Treating Functional Scoliosis

Scoliosis is something that is very common and can be either anatomical or functional. It is far more common to see functional scoliosis, which tend to be relatively mild, though can be fairly severe. A scoliosis is a often described as a frontal plane curve in the spine…and though this is correct, it is only part of the dysfunction.

As spinal motion is coupled, you must not forget that a frontal plane displacement of the spine will be coupled with a transverse plane deviation as well, so this should be considered in the treatment and so often isn’t. If you’ve read the post about Fryettes Laws you will understand about type I and type II motion. Scoliosis has been described by Dr David Tiberio as a type I dysfunction. This means that when the scoliosis is a lateral flexion to the left, then the associated transverse plane dysfunction will be right rotation.

This is a fairly simplistic view, but leads to a very powerful treatment strategy that so far has delivered a favourable result every time I’ve ever used it. Lets go through an example, which will make things much easier:

Scoliosis

If you are looking at a spine and you can see that there is a lumbar curve of left lateral flexion and a thoracic curve of right lateral flexion. The left lumbar lateral flexion will be coupled with right rotation and the right lateral flexion in the thoracic will be coupled with left rotation. So mow we know what the dysfunction is…what are our treatment strategies?

Well…here’s what I do:

For the Lumbar Spine

First of all I position the patient to minimise the dysfunction. In the above example, this means that I position with the right foot on a step, which will minimise the left lateral flexion in the lumbar spine. By having the right foot forward, you are rotating the pelvis to the left, which will right rotate the lumbar spine, which isn’t perfect, but in my experience the trade off here for the lateral flexion benefit is worth it.

For the Thoracic Spine

I positioned the lumbar spine through the pelvis and I will position the thoracic spine through the arms. We have a right lateral flexion and left rotation dysfunction, so I begin by positioning the right hand above head to minimise the lateral flexion and then I position the left hand in slight right rotation at shoulder height to minimise the left rotation dysfunction.

Once you’ve established the basic position (a stretch cage works best for this) you then re-assess the spine and tweak the position to minimise the dysfunction and make sure that you haven’t driven them too far the other way. Over compensating really doesn’t help and is definitely to be avoided. For example, adjust the height of the step, drive more or less lateral flexion with the left hand etc.

Once you have positioned them it’s now time to drive some motion through spine. For this I start by leaving the hands and feet stationary and driving motion from either the pelvis or the head. This is really subtle, but works brilliantly. I tend to start with sagittal plane drivers and then mix up frontal and transverse plane drivers depending on what I see from the patients movement and what they can handle…pain wise. If I want to progress I will use arm drivers, I will ask them to drive into the dysfunction in order to fire the muscles on the opposite side of the spine in order that they increase their tone and hold the spine in a less dysfunctional position. In our above example, I will drive the right arm down, which will drive into the right lateral flexion dysfunction, but increase the tone of the muscles that can pull the patient out of the dysfunction.

Hopefully…I’ve got all my rights and lefts correct in my example!! It is a relatively simple strategy, but with a great thought process behind it, mostly thanks to Dr Dave Tiberio. Like I said, when I’ve chosen to use this strategy, it works every time 🙂 It’s actually a very gentle strategy and like most of my exercise strategies I only allow the patient to use pain free ranges of movement.

If you have any questions or comments please feel free to comment below.

Physioblogger

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4 Responses to Treating Functional Scoliosis

  1. Tony December 5, 2012 at 3:46 pm #

    Hi Neil

    I couldn’t work out why you say not to drive to far out of the dysfunction & not to over compensate? Is that because you are talking purely from a therapy sencse where there might be pain or is it a case of if you are to aggressive then the dysfunction just won’t release?

    All the best,
    Tony

    • physioblogger December 5, 2012 at 4:02 pm #

      Hi Tony,

      In this strategy you want to minimise the dysfunction and not send it to far in the opposite direction. I want to show the body the position I’m trying to keep it in. If you go too far and are too aggressive you will fire up the muscles that ultimately pull the body into the dysfunction…which will make the scoliosis worse.

      Hope that makes sense,

      Neil

  2. Ong Chee Yong October 2, 2017 at 2:11 am #

    For the thoracic curve in the diagram, since we are looking from the posterior view, the curve of the spine is to the left. So wouldn’t it be sensible to describe the movement of the spine as ‘left lateral flexion’?

    I find it confusing that you label it as ‘right lateral flexion’ when what I see is a curve to the left.

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