Erik Dalton Blog

Scoliosis and Massage Therapy

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From Technique Tour course During adolescence, most of us recall our mother’s marching
orders to “Stand up straight!” Fortunately, standing up straight wasn’t a problem for many:
simply retract the shoulders, contract the abdominals, allow
 Scoliosis and Massage Therapy

From Technique Tour course

During adolescence, most of us recall our mother’s marching orders to “Stand up straight!” Fortunately,
standing up straight wasn’t a problem for many: simply retract the shoulders, contract the abdominals, allow
the head to come back, and lift the torso out of the pelvis. Yet for others, the act of standing upright wasn’t,
and still isn’t, quite that easy — one hip may be higher than the other, one side of the rib cage lower —
whatever the case, all the pelvic tucking, shoulder retracting and chin-raising are usually in vain. For these
individuals, “straightening up” is a frustrating experience, like they are fighting their bodies just to get through
the day.

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 Scoliosis and Massage Therapy

When the general population hears the word scoliosis, the visualization of a hump-backed, crooked and
painful body usually comes to mind.

It is, indeed, a frightening experience when parents receive a call from the school nurse informing them that a
scoliotic “deformity” has been discovered during their child’s routine screening exam. Ten in every two
hundred children develop scoliosis between the ages of 10 and 15. Although boys and girls seem equally
affected, the curvatures in females are three to five times more likely to progress into more pronounced
aberrant postural patterns. 1 As scoliosis is frequently asymptomatic, it is often overlooked, and the parent
may only notice that the child’s clothing no longer fits properly.

Is it Fixable or Is it Fixed?
Scoliosis may be classified in a myriad of ways: by its reversibility, severity, etiology, or type and location. A
primary consideration for manual therapists is the type of scoliosis … Is it “structural” or “functional?” Spinal
curves that improve during forward-bending, sidebending and specific rotational movements are generally
referred to as “functional” or “secondary” scoliotic curves. If the curve does not straighten during any of
these maneuvers, it is considered a “structural,” “fixed” or “primary” scoliosis. Many functional curves
remain in the body too long and may become fixed as the brain valiantly attempts to compensate for
asymmetry by altering length-tension balance in associated soft tissues, i.e., muscle guarding. Prolonged

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 Scoliosis and Massage Therapy
postural compensations eventually decompensate in adjacent structures. Then the client begins experiencing
increased symptoms, signs and disease.

Fortunately, scoliosis takes many forms and need not always fall into a frightful medical category. Although it
can be a very complex musculoskeletal condition, successful treatment options are available if the disorder is
discovered in time. This article offers an overview of scoliotic classifications, types of curvatures,
accompanying symptoms, and hands-on examples for correcting the dysfunction.

Spinal Curves — Types and Motion

Abnormal spinal curves can occur in more than one of the body’s planes see (Fig. 2). Names familiar to
manual therapists like hyperkyphosis and hyperlordosis describe excessive sagittal plane curvatures,
whereas horizontal (transverse plane) compensations are commonly referred to as rotations or torsions.
Although scoliotic (side-to-side) curves are primarily considered coronal plane deviations, sagittal and coronal
influences often occur in tandem. An excellent example is the frequently seen humped-back (lateral and
posterior) scoliokyphotic deformity see.

Figure 2: Planes of the body. Scoliotic

curves may include sagittal and transverse plane compensations. MediClip, Lippincott, Williams,

2005 used with permission. Figure 3:

Scoliokyphosis. The above right structure scoliosis is formed by coronal and sagittal plane
influences. The ribcage hump becomes more prominent during forward bending. Courtesy of
Around the turn of the century, osteopathic physician Harrison Fryette introduced the “Laws of Spinal Motion”
Erik Dalton.

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in his classic book entitled Principles of Osteopathic Technique. 2 By studying movements of cadaver spines,
Fryette not only helped manual therapists understand how vertebral segments respond to normal movements
but also aberrant spinal fixations such as scoliosis. Although his second law appears slightly flawed, these
classic spinal biomechanical principles wonderfully detail underlying vertebral motion characteristics during
the acts of forward bending, backward bending, rotation and sidebending.

Comprehension of basic joint biomechanics is fundamentally essential when assessing and treating structural
and functional scoliotic clients. For example, when confronted with a right thoracic scoliosis, therapists must
recognize that vertebrae at the apex of the curve are sidebending left and rotating right causing associated
ribs to form a convex hump. Conversely, a lumbar scoliotic curve that sidebends right and rotates left
produces bulging in the lower left torso see (Fig. 4). Formation of these distorted postures is explained in
Fryette’s first law which states that lumbar and thoracic joint coupling typically occur to opposite sides.

Figure 4: Right thoracic and

left lumbar scoliosis. At the apex of the right thoracic curve, the vertebrae are sideband left and
Therapists mustAdapted
rotated right. learn to immediately identify
from Bill Allen withaberrant joint coupling responsible for these crooked patterns so
permission.
hands-on activating forces can restore balance and symmetry to all affected spinal and soft tissues Hands-on
approaches.

As a rule, scoliotic curves are named according to the side of the convexity. Thus, in the most commonly seen
right thoracic scoliosis, the ribcage will be convex right with an accompanying posterior bulge on the right
between the spinal column and scapula. When therapists encounter this knotty protruding ribcage, they
usually begin digging on the thin layer of overstretched paravertebral fascia covering the bony ribs mistakenly
believing they are releasing fibrotic muscles. In most instances, this well-intentioned maneuver may actually
worsen the condition.

During the formation of a right thoracic scoliosis, the spinal transverse processes sidebend left and rotate
right pushing the longissimus and iliocostalis erectors laterally. The weakened serratus posterior superior
muscles responsible for binding the erectors close to midline, allow the erectors to spread much like the linea
alba often permits rectus abdominis spreading during a mother’s third trimester of birth. When distended,
compensations develop as bulging babies and protruding ribs are left with a terribly inadequate support
system.

Stretch-weakened muscles, ligaments and fascia are reciprocally overpowered as hypertonic erectors on the

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 Scoliosis and Massage Therapy
opposite side shorten forcing the spine to “bow.” Typically, these myofascial tissues become neurologically
inhibited due to joint dysfunction, trauma, overuse syndromes, faulty posture, or paralysis. In (Figure 5) the
therapist’s fingers tonify stretch-weakened erectors and serratus posterior muscles with fast-paced spindle
stimulating maneuvers via the dynamic gamma motoneuron system. Extended fingers then hook and
reposition the laterally migrated paravertebrals back on top of the bulging ribs. To lengthen the erector spinae
muscles on the concave side, the therapist reaches across with extended fingers, digs into the left lamina
groove, scoops out the wiry spinalis muscles, and stretches all the erectors laterally.

Figure 5: Energize the erectors. Fast-

paced, spindle stimulating maneuvers tonight stretch-weakened erectors. Courtesy of Erik
Once some spinal bowing has been removed, additional ribcage flattening can be accomplished by
Dalton.
depressing the scapula see (Fig. 6), lengthening latissimus dorsi see (Fig. 7), releasing the diaphragm and
obliques see (Fig. 8), and stretching the inferior end of the transab-dominal fascial column see (Fig. 9).

Figure 6: Reposition scapula. The

therapist’s right hand lifts the scapula so the left hand can depress humped ribs. The client
inhales while gently pulling his shoulder toward the table against the therapist’s resistance to a
count of five and relaxes. The therapist’s extended right arm pulls and left hand gently
depresses scapula to stretch pec major/minor, open anterior chest wall, and flatten protruding

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ribcage. Courtesy of Erik Dalton. Figure 7:

Lengthen lats and stretch scoliotic concavity.The client’s left hand grasps the therapy table,
while the therapist’s right forearm hooks the lateral lat. fascia, and the left hand braces the
ilium. The client inhales to a count of five, gently pulls up on the table, and relaxes. The
therapist deep hooks lat. fascia and slowly moves headward to lengthen lateral ribcage.

Courtesy of Erik Dalton. Figure 8:

Diaphragm, obliques, and transabdominal column release. The therapist’s extended fingers
hook the respiratory diaphragm, obliques, and transabdominal fascia by slowing sinking on

exhalation and resisting on inhalation.

Figure 9: Lower transabdominal column release. The therapist’s left hand gently braces the
lower respiratory diaphragm while the right hand elevates and left rotates the torso. The client
inhales to a count of five, gently pulls the right shoulder toward the therapy table, and relaxes.
The therapist’s right hand left rotates the scoliotic ribcage and the left hand stretches the lower
pole of the transabdominal column. Courtesy of Erik Dalton.

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 Scoliosis and Massage Therapy
Classifying Spinal Curves
Scoliotic curvatures are generally classified by four degrees of severity:

1. Optimal spine — no scoliotic dysfunction.

2. Mild scoliosis — demonstrates a thoracic curve of 5 degrees to 15 degrees.
3. Moderate scoliosis — denoted by 20 to 45 degrees of curvature.
4. Severe scoliosis — represents curvature of 50 degrees or more.3

(Note: Radiologists usually allow a gray zone that represents a 5 degree range between each classification.)

Etiology and Bone Density

Based on these facts; it seems, as with most human conditions, illogical to assume that human scoliosis
would be caused by a single gene, or even by genetic factors alone. And while idiopathic scoliosis is
considered to have no discernible cause, hereditary links have been established. Thus, if one child in a family
presents with scoliosis, it’s well worth the time to check the others. Since this disorder can pass to offspring,
parents with scoliosis should watch their children for any related signs, particularly during early teenage
years.Approximately 70 percent to 90 percent of scoliosis is termed “idiopathic,” implying no known cause for
the dysfunction. However, structurally trained manual therapists often find that many idiopathic scoliotic
deformities labeled as fixed (irreversible) are actually compensations due to sacral or cranial base unleveling
see (Fig. 10). If sacral and cranial base unleveling indeed prove to be causal factors in a portion of presumed
idiopathic cases, the “no-known-cause” definition should no longer apply. Information sharing among
complementary medical professionals concerning possible biomechanical and biochemical origins of scoliosis
provides hope that someday many more cases will lose their idiopathic classification.

It is also possible that the term idiopathic scoliosis may become outdated, as recent studies demonstrate a
clear link between scoliosis and lowered bone densities. For years, various research groups have focused on
finding a “scoliosis gene” or singular cause for the disorder. Yet searching for a single solution for a complex
problem may only serve to slow down the process.

Scoliosis is closely linked to low bone densities that may be influenced by a wide variety of overlapping
factors that includes genes, estrogen levels, nutrition, exercise, and drugs. In animal studies, lowered bone
density is known to be caused by a wide variety of conditions including lack of physical activity, pesticide
exposure and nutritional deficiencies. Some of these same conditions, especially the lack of exercise and
nutritional deficiencies, are known to also lower bone density in humans.4

Based on these facts; it seems, as with most human conditions, illogical to assume that human scoliosis
would be caused by a single gene, or even by genetic factors alone. And while idiopathic scoliosis is
considered to have no discernible cause, hereditary links have been established. Thus, if one child in a family
presents with scoliosis, it’s well worth the time to check the others. Since this disorder can pass to offspring,
parents with scoliosis should watch their children for any related signs, particularly during early teenage
years.

Closer look at Structural Scoliosis

Ever since Hippocrates coined the term “scoliosis” to describe deformity of the spinal column, “structural
scoliosis” (the fixed type) has occupied the attention of researchers and physicians. Early treatment
modalities were often crude and sometimes violent, as well-meaning practitioners would walk on the scoliotic
hump or apply excessive force using homemade, full-body traction devices. Nevertheless, these pioneering
therapists did develop a number of sound therapeutic principles that still constitute essential features of many
modern treatments, including:

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 Scoliosis and Massage Therapy
Reducing gravitational exposure;
Using traction as a basic corrective force;
Applying pressure over the convexity of the curve;
Creating myofascial extensibility to the concavity.

Structural scoliosis as a physical deformity is often accompanied by functional changes in the thoracic and
abdominal organs as well as psychological and emotional disturbances. The extent of functional change in
the heart, lungs, and other viscera is in direct proportion to the degree of the physical deformity. From puberty
through middle age, scoliotic symptoms such as backaches, head/neck pain, arthritic symptoms, chest pain,
and organ dysfunction cause people to seek help.

Fundamentals of functional scoliosis

“Nonstructural” or “functional” scoliosis refers to a structurally normal spine that appears curved. This
condition can be a temporary abnormality — caused by various conditions — leg length inequality, spasmodic
muscles, or inflammatory conditions such as appendicitis. Although the disorder is considered temporary,
proper muscle and spinal biomechanical approaches are often needed to address the underlying imbalance
pattern.

Functional scoliosis is characterized by an asymmetric position of the trunk and back that usually diminishes
during forward bending, sidebending, rotational, or tractioning maneuvers. Functional scoliotic cases are
frequently accompanied by other signs of faulty and relaxed posture, such as rounded shoulders, prominent
abdomen and flat feet see (Fig. 11). Occurring with equal frequency in boys and girls, functional cases appear
in a large percentage of all school-age children as well as adults.

Figure 11: Functional right thoracic

scoliosis. The “before” photos show asymmetric positioning of the trunk and back including
People
roundedpresenting withprominent
shoulders, crooked spines commonly
abdomen andsuffer fromhead
forward a condition termed
posture. rotoscoliosis
Courtesy of Erikwhere the base
Dalton.
of the spine “corkscrews” headward as the vertebral column turns on its axis see (Fig. 12). These coronal
deviations often result from leg length discrepancy or pelvic imbalances.

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An interesting note: Functional scoliosis is a physiologic posture that can

Fig.be12assumed by any “normal” child
– Corkscrew
or adult simply by bearing more weight on one leg while standing. It is pathologic only if it becomes habitual.
One may justifiably assume the existence of a constitutional defect in muscles, ligaments, body alignment,
nutrition, or structure of the bones. Such a deficiency explains why, for instance, some people naturally sit
and stand erectly, while others may tend to slouch and slump — whether sitting, walking, or standing.

Common functional patterns

Pain management therapists are often presented with a predictable functional scoliotic postural pattern that
closely follows the description in (Fig. 13). If seen from the back, the following asymmetries are exhibited:

Pronated left foot/supinated right;

Up-slipped left innominate (posterior/superior);
Cephalad left pubic symphysis;
symptomatic scoliosis
Left on left sacral torsion;
Lumbar spine sidebent left/rotated right;
Compensatory thoracic scoliosis convex left;
Low left shoulder;
Torsioned shoulder girdle (right forward and left back);
Compensatory left rotation of atlas on axis, and
Left sidebending of occiput on atlas.

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 Scoliosis and Massage Therapy

Figure 13: Common functional scoliotic

pattern. The right arch attempts supination in an effort to level the ilia, but is
In a forward-bent
unsuccessful asposition, the left
the pelvic bowl side of the upper
side-shifts back
over may
the leftbefemur
more and
posterior than theleft
up-slipped right, while
ilium.
at the thoracolumbar junction, the right side is more prominent than the left. The ability to recognize
the various rotational components and compensations is highly important during the functional
scoliotic screening exam. Typically, the vertebrae in the curve tend to sidebend in one direction and
rotate oppositely. If three or more consecutive vertebrae sidebend together to one side and rotate in
the opposite direction, osteopaths refer to this as a “type 1 group curve” or a functional scoliotic
pattern see (Fig. 14).

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Figure 14: Type I group curve. When three or

more consecutive vertebrae bend to one side and rotate in the opposite direction,
During the initial
osteopaths labelscreening exam, the
this a “type1 client
group is seated
curve” and asked scoliosis.
or functional to forward bend. Typically, the
thoracic vertebrae will rotate to the side of the hump and side bend to the opposite side.
Occasionally, when assessing asymmetrical type 1 group curves, the therapist will find non-neutral
vertebral coupling of rotation and side bending to the same side. This usually depends on whether
the therapist is examining above or below the apex of the thoracic curve and whether side bending or
rotation is introduced first.

Short leg syndromes

In cases of functional scoliosis, some may exhibit asymmetry without leg-length differences, but
rarely will one find a leg-length discrepancy without structural asymmetry. Many younger clients
develop a long C-shaped lateral curvature with the convexity toward the short-leg side similar to that
shown in (Fig. 15). Most of this population present with only minimal symptoms, if any. Correction of
the short leg is usually accomplished by balancing the iliosacral joints which allows the youthful spine
to grow straight. Early pelvic-balancing work prevents the development of more severe curves with
accompanying secondary musculoskeletal changes later in life.

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Figure 15: Scoliosis and the short leg

syndrome. Long C-shaped scoliotic patterns from short leg syndromes arise from psoas
imbalance, sciatic irritability healed leg fracture, hyperpronation, unloved hip prothesis
If the convexity of the curve is opposite the short-leg side, the therapist should look for non-neutral
etc.
dysfunctions (facets stuck open or closed) in the lower lumbar vertebrae and lumbosacral junction.

These individuals fill our practices daily complaining of low back and hip pain where no pathology is
present. Attempting to relieve functional scoliotic pain without a good understanding of spinal and
muscle biomechanics is usually futile. Functional scoliosis is extremely common and treatment
options must be developed to help this ailing population. Of course, early detection and deep-tissue
corrections are vital in preventing painful compensatory spinal problems that could manifest
throughout adulthood.

Perfecting Scoliosis Massage Therapy

The etiology of scoliosis has received great attention during the last century and, while considerable

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 Scoliosis and Massage Therapy
progress has been made, much greater knowledge is needed to clarify and completely explain the
predominate dysfunctional mechanics of the scoliotic deformity.

The search for more effective therapy continues, and the present systems or methods of treatment
are a great deal more effective than older procedures. In particular, postural distortions are being
recognized at an earlier age (sometimes at inception), allowing the immediate use of manual therapy
modalities to treat the scoliotic pattern while still in a mild to moderate stage. This alone frequently
prevents progression to a severe stage that brings with it attendant functional disturbances.

So there’s good news and bad news when approaching the question of scoliosis. On the one hand,
it’s all too prevalent a disorder — linked to factors that need more careful monitoring, such as
environmental toxins, nutrition, and general activity levels. On the other hand, with more attention
being given to the condition through objective and subjective research, comes an increase in medical
and manual therapy treatment options, and perhaps, soon, a cure for idiopathic and structural
scoliotic cases.

References
1. Peterson, B. Ed. Postural balance and imbalance. American Academy of
Osteopathy Yearbook. 2003:
2. 148–152.
3. Fryette, H.H. Principles of Osteopathic Technique. Indianapolis, Ind.; 1918:
231–255.
4. Kuchera, M.L. Biomechanical considerations in postural realignment. Journal of
the American
5. Academy of Osteopathy. 1987 Nov: 781–782.
6. Walker, J.M. Musculoskeletal Development. Physical Therapy. 2002 71:
879–899.

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