Structural Integration: A Deeper Dive into Scoliosis and Pain Management

In my previous blog post, I introduced 3 non-surgical treatment options for scoliosis and adult spinal deformity: Orthopedic Manual Physical Therapy (OMPT), Structural Integration (SI), and Corrective Exercises such as Redcord. Today, I am taking a closer look at Structural Integration and how it can be a powerful tool in helping you manage soft tissue pain and tightness associated with scoliosis.

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The Fascial Network and Scoliosis

Structural Integration (SI) focuses on strategically manipulating the body's fascial system to improve overall structural balance. But how does this translate to helping those with scoliosis? Let's delve deeper.

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The fascia, a web-like connective tissue, plays a crucial role in maintaining our body's structure. In scoliosis, this fascial network can become distorted, contributing to the abnormal curvature of the spine. SI helps to:

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• Release Fascial Restrictions: By systematically manipulating the fascia, Structural Integration practitioners can help release areas of tension that may be exacerbating the spinal curvature.

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• Improve Global Body Alignment: Unlike therapy systems that focus primarily on the spine, Structural Integration takes a whole-body approach. This is particularly beneficial for scoliosis patients where there are often whole-body postural alignment patterns that when addressed may lead to longer lasting relief.

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• Enhance Proprioception: Patients who receive Structural Integration may experience improved body awareness, helping individuals with scoliosis better understand and control their posture and movement patterns.

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• Reduce pain: Structural Integration can help to reduce myofascial restriction associated with scoliosis, which in turn may reduce pain.

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Synergy with OMPT and Redcord

While our previous post introduced these as separate and distinct therapies, it's important to note how they can work together. While Orthopedic Manual Physical Therapy (OMPT) addresses specific joint and soft tissue dysfunctions, Structural Integration provides a fascial based broader, whole-body approach to alignment. Together, they can offer a comprehensive treatment strategy. The body awareness and improved alignment gained through SI may enhance the effectiveness of corrective exercises like those performed with the Redcord suspension system.

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Pain Management through SI

For many scoliosis patients, chronic pain and tightness is a significant concern. Structural Integration can help manage this pain and tightness in several ways:

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• Reducing Compensatory Strain: By improving overall body alignment, Structural Integration can reduce the strain on muscles and joints that have been overworking to compensate for the spinal curvature.

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• Improving Circulation: The manipulation of fascia can enhance blood flow, potentially reducing inflammation and pain. Reduced tightness in the body may also facilitate an easier time to move and exercise which further improves circulation.

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• Neurological Benefits: Structural Integration can help reset the body's proprioceptive system, potentially altering pain perception and improving overall comfort.

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• Free and deeper breathing: Structural Integration can help to free restrictions in breathing which in turn can help to relax the nervous system, decrease inflammatory factors in chronic pain, and reduce tension in tight muscles.

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Typically, SI is performed over a series of sessions. For scoliosis patients, this process might be adapted to focus more intensively on areas affected by the spinal curvature. The practitioner will work systematically through the body, addressing:

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• Breath and rib cage mobility
• Pelvic girdle alignment and balance
• Spinal mobility and stability
• Shoulder girdle alignment and balance
• Upper and lower extremity alignment and balance
• Whole body postural patterns

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Final Thoughts about SI

As we've seen, Structural Integration offers a unique approach to manage scoliosis and its associated symptoms. By addressing the body's fascial network and overall structural balance, this method complements other non-surgical conservative treatment options. 

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While more studies are needed, emerging research supports the use of Structural Integration for helping to manage the symptoms of scoliosis and back pain. A prospective, interventional study in the Journal Frontiers in Physiology (see study) reported that after a series of Structural Integration sessions there was increased superficial blood perfusion, a decrease in tissue stiffness and increase in tissue elasticity. Various other studies found that Structural Integration led to improved active range of motion, improved posture, improved balance, and reduced chronic pain.

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It’s important to remember, while non-surgical options offer hope for many, it's crucial to consult with healthcare professionals to determine the best course of action for your specific case. If you're interested in exploring how Structural Integration can be part of your scoliosis management plan and this sounds like something that can help you, contact me at Activcore Denver to schedule a consultation.

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Stay tuned for our next article which will address how Orthopedic Manual Physical Therapy is useful to help patients with the management of scoliosis.

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REFERENCES

Jacobson E. Structural integration, an alternative method of manual therapy and sensorimotor education. J Altern Complement Med. 2011;17(10):891-899. doi:10.1089/acm.2010.0258

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Timgren J (2020) The Role of Myofascial Trigger Points in the Treatment of Reversible Functional Scoliosis. Int J Phys Med Rehabil. 8:571. DOI: 10.35248/2161-0983.20.8.571

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Kumar S, Khuba S, Gautam S, et al. Association of myofascial pain in patients with thoracolumbar kyphoscoliosis or spinal scoliosis, deformity attending a tertiary care hospital in Uttar Pradesh, India. J Evid Based Med Healthc 2021;8(27):2392-2398.DOI:10.18410/jebmh/2021/444

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Joseph AE, Moman RN, Barman RA, et al. Effects of Slow Deep Breathing on Acute Clinical Pain in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Evidence-Based Integrative Medicine. 2022;27. doi:10.1177/2515690X221078006

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Gerwin RD, LeBauer A, Morningstar MW, Aebi M, Jackson RP. Adult idiopathic scoliosis: The tethered spine. J Bodywork Mov Ther. 2013;17(3):422-428. doi: 10.1016/j.jbmt.2012.12.008

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Jędrzejewski G, Kasper-Jędrzejewska M, Dolibog P, Szyguła R, Schleip R, Halski T. The Rolf Method of Structural Integration on Fascial Tissue Stiffness, Elasticity, and Superficial Blood Perfusion in Healthy Individuals: The Prospective, Interventional Study. Front Physiol. 2020;11:1062. Published 2020 Sep 15. doi:10.3389/fphys.2020.01062

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Brandl A, Bartsch K, James H, Miller ME, Schleip R. Influence of Rolfing Structural Integration on Active Range of Motion: A Retrospective Cohort Study. J Clin Med. 2022;11(19):5878. Published 2022 Oct 5. doi:10.3390/jcm11195878

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Deutsch, J. E., Derr, L. L., Judd, P., & Reuven, B. (2000). Treatment of chronic pain through the use of structural integration (Rolfing). Orthopaedic Physical Therapy Clinics of North America, 9(3), 411-425.

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James, H., Castaneda, L., Miller, M. E., & Findley, T. (2009). Rolfing structural integration treatment of cervical spine dysfunction. Journal of Bodywork and Movement Therapies, 13(3), 229-238.

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Findley TW, Quigley K, Maney M, Chaudhry H, Agbaje OM. Improvement in balance with structural integration (rolfing): a controlled case series in persons with myofascial pain. Archive of Physical Medicine and Rehabilitation. 2004 Sep;85(9):S147.

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Findley TMM. Chaundhry H. Findley T. Schleip R. Fascia Research. Munich: Elsevier GmbH; 2007. Sensory improvement with Structural Integration (Rolfing) p. 255.

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‍Disclaimer:  The views expressed in this post are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.