ABSTRACT The authors dialogue about scoliosis, the personal impact of having scoliosis, and how they have used their own bodies through self-experimentation to develop Rolfing Structural Integration and Rolf Movement techniques to bring clients into greater body awareness, ease, and efficiency in movement. With two perspectives – Ward works mainly with adults, and Badenes with teenagers individually and in groups – they offer insights that support experimentation and improvement in how we work with clients with scoliosis.

How has scoliosis affected your life?

Bibiana Badenes: I really think my scoliosis has shaped who I am and influenced my personal development. During my childhood, I had a lot of back and neck pain and movement limitations in specific areas.

Bethany Ward: I agree. While I doubt I would have chosen a scoliotic spine, it continues to be an amazing teacher. You can’t get away from deep myofascial and proprioceptive imbalances. There’s nowhere to go! The more you try to abandon, ignore, or cajole an achy back the worse it gets, because you keep moving and behaving in the same ways. Eventually you have to sit with it and feel it. Self-judgment can give way to curiosity about what you’re sensing and how your body works. In a society forever looking outside the self, befriending scoliosis demands feeling what’s happening inside. I used to do sitting meditation, but in recent years a somatic practice has taken its place. It’s great self-care for my spine, but I also find it very mentally and emotionally integrating.

When did you discover that you had scoliosis?

BW: I was particularly susceptible to neck pain and headaches throughout college but didn’t know why. It wasn’t until my Rolfing Structural Integration (SI) training that anyone mentioned my spine. I clearly remember a fellow student asking, “So how long have you had your scoliosis?” I was taken aback but laughed and responded, “I don’t have scoliosis; I just have a left sidebend and a long right rotation.” But to myself I thought, “Duh, that explains so much.” Growing up, my mom always had a “bad back.” She spent most evenings lying on a heating pad on the couch. She “slipped” a disc getting a jar of mayonnaise out of the refrigerator when I was nine and stayed on that couch for two months. Years later, she had back surgery, which was “successful” until she tripped over a vacuum cord and the pain returned. After I became a Rolfing practitioner, I worked with my mom; we have similar spinal patterns.

BB: My parents took me to the doctor when I was eleven because I was complaining of neck and back pain. I remember having difficulty sleeping on the floor at summer camp. I was tall and felt embarrassed because my posture wasn’t very good. That doctor told me to swim. I guess swimming helped because the curvatures didn’t get worse, but I always felt limited. My father also had spine surgery but never complained of back pain; he was very athletic. The doctor gave me a set of daily exercises, which I never did. I appreciate where young people are coming from. So instead of using a lot of words to describe scoliosis, I try to help them feel – sensing how body tension affects patterns and how releasing this tension creates opportunities for change.

Thoughts about your scoliosis?

BW: The apex of my curve is in the thoracolumbar region but the sidebend starts in the lowest lumbars as you can see from the x-ray in Figure 1, image A. My pelvis compensates by sidebending right, in the opposite direction of the left sidebend in my thoracolumbar spine. This results in a fairly vertical looking carriage overall. People notice my uneven stride but rarely detect axial rotations unless they look closely. Yoga instructors and trainers miss it until I forward fold.

BB: I have a double-curvature. The right convex thoracic curve is about 28˚ and the left convex lumbar curve is about 22˚ (Figure 1, image B). Due to the torsion in my pelvis, my right leg has always felt longer. I have always had problems with my left sacroiliac joint, but my right hip can also be an issue. I always felt my main limitation started in my neck. Once, a memory surfaced: I clearly saw myself as a child being hit by a soccer ball and getting thrown into the air. I asked my mother; at first she thought it happened to my sister, but then she remembered it happened to me. It takes years to appreciate how our bodies compensate after some traumas.

BW: Also, I don’t think most people appreciate how much these non-conscious compensations tax our resources. Structures that align major centers of gravity (head, torso, abdomen, knees, and feet) are better positioned for efficient body use, which can translate to subjective feelings of internal strength, connection, and emotional ease. Postures like ours that stray from segmental alignment expend extra energy just to remain upright. Unless they learn to use perception to experience internal balance, clients with significant scolioses are likely to feel tired and may beat themselves up for being ‘lazy’. They rarely appreciate that their bodies are working overtime. It can be very healing to acknowledge the fatigue and explain why. These clients have often learned to ignore their bodies and soldier through, so teaching self-care is essential.

BB: I never felt symmetrical. Learning how to find support in standing was an important discovery in my Rolfing series. It was a revelation to sense inner expansion with a place to rest. Connecting with your inner strength feels powerful and affects the way you work with others and yourself. Rolfing sessions gave me the opportunity to work with my resources and not against them. It takes years. Nothing seems to be happening and then all of a sudden there’s this aha moment when your body intelligence clearly makes a connection.

I’ve avoided writing about my scoliosis because when I tried, it came from an intellectual point of view. While I can talk about neuromyofascial manual techniques, coordination, balance, de-rotation exercises, and using the Ten Series for scoliosis, what it comes down to is that I am talking about myself. (Maybe I wasn’t ready to show my vulnerability.) But the most important point I want to make is that as I started to sense and find these internal relationships, an internal peace appeared. What I’d considered limitations became potential. Even today there are moments of hesitation; but my own journey in my body has been and continues to be a treasured learning experience.

I feel lucky that I did not have to wear a Milwaukee Corset, because as a teenager I was already struggling with body image. I felt like the Hunchback of Notre Dame. I wanted to hide my body, which limited any natural sense of spontaneity or grace. Underneath it all, my intuition was still there, and I think I followed it to the best of my ability. I never even considered receiving or learning aggressive treatments; I somehow knew that wasn’t the way. This is a very emotional point for me. We should never force scoliotic structures into preconceived alignments. The pattern will only go deeper into the body. Unless we teach clients to find internal support and expansion and listen to what the system is telling us, our work can do more harm than good. Our touch speaks volumes. Firm, steady touch builds unspoken trust.

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Do you see a common physical pattern in teenagers with scoliosis?

BW: Research finds that most idiopathic scoliosis shows up in adolescence, affecting both boys and girls but at a much higher rate among females. Some estimate the ratio of girls to boys as eleven to one. What I see in my office is consistent with these statistics. It shows up in young people but is more common and often a more serious problem for girls than boys. Boys seem more likely to ‘grow out of it’ than girls. The most common pattern I see involves a left thoracic sidebend and right rotation, or what Bibiana referred to as a “right convex thoracic curve.” This is easiest to see from behind when the client forward bends and the right ribs rotate posteriorly. The cervicals and lumbars tend to sidebend in the opposite direction, creating the common ‘three-curve’ scoliosis pattern (Lehnert-Schroth 2007).

BB: I also see more girls with scoliosis, but I see more boys with kyphosis.

BW: I see that too!

BB: Another common pattern I observe is limited range of motion in the neck and left-side vertebral fixations. I suspect that pediatricians could assess these neck restrictions and use them as early indicators of scoliosis before the spinal curves become established. Many children have episodes of being hit in the head and afterward seem okay. No major medical problems arise, but the body compensates with spinal anomalies.

Functionally, I also see a lack of hand-eye coordination. Working with coordination and spatial orientation is key to making progress with scoliosis. These clients tend to relate to the space on their left and right sides very differently. This uneven kinesphere affects how we move and can increase the scoliosis. Coordination exercises can be used to predict future muscle-tone discrepancies. I’ve also noticed that a high percentage of people with scoliosis wear glasses, orthodontics, and/or shoe orthotics.

Most clients with scoliosis are constantly fighting against gravity. Sometimes this seems to show up in their personalities. These clients are often quite hard on themselves.

Scoliosis is complex. Rolfing bodywork is particularly useful because it takes a holistic approach to the human being. Most modalities don’t work with the whole person. It’s why working with touch and movement is so powerful.

We know our embodiment affects our clients’ experience. What have you learned from this?

BW: How we think about embodiment depends on the context. According to Rolf Movement Instructor Kevin Frank (2012, 5), embodiment is “what we know in our own bodies.” Rolf Movement Instructor Lael Keen (2009, 25) emphasizes that embodiment “has to do with presence, and presence has to do with being at home in the body.” When we work with embodiment, we are helping clients reconnect with what their soma knows and helping them more fully inhabit their bodies. This is particularly relevant for clients with scoliosis. What I consistently find is that clients struggle with balance and tend to have strong preferences for the ways they orient in the world. Clients often have a strong hand or eye dominance, or spatial awareness preferences (see Figure 2). Working with embodiment helps them find more functional balance, which supports structural shifts.

BB: Embodiment is also essential to teaching self-care. When clients are better in touch with what their bodies know, they make better choices about their activities. Practitioner embodiment is also very important; clients sense and learn from our presence. If clients feel safe, they can trust in their body’s own ability to heal, change, and regulate. If practitioners are tense, we transmit our stress to clients and undermine their budding confidence. This is probably one of the things that make our work appealing to clients – they can trust the Rolfing approach because they can see and sense our own embodiment. From my own perspective, the more embodied I become, the better my results and the more I enjoy the work. Lastly, embodiment is particularly important for clients with scoliosis because these clients tend to be obsessed with form. This is emphasized when medical doctors use labels and focus on curve angles. It’s refreshing to work with a Rolfing practitioner who teaches integration and functional economy – especially if s/he has also faced similar challenges, as we have, with scoliosis.

How do you work with clients with scoliosis? Do you follow the Ten Series? How often do you see these clients?

BW: Although I usually follow the Ten Series with new clients, I might spend an initial session addressing ‘low-hanging fruit’. By this I mean that if someone comes in with acute pain and I see obvious structural limitations that seem related, I might do one session to see if we can bring the whole system to a higher level of order (and comfort) by addressing glaring issues. I tell clients my thought process. Often, we can get them some relief, which may or may not hold, but may make our future sessions more effective. I believe the Ten-Series approach works really well as a way to start addressing scoliosis.

If I don’t start with a breath session, it will be my second session. Working with breath is extremely important for these clients because one side of the rib cage is usually bigger (the side of the rotation) and another area needs depth. Working with breath, we can help clients develop awareness and expansion of these contracted areas. This helps release intercostal muscles so important to functional respiration and excursion of the rib cage. I pay a lot of attention to the wrapping of the superficial fascial layers, which gets really disorganized in scoliotic spirals. Unlike the traditional Rolfing Ten Series, I also incorporate compression techniques coordinated with the client’s breathing to begin freeing up rib and vertebral relationships.

Session one begins an embodiment inquiry that we will build upon in all future sessions. As we teach our clients how to receive the work, one of the primary interoceptive skills is the ability to sense weight and volume. Both of these are critical for working with scoliosis clients. We started to speak to volume in our discussion of the rib cage. Volume is usually limited in certain areas in these clients – especially front/back depth around T5 and commonly one side of the rib cage. I also start working with clients’ perception of weight. Scoliosis introduces functional leg-length differences and pelvic torsions, which make it impossible for clients to weight evenly through their legs. The inability to find easy support from the ground often influences clients to engage functional patterns that overemphasize the upper gravity center (G’), shoulder girdle, and neck in an attempt to ‘hold themselves up’. Introducing a sense of weight and ‘letting down’ is often a profound experience and is fundamental for helping these clients access ease in their bodies.

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And that’s just session one! Here are a few thoughts for the following sessions:

• Session two: Clients with scoliosis often have one femur (often the right one) that acts like an ‘internal’ body type, and one femur (guess which?) that acts like an ‘external’ body type. As such, each foot needs a different approach. Foot work and dynamic sitting education (put your hand on the client’s back and teach him/her to ‘meet’ your contact by extending his/her feet into the earth) is essential.
• Session three: This session is ideal for working with scoliosis because it provides a chance to address left/right differences from the side and work with convex and concave curvatures more specifically. More details are in the box “Working with Scoliosis in Sidelying” on page 37.
• Session four: When working with a pelvic torsion, the inner line of the leg is critical. This gives you an opportunity to address the asymmetries in femoral rotation. Save time for pelvic-floor education; many things that may seem obvious to you (like where your ischial tuberosities are) may require additional sensorimotor mapping for a client with scoliosis.
• Session five: If there are spinal rotations, the abdominal muscles are involved. The psoas on the side opposite the rotation is often tighter.
• Session six: This session allows you to do the work needed in the deep, small spinal muscles and ligaments. Don’t just focus on the side of the rotation but make sure to spend time on the side with the sidebend, which tends to be less spacious. Request the client to breath into areas as you introduce fuller dimension. Consider putting the client in supported seated positions that allow you to better access the spine.
• Session seven: The head and neck are often compromised because of impaired support from below. Decouple head and eye movement. Also, in clients who have had extensive orthodontic work, cranial movement may have been impeded, which affects the ability of the spine to integrate and respond to challenges. Make sure the upper cervical spine is responsive enough to adapt to unwinding of the entire spine. Address head balance in standing.
• Sessions eight, nine, ten: There will be lots of cleanup and revisiting of previous themes needed for scoliosis clients, so the last three sessions are extremely valuable. Rethink what areas made the most difference. Did your client really benefit from work in the legs and feet? – this is common. What about the deep spinal patterns? You may want to emphasize prone spinal work. Or, challenges in the cranium and shoulder girdle may be important factors. As you complete session seven, you should know enough to strategize your final three integrative sessions. As we get to this part in the Ten Series, I talk with clients about how they may or may not want to use Rolfing SI in the future.

When I work with adolescent clients, we may see a shift in the progression of the scoliosis. That said, most of the scoliosis clients who come to see me are females between the age of thirty and fifty. Most of these clients use Rolfing sessions to help them manage their conditions and come in for sessions approximately every four to twelve weeks

BB: I agree with your Ten Series approach. My practice is different since most of my clients who have scoliosis are teenagers. In addition to the Ten Series, I put them in groups where I teach ‘Body Intelligence’ as soon as possible. These group sessions really improve their results.

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Do you teach movement to these clients?

BW: Totally! Although I believe all clients benefit from Rolf Movement Integration, it’s essential for working with scoliosis. We’re working with a functional spiral as much as a structural one. While movement work can create appreciable shifts in curvature patterns in young people whose spinal curves are still developing, I think working with perception and coordination is just as critical for those of us whose spines have already adapted at a boney level. We can still find fluidity, support, and balance through significant curvatures. This is where embodiment through somatic awareness and imagination come in.

BB: Absolutely. Over the years, my functional and structural sessions have merged until now I cannot separate the two. Working this way has had a personal benefit as well. Since I do the experiential exercises when I teach them, I continue to enhance my own embodiment. I continue to work full time because the work contributes to my own self-care.

I do not teach anything that could be interpreted as ‘how the body should be’. Instead, I try to help my clients learn to feel and sense without judgment. Developing acceptance is very important. I teach a sequence to people with scoliosis that works on the following concepts:

• Trust/support (on the floor and in standing)
• Relationship/expression
• Pushing/pulling
• Inner expansion vs. contraction
• Relaxation vs. collapse
• Direction and forces
• Breathing/whole-body breathing
• Balance vs. imbalance
• Walking
• Exercise vs. rest
• Strength vs. compression
• Self-care exercises for the neck, hands, feet, spine mobilization, sitting, and girdles.

Could you speculate about where or how you think idiopathic (not neuralgic or from a degenerative disease) scoliosis starts?

BW: I suspect it’s a combination of nature and nurture. Research suggests that most adolescent scoliosis has an inherited, or at least genetic, component. Rolfer Larry Koliha and I were teaching a class on working with scoliosis to bodywork practitioners in Iceland several years ago. When we asked participants about their experience working with scoliosis, we were stunned to learn that only one person had worked with a client with scoliosis, and none of the participants had the condition themselves. Such lack of exposure is never the case in U.S. classes. Larry hypothesized it was because everyone in Iceland learns to swim, and because this was a common exercise in the culture, young people grew up using their bodies bilaterally. My theories tended more toward the ‘nature’ side of the equation. Until the 1940s Iceland was pretty isolated with a highly homogenous gene pool. I hypothesized that there was less of a genetic predisposition in the population. I suspect both points are valid: genetics creates the opportunity, but how we live in our bodies has a lot to do with whether a predisposition is realized.

BB: I always wonder why scoliosis is so much more prevalent in girls than boys.

Some of the things I’ve read suggest cultural differences. Perhaps boys are more likely to be involved in spatial activities such as ball games (baseball, soccer, etc.), which allow them to remap and release neural patterns before long-term compensations set in. But we just don’t know. Scoliosis is a symptom of the whole neuro-myofascial-skeletal system – not just the spine. So we have to teach clients to rebuild this system via their sensing and not focus on form.

What about homework? Do you want parents to be more or less involved?

BW: You can’t cram functional learning – it takes time. Homework is useful only if it gets done, so I like to give clients things they can do when they’re waiting in a line (play with perception in standing), or sitting at a stoplight (notice ‘backspace’), or talking on the phone (keep a ball nearby for foot mapping). I also encourage clients to do somatic exercises on the floor before retiring for the night; it makes a nice transition to sleep. Adults and adolescents alike are more likely to do homework if they understand how it might benefit them. So the most important thing is to get to know your clients and what motivates them. This is especially important for kids who may not have asked to get bodywork therapy. I once had a client bring in his son to address a spinal curvature and an extremely tight chest. Initially the boy had no interest in our sessions. So we just talked. As he began to open up, I learned he was an avid swimmer. When I mentioned that Rolfing work might facilitate fuller breathing, he wanted to try it. Clients need to be invested for the work to be effective.

Parents can help or hinder. I worked with one mother/daughter pair who each had scoliosis. It was wonderful to see them support each other in practicing homework and moving more. But I have also seen parents who are overly involved or critical. On several occasions, I have made time to talk with parents separately about their use of language. Descriptions such as ‘bad posture’, ‘crooked’, and ‘lazy’ have no place in our sessions, but often creep into the vocabulary of well-meaning parents. I acknowledge that they probably don’t even realize that they’re using these words, but owe it to them to highlight how these terms shape their child’s body image. Parents are usually receptive.

Whenever possible, I prefer to interact directly with adolescents and create the expectation that they are responsible for doing their homework and giving me feedback. It’s about creating self-sufficiency and ‘internal support’ – a metaphor that goes a long way when working with scoliosis.

BB: I also educate parents about how to better support their child. I often see a pattern of young girls with scoliosis whose mothers place very high expectations on them. I can’t help but wonder if these girls respond to this pressure by compressing physically. It’s just an observation.

Some parents think that scoliosis is only an aesthetic condition. Unless their child is in pain, they don’t think it’s something they need to address. But I find that working with these patterns not only results in straighter spines but also improves attention and academic performance, develops greater self-confidence, and increases social interaction. I tell them, “Hands on the body are hands on the nervous system.” I think somatic coaching plays a big role. It’s important to motivate clients and make them part of the equation.

One more thing – some parents think that we can complete this work in a matter of weeks. This is a learning process. As a result, I only take children whose parents commit to a longer period of time, and I tend to space my individual and group sessions so they don’t feel burdensome.

What about non-idiopathic scoliosis? Have you had any success with that?

BW: In cases of scoliosis that result from things like a disease, a neuromuscular disorder, a tumor, or spinal malformation, our work is less effective in terms of changing spinal curvature or lessening pain. That said, one of the most startling spinal changes I ever observed occurred with a client in her early sixties who presented with a dramatic scoliotic pattern. She was a nurse who told me that she hadn’t had the scoliosis until a couple years prior. At that time, she’d been in a significant car accident and she attributed her alignment to the event. Although I tend to rely on client input, when she told me she’d never had scoliosis as a young person, I was skeptical. Perhaps, like myself, she’d had the condition but never realized it. The pattern was similar to the idiopathic adolescent scoliosis I commonly see, which often becomes more pronounced with age. I couldn’t help but think the accident had simply hurried the process. I’m glad I kept silent. We did a pretty traditional Ten Series with only a moderate amount of functional work. When she showed up after her seventh session, her spine was straight. It was as if something sprung loose and the spine unwound. She was thrilled and I was speechless. I am humbled by what the body can accomplish when we take obstacles out of its path.

BB: In my opinion, we always can help people with scoliosis (through movement, awareness, and manual therapy) to avoid future compensations. If it is related to pathology, especially neurological, we have to be aware that we are part of a multidisciplinary team and that we need to work together. I love this work! It’s amazing what can happen when we help people find simultaneous stability and mobility.

BW: It can change everything.

Working with Scoliosis in Sidelying

By Bethany Ward

Each client is unique, but a lot of scoliosis patterns are a version of the ‘three-curve’ scoliosis pattern described by Christa Lehnert-Schroth. In her seminal book on scoliosis treatment, Lehnert-Schroth describes how torsion relationships create overly strong muscles on the convex side of the curve and short tight muscles on the concave side. Discussing her model she explains that “left lumbar spinal erectors muscles are overly strong, thus the right thoracic group becomes stronger as well, and finally the left cervical group, resulting in a typical three-curve scoliosis posture” (Lehnert-Schroth 2007, 50).

This model informs my seeing and interventions. I find that discomfort often shows up in the overly strong convex regions (i.e., painful left trapezius and left low-back/sacroiliac regions). When working in these areas, my intention is predominantly to differentiate and ease hypertonic tissue. I find I get better results when I devote more of my efforts to freeing and ‘waking up’ the shorter, weaker, less embodied areas around concave spinal curves. For clients with scoliosis, this often means focusing structural and functional interventions around the right lumbar, left thoracic, and right cervical spine. Of course, this is a generalized observation and interventions need to be customized to the individual.

To address concave curves, I often work with the client sidelying, bolstering at different locations on each side (see images below). By placing a bolster at the left waist, I can more effectively free the right iliac crest and lift the lower ribs. This is also a good time to address shortness in the right anterior neck and shoulder. When the client turns to the opposite side, I bolster under the convex left thoracic curve to facilitate right rib expansion. Bolstering each side differently facilitates creating space, increasing breath, and refining perception on the concave curves of the spine.

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Bibiana Badenes is a physiotherapist, Certified Advanced Rolfer, and Rolf Movement Practitioner in Spain. She organizes the BodyWisdom Spain Congress, teaches internationally, and serves on the board of ISMETA.

Bethany Ward, MBA, is a member of both the Rolfing and Rolf Movement Integration faculties at the Dr. Ida Rolf Institute™. She is a member of ISMETA’s Leadership Council and past president of the Ida P. Rolf Research Foundation.

Bibiana and Bethany became friends in 2016 teaching a gait workshop while walking the Camino de Santiago in Spain, which Bibiana organized with colleague Til Luchau and Advanced-Trainings.com. At a second workshop last year, each shared how living with scoliosis had brought cherished insights as well as challenges.

Bibliography

Frank, K. 2012 Dec. “Rolf Movement® Faculty Perspectives: Differentiating Categories of Embodiment: An Educational Rationale for Rolf Movement Integration within Rolfing® SI.” Structural Integration: The Journal of the Rolf Institute® 40(2):3-6. Available from https://bit. ly/2QpijBa.

Lehnert-Schroth, C. 2007. Three-Dimensional Treatment for Scoliosis: A Physiotherapeutic Method for Deformities of the Spine, 1st English edition. Palo Alto, California: The Martindale Press.

Keen, L.K. 2009 Dec. “Embodiment and Grace.” Structural Integration: The Journal of the Rolf Institute® 37(4):27-30. ■

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