BY Jimmy Gialelis, L.M.T., B.C.T.M.B.
If you count children and adolescents among your massage therapy clients, you may have encountered scoliosis in teens.Understanding what this condition is and how it affects the body is critical to adjusting your massage sessions to give these clients maximum benefits.
What Is Scoliosis?Scoliosis represents a deviation in the vertebral column in either a lateral or spiraling manner in an otherwise healthy individual. Torsion and shearing forces are present within the spinal column tissues, and a clear deformation of the spinal column is witnessed along the sagittal plane.
According to the National Scoliosis Foundation, scoliosis affects “about three percent of children under the age of 16 [and] scoliosis is the most common spine condition in young people.” Clear Scoliosis Institute, which has a chiropractic treatment focus, notes that in 2015, approximately 29,000 scoliosis surgeries were performed on adolescent clients. Spinal deformities in children and adolescents account for the largest share, 48 percent, of musculoskeletal deformities seen by health professionals.
By definition, the cause of scoliosis in teens is most commonly idiopathic, without a known cause, in approximately 70 percent of cases. Less common causes include congenital (15 percent); neuromuscular in origin, such as in spina bifida or cerebral palsy (10 percent); and most rarely, mesenchymal disorders such as Marfan syndrome or Ehlers-Danlos syndrome (less than 5 percent).
According in a 2011 study by the Healthcare Cost and Utilization Project, annually there are approximately 442,900 office visits, 133,300 hospital visits and 17,500 emergency room visits involving children with scoliosis. These numbers remain consistent as these children age into their teenage years.
According to studies published by Scoliosis Journal, 2 to 3 percent of the U.S. adult population, or 7 to 9 million adults, suffers spinal curvature of greater than 10 degrees. Curvatures of greater than 20 degrees are witnessed in 0.3 to 0.5 percent of this population, whereas curvatures greater than 40 degrees are witnessed in less than 0.1 percent.
Girls are at greater risk than boys of developing this condition, especially in later childhood, 8 to 12 years of age. The average age of curve acceleration is 11.7 years, according to the Journal of Bone and Joint Surgery.
Symptoms of Scoliosis in TeensThe classic signs and symptoms of scoliosis in teens include:
• Hypertonicity of musculature
• Asymmetrical back muscles
• Lateral tilting of hips
• Unequal leg lengths
• Abnormal gait
• Deviations of rib cage
• Slower nerve functionality
• Decreased lung capacity
• Increased pressure upon heart
• Weakness in extremities
Risk factors to consider include gender; females have a higher risk of progression than males. Others are curve severity—S-shaped curves tend to worsen more than C-shaped curves—and the location of the curve, as curves in the thoracic region worsen more than curves in the cervical or lumbar regions.
Bone maturity is also a factor: The risk of progression decreases dramatically if the bones have already stopped growing. Braces have the most effect in children with this condition whose bones are still growing.
In the scoliosis patient, neurological exams typically test for muscle weakness, numbness or paresthesia, and abnormal reflexes.
Traditional X-rays can confirm the diagnosis and severity of scoliosis in teens. To reveal an underlying condition or cause, such as a tumor, additional testing includes magnetic resonance imaging (MRI), which uses radio waves and magnetic fields to produce detailed imaging of bones and soft tissues; computerized tomography (CT) scans that produce multi-directional images of body regions; and bone scans, which involve injecting a radioactive material into the body to better identify injured bones.
Bracing as a Treatment for Scoliosis in TeensA doctor will recommend braces for children whose bones are growing at a significant enough rate to exacerbate their scoliosis condition. Typical signs of development indicating to doctors that braces may be removed include: two years after girls begin to menstruate; when boys begin to shave daily; or when there is no further change in a child’s height.
Two brace types exist. A low profile brace is made of modern plastic that contours to the body shape. This type of brace is almost invisible under clothing, as it fits under the arms and around the torso. (This does not aid in cervical scoliosis.)
The Milwaukee brace is a full-body torso brace with a neck ring with rests for the chin and back of the head. Since this type of brace is more cumbersome, it is used as a last-resort measure.
Puberty and ScoliosisA unique circumstance affects scoliosis in teens: puberty. The physical changes, coupled with attitudes, perspectives, judgments and personal feelings, impact the mental and emotional bodies of teenagers. As the teenage body develops, social perceptions shape the teen’s self-perception, and this perception impacts all aspects of a teenager’s health.
As boys develop into men, physical features such as the emergence of body hair, tonicity and size of muscles, height, weight and reproductive organ development are factors that weigh heavily upon a young man’s mind.
As girls develop into women, physical features such as gluteal appearance, breast development, height, weight, facial features, body shape proportions and body hair will likewise weigh heavily upon a young woman’s mind.
In either case, self-perception of physical changes is a major factor in how comfortable a teen becomes with his or her body and whether teens choose to receive massage therapy.
Think back to when you were you a teenager. Was there a time you felt self-conscious about your body? Did you compare your physical development with that of others? Were you teased by anyone, either peers or adults? Even an innocuous comment can burn a mental imprint that remains into adulthood.
Right now, hold compassionate space for yourself if recalling those years has brought upon an emotion. The teenage client also needs this compassionate space held with mindful intent.
Sadly, scoliosis patients have been shown to be more than 40 percent more likely to have suicidal thoughts, as well as greater worry and concern about peer relations, according to a 1997 study published in the journal Spine. They also have more negative self-worth perception (Enferm, 2014) and more psychological problems affecting their quality of life (CJSS, 2009).
Coping with Scoliosis in TeensConventional scoliosis treatment methods used by allopathic practitioners include:
Surgery. Severe scoliosis worsens with time. Doctors may recommend surgery to insert rods into the back, perform spinal fusions to slow progression of the condition or perform thoracoplasty to remove excessive rib bone. Rods are typically not utilized unless the client’s condition is rapidly progressing.
Complications of surgery include excessive scar tissue, limited range of motion, bleeding, infection, pain and neuropathy.
Physical Therapy. Generally, physical therapy treatments are designed to strengthen musculature of an afflicted region. In the case of scoliosis, a patient will visit a physical therapist’s office several times weekly to perform regimented exercises designed to restore strength to the spinal column. Over time, a gradual strengthening of either side of the spinal musculature is said to correct spinal curvatures incrementally and restore functionality of limbs lost to weakened spinal muscles.
Scoliosis Intensive Rehabilitation (SIR). This approach employs a regimented exercise program designed to correct behavioral patterns along with physiological factors. There are three treatment dimensions to SIR: aiding sensory nerve functionality; kinesthetic exercises to strengthen certain muscles; and individualized exercises to restore torso balance and mobility.
Daily tasks of the patient are assessed and altered to promote greater fluidity of motion. Inpatient care is also provided for patients experiencing cardio-pulmonary dysfunction due to deviated rib cages.
Schroth Method. This method is a physiological treatment system involving isometric exercises to either strengthen or lengthen asymmetrical muscles of the body. The main goal of this system is to halt progression of spinal abnormalities and, in best-case scenarios, reverse spinal curves.
Think of this method as assisted yoga, as the scoliosis patient is guided into positions that either strengthen or stretch targeted muscles.
Issues for the Massage TherapistThe most fundamental question massage therapists should ask: Is the client’s scoliosis case functional or structural?
If spinal curves improve with torso movements, the client has functional scoliosis, which can be alleviated over time. Massage therapies designed to realign spinal structures may be employed.
If no improvement is witnessed with torso movement, the client has structural scoliosis, which necessitates more allopathic approaches to correct spinal dysfunction. Then the primary focus of massage therapy becomes aiding allopathic means and providing pain relief.
Also, consider the “tight vs. taut” muscle interplay. This has worked well in my practice. Tight musculature is functionally too strong, locking tissue in contracted positions. Taut musculature is functionally too weak, presenting an elongated appearance with ropey tissue feel. Stimulating the taut spinal column portion while conversely sedating the tight spinal column portion yields a balancing of the paraspinal muscles, pulling the vertebral column bones out of alignment.
Techniques to TryThe Ste-Justine AIS Scoliosis Cohort Study of 1994 indicated pain levels in children with scoliosis were higher than in the average child population. Compassionate touch via massage can provide these children, later to become adolescents, a means of learning how to cope with chronic pain in a holistic way.
Abdominal (core) massage. Releasing the tight musculature associated with the diaphragm and oblique muscles as well as lateral fascial bands will ease tension of the back musculature, allowing the back to soften, preventing pull upon the spinal column bones.
Decompressing joints via work on soft tissues. Creating space within joints, especially along the spinal column, shoulder and hip joints,with the use of passive range-of-motion exercises and stretching applied to soft tissues, can create needed space within the vertebral column to decompress joints and take pressure off spastic muscles along the spine.
Hydrotherapy. Utilizing hydrotherapy, such as thermotherapy and cryotherapy, may greatly alleviate pain associated with scoliosis in teens. Thermotherapy, or heat-based treatments, will encourage blood flow to an injury site, reducing pain, decreasing joint stiffness and relieving muscle spasms. Cryotherapy, or cold-based treatments, will discourage blood flow to an injury site, reducing swelling, diminishing nerve irritation and limiting the inflammatory response.
Your Healthy Touch Can HelpScoliosis patient Chelsey Godel is one individual who has used complementary therapies, including massage, for relief.
“I was first diagnosed when I was 12, in junior high school, when the nurses did scoliosis check-ups,” said Godel of Phoenix, Arizona. “I didn’t use any treatments until I went to massage school around age 19 and realized there was something I could do.
“When I was diagnosed, I wasn’t educated enough to know I should have worked at correcting my alignment before I was an adult and the scoliosis was progressing,” she added. “Massage, chiropractic and yoga have helped, but I find that massage and yoga and stretching seem to have [longer-lasting] effects.”
In this time of increased technology, it is easy for a teenager to escape the physical world, remaining welded in a virtual world. The psychological ramifications of never receiving loving physical touch can be life-altering and detrimental.
Common mantras of massage therapists such as “heal the planet one body at a time,” “touching one’s mind, body and soul,” and “loving touch to unite the body and spirit” are especially true for the teenage client—particularly a person living with scoliosis, who can greatly benefit from the nurturance and pain relief provided by massage.
About the author
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine; his articles include “These 5 Keys Will Unlock the Door to Massage Session Re-Bookings.”