Scoliosis – defined by the Mayo Clinic as “a sideways curvature of the spine” – can be responsible for a broad spectrum of physical complaints, ranging from mild backaches to disabling pain and limited tolerance for physical activity. While many successful treatment options are available that improve dysfunctional curves of the spine, including bracing and surgery, those who undergo these corrective treatments sometimes continue to experience pain even after the spine is brought closer to a normal alignment. Improving the position of the bones of the spine is only one piece of the scoliosis puzzle. Another critical piece is addressing the motion of the bones. Depending on the type of scoliosis present, this may be an area of great potential for symptomatic improvement. Physical therapy, yoga, and Pilates are all very effective methods that can increase the amount of motion available to the spine, allowing for improved function and decreased pain.
But – what about motion within the spine? As you likely are aware, one of the functions of the spine is to surround and protect the spinal cord. Between the bones of the spine and the spinal cord is a tough, protective membrane, called the dura. This membrane sheath envelops the spinal cord, and contains the fluid that nourishes it as well. There are only a few places where the dura is attached to the bones of the spine, and that is for good reason – as a person flexes or extends their trunk, the dura needs to be free to slide and glide within the spine. Otherwise, the spine would not be able to bend very far. As an example, imagine two “bendy” straws, one inserted fully inside the other. If we wanted to flex the straws at the “bendy” part, the straw on the inside would have to slide a bit along the straw on the outside in order for you to successfully flex them. If, for example, we glued one straw inside the other, we would not be able to bend them as far, and we might even crush them a bit in our attempt, resulting in a pinched fold rather than a rounded bend.
The same principle applies to the dura within the spine. If it were stuck to the inside of the bones of the spine, the amount of flexion, extension, side bending and rotation available to the spine would be significantly decreased. The dura would instead pull on the inside of the spine, limiting motion. Further, the dura would also tug on the nerves that come out from the spinal cord, resulting in pain. In a scoilitic spine, dural adhesions, or places where the dura is stuck to the bones of the spine, the spinal cord, or both, form easily. Even if the position of the spinal bones is corrected with surgery or bracing, the dural restrictions may remain, causing pain and preventing optimized spinal motion.
This is where Craniosacral therapy can help. Several Craniosacral techniques are geared towards freeing-up restrictions of the dura within the spine, therefore allowing the potential for improved mobility and decreased pain. Using the few bones that the dura is normally secured to as “handles,” the therapist can gently stretch and lengthen places in the dura that are shortened, pinched, and stuck, taking tension off of nerves, allowing improved flow of the fluid around the spinal cord, and providing a little more space between the bones of the spine. A little gain in freedom of motion for the dura can go a long way towards improved overall spinal mobility. Following this work with gentle physical therapy or yoga exercises prescribed by a skilled practitioner can help the client use and build on these improvements.
Debbie Turczan is a Physical Therapist specializing in Craniosacral Therapy, with offices in New York City and Long Island.