Performing a visual assessment

This blog is part of the Analyzing Scoliosis series, which is designed to teach movement practitioners how to work confidently with clients who have scoliosis. In previous posts I discussed the typical scoliotic body, common types of scoli (AIS and functional scoliosis), when to work with a client, handling a misdiagnosed client, the importance of movement, the role of the instructor, assembling your dream team, the importance of the analysis process, and performing a physical assessment. My book, Analyzing Scoliosis, which covers the topics in this series (as well as others) in more depth, is available on Amazon.

This post, in particular, will be best understood if you have read the previous post on performing a physical assessment.

As I mentioned in the physical assessment post, you’ll have so much power at your disposal once you’ve mastered how to assess where the bones of a scoli client are in real time. Adding a visual assessment to your physical one will only increase that power. You’ll be able to quickly spot rotations and side shifts in your client’s posture while they move without your client even noticing that you’re assessing them.

You’ll start the visual assessment by checking the client’s plumb lines. These are simply bony landmarks that should be in a straight line—you probably remember them from early on in your Pilates training (complete list here). As you are looking at all these different plumb lines, make a mental note or jot down a list of any other bones that don’t seem to be in line. Don’t worry about trying to put the whole scoli story together for your client yet, though. Just visually observe your client.

Leg Length Discrepancies
In addition to checking plumb lines, you will also need to watch out for signs of a leg length discrepancy.

When one leg is longer on a client, their body will attempt to make that longer leg shorter. Most of these habits are not known to the person, but if you know what to look for you can figure it out. Here are some ways you may observe your client attempting to make their longer leg shorter:

• hyperextend the knee of the longer leg, but not the shorter leg
• stand on the shorter leg and bend the knee of the longer leg
• stand on the shorter leg and stick the longer leg out on an angle slightly in front of them
• stand on the longer leg with the shorter leg on the ball of the foot
• stand on the longer leg, really sink into that hip dropping the shorter leg’s hip down, and then stand on the shorter leg

The pelvis can be a truly helpful clue when you’re looking for a leg length discrepancy. When your client’s feet are standing on a level surface, pay attention to what their pelvis is doing (you can put together what you felt during the hands-on assessment with what you visually notice here).

Putting the Pieces Together
Now, I’d like you to think about what you observed during your physical and visual assessments. What were the main body parts that stuck out to you? Do you see a connection between any notes you jotted down with the assessments? My guess is yes.

If you don’t see a connection or are feeling overwhelmed, take a deep breath. Scoliosis is a complex condition, and you don’t have to know all the answers immediately. Write down what you see, and take it a step at a time.

Scoliosis has many contributing factors, and sometimes it’s a bit like the “chicken or the egg.” Think about what’s exacerbating your client’s main curve, and what else could be happening in their spine as a result of that main curve. This excerpt, from my book The Beautiful Scoliotic Back, provides a good metaphor:

Here’s a simple way to visualize scoliosis: Think of your ribcage as a house. The foundation on which the house (ribcage) was built is crooked, making for a crooked house. From the crooked house, you sometimes get a crooked rooftop line (shoulders), and the windows may be uneven (shoulder blades). Since the foundation of the house is a bit crooked, the basement (pelvis) may be a bit off-kilter, as well.

Everything you’re assessing and noticing on a client with scoli is somehow connected, in the same way that everything in a house is connected. It’ll take patience and persistence, but trust that—in time—you’ll find the big picture of how all the different pieces in their body are connected.

So far I’ve covered a physical and visual assessment. Next time, I will discuss how to use dot stickers, which will create a visual representation of the client’s spine, further helping you to put the pieces together and see the overall house.