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Section 3a: Assessment Tools - With scoliosis clients; which lesson/protocol do you begin with?

 

Assessment Tools (for Part 1):

Here are some scoliosis-specific assessment ideas I like to use. You can apply them to both your hands-on protocols as well as movement teaching strategies. 

     To practitioners trained in the hands-on techniques of Hanna (Clinical) Somatics: As a general guideline for working with scoliosis clients, I recommend they receive all the hands-on lessons/protocols, both sides for the one-sided protocols, (that would be a minimum of 5 sessions to start. I offer a discounted 5 session package.) It is crucial that they develop a consistent self-care practice with a variety of movement, facings (prone, supine, side) as well as movements that address spiral, including specific strategies for their unique curves and pain/tension issues. Invite your client/student to be patient and gentle with themselves and their process, and not over-effort, but instead invite the changes to happen gradually. Start with the truth of where the muscles are, present tense. No Pain =  All Gain!

     With which protocol (lesson) do you begin? When I am evaluating a new client (with or without scoliosis), and deciding what protocol to begin with, I am looking for the reflex that is most dominant, the “key” to the puzzle, so to speak, to begin the change process. Working with Scoliosis is about contractive patterns, just like with any client, but the patterns are more extreme, and a little (or a perhaps lot) more stubborn—a deeper “brain habit”. But all the same principles apply.

     Someone with scoliosis clearly has a strong TR, side-bending reflex, effecting the lateral curve, and needs Les 2. But is that really the place to begin? In my early years as a practitioner, I always tended to go there first. But over time, I’ve come to see (and my colleagues at Essential Somatics agree) that addressing the front and back of the body first may be a better preparation, and then Les 2 lands better. RL and GL reflexes are more primary. Tom Hanna defined ‘somas’ as creatures designed to stand up and move forward. So, think of it in terms of designing a good somatics basics class. Would you begin with side-bend? Probably not, right? You would address the front and back of the body first, with (at the least) arch and flatten, and maybe back lift, arch and curl, to prepare for side-bending and twisting later in the class. So, usually Les 2 (hands-on protocols) may be the 3rd or 4th session in a series for most of my clients.

 

>> And there are exceptions: If a client can’t comfortably lie face down, nor on their back, and the only position they can be in without pain is on their side, then of course we begin on the side. We might do Lesson 2, or a preparation for it, with arch/round, maybe pandiculate ribs and breathing, and/or a more gentle version of Les 2 (I’ll describe a gentle version Les 2, and and work with ribs, in a later article) relative to what that client can do safely and comfortably. I might also create a version of Les 1 or Les 3 side-lying.

    Another reason for starting with Les 2 (or an adapted version) would be if they were so locked down on one side that nothing else could move, making it the dominant reflex. Such a scenario may appear occasionally in a client with a more extreme scoliosis, and severe lock down in their torso. In this case, I might still do a little arch to neutral, flatten to neutral as a beginning, if possible addressing front/back of the body, in whatever position works for them, side-lying, sitting, etc.

    An important strategy for any type client, student: If there’s pain in a movement or position, find another movement and position that the body will allow without discomfort, pain, and begin there. The soma is showing you where it needs to begin!

   As most of you are aware, each of our basic protocols, and the movements that go with them, focus on a specific reflex, but also include aspects of other reflexes within it. To re-pattern and free up the back and front of the body may be a great preparation for Les 2, and then you can go deeper into the habituated intercostal muscles holding the ribs hostage in distortion, which are part of what holds the lateral curves/torques in the spine, that present with scoliosis. Free the ribs and the muscles that attach to them, and the spine will respond.
  
Lateral Curves and torque/twist:

With lateral curves, there is almost always torque and spiral present due to the structure of the spine, and how the facet joints meet on diagonal planes. If there is a lateral curve, there will also be a spiral. My kinesthetic anatomy teacher, Irene Dowd, suggested that to change the lateral curve in the spine is to evoke change to the torque/twist pattern, and vice versa. I have found that is true; one effects change in the other. (More on measuring and pandiculating twists, torques, and freeing the ribs in future articles.)

Continue reading in the SomaTimes - Section 3b: How to measure and "quick sketch" a curvy spine.