Treatment for Disruptive Postural Patterns Part One: Physiological Scoliosis

Treatment for Disruptive Postural Patterns
Part One: Physiological Scoliosis

A person’s posture speaks volumes about the body’s possible lack of equilibrium. But what if you never learned the language of posture and therefore can’t treat the patterns that are detrimental? Then you are with the majority of massage practitioners. Most students of massage are presented with textbook cases of overly exaggerated postural patterns, such as military or sway back. Most likely, very few clients have walked in your door exhibiting such obvious stances. And so you have always figured that there is no disruptive postural pattern to treat if it isn’t blantently exhibited. Unfortunately, this view of postural patterns is slowly causing your client to lose energy as they fight for equilibrium and setting them up for disaster when an injury comes their way.

This three-part series will explain the three most common disruptive postural patterns and their treatment. By understanding and treating physiological scoliosis, tortional distortion, and kyphosis you will help your clients exert less energy to maintain equilibrium.

Physiological scoliosis is not to be confused with structural or idiopathic scoliosis. While structural scoliosis can cause disfigurement, physiological scoliosis is more subtle. Actually, everyone suffers from physiological scoliosis to some extent. This postural pattern originates from the liver being on the right side of the body and the spleen being on the left side. Because the liver cannot compress and the spleen can, people can bend more easily in the thoracic spine to the left. All of the other areas of the body then try to compensate for this imbalance.

Over time, the thoracic spine and rib cage will have decreased range of motion (ROM) in right-side bending in both active and passive observation. This causes the upper thorax to have a slight list to the left. As a result, both the cervical spine and lumbar spine will compensate.

One of the underlying principles of the body’s organization is to minimize energy expenditure while in the upright position. The body tries to carry its weight over the pelvis and feet. When you hold up a broomstick with the bristles up to the ceiling and balance it, it’s easy to hold straight up and down. But if the broom is off center, it takes more energy for you to hold the broom up. The same principle is true in the body. Any body part that moves away from the gravitational line causes the body to expend a great deal of energy in an attempt to return it to a more balanced state.

The restricted ROM of the thoracic spine can be seen by having the client stand up and side bend to both sides. Many times, though, the client cannot perceive the difference unless a mirror is available. One way to help the client become aware of the imbalance is to do a passive range of motion test with the client supine. Contact the left and right lateral ribcage, about the level of the seventh rib, and, with a broad contact, push the ribcage directly medial, alternately from both the right and left sides. You will notice, in the vast majority of people, a distinct difference in the overall side-to-side movement of the ribcage referenced to the midline. Also, the end of the movement of pushing from the right side to the left will feel much less springy than pushing from the left towards the right. Most people can feel this difference at the end of the ribcage movement, and especially if they are made aware of it.

Another aspect of this ribcage imbalance is that the ribcage is also restricted in another direction. By placing your hands on the anterior ribcage at the levels just below the clavicle and at the inferior angle of the ribcage, apply pressure directly posterior. There will be a sense of restriction of the left side compared to the right.

With postural scoliosis, the thorax is slightly side bent to the left. In order for the body to have the head’s weight in a better position relative to the gravitational line, the head will side bend to the right. As a result, several muscle groups in the right neck will be chronically tight. The right lateral neck muscles, especially the scalenes, will tend to be ropy. The right lateral suboccipital muscles will also generally be tighter than the left side, especially the superior oblique. The left medial suboccipital muscle, especially the rectus posterior superior and minor. The minor will be the tightest. The atlas, in palpating the transverse processes, will, in most people, seem to be rotated to the right. Oddly, the right muscles of mastication, especially the masseter, will also be tighter than the left.

Movement of the cervical spine will also be limited. Translation of the lower cervical spine from left to right will be restricted. This can be tested on a supine client by taking a broad contact on the lateral areas of the lower cervical spine and translating the spine left to right and then right to left and comparing the relative ease and total ROM of the movement. It would be unusual to find someone who was not restricted translating from the left to the right.

In order for the entire thoracic spine, ribcage and head to be in a better gravitational line with the pelvis, the lumbar spine will also side bend to the right. Just like in the other areas of the spine there will be a relative imbalance between side bending. The lumbar spine will be able to side bend to the right easier than it can side bend to the left. Again, what we will find as a result of the chronic adaptation to the thoracic spine being slightly side bent to the left is that the lumbar spine will be slightly bent to the right.

Many times, these differences, although palpable in the client, are not observable in X-rays.

Let’s review the imbalances found in a client with physiological scoliosis. Remember, at each level there is a change in lateral flexibility and the body is trying it’s best to get the center of gravity over the feet.

 

Right thoracic scoliosis (apex of the curve is to the right)

Decreased right lateral flexion of the rib cage and thoracic spine

Decreased anterior to posterior movement of the upper left anterior rib cage

Slight left scoliosis of the lumbar spine (apex of the curve is to the left)

Decreased left lateral flexion of the lower lumbar spine

Decreased translation of the lower cervical spine to the right

Tighter right neck muscles

Tighter right lateral suboccipital muscles and left medial suboccipital muscles 

Tighter right masseter muscle

C1 usually in right rotation

Tip of coccyx is to the left

At this point, the question may be asked, “Why treat physiological scoliosis?” For the most part this pattern is something that the majority of people have, and generally, it is not symptomatic. If nothing else though, through treatment, trends in the pattern can be reduced and the client will feel substantially more energetic due to the fact that the body is using less energy to hold itself upright.

When a trauma is introduced into the system, then the body’s ability to adapt to the pattern can be severely limited. As a result, this physiological scoliosis pattern can augment and perpetuate the disharmony caused by new challenges to the system.

What can be done to reduce the pattern? You cannot remove to liver! So you need to address the restricted movement that has developed over the years. The main area of emphasis is at the thoracic spine, since it causes the rest of the body to organize around it.
For the majority of areas that are restricted, direct myofascial release techniques seem to work the best. In the ribcage, the way to address the imbalance is to place your hand on the right lateral ribcage around the fifth and sixth ribs. Position the supine client so that they are in a slight right side bending position, reach under their back and find the stiffest area of the thoracic spine, usually T4-6, and lift the spine towards the ceiling either with your fingers or a fist with your knuckles into the table. Once you are comfortable in this position, push the right ribcage to the left until you reach the barrier of movement. When you reach this barrier, simply hold the position. After a small amount of time, usually under a minute, you will begin to perceive a reduction in the stiffness of the barrier in the ribcage movement and the area where you are lifting the thoracic spine will feel like it is bending around your contact towards the table and becoming springier.

Commonly, while you are doing this kind of technique, your client will feel a sensation like you are reducing your hand pressure. You can demonstrate to your client that you haven’t changed anything by lifting the thoracic spine slightly to let them feel that you are still lifting the spine off the table and that the sensation they are feeling is actually their body relaxing and changing.

The ribcage movement can then be reassessed and both you and the client should notice a greater movement of the ribcage from right to left and a less stiff feeling at the end of movement. This technique can be redone several times, with each time resulting in better movement of the ribcage.

The side-to-side movement correction can be followed up by addressing the decreased movement of the left anterior ribcage in the anterior to posterior direction. Place your hands on the left anterior ribcage with one hand just below the clavicle and the other at the lower angle of the ribcage. Using a direct myofascial release technique, gently push the ribs toward the back until you reach a stiff barrier. Hold this position for a minute or so until a softening is perceived. This technique can be repeated several times with each time producing a noticeable softening in the barrier. When you have finished, retest the side-to-side movement of the ribcage by again placing your hands on the lateral ribcage and pushing the ribcage alternately to the right and left. Not only should you notice more balanced movement in respect to the midline, the feeling at the end of movement should be quite a bit less stiff. Your client should notice the changes too, especially if you have been helping them become aware of the changes as they occur during the treatment.

Treating the thoracic spine first will often cause a reduction in the compensatory patterns of the cervical and lumbar spine. The movements that were previously restricted may be found to be more free and easy. Both the lumbar and cervical spine should still be addressed.

The cervical spine can be treated in the same position that translation of the lower cervical vertebra was checked. With your left hand, take a broad contact on the left side of the lower neck and move the spine from the left to the right until a stiff barrier is felt. Try not to side bend the neck or rotate it. To enhance the effects of this position, let your right hand go to the area of the humeral head and acromium process to stabilize and prevent the body from moving to the right as a result of the pressure from your left hand. You can also exert a small amount of force on this area by pushing from the right to the left to increase the treatment effect at the lower cervical and upper thoracic area. Again, hold this position for a minute or so until a softening is perceived. Retesting of the translational movement will be freer. This technique can be reapplied several times.

One of the interesting things that you will notice is that the neck muscles that were previously tight should feel significantly looser. This happens without even treating those muscles directly.

Treating the lumbar spine has two aspects. The first technique addresses the lumbo-sacral junction. The second technique treats the left scoliosis of the lumbar spine itself.

Treating the lumbo-sacral junction is quite simple. The client is supine, with knee supports if needed. Reach under the client from the side, until you reach the sacrum. It is probably best to use the hand that is closest to the feet. Once there, with either fingers or some part of your hand raise the sacrum ½” to 1” off the table. Your contact should be closer to the apex of the sacrum. With your contact in this position towards the apex, the lumbo sacral junction will want to drop to the table, decreasing the lordosis. If you cannot maintain this position due to your client’s size, a tennis ball can be placed in the same position as your hand.

Once you have established this position, reach under the client’s back until you reach the left side of the spinous processes of the lumbar spine. Hook your fingers onto the spinous processes in order to pull the lumbar spine from left to right. Pull the lumbar spine until a stiff barrier is perceived and then hold that position until a release is perceived. As with the other areas, this technique can be repeated several times to achieve significant release. Typically, the client will feel significant changes in this area and many times will express amazement at the feelings they are experiencing.

At this point you have finished the basic treatment to reduce the stiffness in the body due to the physiological scoliosis. You can go back to other areas and palpate the once tight musculature and notice that there is a significant reduction in the overall tone even though you have not directly worked on the muscles there. If there isn’t a significant reduction in tone, then any suitable technique to treat the muscles of that area should quickly and easily lead to relaxation of that area.

The fact that there is a reduction in the tone throughout the body, without directly treating the muscles, indicates that much of the underlying muscular tension is compensating for this postural strain. Also, achieving muscular relaxation without directly treating an area should give you a new understanding of the interrelationships within the body.

In future articles, we will discuss other postural patterns that also cause the body to compensate and to tighten in certain areas.