SCOLIOSIS: WHAT TO DO?
Part Two by Miita Mazzali Fulgenzi
Certified Advanced Rolfer®
Rolf Movement Practitioner
ATTENTION: The following instructive material is intended for trained professionals only. It is possible to cause injury by uninformed use of these techniques! It is not the intention of the author, formatter, or host of this information that anyone be harmed in any way by it. By reading this material, you agree to hold harmless all involved, including the European Rolfing Association and its members.
3. How to work Premise: all Rolfers® are trained to work with every kind of structure. What follows are indications to work more accurately. All suggestions can be added to the normal work routine, or can be substituted by something more specific or efficient. An overall view must be kept; while working in a specific way we must not neglect the integration of the whole. I want to stress that, in a person who has a scoliosis, is the "core" which is affected. As we create connections and give support from the ground, a sense of deep balance is increased. It is important to work not only with the client lying down, but also sitting and standing. Even if Rolfing® sometimes induces only a limited decrease of scoliotic rotations (mainly in adults), easing the imbalance associated with compensations can make the client more comfortable.
1) Legs. A piece of advice from Michael Salveson has proved very useful to me: Treat scoliosis starting from the client's legs. Although we didn't have enough time to discuss how he works, this idea guided me treating a severe scoliosis (45 degrees in the main, more rigid, curvature, and 55 degrees as compensation curvature) in a little girl 11 years old. Her spine was very soft and looked extremely unstable, while her legs muscles were stiff and short. Everything I did to help her legs had a positive influence on her spine and created a more homogeneous tonus. Very often legs have tensions because of the need to support and compensate for instability of the "core". Intervening on the fascial arrangement of the legs already modifies the arrangement of the pelvis and, because of the insertion of the psoas, the spine. In addition to working along the lines of force considered in Jan Sultan's Internal- External model (and, if you like, the way of working considered in my article "Remarks about structure starting from an aesthetic point of view"), I recommend performing the following.
Place the client on her side, with her legs flexed open and one leg is bent to stabilize the lumbar area (photo 6). Passively straighten one leg at a time, backward and forward, to test the range of motion; you will easily realize if full extension is inhibited and where major tensions are. The same test should be performed on both sides. In this position, we can also work by asking the client to gently lengthen her leg. A good image to use, drawn from Hubert Godard's way of working, is to tell her to slide her leg, caressing the table with her skin. In this way we induce a tonic movement, from the "core".
2) Sides. The side where the triangle formed between the waist and the arm is smaller, is the side where the weight of the trunk burdens more. This triangle has to be opened and lengthened in order that the weight of the upper body can be shared more evenly on the pelvis. For instance, we can work erector spinae and quadratus lumborum while the client exhales and glides her arm upward and her leg downward, thinking of creating space in between (photo 7). It is very useful to ask that her movement has a tangible direction (Hubert Godard's Movement workshops). Giving space to the shorter side reduces the inclination of the shoulder girdle.
3) Pelvis. Balancing the pelvis requires some patience. A) Hip rotators must be treated: if shortened they contribute to the asymmetry of the pelvis. B) On the side of iliac crest posterior tilt we find short hamstrings; where there is an anterior tilt it is the quadriceps that works and shortens more: we have to work as required. C) Closing the iliac crest in out-flare: we ask the client to bend the leg in the side of the out-flare and bring it toward the opposite side, then we ask her to push her knee against our resisting hand for a few seconds, then release (photo 8). We then exaggerate movement of the leg inward, until we feel a tissues resistance and hold her leg for a while in that position. Three times. This maneuver brings all the innominatum bone toward closure. In this side the internal obturator is short. On the other side, where the iliac crest is in in-flare, just the opposite procedure: we ask to bend and open her leg outward and to push against our hand, then we open her leg even more and we keep it in this position for a few seconds (photo 9) Three times.
So to give further balance and to release any tensions in the pubic symphysis, we can make both legs work opening and closing against resistance for a few seconds (photo 10 and 11).
D) To counteract the pelvis rotation on the horizontal plane, I find it is useful to work with the client sitting, making sure she is sitting in a well balanced way on the bench before starting any movement. We can hold her ilio-psoas tendons from her groin, resisting her movement while she attempts to rotate her pelvis further into its rotational pattern (photo 12). We must remember that appropriate work on the viscera also helps to decrease pelvis rotations. E) Major pelvis ligaments (sacrotuberous, sacroiliac) have to be balanced: we palpate to determine which side is more rigid and lean on them, with client in 6th hour position.
4) Sacrum. As I've already written, when we work to give balance in two planes of the space, the third will also be modified. When we work to put anterior the lumbar kyphosis (it's always easier to push anterior a vertebra or transverse process than to pull it posterior) we are also balancing the sacrum. To straighten a little the sacrum inclined on one side (following the inclination of the lumbar vertebrae) we ask the client, who is sitting on the bench and bending forward, to meet our hands by pushing her feet on the floor. The knuckles of our hands are put beside the first (on one side) and the fifth (on the other side) sacral vertebras spinous processes. When we feel the client pushing, we transmit a little force as we want to screw, or unscrew the cap of a jar, depending on which direction we want to move the sacrum (photo 13).
If the sacroiliac joint is blocked (when the client walks there is an aberrant or little movement in that area) and you haven't received any specific training on this topic yet, you can use a very effective and save trick. With the client supine, place a little foam-rubber ball - as big as a tennis ball, but much softer - under the center of sacrum (you can ask your client if she feels it's central). Leave it there while you work somewhere else. The weight of your client and the cranio-sacral rhythm will release the tight ligaments and the joints. A few minutes later the client will feel much better and you will see more movement. This is also very good for people who have chronic problems in that area, and for the Rolfer after a tiring day.
5) Thorax. It's important to give elasticity to the ribcage, chiefly in adults, who have more rooted rigidities. One strategy is working while the client is breathing against resistance, especially where the sunken parts of the sternum are set. In my experience working against resistance (which is not a strength test, neither for the client, nor for the Rolfer®!) can help people with scoliosis to feel they aren't as weak as they thought or as they have been led to think. We ask the client to exhale deeply and then to breathe in, so as to push away our hands that are pressing a little on her thorax (photo 14). It is possible to work in the same way on specific spots of the thorax.
6) Back. As I have written before, it is easier to push forward transverse processes that are posterior (gibbus) than to do the opposite. In my advanced training (Rome, 1996), I observed Jeff Maitland using the type-1 vertebral motion in a very effective way. While seated, the client bends to the side where the gibbus is. Vertebra after vertebra we invite the client to come from her feet toward our hands, while we press on the gibbus-side transverse processes, increasing their physiologic movement forward.
For the concave side, we ask the client to bend to the same side and to come from her feet, lengthening the arm over her head, so to open the costal girdle where it is closed, and to breathe in while our fingers work to create space between the ribs (photo 15) If a rotation of the trunk on the horizontal plane is present , it is possible to ask the client to exaggerate it (while maintaining connection to the ground) while the Rolfer counteracts her rotation. This effective trick can be applied to several areas, such as pelvis, shoulders and psoas.
7) Scapulae. The scapula slipped medially (on the concave side) can be brought outward lengthening the rhomboids attached to it. I would like to remind everyone that the superior medial angle of the scapula becomes a fixed point for many movements and is in trouble in many people.
The shoulder blade slipped outward (on the gibbus, or convex side) has tissues tied up on the lateral border: definition and fluidity of movement are needed. The serratus anterior is very important, a big tonic muscle that plays a major role in position of the shoulder blade. We can help matters by releasing the insertion below the medial border of the shoulder blade (photo 16). We also can lengthen it while the client, lying on the opposite side, breathes out (the costal girdle closes and the shoulder blades moves closer to the spine), and gently slides her arm backward toward the spine (photo 17). On the side where the frontal part of the humerus is pushed forward (gibbus side), tissues between it and the clavicle are thickened; everything must be addressed to restore space and definition.
8) Costal girdle. In the more opened side (gibbus side) we can give elasticity to intercostal muscles by accompanying them inward while the client breathes out, i.e. while ribs get closer together . We can work on the side opposite the gibbus while the client is prone, with her torso side-bent so as to open the ribcage. We ask her to slide her arm slides laterally over her head, caressing the Rolfing table (tonic movement), while she breathes in (opening the ribs more), toward our fingers that work to give more space (photo 18) .
9) Psoas and viscera. Although they are in the territory of the fifth session, the areas should be treated earlier, perhaps by doing a little work at the end of the earlier sessions, to adapt them to what has been done in other parts. Activating the psoas creates connection, which is very important for people who have scoliosis. If not adjusted, the viscera can be badly affected by structural work done elsewhere. Visceral restrictions can also prevent a release of the structure.
10) Cervical vertebrae. There is always a compensation curvature in the neck that should be integrated at the end of each session. The side that has little or no space between atlas and occiput is an area that can cause pain and dizziness as the years go by, if not treated. We have to give space and movement freedom in this area.
11) TMJ and cranium. Dr. Ida Rolf taught us that the sphenoid bone is the keystone of the human body. In people with scoliosis the sphenoid is conditioned by underlying asymmetries even more. To be more specific, as required in these cases, it is advisable to attend specific workshops
A few words about the temporal muscle: like all the fan shaped muscles (deltoid, gluteus minimus and medius), its fibers can act in a different ways, following completely different lines of movement and force. Its anterior fibers can become antagonist of the posterior ones (or vice-versa), inhibiting its action. This is what occurs in people with scoliosis, because there are strong asymmetries. Releasing the tighter fibers in this muscle will release tensions in TMJ, facilitating movement in cranial sutures and giving more balance.
I would like to finish by remembering a very effective trick used by Hubert Godard (movement training, Rome 1997). At the end of a session he invited his client to get on the Rolfing table and walk a little on it. The movement on a soft surface removed many rigidities and once back on the ground a fluid and harmonious movement was induced, a beautiful sight to see.
Bibliography Dr Ida Rolf. "Rolfing and physical reality", Healing Arts Press, 1990 Dr. Ida Rolf: "Rolfing", Harper &Row, 1978 Alain Bernard: "Trattato di osteopatia strutturale"Vol. I, II, Marrapese, 1986 Marcel Bienfait "Fisiologia della terapia manuale", Editore Marrapese 1990 Marcel Bienfait: "Scoliosi e terapia manuale" Editore Marrapese 1990 Léopold Busquet: "Le catene muscolari", vol. I,II,III,IV, Marrapese, 1992 I.A.Kapandji: "Fisiologia articolare", Marrapese, 1983 Jeffrey Maitland: "The art of Rolfing®. Principles. Taxonomies. Techniques." distributed in advanced training, Rome 1996 A. Mancini, C. Morlacchi: " Clinica ortopedica", Piccin, 1977 Patrick Michaud "L'esame morfologico in ginnastica analitica", Marrapese,1989 René Perdriolle "La scoliosi", Ghedini Editore, 1982 Vincenzo Pirola "La chinesiterapia nella rieducazione della scoliosi", Sperling &Kufer, 1993
(Drawings used in this article are taken from these books).
Ida Rolf: "Rolfing® and physical reality", Healing Arts Press,1990, pg.187 op. cit., pg.203 Hans Flury: " Theoretical aspects and implications of the internal- external system", Notes on Structural Integration Nov. 1989 If I remember well, I saw Hans Flury using such a test in one of his workshops on "Normal Function". Jeffrey Maitland: "Spinal Biomechanics" , from: "The art of Rolfing®"- advanced training in Rome, 1996