Issue link: https://www.massageandbodyworkdigital.com/i/992435
CLINICAL ORTHOPEDIC MANUAL THERAPY TREATMENT For all these reasons, clinical orthopedic manual therapy treatment can play an important role in the treatment plan for clients who have scoliosis. Treatment should be aimed at both loosening the tight musculature involved and mobilizing the joint dysfunction hypomobilities that occur. Tight musculature can be treated with heat, soft-tissue manipulation (massage), and stretching. Joint hypomobility dysfunction can be treated with heat and joint mobilization. SOFT-TISSUE MANIPULATION Soft-tissue massage should be oriented at any and all tight myofascial tissue. But usually, greater focus should be placed on the locked-short musculature on the side of the concavity. The primary focus should be the paraspinal musculature—the erector spinae and transversospinalis groups— but the transversospinalis musculature (rotatores, multifidus, semispinalis) in the laminar groove of the spine should be especially focused on. The quadratus lumborum should also be a primary target of massage (Image 3). As with all manual therapy, if the massage is done after heat is applied to soften and warm up the tissue, the work will usually be more effective. I don't believe there is any one magical stroke for working on tight musculature. Because locked-short and locked-long muscles tend to be globally tight, deep stripping strokes performed along the length of the musculature can be very effective. Cross-fiber work tends to be better at breaking up patterns of adhesions that would likely develop as the condition becomes more chronic. I like to think of the manual therapist's job as being a detective, searching for the tight/taut tissues. For this reason, I am a fan of circular strokes because they allow us to approach the tissue from all angles, increasing the likelihood that we will find the tightest areas. When performing massage, I often think of something that Sandy Fritz, massage therapy educator and author, once said to me: "No massage stroke should ever end the way it was intended when it was begun." I don't know if this statement was original to Sandy, but it has stayed with me for many years. This means that instead of performing cookbook strokes, we should amend and adjust them based on the client's tissues. When receiving massage from a new therapist, this is the first thing I notice. Is the therapist feeling my tissues? Is the therapist adjusting their work to the state of my tissues? Is the therapist adjusting their work to the response of my tissues to the stroke they are performing? The ability to adjust the work to the tissues of the client is the essence of competent clinical orthopedic manual therapy. A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 73 Working the quadratus lumborum can be done with the client prone or side-lying. 3A: Prone. 3B: Side-lying. Permission Joseph E. Muscolino, The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns, and Stretching, 2nd Edition ( Elsevier, 2016). STRETCHING After heat and/or massage have been performed, we should stretch the client's tissues. When it comes to stretching a scoliotic spine, it is extremely important that the stretch force is applied to the scoliotic curve itself. The problem is that the scoliotic curve will resist lengthening, and the rest of the spine will tend to compensate and move instead. This is especially true if the client has an S-scoliotic curve (Image 4A). For example, if the client has a lumbar scoliotic curve of left lateral flexion (termed a right lumbar scoliotic curve based on the convexity being on the right side) and we stretch the client into right lateral flexion, if the force is not specifically applied to the lumbar region, the thoracic region will likely move instead. And if the client has a thoracic scoliotic curve in the opposite direction—in other words, a curve of right lateral flexion (termed left scoliotic curve for the convexity on the left)—it is even more likely that the thoracic spine will 3A 3B