Patients with structural scoliosis are some of my favourite to work with. Each individual usually displays a 3 dimensional deviation of the spine that causes an array of musculoskeletal asymmetries. To provide the best treatment possible with this population, attention to detail is crucial.
There is plenty of information on the internet about scoliosis so my intention is not to regurgitate the basics, but to help manual therapists approach and treat this population successfully. If you are a patient with scoliosis I hope this blog provides you with some insight as to how your musculoskeletal symptoms can be alleviated and athletic performance can be optimized. Please understand that the 3 considerations provided in this blog are not medical advice and will not “straighten” out curvatures. Improving function, pain levels, and quality of life is the goal.
Before we get to these 3 considerations I would like to take a moment to comment on Chiropractic manipulation and scoliosis. A Chiropractic adjustment is a powerful treatment and should be treated as such. When acute back pain occurs in patients with scoliosis one of the most effective treatments that can provided is a Chiropractic adjustment (I am a little biased here). With that said, being adjusted 3 times per week for months without any additional therapy can lead to hypermobility in certain areas leading to further compensation patterns up and down the kinetic chain. This is bull shit and should never happen, ever. It is important for patients with scoliosis to be educated on how their bodies have adapted to their spinal curves and understand what movement patterns are dominant. Once this has been understood it not only empowers these patients but helps them partake in and avoid certain activities that they know may aggravate or alleviate symptoms. Chiropractic manipulation can be a valuable component of a comprehensive treatment plan for those with scoliosis, but it should not be abused and over used to the point of dependency.
Consideration #1 – Find the dominant oblique(s)
Each scoliosis patient I have seen has a dominant oblique. This is not always the “shortest” oblique from a static postural standpoint, nor is it always the most hypertonic (although it will be hypertonic). To find the dominant oblique pay close attention to gait and movements that require multisegmental rotation. Once you suspect the dominant oblique confirm your results using NKT®. I have seen patients with one external oblique compensating for all 3 other obliques as well as contralateral psoas and QL. Addressing these compensation patterns can provide drastic functional improvements up and down the kinetic chain. Once you have identified the dominant oblique(s) and the structure(s) it is compensating for, trace it along the spiral line (pictured below) to gain a better understanding of its effect on the entire system.
#2 – Relationships between upper traps, scalenes, and sternocleidomastoid
Think of these structures as guy wires suspending the neck in space. It is very likely due to the structural scoliosis that some will be shorter than their opposites. Please do not assume that the “shorter” tissues need to be stretched and the “longer” ones need to be strengthened. This fallacy that is still taught in many institutions is little more than a risky assumption. Test these structures against each other using NKT® to understand which muscles the individual relies on for stability. Do NOT assume that the upper trapezius needs to be stretched or released. In many cases just the opposite is beneficial.
#3 – Feet are Secondary
Based on my experience working with this population, most asymmetries in the feet are a reflection of compensations created by the scoliosis higher up the chain (assuming no previous injury to the foot). If you stand up right now and twist your body to the right you will notice your right foot “supinates” as the medial arch rises and your weight shifts to the lateral aspect of your foot. Also notice how your left foot simultaneously “pronates” as the medial arch drops. You will see these compensations in static posture in individuals with pelvic torision (with or without scoliosis). Use these static foot postures to understand how scoliosis has affected the pelvis and lower limb. As you make functional changes to the thorax you may not see spinal curves change significantly on xray, but you might notice subtle changes in the feet. This is a representation of the body improving its center of gravity and ability to stabilize during movement. These changes should be noted in gait as well. Watch for less asymmetrical hip hike, decreased tension in the neck, and overall improved fluidity as pain levels decrease.
The intention of this blog is to help clinicians and patients alike reconsider their current method of treatment regarding scoliosis. NKT® and Anatomy in Motion (AiM) are phenomenal tools to help not only understand how scoliosis has affected the musculoskeletal system, but how to educate these individuals on how to use their bodies in ways that avoid pain and optimize performance.