We left off on the last part of this series talking about the need to deal with the obturator internus. As we mentioned I believe it will also be short on the site of the out-flare. We have them open the leg where there is an in flare in the iliac crest and have the client on their back and bend that leg and then open it outward. Then we ask them to push against our hand and then one more after holding against their movement. Its essentially like doing a PNF stretch. We repeat 3 or four times. The opposite hand is holding down the opposite iliac crest.
Then we move on to further stabilization by having the client bring both feet up on the table, knees bent. We will do this next move to release any tension in the pubic symphysis area. We place our hands on the outside of the knees and resist the opening of their legs. Do that three or four times. Then, cross your hands and place the heels of your hands on the inside of their legs and repeat by resisting inside movement three or four times. If there is a noticeable rotation in the horizontal plane of the pelvis, have your client sit on a bench, table or chair. Place your hands on the illiopsoas tendon and resist their movement into the pattern of ease.
Obviously the sacrotuberous and the sacroiliac tendons will need some work. With your client in a prone position, palpate to determine the more inflexible side and work them to create some length and freedom. The next move on the sacrum is a bit trickier and requires some observation and palpation skills. We want to look for which lumbar vertebrae we can move forward to help balance the kyphosis and the sacrum-which will be inclined to one side. With your client sitting again have them bend forward and push through their feet to meet your hands. Place your hands/knuckles on the first and fifth lumbar vertebrae on the opposite side of each other. Depending on which way you feel it needs to go, the knuckles twist in either a counter clockwise or clock wise manner at the same time. I learned a trick at the Rolf Institute years ago from one of the instructors that said, until you get the skill set down, which I am still not sure I have on every sacrum I want to adjust, you can take a small ball and have your client place it where they think the middle of their sacrum is. Have them rest on that for awhile and often times it will balance things out! Try it on yourself some time.
Next is the thorax. We want to create as much movement in the thorax as we can because of the rigidity that exists there especially with adults who have been dealing with Scoliosis for some time. It’s the same concept of calling for movement and resisting it with the various tools of your hands in the costal arch, ribs, sternum etc. Let your client use their breath to facilitate new movement while you resist and open the fascia to create more space. Big exhale big inhales!
Next we move on to the back. Have your client seated and remember to push the transverse processes that are in a posterior position forward. Have your client bend to the side of the gibbus and then push through their feet again towards our hands which are placed on those vertebrae. Then to deal with the concave side we have the client put their arm over their head to that side and again work the gibbous as they bend forward. If the scapula has moved medially on the concave side look to the rhomboids that attach to them and loosen them. If it has slipped to the lateral side any of its attachments could be in need of work, especially the serratus anterior which is very important in keeping the shoulder blade in an organized position. Work under the scapula at its medial attachments while the client is on their opposite side. Curl your fingers under the scapula and have them breath deeply – moving the the scapula closer to the spine. You may find that the humerus is locked more forward. Working the lateral part of the clavicle can bring it back somewhat into a more comfortable position.
The costal girdle on the gibbus side can use work on the intercostals. Just go deeper when the client takes a breath.Then move to the opposite side of the gibbus with the client prone. Have the client move their arm over their head using a sliding arcing movement. Use their movement to work into the intercostals and the rib attachments to the spine.
The psoas should be worked as well as the viscera. Obviously people with scoliosis have need for the psoas muscles to be balanced as much as possible. Visceral training is a great complement to any structural work and should be investigated if you are truly interested in doing great work on those who come to your office with imbalances of the structure.
It is important to attend to the cervical vertebrae as part of your finishing touches. Find the side that is lacking in space and do your best to soften and lengthen. Also, it is highly recommended to do some cranial work to do deal with the TMJ and other aspects of dysfunction in the cranium caused by scoliosis. It’s my thought that if one does structural work, both visceral manipulation and cranial training should be a part of your repertoire.
At an annual meeting I was told that Hubert Godard who came to Rolfing from a dance background, had his clients lie on his soft table after a session to remove rigidities with great results. It can work wonders depending on the success of your session. When I lived by the beach I would have my clients take a walk slowly and consciously in the sand after a session. This allowed them to feel more fluidity in their bodies. Hard surfaces are unkind to our bodies and their movement quality. Soft grass in a park is also a lovely medium to soften the tissues of their deeply held patterns.
Good luck, have fun, and don’t take yourself or your work too seriously, that way you also have the potential to allow the Divine in to lend a hand in the process!