Published on Rolf Lines® vol. XXVII, n.4 - Fall 2000
Available in the original Italian at the Rolfing Italia website HERE
Formatted in English in HTML by E.D. Gordon for Katsujin Concepts Design

"A Rolfer®'s first goal is to restore symmetry, and symmetry, in the last analysis, is a synonym for balance" .
"In all Rolfing® work, we are involved in a lengthening process….that's the only way you can straighten a body".

It is in the light of these declarations by Dr. Ida Rolf that we can give effective support to our clients who have scoliosis.

Rolfing® is the most powerful tool available to align a body that is unbalanced by scoliosis, provided that we are able to put everything "where it belongs".

This article is for Rolfers® who, fearing to make a mistake, are reluctant to treat scoliotic clients. It is impossible to discuss in a single article what has been written about in hundred of books.
Therefore only a few cues, that I personally have found effective, will be given.
If these cues are given analytically it is not in order to underestimate the whole, but so that each Rolfer® has more tools to use when they are necessary.
The aim is to sharpen our body reading in order to employ a more definite strategy.
I have mentioned here only the teachers I actually saw working with people affected by scoliosis.

Let's consider:
1) what scoliosis is
2) how to examine structural deviations

1. Description of scoliosis:

True scoliosis is "idiopathic" – or of unknown origin - and is characterized by the presence of a misalignment of some, or even all the vertebrae creating a helicoidal shifting of the spine. The back develops a gibbus (or more than one), meaning that, at the same level, one side of the back is more posterior relative to the other side. This can easily be seen by asking the person to bend forward (fig.A, fig.B).
If a gibbus is not present it is not a true scoliosis, but rather a scoliotic behaviour, a condition much easier to change.

This is a very important parameter: if a child has a gibbus, it must be treated until the end of the bones growth. Unlike curvatures formed in the spine by a normal side-bending, curvatures formed by scoliosis don't straighten up spontaneously.

a) In the scoliotic spine one or more curvatures in the frontal plane may be seen, the primary curve and the compensation curves. The more lateral point of the curvature is called apex.
b) The vertebrae rotate on the horizontal plane. These rotations as a whole create the gibbus, that is formed by transverse processes shifted posterior on one side and by the ribs following this shift (convexity)(fig.C, fig.D). At the same level, on the other side of the spine, the transverse processes go forward and we see a depression (concavity).
c) In the sagittal plane, the two sides of the body have different curvatures. This means that, in profile, one side of the spine is lordotic, while at the same level the other side is kyphotic.

Every scoliosis has its own conformation and evolution, linked to the personal history of the people affected by it.
Scoliosis can be caused by illness, such as bone tuberculosis, or paralysis, as well as a bone anomaly, such as shorter leg or an extra half-vertebra.
In these cases, if you don't have a specific background, it's better to ask a teacher or a doctor who knows Rolfing® for advice regarding the initiation and the extent of your intervention.

Scoliosis affects females to a larger extent than males and it advances during periods of bone growth. This means that if the scoliosis appears at an early age (childhood scoliosis), it can become very severe if not treated.

Scoliosis worsens far quicker one year before and one year after puberty but when it is discovered, it must be treated every time the child becomes taller. Once we have finished the 10 Rolfing® sessions, we should ask the parents to measure their child's height and to bring them for another session every time they notice an increase.

To understand what the body needs during periods of rapid growth, just imagine that a very deep tension prevents the myo-fascia from spreading correctly during the bone growth. This "pin" blocks a few segments and the body is forced to twist at several locations. Soft tissues shortening goes together with the increasing of scoliotic curvature. Therefore the first important concept to remember is: to straighten a scoliosis it is
necessary to create more space by lengthening the fascia. It's a physics law: when two bodies are compressed together, they react by rotating .
Other parts of the body have to compensate when the spine becomes scoliotic. The head, which orients itself in the space through the eyes and keeps the body balanced through the inner ear, must be level.
Compensation curvatures are in fact an adaptation to maintain the body in an upright position. Even if in the sagittal plane the shoulder girdle partially absorbs the imbalance of the lower spine, there are always compensations in the neck.

In a scoliosis, shortening involves, first of all, the muscles joining vertebras. If we consult Kapandji's books and consider the physiology of joint movement in the spine, we notice that flexion movement has a larger range at the lumbar level, while rotation is greater at the thoracic level. Consequently thoracic scoliosis are more dangerous because they have a favorable ground on which even more rotation may be allowed.
When scoliosis is in an advanced stage, some vertebras can actually degrade to a cone shape that can no longer be modified. In spite of this, we can work to release compensations and let the body be more at ease.

2. Structure examination
In observing the client standing, the triangle, formed by the waist line and the arm (fig.E), is an obvious indication: people with scoliosis have one triangle smaller than the other.
On one side we can notice the so called (at least in Italy and in France) "hatchet stroke", adjacent to the spinal concavity (fig.F).
On the side where the hand doesn't touch the body, or is more distant, we will find a major shortening of the psoas (photo 1).

In the pelvis there are many factors that we will consider one at a time:
1) one ilium will be in anterior tilt, one in posterior tilt. The lines of force will therefore be very different in each leg. We can put our hands on the iliac crests to see which is higher: the higher side will be the one with an anterior tilt (photo 2). At the lumbar level a lordosis goes together with the anteriorly tilted ilium, a kyphosis with the ilium in posterior tilt.
If you are supporters of precision, you can do a test: put one of your fingers on the anterior superior iliac spine of the client and another on the posterior inferior iliac spine
(three fingers of the person you are measuring below the superior posterior iliac spine). If the finger in front is lower, the ilium is anteriorly tilted and vice versa (photo 3).
2) One ilium will be in out-flare, the other in in-flare. To evaluate that, we can trace two lines starting from the umbilicus to each ASIS: the longer one will be the side of the out-flare (photo 1).
3) The pelvis as a whole can have a rotation on the horizontal plane. To evaluate this , instruct the clients to stand in a relaxed manner, and rotate the pelvis right and left. The direction the pelvis rotates more easily is the direction of rotation .
It is advisable to repeat this test from time to time.

4) Each ilium can be twisted: to evaluate that, we can put the palm of our hands on the glutei while our clients are standing: in this way the behaviour of each ilium will be more evident (photo 4).

The sacrum can seem difficult to understand, because it moves in all the three planes and there is an oblique component that creates difficulty for the beginner. The base of the sacrum follows the lumbar segment, so on the frontal plane it will have the same inclination of the lumbar vertebrae. In the horizontal plane, the sacrum basis will be posterior in the same side of the lumbar kyphosis. Working on these two variables allow us to also influence the third, and so the obliquity.

The legs are affected by imbalance in the pelvis and sometime there is a sacro-iliac joint blocked. To check if one leg really is shorter than the other, we may ask the client to lay down supine, with legs bent. This will show if one of the femurs is
longer (fig.G). To check if the lower legs have different lengths, we'll ask the client to sit on the edge of the table, with her lower legs hanging down (fig.H).

Regarding the back, we ask the client to bend forward to see the gibbus. Electro-myography studies have shown that muscle activity on the concave side of the scoliotic curvature is almost zero. If scoliosis creates more than one curvature, to recognize which is the main curvature and which are compensations, we can ask the sitting client to bend to the side. The "core" curvature is where we find just a very little closure movement on the convex side during the side-bend. The other curvatures can be modified much more easily.

In a body that has a scoliosis, the shoulder girdle will be lower on one side ( fig.I).
The best evaluation of this is obtained by looking at the clavicles: if they are slanting
as a whole, but in line with each other, it is do to scoliosis; if only one clavicle is inclined, it is caused by other factors such as a shoulder raised to carry a handbag, poor posture while studying or writing or a previous trauma (photo 1).
The ribs are fixed open where the convexity of the curvature is (where we see the gibbus) and they are closer together on the concave side (fig. J).
On the concave side the scapula slides medially and we find shortened rhomboids.
The scapula slides laterally on the convex side with a corresponding shortening of serratus anterior and all the muscles between the scapula and the arm, including teres minor and major, infraspinatus .. (fig. J). If we place our thumbs on the inferior angle of the scapulae, we can evaluate their position with respect to the spine and the torso more clearly (photo 5).

Lumbar and thoracic vertebrae follow the Type-1 Motion , meaning that, when there is a lateral bending of the spine, every vertebra that has free joint facets moves rotating its transverse process downward and forward on the same side as body bending .
Cervical vertebras always compensate. On one side, between the atlas and the occiput, there will be a greater compression.

The cranium and viscera are also forced to adapt to the scoliotic spine. As both evaluation and treatment in these areas are highly complex, I suggest that specific trainings be obtained.

Even if Rolfing® sometime induces only a limited decrease of scoliotic rotations (mainly in adults), easing the imbalance associated with compensations makes the client more comfortable.

Bibliography
Dr Ida Rolf. "Rolfing and physical reality", Healing Arts Press, 1990
Dr. Ida Rolf: "Rolfing", Harper &Row, 1978
Alain Bernard: "Trattato di osteopatia strutturale"Vol. I, II, Marrapese, 1986
Marcel Bienfait "Fisiologia della terapia manuale", Editore Marrapese 1990
Marcel Bienfait: "Scoliosi e terapia manuale" Editore Marrapese 1990
Léopold Busquet: "Le catene muscolari", vol. I,II,III,IV, Marrapese, 1992
I.A.Kapandji: "Fisiologia articolare", Marrapese, 1983
Jeffrey Maitland: "The art of Rolfing®. Principles. Taxonomies. Techniques." distributed in advanced
training, Rome 1996
A. Mancini, C. Morlacchi: " Clinica ortopedica", Piccin, 1977
Patrick Michaud "L'esame morfologico in ginnastica analitica", Marrapese,1989
René Perdriolle "La scoliosi", Ghedini Editore, 1982
Vincenzo Pirola "La chinesiterapia nella rieducazione della scoliosi", Sperling &Kufer, 1993

(Drawings used in this article are taken from these books).

Ida Rolf: "Rolfing® and physical reality", Healing Arts Press,1990, pg.187
op. cit., pg.203
Hans Flury: " Theoretical aspects and implications of the internal- external system", Notes on Structural
Integration Nov. 1989
If I remember well, I saw Hans Flury using such a test in one of his workshops on "Normal Function".
Jeffrey Maitland: "Spinal Biomechanics" , from: "The art of Rolfing®"- advanced training in Rome, 1996