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According to the Scoliosis Research Society, degenerative spine disease is one of the most common reasons adults develop scoliosis. 1 The greater the degree of deformity, the more the unrelenting force of gravity (14.7 pounds per square inch) drags on the body's bony framework (Image 1). In the severely deformed, eccentric force distribution produces compensations that travel throughout the neuromyoskeletal system (Image 2). The effects vary greatly: some scoliotics present with disability and pain, while others with similar degrees of spinal curve sail through life burdened with only occasional discomfort. Manual therapists often shy away from treating seriously malformed spines, and for good reason. In the absence of a basic understanding of spinal biomechanics, soft-tissue work may not produce the desired results. Moreover, treatments that are too heavy-handed may even exacerbate the client's pain and disability. Yet, one thing I've learned in many years working with scoliotics is this: there is always a functional (fixable) component to every structural (fixed) scoliosis. technique MYOSKELETAL ALIGNMENT TECHNIQUES Scoliosis: Fixed or Fixable? By Erik Dalton ASSESSING WITH THE ADAMS TEST When assessing medically diagnosed lumbar or thoracic curvatures, the first order of business is to determine whether the misshapen spine is a fixed (structural) scoliosis, a less serious functional scoliosis, or a little of each. A nonstructural or functional scoliosis is usually treatable and results from compensations such as a short limb, torsioned pelvis, or cranial imbalances. The simplest way to discern functional from structural dysfunction is with the Adams test. Stand behind the client and ask her to slowly bend forward, with arms relaxed and hanging freely (Image 3). Keeping your eyes in line with the client's back, carefully observe any changes in the shape of the thoracic and lumbar spine. Compared to the standing position, does the convex hump change, get worse, or diminish? If the curve stays the same or gets worse, some of the vertebral joints (and possibly ribs) are fused. To confirm your visual observations, ask the client to slowly side bend and rotate her torso, allowing the arms and head to gently swing side to side. During these maneuvers, if any vertebral segments of the convex hump become more symmetrical, they are not yet fixed and should be addressed. This condition, where three or more adjoining vertebrae get stuck sidebent to one side and rotated to the other, is a Type 1 group curve (Image 4). According to my mentor, the late Philip Greenman, DO, "A functional scoliosis is a postural adaptation to an imbalance in one's base of support." 2 2 1 All images courtesy ©erikdalton.com. 100 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 4