Issue link: https://www.massageandbodyworkdigital.com/i/1208028
IF IT AIN'T BROKE, DON'T FIX IT As mentioned, and contrary to popular belief, scoliosis is most often asymptomatic (not painful or limiting). As referenced above, multiple studies have found that people with scoliosis do not have back pain any more frequently than people without scoliosis. This knowledge alone can help clients decouple the assumption and fear, common among those with scoliosis, that if their spine has a curved shape, it's flawed or dysfunctional (since a shape is not a dysfunction), and that pain is inevitable (it's not). Since most scoliosis in adults is well- compensated and asymptomatic 9 , the best approach for manual therapists is usually "If it ain't broke, don't fix it," if for no other reason than the fact that unskillful work can provoke or worsen pain in those with scoliosis. In my own private practice, in professional supervision of other practitioners, and in our Advanced Myofascial Techniques trainings at Advanced-Trainings.com, experience suggests that this danger is minimized by working to gently increase mobility options and refine proprioception, rather than trying solely to "correct" vertebral position, straighten curves, or remold the shape of the spine (Image 4). For the times when people do have both scoliosis and pain, the most effective strategy seems to be to treat any pain as pain per se, rather than as "scoliosis pain." That is, whether the spine is curved or not, we approach back pain as back pain, sciatic pain as sciatic pain, etc. This self-evident, empirical, and individualized approach whole-body mobility, rather than trying to simply correct the spine's static shape. Feel for the places and directions your client can and can't move; use gentle active movement and breath; and think about evoking a three-dimensional, whole-body kinesthetic experience in your work, rather than becoming over-focused on trying to passively stretch or straighten out the spine's static shape (Image 4). • Work in 3D. Think about scoliosis as a spiral, not just a curve. Gently encourage mobility in all planes (sidebending, but also flexion, extension, and rotation). • Keep the big picture. Scoliosis involves the limbs, pelvis, shoulders, rib cage, viscera, and the whole body. Don't over-focus on the places you see the most bend. • Think mobility, rather than position. Working to increase options for mobility will often yield more satisfying and lasting results than trying to reposition or reshape the spine alone. Encourage active client movement, both on the table and in your client's life. Movement, fitness, and balance activities are important adjuncts to manual therapy with scoliosis. • If it ain't broke, don't fix it. Most scoliosis is not a problem: a shape is not necessarily a dysfunction. Find out about your client's experience, symptoms, motives, and goals, rather than assume all scoliosis needs "correcting." • Connect to other resources. Social support (like www. curvygirlsscoliosis.com) can be a helpful way to normalize teens' concerns, especially with bracing or surgery. Also, refer children and teens with scoliosis, or anyone whose scoliosis or symptoms seem to be changing, to a primary care provider, physical therapist, or orthopedist for evaluation and monitoring. 4 Lewis Albert Sayre (left, 1820–1900), a leading orthopedic surgeon and a principal founder of the American Medical Association, treated scoliosis with an immobilizing plaster cast applied while under passive traction. His methods did not survive him. To Learn More • "Scoliosis: Advanced Myofascial Techniques" online video or DVD course with Til Luchau, at a-t.tv/dc. • Listen in as Til Luchau and Whitney Lowe discuss "Scoliosis and Manual Therapy" in Episode 7 of The Thinking Practitioner Podcast (a-t.tv/ttp), sponsored by ABMP. 92 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 2 0 Scoliosis: Key points to remember