To give a prescriptive list of areas to treat when faced with a patient with scoliosis is to do an injustice to both osteopathy and the scoliosis. After all, a scoliosis is a general term for a lateral curvature of the spine but a variety of scolioses exist, all of which have unique characteristics that are necessary for the osteopath to consider when assessing, diagnosing and treating.
Idiopathic scoliosis is a scoliosis that has no known pathological cause. Of all the scolioses it is the most worrisome due to its potential compression of the viscera; the lungs and pericardium. The scoliosis begins normally during childhood or adolescence and stops once spinal growth ceases. The scoliosis can be either thoracic, thoraco-lumbar or lumber. It is normally thoracic and is identified by the involvement of the ribs which which produce a so-called "high-side", a phenomena in which the ribs are thrust backwards on the side of the convexity.
Compensatory scoliosis is one where there is nothing intrinsically wrong with the spine per se but rather external forces affect the spine, such as a tilted pelvis from shortened adductor or abductor muscles, a leg-length difference or a fixed abduction or adduction deformity of the hip. Usually, once the cause has been removed, the scoliosis dissappears unless the scoliosis has been left untreated for many years and resulted in tissue shortening around the spine.
Secondary scoliosis is normally secondary to an underlying pathology such as poliomyelitis or cerebral palsy where unequal muscular contracture as a result of the pathology results in extreme angulation of the spine.
Sciatic scoliosis is a temporary form of scoliosis which is normally a person's attempt to protect oneself by reducing pressure on an irritated nerve. Once the acute phase is over the scoliosis normally disappears.
Examination guide for the osteopath:
The osteopathic examination should focus on assessing the movement of the axial skeleton. The osteopath should try and determine to what extent the axial skeleton, that is, the sacrum, the spine, the ribs, the sternum and the cranium are being dragged away from the mid line. The osteopath needs to examine these areas both passively and actively in order to assess which of these areas show most restriction of mobility. It is often the case that the thoraco-lumber area and the cervico-occipital junction display most restriction.
Once the osteopath has observed the axial skeleton, the peripheral areas should be observed. For example, observation of the foot-arches, knees, hips, the pectoral girdles. Osteopathic examination should involve comparing the shoulders and the pelvic girdles, assessing inequality. The osteopath should be aware of the Adam's test, a test which involves flexing the spine forward as if to touch the toes. This test exaggerates the high-side and shows the extent of the scoliosis.
Factors for the osteopath to consider:
The pelvis - The osteopaths needs to observe the pelvis for tilting. A tilted pelvis will result in a lateral curvature of the lumber spine. Therefore the osteopath needs to decide what is causing the imbalance in the pelvis and if necessary to treat the muscles that connect to the pelvis such as the hip adductors and abductors. Similarly the osteopath should check for a leg-length difference.
Pelvic and Shoulder girdles - The osteopath can develop a good understanding of how the body is adapting to the scoliosis by observing the pelvic and shoulder girdles. Any raised shoulder could well be coming from a lateral curvature in the spine. So too a raised posterior superior iliac spine could be causing an imbalance in the spine and shoulders.
Occipital protuberance - The occipital protuberance should be directly above the gluteal crease. Any deviation from the line indicates a lateral curve in the spine.
The diaphragm - The diaphragm should be observed both passively and actively as the patient breaths. The osteopath should check the lower 6 ribs and the upper lumber spine where the crura of the diaphragm attach. A lateral curvature of the spine that involves rotation through the thoracic spine will inevitably affect the ribs and the diaphragm.
From a cranial-osteopathy view much emphasis is placed on a few areas:
The spheno-basilar-symphisis - the body's attempt to overcome the scoliotic changes in the spine results in the cranium shifting in order to keep the vestibular and optic senses balanced. This may mean that the cranium is tilted slightly, causing alteration in the natural position of the occipital condyles. This will then be reflected in the movement of the spheno-basilar-symphisis. The osteopath needs to assess each person individually to check to what degree and in which direction the occipital condyles have adapted and so too, what type of strain is reflected through the spheno-basilar-symphisis.
The abdominal muscles are a doorway to palpating the viscera. So often the lateral curvature of the scoliosis results in compression and compensation of the visceral contents. Using cranial and visceral osteopathic techniques in particular, the abdominal muscles give a good indicator as to the internal changes occurring from the change in weight bearing.
Treatment guide for the osteopath:
The osteopath should mainly focus on the somatic dysfunction that occurs as a result of the scoliosis, paying particular attention to the postural decompensation that occurs. The treatment should then be aimed at focusing as much as possible on restoring the biomechanical changes and helping them do compensate. The osteopath should try to reverse the postural decompensation and try and strengthen any areas that will help strengthen the curve and prevent it from collapsing. Similarly, the osteopath will do well to pay attention to balancing the sacrum and pelvis and as much as possible restoring symmetry. Finally, the osteopath should include work around the neck and cranium in order to remove any possible dysfunction in the proprioceptive units within the cranium.
Idiopathic scoliosis is a scoliosis that has no known pathological cause. Of all the scolioses it is the most worrisome due to its potential compression of the viscera; the lungs and pericardium. The scoliosis begins normally during childhood or adolescence and stops once spinal growth ceases. The scoliosis can be either thoracic, thoraco-lumbar or lumber. It is normally thoracic and is identified by the involvement of the ribs which which produce a so-called "high-side", a phenomena in which the ribs are thrust backwards on the side of the convexity.
Compensatory scoliosis is one where there is nothing intrinsically wrong with the spine per se but rather external forces affect the spine, such as a tilted pelvis from shortened adductor or abductor muscles, a leg-length difference or a fixed abduction or adduction deformity of the hip. Usually, once the cause has been removed, the scoliosis dissappears unless the scoliosis has been left untreated for many years and resulted in tissue shortening around the spine.
Secondary scoliosis is normally secondary to an underlying pathology such as poliomyelitis or cerebral palsy where unequal muscular contracture as a result of the pathology results in extreme angulation of the spine.
Sciatic scoliosis is a temporary form of scoliosis which is normally a person's attempt to protect oneself by reducing pressure on an irritated nerve. Once the acute phase is over the scoliosis normally disappears.
Examination guide for the osteopath:
The osteopathic examination should focus on assessing the movement of the axial skeleton. The osteopath should try and determine to what extent the axial skeleton, that is, the sacrum, the spine, the ribs, the sternum and the cranium are being dragged away from the mid line. The osteopath needs to examine these areas both passively and actively in order to assess which of these areas show most restriction of mobility. It is often the case that the thoraco-lumber area and the cervico-occipital junction display most restriction.
Once the osteopath has observed the axial skeleton, the peripheral areas should be observed. For example, observation of the foot-arches, knees, hips, the pectoral girdles. Osteopathic examination should involve comparing the shoulders and the pelvic girdles, assessing inequality. The osteopath should be aware of the Adam's test, a test which involves flexing the spine forward as if to touch the toes. This test exaggerates the high-side and shows the extent of the scoliosis.
Factors for the osteopath to consider:
The pelvis - The osteopaths needs to observe the pelvis for tilting. A tilted pelvis will result in a lateral curvature of the lumber spine. Therefore the osteopath needs to decide what is causing the imbalance in the pelvis and if necessary to treat the muscles that connect to the pelvis such as the hip adductors and abductors. Similarly the osteopath should check for a leg-length difference.
Pelvic and Shoulder girdles - The osteopath can develop a good understanding of how the body is adapting to the scoliosis by observing the pelvic and shoulder girdles. Any raised shoulder could well be coming from a lateral curvature in the spine. So too a raised posterior superior iliac spine could be causing an imbalance in the spine and shoulders.
Occipital protuberance - The occipital protuberance should be directly above the gluteal crease. Any deviation from the line indicates a lateral curve in the spine.
The diaphragm - The diaphragm should be observed both passively and actively as the patient breaths. The osteopath should check the lower 6 ribs and the upper lumber spine where the crura of the diaphragm attach. A lateral curvature of the spine that involves rotation through the thoracic spine will inevitably affect the ribs and the diaphragm.
From a cranial-osteopathy view much emphasis is placed on a few areas:
The spheno-basilar-symphisis - the body's attempt to overcome the scoliotic changes in the spine results in the cranium shifting in order to keep the vestibular and optic senses balanced. This may mean that the cranium is tilted slightly, causing alteration in the natural position of the occipital condyles. This will then be reflected in the movement of the spheno-basilar-symphisis. The osteopath needs to assess each person individually to check to what degree and in which direction the occipital condyles have adapted and so too, what type of strain is reflected through the spheno-basilar-symphisis.
The abdominal muscles are a doorway to palpating the viscera. So often the lateral curvature of the scoliosis results in compression and compensation of the visceral contents. Using cranial and visceral osteopathic techniques in particular, the abdominal muscles give a good indicator as to the internal changes occurring from the change in weight bearing.
Treatment guide for the osteopath:
The osteopath should mainly focus on the somatic dysfunction that occurs as a result of the scoliosis, paying particular attention to the postural decompensation that occurs. The treatment should then be aimed at focusing as much as possible on restoring the biomechanical changes and helping them do compensate. The osteopath should try to reverse the postural decompensation and try and strengthen any areas that will help strengthen the curve and prevent it from collapsing. Similarly, the osteopath will do well to pay attention to balancing the sacrum and pelvis and as much as possible restoring symmetry. Finally, the osteopath should include work around the neck and cranium in order to remove any possible dysfunction in the proprioceptive units within the cranium.