What is Scoliosis?
To understand scoliosis it may be helpful to first consider what normal spinal curvature entails. The spinal column is a stack of individual vertebrae ranging from 2″ to 6″ in diameter.1 There are 7-cervical, 12-thoracic, 5-lumbar separate vertebral bones plus fused bones which make up the sacrum and coccyx region.2 When viewed from the side a normal spine will look like two continuous “S” curves. From behind the cervical and lumbar curves are convex or lordodic and the thoracic curve is concave or kyphotic and when put together they account for the “S” curves seen. From the front the normal spine appears to be straight.1
In scoliosis an abnormal curvature occurs in such that both the vertebrae and the rib cage in the thorax rotates toward one side in an asymmetrical fashion.3 The spine when viewed from the front now no longer looks straight but demonstrates lateral or side-to-side curves as each involved vertebrae twists or corkscrews on the one below.1 This can take place in the thoracic or lumbar area (this will look like a C-curve from the front view), or if both of these regions are involved it is termed a thoracolumbar scoliosis (this will look like an S-curve from the front view).3
You may find it helpful to view the anatomy of the spine and this condition at Integrative Learning Center of Mid-America’s Online Library as you read this article.
Fifteen percent of scoliosis is caused by and secondary to another problem. Of these cases consider if the scoliosis is functional or structural.1 If the scoliosis is functional, it is usually a temporary condition caused from another problem. This nonstructural situation may occur in response to a recent trauma or an auto accident for example and with or without treatment may resolve. If the condition is structural in nature or there are actual bony changes it can be a more serious and sometimes progressive disease. Structural scoliosis can occur secondary to another medical problem, such as cerebral palsy, connective tissue disease, Marfan’s syndrome or congenital deformities or abnormalities, in which abnormal stress is placed on the spine.1
Eight-five percent of scoliosis is idiopathic or of unknown cause.1 Onset typical occurs during adolescence, usually from age 12 to 16 years, especially during growth spurts.3 In April 2007 the first gene associated with idiopathic scoliosis was identified as CHD7, at Texas Scottish Rite Hospital for Children.4
Children are frequently screened for scoliosis in schools with a simple forward bending motion at the waist called Adam’s Bend Test (feet straight ahead, knees locked, palms together, arms overhead) reaching toward their toes.1, 4 The medical practitioner views the spine with an unclothed back to determine if a scoliosis may be present or if further tests are indicated. Females tend to have a higher frequency of adolescent scoliosis and more often require medical treatment due to more progressive curves.1, 4
Adult idiopathic scoliosis can also occur. This may develop as a progression from adolescent scoliosis, or following fractures, traumas, osteoporosis or degenerative disc diseases. Pain from scoliosis is more common in adulthood than in the adolescent, especially if left untreated. Other symptoms of scoliosis include:4
- Rib hump or prominent shoulder blade on one side
- Uneven hip and shoulder levels
- Leg length discrepancy
- Asymmetrical spinal musculature or breast levels or size
- Head is held off to one side
- Fatigue with certain activities
Mild or slight scoliosis is common in the population at large and may be secondary to handedness, postural, movement or use patterns. X-rays are used to diagnose scoliosis and goniometric type measurements (Cobb angle) are taken to determine the severity of the abnormal curvature.4 If the curve is less than 25, no treatment is recommended, if it is between 25 to 30 a back brace may be used for medical treatment. In curves larger than 45 surgery may be recommended for insertion of a rod next to the spine or spinal fusion to stabilize the curve.1 A poor prognosis with risk of organ involvement or failure is only common in very advanced cases of scoliosis.
Precautions & Contraindications
The primary precaution with scoliosis is to avoid excessive rotation into the already rotated spine and ribcage. The concern here is that further compromise of the vertebral bony structure or thorax rotation can impair or lend to organ dysfunction in an already compromised region. Increased pain levels are a more common risk. Collapsing into the dysfunction pattern is not desirable.
For details on how somatic education can benefit individuals with scoliosis, see the addendum to this article.
Addendum: Benefits of Somatic Education for Scoliosis
Bones for Life®
There is a wide range of dysfunction in cases of scoliosis, from someone who has a minor muscle imbalance in their spine based on hand dominance and use patterns to the person who requires a surgical correction of their curve. The spinal rotation that results in these cases can frequently be benefited by Bones for Life® (BFL) exercises (called processes). The combination of strengthening the weak or under functioning spinal segments of rotation coupled with “axis” promoting processes provides a dynamic means of spinal reorganization.
If the scoliosis is significant, consistent and repeated applications of BFL processes will be needed to affect he possible improvements in spinal dynamics. For those who have a minor condition, the changes experienced can be quite immediate and dramatic within a single class session. Change occurs when certain BFL processes are used to specifically facilitate a counter rotational component of a person’s scoliotic curve. Because the counter rotation is achieved in an ideal “axis” alignment, the original dysfunction is reorganized and a sense of improvement in one’s function and overall well-being is noted.
The Feldenkrais Method®
Our patterns of movement evolve through trial and error. A myriad of influences including the environment we live, move, and breathe in along with the constraints and inclinations of the society in which we were raised impact this evolution. At some point in our development, organizational patterns fade into unconsciousness actions that guide us in multiple ways, some quite positively and others negatively. The Feldenkrais Method® offers a unique approach to revealing these patterns through a guided pathway of discovery and movement exploration.
With scoliosis, these patterns become central to both the problem and the solution. In the context of Feldenkrais® lessons, that which is unaware comes to the surface and more highly organized functional patterns of movement can emerge. Both group movement classes called Awareness through Movement® and one-on-one Functional Integration® sessions, that involve hands-on input can be beneficial for persons with scoliosis offering pain relief and improved function.
Denise Deig is the author of Positional Release: from a dynamics systems perspective. A Physical Therapist, Guild Certified Feldenkrais Practitionercm and Bones for Life® Teacher/Trainer. She has a private practice in Fishers, Indiana. You can find out more about her and her practice at www.denisedeig.com. Deig can be reached by email at firstname.lastname@example.org. She offers certification and continuing education programs through http://www.integrativelearningcenter.org
- EMedicineHealth.com. Scoliosis Causes, Symptoms, and Treatment. Online access 10/13/2007. http://www.emedicinehealth.com/script/main/art.asp?articlekey=59260&pf=3&page=1
- Gray H; edited by Goss CM, ed. Gray’s Anatomy of the Human Body. 29th ed. Philadelphia: Lea and Febiger; 19073.
- ScoliosisSpecialist.com. What is scoliosis and what causes it? Online access 10/13/2007. http://scoliosispeacialist.s5.com/about.htm
- Wikipedia.org. Scoliosis. Online access 10/13/2007. http://en.wikipedia.org/wiki/Scoliosis