Features Practice Technique
Healing Hands on Curved Spines

The potential benefit that massage and manual therapy offer to people living with scoliosis is undeniable from many personal points of view and anecdotal stories, yet very little attention in the published literature has been devoted to how massage therapy can help alleviate the muscle tension that is almost universal in the condition of scoliosis. 

Case reports demonstrate the efficacy of massage therapy in the management of scoliosis.

As far back as 1887, Douglas Graham wrote in his treatise, The Treatment of Scoliosis by Means of Massage: “The results obtained from the employment of massage in carefully selected cases of lateral curvature of the spine seem to have been so successful that they deserve more than a passing notice.”1

The purpose of this article is to lend credence to the opinion that massage is a valuable tool in the management of scoliosis and its associated symptoms; to offer a few tips in how to recognize scoliosis in your clients; and to explore how to modify their massage treatment to give them the optimum possible benefit from their experience.

About Scoliosis
Scoliosis, commonly defined as a lateral deviation of the spine, is more accurately described as a “coiling” of the spine rather than as a pure bend to the side. Scoliosis is three-dimensional, and it is the rotation of the spine that is responsible for producing cosmetic differences in the symmetry of the torso. This point will become important later in this article, when we discuss how best to position an individual with scoliosis as they lie down upon your table. While the role of the muscles in the cause of scoliosis remains controversial according to many researchers, it is readily agreed by all that scoliosis is accompanied by changes in the soft tissues of the body. Understanding the unique biomechanics of scoliosis can provide the therapist with insight into which specific muscle activation and relaxation strategies will be most beneficial.

Despite the shortage of massage therapy-related information in the scoliosis literature, there are published scientific case reports that demonstrate the efficacy of massage therapy in the management of scoliosis, either alone or in conjunction with other therapies. One of the most inspiring is the experience of Martha Hawes, PhD, who was both the author and the patient of a case study published in the journal Scoliosis in 2009.2 This study noted not only improvements in the lateral curvature of the spine (as measured by Cobb angle), but also improvements in cosmetic appearance, lung function, and height. Another study from 2008 on an 18-year-old female with scoliosis suggests that manual therapy (specifically myofasical release) may be effective in improving posture, quality of life, range of motion, and lung function, and in decreasing pain levels.3

While we tend to think of scoliosis as a disease that affects only adolescents, research has proven that the incidence of scoliosis actually increases with age.4 A mild scoliosis in adolescents can grow to become a major concern in adulthood, and very rarely are adults screened for scoliosis. This is one of the reasons massage therapists play such a valuable role in the detection of cases of adult scoliosis; having the opportunity to work with your clients shirtless, you may be able to catch subtle signs that other health-care practitioners might not notice.

Detecting scoliosis in your clients
The severity of scoliosis typically decreases when a patient lies down, so it can be difficult to detect unless you are aware of what to look for. Typically in a patient with scoliosis, you will find areas of muscle tension and guarding in the paraspinal muscles on the convexity of the curve.5

You may notice one scapula (typically the right) appears to protrude more than the other. One easy-to-use device that can be very helpful in detecting suspected cases of scoliosis is a scoliometer; they are inexpensive and require very little training to use, so it’s not a bad idea to consider having one around. In 1994, a report concluded that using a scoliometer was an effective method of screening for scoliosis.6

When you suspect that a patient may have scoliosis, the first step is to ask them if they know whether or not that they have scoliosis. If they do not know, the next step would be referral for radiographic imaging. Only an X-ray can truly confirm or deny the presence of scoliosis.

Massage therapy approach for scoliosis patients
If you identify a patient with scoliosis, the correct relaxation strategy would be to focus on the paraspinal muscles on the convexity of the curves. In a classic double-major right thoracic, left lumbar curvature, this would be the right side of the thoracic spine and the left side of the lumbar spine. With this spinal configuration, you would tend to notice a “zig-zag” pattern of muscle tension, beginning in the right levator scapulae, travelling to the left posterior trapezius, moving back to the right rhomboid, then the left quadratus lumborum, and finally the right piriformis. Most scoliosis patients who have a lumbar curvature with the convexity to the left will tend to stand with more weight placed down their left leg; this can result in tension in the hamstrings and calf muscles in the left leg. Also, do not ignore the muscles in the neck, especially in the suboccipital region – neck pain is a very common presenting symptom in patients with scoliosis.

Positioning a patient with scoliosis on your table properly can help to “unwind” the three-dimensional coiling of the spine that occurs in this condition. While each case of scoliosis is unique, there are certain guidelines that can be followed in the majority of cases. Again referring to a classic right thoracic, left lumbar double-major curve type, having the patient place their left arm above their head and relax their right arm below the table can help to de-rotate the torso. You can place a wedge or towel underneath the patient’s chest on their left side to further accentuate this effect; similarly, raising up the front of the right hip slightly while the patient lies on their stomach helps to de-rotate the lumbar spine through the action of the pelvic girdle. If the patient has a left thoracic, right lumbar curve pattern, this configuration would be reversed.

Massage therapy plays a valuable, but often overlooked, role in helping patients with scoliosis lead healthy, pain-free lives. Patients with scoliosis tend to have more muscle tension and muscle pain than the general population, and manual therapy is an effective method of helping relieve these symptoms. In addition, by being aware of scoliosis and knowing what to look for, you can help people who might not otherwise know they have scoliosis to find the care they deserve.

RESEARCH AND REFERENCES

1. Graham D: The treatment of scoliosis by means of massage. Ann Surg 1887 Dec;6(6):485-92.
2. Brooks WJ, Krupinski EA, Hawes MC: Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review. Scoliosis 2009 Dec 15;4:27.
3. LeBauer A, Brtalik R, Stowe K: The effect of myofascial release (MFR) on an adult with idiopathic scoliosis. J Bodyw Mov Ther. 2008 Oct;12(4):356-63. Epub 2008 Jun 4.
4. Voros G, Neubauer P, Khoshnevisan M: Prevalence of scoliosis in adults age 40 years and older: a study of 2,973 individuals. Paper #2. Presented at the North American Spine Society 22nd Annual Meeting, Oct. 23-27, 2007, Austin, Texas.
5. Koo B, Cheng JCY, Guo X: Motor unit analysis of paraspinalis muscles in idiopathic scoliosis. J Bone Joint Surg 1998;80B(3):226.
6. Korovessis PG, Stamatakis MV: Prediction of scoliotic Cobb angle with the use of the Scoliometer. Spine, 1996 Jul 15;21(14):1661-6. </I>

Dr. A. Joshua Woggon, a 2010 Graduate of Parker College, is the director of the CLEAR Scoliosis Treatment and Research Clinic in Dallas, Texas (www.clearscoliosisclinic.com), and the director of research for CLEAR Institute, a non-profit organization dedicated to advancing chiropractic scoliosis correction (www.clear-institute.org). He can be contacted at jwoggon@clear-institute.org.