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72 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 8 TREATING THE UNDERLYING CAUSE OF SCOLIOSIS Direct treatment of the scoliosis itself is extremely valuable. However, there may be an underlying cause of scoliosis that, if not addressed, will lead to a perpetuation of the scoliotic curve regardless of the manual therapy treatment performed for the tissues at the scoliotic curve. For example, if the client has a dropped arch due to overpronation of the subtalar joint, the length of the lower extremity on that side will decrease, leading to a dropped pelvis on that side. If the spine were to remain straight, it would resemble the Leaning Tower of Pisa (Image A), which would result in the eyes and inner ears being unlevel, making proprioception difficult. To prevent this, the spine would develop a compensatory scoliotic curve to bring the head to a level posture (Image B). In a case like this, direct treatment of the scoliosis itself is treating the symptom, not the cause. This is not to say that treatment of the locked myofascial tissues and joint dysfunction of the scoliosis is not needed—it very much is. But it will never truly resolve the issue if the underlying cause, in this case the dropped arch, is not also resolved. Similarly, any condition that causes the pelvis to drop on one side, such as genu valgum of the knee or asymmetrical tightness of frontal plane abduction/adduction musculature of the hip joint, would likely result in a compensatory scoliosis. Of course, not every scoliosis is caused by dysfunction in the kinematic chain of the lower extremity. Some scolioses are described as "idiopathic" because the cause of the condition is unknown ("idio" meaning unknown, and "path" referring to the condition). But because there often is an underlying structural cause of the scoliosis, it is important to assess for its possible presence, and if found, treat it. A B EFFECT OF SCOLIOSIS As with any postural distortion pattern, a scoliotic curve can present as mild, moderate, or severe. The degree that this impacts the client can vary tremendously. In and of itself, a scoliotic curve does not necessarily cause pain or dysfunction. There is often a tremendous lag between objective structural distortion and subjective pain and dysfunction. However, a scoliotic curve does lead to a number of compression and tension forces that will likely lead to dysfunction, if not pain, in the long run. For example, the musculature in the concavity will adaptively shorten and become locked-short. The musculature on the convex side will be lengthened and become locked-long (Image 2). Tightness of musculature often leads to pain due to the tension forces within the musculature itself, as well as on its attachments. Tight musculature will also usually resist lengthening and therefore limit motion of the joints that are crossed. Further, the facet joints and the vertebral bodies on the concave side will become compressed. The same structures on the convex side will be under tension stress. This leads to increased physical stresses on the joints that can cause pain and dysfunction, and perhaps lead to greater osteoarthritic degeneration in time. A B Musculature on the concave side of a scoliotic curve is locked-short; musculature on the convex side is locked-long. Locked-short Locked-long Locked-short Locked-long 2