Sciatic scoliosis

[marticlar]

Why does one develop scoliosis when a disc herniation occurs? Is it due to muscle spasm from pain?

[physiobob]

Originally Posted by marticlar

Why does one develop scoliosis when a disc herniation occurs? Is it due to muscle spasm from pain?

I suppose this is generally a correct possibility although it would be better described initially as a 'list'. It left uncorrected the list could be compensated for over time with a balancing curve or rotation leading to a scoliosis. Hope this helps.

Note though that sometimes people shift towards the problem, at other times away from the problem.

[BillOst]

Originally Posted by physiobob

I suppose this is generally a correct possibility although it would be better described initially as a 'list'. It left uncorrected the list could be compensated for over time with a balancing curve or rotation leading to a scoliosis. Hope this helps.

Note though that sometimes people shift towards the problem, at other times away from the problem.

Are you sure that the scoliosis wasn't there first? It makes more sense IMHO to have a disc, that is squeezed unevenly, to bulge and eventually prolapse toward the convex side and that way impinge on the nerve root - create muscle weakness and the "normal" side then becomes effectively hypertonic and exaggerates the previously compensated scoliosis.

BillOst

[physiobob]

Originally Posted by BillOst

Are you sure that the scoliosis wasn't there first? It makes more sense IMHO to have a disc, that is squeezed unevenly, to bulge and eventually prolapse toward the convex side and that way impinge on the nerve root - create muscle weakness and the "normal" side then becomes effectively hypertonic and exaggerates the previously compensated scoliosis.

BillOst

Of course this is also a possibility. One can look for a postural, more reactive scoliosis or a more structure one by looking at boney changes on x-ray. Also comparing the deviations in sitting and standing to see if they are absent on one or the other. I suppose my response was to a question specifically about a scoliosis that resulted from a disc herniation/prolapse. There are of course numerous other reasons for this imbalance, both postural and structural.

[JAW]

I can reply to this wearing several 'hats' one of which is as a specialist Consultant Physio, and another as a bod who has injured a disc in the past. My disc was damaged in a ski accident several years ago, healing well, but leaving a tag of tissue. At times when I pivot over the same segment, and cause localised inflammation to arise, I develop an involuntary deviation, or 'scoliosis' as my subconscious protects me from pinching the damaged area. Its quite involuntary and bears no relation to un underlying developmental scoliosis. After a couple of days when the iflmmation subsides, so does the deviation /scoliosis.
This pattern is frequent in folk with swollen inflammed deep tissue, our subconscious is protective by nature, and instinctively 'moves' us to a naturally safe pattern. Patterns of posture are habitual and movement is a learned pattern or behaviour. Frequently my clients with irritabel disc problems present with mild postural deviations, and localised acute pain, no leg pain, no neuro signs. Often disc problems as confirmed with MRI.
Disc problems are far more common than we credit

[BillOst]

I think we are singing off the same song sheet here.

However I was intrigued by one of your earlier observations in this thread that the body sometimes shifts away from the problem. One of my mentors many years ago used to say that "the body hugs the lesion" meaning that you could home in on the primary problem by following the tension pattern that developed susequent to an unresolved trauma. Have you found the opposite pattern to occur more than rarely?

Best wishes

BillOst

[JAW]

Yes, I find that the body does indeed often shift towards protection, whether it is by standing more on the non damaged limb, while holding the damaged one in easing patterns, or involuntarily tensing up to prevent movement at an inflammed irritable tissue site. That pattern then lasts years after the injury has gone, and the subconscious still carries on protecting and not chancing 'going back there' again. It's also often kinesthetic memory associated with accidents, and the pattern that caused the trauma, for example road accidents, and reliving the incident over and over and reproducing the movement memory trace over and over.
In my experience deep muscles relax to prevent micro movements, or any movement of joints, and superficial longer muscles take over. I wouldn't exactly call that 'hugging'.

[physiobob]

Originally Posted by BillOst

I think we are singing off the same song sheet here.

However I was intrigued by one of your earlier observations in this thread that the body sometimes shifts away from the problem. One of my mentors many years ago used to say that "the body hugs the lesion" meaning that you could home in on the primary problem by following the tension pattern that developed susequent to an unresolved trauma. Have you found the opposite pattern to occur more than rarely?

Best wishes

BillOst

Now this is a pandora's box if ever there was one but lets get onto it over this coming week. Right now it's sunday evening and I am just back from PT'g all day to a bunch of classical ballet dancers and need my homemade hamburgers! To start of a line of thought, some say it depends on the lumbar level of the lesion as to whether you move towards or away from the lesion. I'll look up some old notes I have to see what various MET, Butler, Mulligans people have said to me over the years.

More soon.........

[JAW]

...comes from experience not just books. In anatomy books we are told that muscles go from a-b, and do this that or other action. Its not true, anyone who has been qulaified long enough, or been priviledged enough to view 10 or 12 real skeltons will know that they are all different, lengths of bones, muscle insertions.
Books are interesting, but then people aren't as the books describe. Doubt I will be back to join in for a few weeks at least. This has been just a fleeting visit

[BillOst]

PB

Maybe hugging was a poor translation, the doctor is French and he described it as "wrapping around". I have always found this a useful guide when dealing with people who have chronic musculoskeletal syndromes. I look forward to our discussion, maybe I need to read up on Fryettes Laws if we are going deep into lumbar mechanics :-)

Best wishes

BillOst

[alophysio]

Hi,

To shed some light on this thread, sometimes the body shifts away from an injury. Brian Edwards used his system of combined movement examination to determine whether something was a "stretch" pattern of pain or "compression" pattern of pain.

For example, if there is a posterolateral disc bulge to the right, then often the patient will list to the right (if it is possible). The theory is that flexion and lateral flexion left will "stretch" the right posterolateral region of the segment and further exacerbate the disc pain.

The opposite example would be a facet joint that gets caught on a meniscoid - e.g. the right facet joint at L4/5. It is often called "stuck in flexion". In this case, the problem and pain is in the lower right L/S but the patient will list to the left because the facet joint n the right cannot close. A simple manipulation of the joint usually puts things right again.

As for "hugging" the injury - i agree to a certain extent. The body will act to protect an injury. After you have felt many normal bodies and many dysfunctional bodies, it becomes something that you can feel. I understand the concept of feeling this tension but i find it difficult to teach others what i am feeling. I am more intuitive than anything else so it is difficult to teach someone what to feel...

I hope this helps!

[JAW]

To quickly reply. I have worked in this area for nearly 25 years, but never bother to publish. I find many of the gross generalisations made about "when this happens, this will result.." rather an insult to individuality. In my experience there are rarely easy patterns of when this bulges that happens. I believe it is more about always staying fresh to each person when they come for an opinion, and avoiding putting people into convenient boxes. I believe this has been the downfall of much of modern medicine.
You write "The body will act to protect an injury. After you have felt many normal bodies and many dysfunctional bodies, it becomes something that you can feel. I understand the concept of feeling this tension but i find it difficult to teach others what i am feeling. I am more intuitive than anything else so it is difficult to teach someone what to feel..."

It is our true self that protects our self. Our body is our subconscious mind in action. So to refer to the body, is to seperate body and mind. We protect ourself, being safe is a fundamental. We support an injury site as a fairly low level instinct to prevent further damage. We do this on an emotional level as well, with relationships, and more.

Normal bodies and dysfunctional bodies?
Is there such a thing?
At some level we are all dysfunctional, again this is about developing outward interest and curiousity and awareness of the natural organic path and flow of integrated human movement.

If anyone would like to discover more about 'feeling and sensing', then maybe trot along to Reading in Berkshire and I will introduce you to some Feldenkrais, NLP, Hypnosis, and coaching. Alternately I produce audio lessons you can work with at home.
When I have presented to Physiotherapists and others at conference, or workshops, they are frequently amazed at what they discover about their own body. I will put up a couple of introductory and diploma courses soon