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Cranial Connections

By Don McCann, MA, LMT, LMHC, CSETT

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Rational Treatment for Scoliosis

As massage therapists, we see a considerable number of clients with neck and back pain. The constant with these clients is an imbalance of the pelvis and exaggerated curvatures of the spine. The argument can be made that the majority of back pain is due to a degree of scoliosis. Understanding scoliosis and where it comes from, provides the key for the effective treatment and rehabilitation of scoliosis.

According to Taber's Cyclopedic Medical Dictionary, "lateral curvature of the spine. Usually consists of two curves, the original abnormal curve and a compensatory curve in the opposite direction. [Commonly there are] congenital. Scoliosis present at birth, coxitic. Scoliosis in the lumbar spine due to tilting of pelvis in hip disease, habit. Scoliosis due to habitually assumed improper posture or position, inflammatory. Scoliosis due to disease of the vertebrae, ischiatic. Scoliosis due to hip disease, myopathic. Scoliosis due to weakening of spinal muscles, ocular. Scoliosis from tilting of the head because of visual defects, paralytic. Scoliosis due to paralysis of muscles, rheumatitic. Scoliosis due to rheumatism of the dorsal muscles, sciatic. Scoliosis due to sciatica, and static. Scoliosis due to difference in length of legs."

From these definitions of scoliosis and its causes, we can see that spinal musculoskeletal conditions that include scoliosis are common in our culture due to a variety of factors, some included in the definitions. One of the most important contributing factors is the sedentary nature of today's population and lack of musculoskeletal strength building exercises for people in all walks of life. This not only takes place with adults who become sedentary due to work, overall tiredness and dislike of exercise, but also with children due to computers, TVs and electronic games being a main source of recreation.

scoliosis - Copyright – Stock Photo / Register Mark When children do not exercise to develop strength in their musculoskeletal system, they are at risk of developing increased curvatures of the spine that lead to scoliosis. In addition to the lack of exercise, spending too much time in inappropriate furniture including desks, chairs, couches and beds, results in an increase of diagnosed scoliosis from school screenings. Another issue is that as children enter the rapid growth teenage years, the curvatures already existing will worsen due to the lack of strengthening and coordination of spinal muscles. This increasing number of clients with scoliosis presents unique challenges. As massage therapists, it is possible that the lack of understanding structure and inappropriate treatment protocols could make the conditions including pain and structure worse.

All of your clients have some curvatures of the spine, so you need to view scoliosis in terms of the degree of curvature. From Yokum's accumulation of radiographic knowledge of x-rays of children, normal rotations of the acetabulum are already present at 0-3 months and increase by 12 months. This is what we call the core distortion pattern. Also evident when viewing the x-rays is that with the rotation of the iliums, there is a tippage of the sacrum at the base of the spine. The greater the rotation of the iliums, the greater the tippage of the sacrum with resulting increased curvatures of the spine. There is a correlation here that relates directly to the degree of scoliosis. Thus, there is a foundation that has to be addressed if the curvatures of the spine (scoliosis) are to be reduced. It is necessary to provide support and leveling of the sacrum by reducing the rotations of the iliums.

Some of the ilium rotations are congenital, but a surprising number are functional and can be reduced. The functional rotation of the iliums also produces a functional long leg and short leg. When this happens, both legs, whether it is the long one or the short one, distort to try to minimize the overall structural imbalance. When viewing the functional long leg that results from the anterior rotation of the ilium pressing the hip joint down, you can observe how the leg has tried to absorb the extra leg length. Some of the most common compensations are hyperextension, medial rotation of the knee, lateral rotation of the foot and lower leg, and eversion of the arch. Specific muscles that attach to the ilium that will be over developed and over contracted tend to be anterior and medial fibers of the gluteus medius, tensor fascia latae and iliacus. For long term support to balance the rotation of the iliums, it is necessary to apply specialized soft tissue protocols to address the rotation of the iliums and distortions in the leg.

The posteriorly rotated ilium, which produces a short leg, also has specific distortions in the structure and soft tissue of the leg. Specifically, the tendency for lateral rotation from the hip to the knee, either hyper or hypoextension, and a shifting of weight back to the lateral heel. There also tends to be over contraction and over development in the quadratus lumborum, gluteus maximus, piriformis and rotators.

For long term results, the weight bearing support at the SI joint for the spine needs to be addressed. The only long term therapeutic correction I have found is Cranial/Structural Therapy. The core distortion with the anterior/posterior rotation of the iliums and tipped sacrum relates directly to the distortions found in the movement of the cranial bones. It is well documented through osteopathic work and craniosacral that a strong relationship exists between the cranial motion and the sacrum. Cranial/Structural techniques address these distortions by reducing the soft tissue restrictions of the cranial motion that relate directly to the anterior/posterior rotation of the iliums. This produces an almost immediate observable and provable change using kinesiology testing in the rotation of the iliums. The weight bearing separations between the tipped sacrum and the rotated iliums are immediately reduced, allowing the sacrum to become level. This provides a level support at the base of the spine which initiates an unwinding of the exaggerated spinal curvatures.

There are additional benefits from Cranial/Structural therapy. When the rotation of the iliums is greater than 15 degrees, there is a dramatic lessening of muscle strength and function. Thus, the greater the rotation, the greater the loss of muscle strength and function. This weakness is apparent in the legs and up the spine due to the exaggerated curvatures. It continues through the neck, shoulders and arms again from the curvatures of the spine producing rotations of the thorax and internal rotation down the arms. Approximately 50% of the muscles of the body are dramatically reduced in strength and function with the core distortion rotations. Once this is released, these weakened muscles show a dramatic increase in strength and function.

Jackie was a 5'10" 14-year-old volleyball player. She was screened at the volleyball physical and referred to an orthopedist for evaluation of a probable scoliosis. The evaluation showed a 38 degree scoliosis with recommendations for Harrington rods or continuously wearing a brace to straighten her back. Her parents brought her for therapy, hoping to avoid the surgery or brace so she could continue with the sport she loved. The core distortion was evident in the structural evaluation with the left anteriorly rotated ilium and right posteriorly rotated ilium resulting in the exaggerated curvatures of her spine The anterior left ilium produced a functional long leg with a medial knee, hyperextension, lateral foot and lower leg, and everted arch. The posterior right ilium produced a functional short leg with significant tension and overdevelopment in the gluteus maximus and vastus lateralis muscles, and weight shifted to the outside back of her right heel.

Kinesiology muscle testing verified the core distortion with a dramatically weakened left leg gluteus medius, quadriceps, soleus fibers, and flexor inverter muscles, as well as weakened iliacus and tensor fascia latae. On the right side, the hamstrings, gluteus maximus, piriformis, quadratus lumborum, lower psoas, peroneus longus, and obliques including the diaphragmatic arch were dramatically weakened. These are characteristic findings prior to the application of the Cranial/Structural Core Distortion Releases (CSCDR). After the CSCDR was applied, there was an immediate lessening of the degree of the ilium rotations resulting in equalizing leg lengths.

Kinesiological testing showed an immediate increase in strength and function of the muscles associated with the iliums and long and short legs. Structural evaluation revealed visible improvements in the rotations and the distortions of the legs and upper body. This was followed with a specialized soft tissue myofascial protocol treating the distortions in the soft tissue from the rotated iliums which were specific to the muscles and soft tissue described above. This brought the iliums further into balance and released additional soft tissue distortion in the legs, the diaphragmatic arch and thorax. The session ended with strokes to release the spinal musculature from its old myofascial holding pattern and allow a normalization of the articulation of the vertebrae.

Jackie received eight sessions on a weekly basis, integrating Cranial/Structural therapy with specialized myofascial protocols. The muscles continued to strengthen to support the structural changes. Jackie was again evaluated for volleyball and cleared to play with a 25 degree scoliosis – the high norm. Jackie continued to receive monthly sessions for six months, then one session every six months while competing through high school. She went onto have a successful collegiate volleyball career.

The keys to treating Jackie's scoliosis were, first, to verify that the core distortion was the basis of the problem. Second, to achieve a significant change in the weight bearing structure of the rotation of the iliums and sacrum by using CSCDR. This not only gave her weight bearing support by dramatically reducing the rotation of the iliums and leveling the sacrum, but also brought a significant number of weakened muscles back to full strength and function that were necessary for her to maintain structural changes. And third, to address the whole structure starting with specialized myofascial therapeutic protocols to bring the iliums further into balance, release the distortions in the legs due to long leg/short leg imbalance, release the diaphragmatic arch and thoracic up into the head neck and shoulders, and finally to release the old spinal musculature holding patterns of the scoliosis. These were the keys to the long term rehabilitation of her scoliotic pattern.

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