Notes on Scoliosis
Scoliosis, abnormal curvature in any of the three spine sections, may be for our purposes here classified as either functional or structural. Functional scoliosis may be pathologic in nature and should be checked by a physician. In functional scoliosis, the spine and/or ribs are pulled out of normal alignment by dysfunctional soft tissue (muscle, nerves, fascia). Structural scoliosis is a disease in the formation of spinal segments and/or ribs, usually beginning from infancy through early development ages. Other types of scoliosis are developmental (infantile, juvenile, adolescent), neuromuscular, and congenital.
As expected by the name, functional or non-structural scoliosis has origins in body compensations which create muscle imbalances that pull the spine and ribs out of alignment. In some cases, these muscles merely have attachments to bones of the spine or they are intimately connected on both sides of the spine and indeed serve to brace the skeleton. From a myoskeletal viewpoint, functional scoliosis can pull the spine into an abnormal “C” or “S” curve in a front-to-back or side-to-side direction or both and can be complicated further by a twist or torsion in the spine.
Unlike structural scoliosis, the functional type is rarely idiopathic, meaning there is usually a determinable cause for the curve and muscle imbalance. Often times, posture is pointed to as the primary cause. Next, carrying a wallet or thick objects in back pants pockets upsets the pelvis, throwing off the lumbar spine. Muscle compensations can affect other parts of the body which result in an unleveling of the eyes. When this happens, the spine will also compensate in order to level the eyes again, and that in turn may develop a scoliotic spinal curve.
Assessing Functional Scoliosis
Manual therapists conduct a number of skeletal and movement assessments when looking at dysfunctional spinal curvatures. Level of the cranium and pelvis is checked. Leg length and foot arch is compared. In functional scoliosis, the curve generally disappears when the patient’s torso is rotated or tractioned. It also diminishes when a patient sits on a chair and sidebends or leans their torso forward into such a position that their chest and stomach is resting on the tops of their upper legs, arms hanging down outside either lower leg. However, if spinal segments are rotated, ribs may be visibly higher on the outside curve side.
Other indicators are observing the level of the mouth and shoulders while the patient is standing upright, checking level of the hips or bony protrusions of the pelvis, checking leg length, and looking for sacral torsion or rotation.
The main culprits in larger curves among muscles of the back are the erectors and there are several of these. They have attachments to the spine and/or ribcage and essentially run parallel to the spine. Some run right alongside the spinal segments; others run parallel, but further away from the midline. If you consider these to act rather like a guitar string or an archery bow, you can see how a dysfunctional, strong contraction of the muscle (the bowstring) bends the spine (bow). But the erectors are not the only muscles involved. All of these must be addressed if they are assessed to be problematic.
In the upper thoracic spine, the rhomboids, attach to the spine on one side and on the medial border of the scapula on the other. The rhomboids are downward rotators of the scapula. A dysfunctional rhomboid on one side could cause a lateral pull on the lower cervical and upper thoracic spine.
The trapezius also has attachments along the thoracic spine as well as shoulder blade and collarbone. Its fibers pull outward, too, away from the spine. A dysfunctional trapezius could create a larger scoliotic curve than the rhomboids would and affect more spinal segments.
In the low back, there is a muscle on each side of the spine that attaches to the lowest rib, spine, and top rim of the pelvis called quadratus lumborum. They’re known as “QL” for obvious reasons. QL is a core stabilizer and has a tendency toward hypertonicity or constant tightness. The functionality of the QL is to work as a hip hiker, but it often puts a side-strain pull on the lumbar spine as well as an upward tension on the ilium. Scoliosis here may be caused by QL alone or QL in tandem with the lumbar erectors.
The posterior fibers of the deltoid (posterior deltoid) has some attachments to the shoulder blade, too, and can work in tandem with thoracic erectors to pull the spine out of alignment.
In addition, there are several small muscles that attach between the vertebrae or between vertebrae and ribs that may be involved in functional scoliosis. These are the multifidus, intertransversarii, rotatores, and levator costalis.
Structural issues elsewhere in the body can directly cause or indirectly contribute to functional scoliotic spinal curvature, such as pelvic tilt, torsion, and rotation, cervical injury or dysfunction, leg length discrepancy, foot imbalances such as pronation and supination, valgus and varus knee, and so on.
Manchester-Bedford Myoskeletal’s Viewpoint
Functional scoliosis can be assessed and evaluated in our treatment office. Our methods of working with patients with scoliosis address soft tissue dysfunction in all forms. We assess muscle inhibition and facilitation, range of motion, skeletal alignment in movement and static form, and work to relieve muscle and myofascial tension where needed. We also bring life back into inhibited muscles and reeducate the brain to connect the neural communication pathways to get the proper muscles working again. We educate you on how to continue your self-treatment at home between sessions and reassess you at your next session to observe improvement. Our goals are the same as yours: Getting you back to life without pain.