some comments about the palpatory features of a right side bent, left rotated lumbar spine: “The posteriorly displaced transverse process will be most prominent, i.e., most easily palpated, at the apex of the curve, and progressively less prominent as one progresses toward the midline (crossover) points above and below the apex.”

This means that since L3 is the most left rotated, its left transverse process will be the most prominent or the most posteriorly displaced of the five and since L2 and L1 are progressive) less left rotated, their left transverse processes will be progressively less prominent or progressively less posterior (Pare makes the same point when he says that the left costal processes of L2 and L1 are progressively more anterior).

Immediately after describing all five lumbar vertebrae as left rotated, Mitchell, et al. say, “A more detailed way to describe rotoscoliosis is to describe how each vertebra is rotated and side bent in relation to the vertebra below. Thus, L5 is side bent right and rotated left in relation to the sacrum; L4 is also side bent right and rotated left in relation to L5. This rotation toward the convexity continues in small increments to the apex, at L3. L2, above the apex, if compared to the sacrum, is only a little less left rotated that L3. But compared with L3, L2 is right rotated and right side bent. The small increments of right rotation will continue up through the crossover, where side bending changes from right to left, and on up to the right rotated apex of the upper group. In terms of descriptive geometry, rotation and side bending are 90° out of phase.”

Mitchell, et al. have not contradicted Freyette’s way of describing rotation or themselves. Rather, they have added the idea of comparing the rotation of each vertebra to the one below it. Thus, L2 in relation to L3 is right rotated. By implication, L1 in comparison to L2 is also right rotated. But when you compare the left prominent, posterior transverse processes to the right transverse processes by means of palpation (and the sacrum), L2 and L1 are left rotated. The point of reference for Freyette is the left transverse processes in relation to the right transverse processes and, like Mitchell, et al.’s more detailed way of describing a rotoscoliosis, the point of reference for Pare and Schleip is the inferior vertebra. But unlike Mitchell, et al., Pare and Schleip do not fully realize that the points of reference for describing rotation have changed, but not in a way that conflicts with Freyette’s first law. Thus Pare’s way of describing rotation does not support Schleip’s contention that the direction of rotation shown in Mitchell’s drawing is in conflict with the direction of rotation described by Freyette’s first law. Furthermore, it follows in a rather straightforward way that Pare’s way of describing rotation also does not support Schleip’s claim that the “explanatory theory of an unilateral psoas shortness would be partly in conflict with the direction of rotation shown.”

As I pointed out in “Meaning and Grounds”, Schleip’s reply in “Walking on Solid and Less Solid Ground” never addressed my criticism and misleads the reader by making it appear that I was making a small point about the acceptability of Freyette’s laws as it appeared in a tangential footnote. Since “Meaning and Grounds” appears in this issue of Rolf Lines, there is no need to repeat my reply to this misunderstanding. Contrary to what Pare says, I do realize that Schleip is concerned with the unilateral short-psoas theory of scoliosis. But I am more interested in taking issue with the claim that Pare’s present argument (and Schleip’s) addresses only the issue of whether or not a -short’ psoas is likely to be the root cause of scoliosis. This statement is not entirely accurate. In point of fact, both Pare and Schleip also address the issue of rotation, and, as I have just demonstrated, they confuse the osteopathic conventions for describing rotation in two different ways that both occlude and fail to answer my original criticism of Schleip’s description of rotation in “Lecture Notes.”

To some readers the issues raised in this series of replies about the spine may seem unnecessarily tedious and complicated. The fact that my points were never properly addressed and that the conventions for describing rotation were confused compelled me to reply once again. Usually my interest in these matters is wholly practical and, even though it may not be obvious at this point in the discussion, this series of replies has important practical consequences, as Erik Dalton points out in his interesting and informative article, “Refrying Freyette.”12 So before I bring this discussion to an end, I want to underscore the important point that these issues actually have simple and practical consequences for our everyday practice of Rolfing. For example, the extent that our work is unable to release facet restrictions in the spine is more often than not the extent to which we will be limited in our ability to achieve the goal of structural integration. Effective Rolfing for the spine requires understanding spinal biomechanics. If you are interested in these practical matters and in how to release joint restrictions in the spine, sacrum, pelvis, and ribs, by means of Rolfing soft-tissue techniques, you might want to consult my new book, Spinal Manipulation Made Simple13. It will be available by the time this issue of Roll Lines arrives in your mailbox.

In closing and just for the record, it is worth pointing out that there probably is no one root cause for scoliosis. Consequently, the search for a root cause is probably futile. According to some experts, there are a number of causes of scoliosis: idiopathic, congenital, and acquired.” Acquired scoliosis can result from osteomalacia, as a response to inflammation or irradiation, from sciatic irritability, from a healed leg fracture, following a hip prosthesis, and from psoas syndrome. Interestingly, a research scientist, who is also my client, informed me that some of the research he has been involved with indicates that scoliosis could be the result of neurological developmental problems. While few would seriously argue that the psoas is the root cause of scoliosis, it is clear that it can have a real effect in some cases. That is why it is sometimes called “the hidden prankster.” Since psoas syndrome is listed as one of the causes of scoliosis, and since Schleip and Pare are concerned with the relationship between scoliosis and the psoas, their discussions are incomplete because neither take account of psoas syndrome. I mention psoas syndrome, for example, because a contracted right psoas will create a right side bend. Recall that this condition is the very opposite of what Schleip imagines in “Walking” where he says he was thinking of a tight left psoas and a right side bent lumbar spine.

Arguing that the psoas is not the root cause of scoliosis surely does not demonstrate that it is never a cause. Therefore, as a way to round out this discussion, it would be important and interesting to hear what Schleip and Pare might have to say about those cases, such as psoas syndrome, where the psoas is indeed a factor. To this end, we are fortunate to have Dalton’s contributions to understanding scoliosis and spinal biomechanics included in this round of discussion. Perhaps the rich detail of his article will also help overcome my tedious, but necessary, attention to so many different spins on rotation.

1. Pare, Stephen. “The Psoas in Scoliosis: Reply to Jeff Maitland and Robert Schleip,” Rolf Lines, November 2000, Vol.XXVIII, No. 4, pp. 35-37.

2. Maitland, Jeffrey. “The Backbone of Structural Integration,” Rolf Lines, Winter 2000, Vol. XXVIII, No. 1, pp. 18-20.

3. Maitland, Jeffrey. “Meaning and Grounds,” Rolf Lines.

4. “The Psoas in Scoliosis,” p. 35.

5. Greenman, Phillip. Principles of Manua Medicine. Third edition, Baltimore: (Lippincott, Williams, and Wilkins),1996, pp 60-61.

6. Ward, Robert C., Executive Editor. Foundations for Osteopathic Medicine. Baltimore: (Lippincott, Williams, andWilkins), 1997, p. 1136.

7. “The Psoas in Scoliosis”, p. 34.

8. Schleip, Robert. “Lecture Notes on Psoas and Adductors,” RolfLines, November 1998, Vol. XXVI, No. 5, pp. 19-24.

9. Mitchell, Fred; Moran, Peter; and Pruzzo, Neil. An Evaluation and Treatment Manual of Osteopathic Procedures. Valley Park, Mo. (Mitchell, Moran, Pruzzo Associates), 1979, p. 67.

10. Ibid, p. 68.

11. Ibid, p. 68.

12. Dalton, Erik. “Refrying Freyette: A Few More Words on Spinal Biomechanics,” Rolf Lines, November 2000, Vol. XXVIII, No. 4, pp. 29-34.

13. Maitland, Jeffrey. Spinal Manipulation Made Simple: A Manual of Soft Tissue Techniques. Berkeley: (North Atlantic Books), 2000.

14. Foundations for Osteopathic Medicine, p. 990.

15. Robert Schleip, “Walking on Solid and Less Solid Grounds: Reply to Jeff Maitland,” Rolf Lines, Winter 2000, Vol. XXVIII, No. 1, pp. 20-21.