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posture; rather, we look at the foundational pedestal as being the cause. Therefore, if we straighten the pedestal, we straighten the statue (Image 2). Another way to visualize a tilted structure is to compare it to the Leaning Tower of Pisa (Image 3). The tilt of the Leaning Tower of Pisa comes from its foundational base, not the building itself. In a like manner, if the pelvis is tilted, then the spine will end up being tilted (Image 4A). A tilted spine will result in a head that is not level, which throws the eyes and inner ears off level, creating proprioceptive confusion and making it extremely diffi cult to orient ourselves in space. To counteract this, the human body has a refl ex known as the righting refl ex that keeps the head level. In this case, the righting refl ex will compensate for the tilted pelvis by curving the spine to bring the head back to level. In effect, a scoliotic curve is created to compensate for the unlevel pedestal/pelvis (Image 4B). Therefore, whenever a client presents with a scoliotic curve (or any abnormal spinal curve, for that matter), the question must be asked: Is this a primary postural distortion pattern whose cause is located within the spine? Or is this a secondary compensatory distortion pattern resulting from an unlevel pelvis? To determine this, we must assess the posture of the pelvis. To create a rubric for how to approach this, let's look at one cardinal plane at a time, beginning with the frontal plane. FRONTAL PLANE At the outset of any standing postural examination, checking pelvic iliac crest height is essential. Are the two iliac crests level? Or is one lower than the other? If one iliac crest is low, then the spine would tilt in the frontal plane to that side, unless we compensate with a scoliotic curve (Image 5). What would be an effective treatment strategy for a client with a compensatory scoliosis? Certainly, we might choose to direct some of our work toward the soft tissues of the spine. In this case, massage should 36 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 2 A statue on a pedestal that is tilted (A) and level (B). Illustration by Giovanni Rimasti. (A) The pelvis is laterally tilted down to the right with the entire spine and head tilted to the right. (B) A compensatory scoliotic curve brings the head back to level. Permission Dr. Joe Muscolino. Kinesiology: The Skeletal System and Muscle Function, 3rd edition (Elsevier, 2017). The Leaning Tower of Pisa. Illustration by Giovanni Rimasti. 2 A B 4 3 A B