Early diagnoses???

[structural75]

Thought this might be of casual interest... another perspective on etiology of scoliosis and possible strategies relating to intervention.

Excerpt from a book written by Peter Schwind, Ph.D., Advanced Rolf Practitioner

From the perspective of the Myofascial concept, scoliosis appears not only as an irregular curvature of the spine that manifests in three dimensions, but also as an altered spatial relationship of the visceral cavities and a very stable displacement of individual organ axes. This perspective can be supported by the fact that, from a manual diagnostic standpoint, the tendencies to develop scoliosis may be diagnosed in the early years of life before the scoliotic curve manifests in the spine. Manual diagnoses provides insight into altered tension relationships of the membranes that cover the visceral cavities. These altered tension relationships may be found within the craniosacral membrane system as well as in the connective tissue groups of the abdominal and pelvic cavities.

In the past two decades, I have had repeated opportunities to observe the long-term development of scoliosis in cooperation with pediatricians and orthopedists, beginning with infacny. Our observations do not claim the validity of a scientific study, but they do suggest a reevaluation of the traditional view of scoliosis, which is focused on the diagnosis of the spine and back.

The observations we were able to make of so-called ideopathic scoliosis in infancy were particularly illuminating. The children were brought to us because their mothers had pronounced scoliosis; in some cases, scoliosis was present in three generations. Even though no irregular curvatures of the spine were observed in orthopedic examinations of the infants, we were able to discover altered pull forces of the dura mater on the cranium and the sacrum in our manual examinations. In a manner of speaking, we found scoliotic tendencies anchored in the deep membranes as early as the first weeks of life. Our diagnosis was confirmed in subsequent years; all of the children we had diagnosed ultimately developed spinal curvatures that could be diagnosed by radiography.

Based on our observations, we drew the conclusion that scoliotic patterns can be manifest at a point in time when the tonal forces of the musculature are weakly developed, i.e. substantially earlier than at ten or eleven years old, when it becomes particularly obvious due to the child's increased growth in height. Thus, at least in some cases, scoliosis cannot be attributed to irregular muscular forces in the back. Rather, it could be considered the result of an unusual growth behavior of the myofascial system which causes disorientation of muscle tone as a secondary effect. This assumption can be supported by the fact that it is the connective tissue and not the central nervous system that primarily supports the growth process of the organism.

It is not simple to make general statements on the etiology of scoliosis solely on the basis of individual cases. However, our diagnostic observations, along with the practical results of the treatment techniques we used, at least provide a starting point when reconsidering the traditional diagnosis and treatment of scoliosis.

[WNCmom]

Structural:

I do find your post interesting. The practitioner who has been working on our son is doing MFR along with craniosacral work and has mentioned the dural tube and other elements listed in your post, and also her belief that tendencies to develop scoliosis may be present even in the womb. In addition, both my husband and my father-in-law have mild scoliotic curves. So the question is whether MFR work can alter the tension relationships in a still-growing child and halt the progression of a moderately severe curve.

Mary Ellen

[structural75]

It's possible, but not always successful and not always the primary or sole cause of the scoliosis. Such membrane alterations can be present with other factors as well, ...such as syrinx or chiari... .

As the author mentioned, there has been success with treating the cranial and visceral membranous structures... but the author of that excerpt and his colleagues are some of the most talented and knowledgeable manual practitioners/rolfers/osteopaths/pts in the us and europe. It would require the utmost expertise in evaluation/manual diagnosis and treatment to see those results. I'm sure that your massage therapist/mfr/craniosacral person is very good... but we're talking about very, very different leagues here. The work these people are doing is not the simplified/energetic craniosacral that massage therapists do... . It is particularly important to be able to affect the visceral membranes of the thorax, abdominal and pelvic cavities... internal form will always be deform/disrupted in moderate to severe cases of scoliosis... whether primary factor or secondary.

If you were to explore that route, those possibilities mentioned in the excerpt, I would find a specialist in those fields... that is going to be the best chance for success.

Peter Schwind is part of this group in Germany: http://www.munich-group.com/

structural

[structural75]

Betall,

Myofascial release and craneo-sacral therapy is a passive treatment for scoliosis.

To clarify, the excerpt I posted from Peter Schwind is not refering to "myofascial release" or "craniosacral therapy" as people commonly know it to be... not the type that PTs and massage therapists often practice. Peter is an advanced Rolfer and has studied/mentored and now teaches for French Physical Therapist and Osteopathic Physician of forty plus years, Jean-Pierre Barral. Structural Integration/Rolfing is NOT myofascial release technique... It incorporates small and precise movement during manipulations in order to reach the nervous system. Dr. Rolf was commonly noted as saying; "If you don't reach the nervous system, you haven't done your job". Peter also points out in that excerpt the importance of the 3-dimensional pattern AS WELL AS the importance of the inner cavities of the body that both dictate and are influenced by that 3-dimensionality.

With all of the various 'techniques' out there it's easy to assume that SI/Rolfing is just another technique... That is anything but the case. It is an approach all to itself which then guides the use of manipulative techniques.. which are rather infinite.

The cranial work he refers to is cranial osteopathy, not the simplified and often energetically based craniosacral therapy that many are practicing out there.

Don't get me wrong, I think movement work as well as manipulative are important. But keep in mind that as Peter accurately mentioned, it is the connectiive tissue that dictates growth and development, not the nervous system. The nervous system develops patterns of movement within the confines that the connective tissue system allows for. As long as the restrictions are present in that network, namely the visceral/inner cavities/cranial network, the nervous system is at the mercy of those limitations. No amount of movement/exercise/strengthening is going to force its way through those limitations to any great extent... Which is partly why you see inconsistent and variable results with PT/movement based approaches.

I think the ideal would be to combine the two for the greatest effect. But SI/Rolfing is anything but "passive". At the same time, there is definitive value in releasing restrictions within the fascial network of the body, which then gives opportunity for the nervous system to physically have more/different movement capabilities. Without such intervention you're such running into a brick wall repeatedly and forcing the issue.

I'll post you another excerpt that you might find helpful in clarifying this idea.

structural

[structural75]

BETall, Although not exhaustive or inclusive of all possiblites, this might help clarify the significance and importance of manipulative work. It may also point to the inherent limitations of utilizing the nervous system alone to evoke change beyond simple muscular toning and coordination.

We must observe that the form of the spine diagnosed as scoliosis obviously arises from fundamentally different causes. In many cases, a genetic disposition is obviously present. In other cases, however, these genetic factors do not have a role and in other cases it was an unusual position of the fetus during development which apparently caused a change in the membrane structure in the interior of the visceral cavities, especially in the area of the chest cavity and within the craniosacral system. Finally, we encounter the cases that are relevant to the treatment technique we describe, namely the cases that display a drastic displacement of the axes of mobility of the organs located below the diaphragm.

In most of such cases that we have investigated, the stomach plays an important role. In the section that examined the significance of the breathing pattern, we have seen that the dynamics of the breathing process will fashion and stabilize the chest cavity. All pronounced changes in the mobility of an organ on one side of the diaphragm will influence the chest cavity. As we can see, this sort of altered spatial excursion of the diaphragm and lung occurs on the same side. Here, altered rotational forces are acting from the anterior direction on entire groups of thoracic vertabrae; as soon as one cupula of the diaphragm has the tendency to be in permanent descent, the joints within the back must compensate for this descent with a corresponding lateral bend. To a lesser extent, similar influences are conceivable if an infection within the chest cavity has caused onesided adhesions on the connective layers of the thoracic wall. A displacement of the axis in the lung area occurs that follows the reshaped thoracic wall. In this manner, the shape of both halves of the chest can change drastically.

However, in relation to this, the subdiaphragmatic organs appear to be of greater significance in influening the curvatures of the spine. So it is important to examine both cupulas of the diaphragm carefully for their spatial relationships and mobility relative to the organs. In so doing, we should focus our attention on the elastic capacity of the intercostal membranes and the subcostal myofacial layers as well.

During embryonic development, all of the organs undergo a characteristic shift in position, a type of "voyage through space", until they arrive at their destination within the interior of the visceral cavities. In practice, we can see that there is at least one common type of scoliosis that can be attributed to an incomplete spatial curve of the stomach. In this case, the back appears to be sunken in the upper left lumbar region and the vertabrae above it display the typical scoliotic curvature such that the entire upper body appears to have been displaced to the right in relation to the pelvis.

At first glance, there appears to be an imbalance in tone of the erector muscles, and the latissimus dorsi muscle is indeed usually very weakly developed on the left side. The muscular support of the quadratus lumborum muscle that spans the upper crest of the pelvis and the lower edge of the twelth rib appears hardly present at all.

If we direct our attention to the examination of the prevertebral region, we also find a drastically altered spatial position of the stomach in relation to the midline of the body. Apparently, in these cases, the stomach did not completely follow the spatial curve intended for it during embryonic development. For this reason, it is located more medially compared with its normal position and therefore can provide only minimal support for the left cupula of the diaphragm. Its relationship to the spleen is altered in the cranial direction and its relationship to the left kidney in the inferior direction. Therefore, on the right side of the thorax, a stable support is present from the liver, which is "denser" than the stomach. The left cupula of the diaphragm drops and the formation of the typical scoliotic curvature occurs in the sections of the spine located over it.

Unfortunately, in this sort of situation, I was able to achieve very few results with treatment techniques applied to the back. There is even the danger that manual influnce on the myofascial layers of the scoliotically curved back could cause a destabilization of the individual joint sections. In contrast, a subdiaphragmatic, i.e. visceral, procedure is consistently able to provide satisfactory results, in particular when we select the tretment strategy that accompanies the child's growth process over a longer period of time with minimal interventions.