Third Cardinal Sign, Assessment for Right Leaning Scoliosis

 

A common pattern noted from early in my practice was tightness and tenderness on palpation of the right QL's. Of course there are many exceptions to this...it might be greater on left or present on both sides...but the most common pattern is the affected right side together with spasm and tightness through the left glutes. After several years practice I worked out the left glute thing being the effect of left hip rotation (First Cardinal Sign) binding the SIJ impacting the back line of that lower limb. The tenderness and tightness through the QL's remained a mystery until much later when realising the impact of mild scoliosis with right convexity at the lumbar vertebrae as a result of a structurally short right leg. The effect of right leaning tilt on the pelvis opens lumbar disk spacing to the right, encourages mild disk bulging and strain through the soft tissue.

 

The degree of scoliosis present through the spine is most commonly mild. I have only sight two acute cases of scoliosis in my practice to date. Mild scoliosis is virtually unnoticeable to visual inspection and the client is usually unaware of it. The client may never have been told of its presence. Yet it can be the cause for their history of upper back and neck issues of discomfort and tightness, pain and/or headaches. It can be cause for low back pain and disk bulging through the lumbar region. It is another piece of evidence supporting the fact a structural leg length discrepancy exists.

 

With client prone on the table, mild scoliosis is best observed by palpating the ribcage. The most common is scoliosis with right convexity through the Thoracic. Due to decades of the spine's diversion to the side in the Frontal plane, pressing to the right, the costals bulge to the right and are stretched out and flattened on the left. A greater degree of muscle development and tightness is present in the right spinal erectors. The right shoulder will be elevated over the left.

 

Less common is a right leaning pelvic tilt with a scoliosis exhibiting a left convexity through the Thoracic as a result of a switch back in the region of the lumbo-thoracic junction. Bulging of the left costals and flattened right costals will be evident. I find left convexity cases typically are low range leg length discrepancy cases not being as strongly encouraged to continue rightward through the Thoracic. Left convexity cases exhibit an elevated left shoulder, more highly developed and tighter spinal erectors on the left through the Thoracic and are more likely to experience dysfunction and pain in the upper left quadrant of the back.​