In a true scoliosis the shoulder girdle will be obviously lower on one side than the other. The best observation point to this reference are the clavicles. If they are slanting, but in line with each other it is due to a scoliosis. If only one side is inclined, it can be from other factors like carrying a bag, some former trauma, etc. The ribs will be fixed open where there is convexity of the curvature, that is where the gibbus will be noticed. The ribs are closer together on the concave side. You should notice the scapula being pulled medially by the rhomboids. As the scapula is sliding laterally on the convex side, the serratus anterior and the muscles between the arm will shorten. There will also be a compensatory pattern in the cervical vertebrae at the AO joint with a notable compression.
I think its important to realize there are some degrees of scoliosis and age factors that will only allow a client to feel more comfortable from our work. Once the bones have changed their structure due to the forces paced upon them over long periods of time, there is only so much that we can do.
So the question begs, what can we accomplish as therapists? First of all it depends on the degree of the pattern. It’s a core issue and we must never lose sight of this fact, nor the need to integrate our work throughout the body. There is value to working with the client lying down, sitting and standing as well.
First and most importantly I want to plant a very important seed about the legs. When you think about a client with scoliosis, it is very easy to get fixated on the spine where the pattern is so clear. Don’t fall prey to the obvious. Work the legs, they are often rigid from compensating for the patterns above them! Releasing there can often feel remarkable and allow the upper pattern to ease somewhat. The legs affect the pelvis, the pelvis affects the psoas, and the psoas affects the spine.
Years ago, after I had been practicing about 10 years, I was taught a test that gave more information about the tension in the body of my scoliotic clients. Have them lie on their side with knees bent. Take one leg and straighten it and then the other leg. There will be more range of movement on the side with less tension. Switch sides and do it again. Work more on the leg that has less length of movement. The movement is very passive. Make sure your client moves slowly and gently to impact and fire their core muscles.
Another tool to use is to open and free the smaller triangle of the QL area. It is probably familiar to you. It can be done prone, supine and often most effectively from the side posture. Feldenkrais like movements like stretching the arm upward while lengthening the leg of the shortened side on an out breath can be very helpful. When you balance the shortened triangle, it invariably helps to balance the shoulder girdle.
Don’t neglect the hip rotators. Side posture work as illustrated in the Lyons Institute Structural Integration DVDs is an easy way to accomplish these necessary changes. You can also do work while prone, with the client’s knee bent, using a movement like drawing a draft beer. Bring the heel laterally while using your hand or elbow in the rotator muscles. If you find a posterior tilt in the pelvis, you must address the hamstrings on that side. Conversely, if there is an anterior tilt, the quadriceps must be the culprit and released.
If you notice a flaring out of the ilium, oftentimes you can help create more balance in the pelvis by having your client bend the leg of that out flared innominate bone and take it to the opposite side. Then have them take it back to the middle starting point and resist that movement for a few seconds or one breath and repeat. Then take it further until you feel resistance and hold it there. Repeat this a few times.
Then we must deal with the obdurator internus which will also be shortened on the out-flared side. With the client on supine, have them bend their leg by bringing the foot up toward the pelvis aligned with the other knee. Bring her knee down to the table while using your opposite hand on the ASIS of the opposite side. Have her bring her bent knee medially while you resist at her knee. Then open it a bit more, and repeat.
So, if you are practicing pure massage, you may want to consider buying our Structural Integration series. We also have a new course coming out in July that will be a very in-depth 10 session series using cranial sacral therapy as well.
In the next blog post we will continue with the “tools of the trade” in helping our clients with scoliosis. Don’t hesitate to post questions.