Scoliosis as a natural attitude - Idiopathic scoliosis: old and new concepts, clinical case

Edited by Dr. Giovanni Chetta

"Artificial" life

In the context of biomechanics and patho-mechanics, a robust bridge is therefore highlighted that connects the foot to the overlying body segments until potentially reaching the temporomandibular cervico-occipital joints and vice versa, involving the myoconnival tensegrity network " whole organism The cultural factor can act on the normal postural physiology by altering the environmental information thus interfering with the normal evolutionary process. More and more "artificial" habitats and lifestyles lead to postural alterations in the "civilized" man that negatively affect his physical and mental health and beauty.

We have seen how the control of the lumbar lordosis , a typical and exclusive characteristic of mankind, is a determining factor: it allows stress to be minimized and biomechanical efficiency to be optimized through a correct distribution of loads and functions between fascia and muscles. Two factors have a particular influence on it and therefore on the whole posture: breech support and occlusal support.

Breech support

Man is the only mammal to have conquered the bipodalism , this condition that has allowed him the primacy among living beings: in fact the migration of the masticatory muscles in the caudal direction, has made possible the cranial expansion (no longer harnessed by the chewing muscles) and therefore the development of the cerebral cortex.
The infant, thanks to the extensor muscle development, assumes the seated position and subsequently the erect position at 4 months. At about twelve months of life there is a gradual transition to bipodalism. The formation and growth of the musculoskeletal system are mostly the result of the complex and personal antigravity action of the individual. Unlike all other quadrupedal mammals, which stand and walk correctly shortly after birth, humans have to wait about 6 years to get a stable posture. At the age of 5-6, in fact, we they form and stabilize the vertebral curves and this happens thanks to the external proprioceptive maturation of the foot which is therefore the first responsible for the modifications of the vertebral curves in an upright position. The physiological lumbar lordosis is formed and stabilized starting from the formation of a physiological and stable plantar vault that frees the cephalic trunk from a state of hypertonicity, thus also determining dorsal kyphosis and cervical lordosis. At the same time, the chewing (appearance of the first molars) and swallowing functions reach full development. The complete development of the postural function (postural tonic system) together with the correct ocular focus usually occurs around the age of eleven (Loveyoi, 1989). The inner ear and eye transmit to the brain a direct perception of the external environment which must necessarily be compared with those deriving from skin exteroceptors and proprioceptors (Kruger, 1987).

As the Viennese architect, painter and philosopher F. Hundertwasser had well guessed, il flat ground it is not suitable and healthy for man. Our entire organism has evolved, over millions of years, to allow us to better adapt to the natural terrain, which is disconnected. The skin exteroceptors and proprioceptors of the foot, as the only fixed point of relationship of our equilibrium system with the external environment, are of enormous importance in the determination of posture and therefore of our myofascial-skeletal development and balance. Given the enormous complexity, our organism functions, as already mentioned, as a cybernetic system, that is, a system capable of self-regulating, self-adapting and self-programming. On the basis of the information received moment by moment from the external and internal environment, he constantly tries to best pursue the goal of homeostasis (condition of dynamic equilibrium of the organism). Although it represents the cybernetic system par excellence, it encounters, like all systems of this type, an adjustment / programming error tending towards infinity the more the input variables tend to zero and vice versa. In other words, the more the information environmental conditions that our organism receives are numerous and different, the more it succeeds in pursuing a fine and correct regulation of its functioning. It is easy to realize that the input variables on the flat ground are much lower than those received by living on natural ground, consequently, the postural error deriving on flat ground will be much greater than that on uneven ground. It is a fact that among peoples who still live in natural conditions (barefoot on uneven ground), such as some African or Mexican populations , back pain and neck pain are unknown (although it is common to carry heavy loads on your body for long stretches is).

Furthermore, as the French physiotherapist F. Mezieres correctly maintained, lumbar hyperloodosis is always primary (Godelieve, 1995). In fact, humans usually react to flat ground creating a lumbar hyperlordosis mainly through the strong and vast iliopsoas muscle ( has a large origin on the entire internal face of the iliac wing, iliac muscle , and one on transverse processes, on vertebral bodies and intervertebral discs of the last thoracic vertebrae and lumbar vertebrae, large psoas muscle , the common insertion is on the lesser femoral trochanter).

Lumbar hyperlordosis can be substantially of two types, as can be verified by analyzing the radiographs on the sagittal plane (in the absence of analgesic attitudes), probably based on the prevalence of the psoas muscle fibers involved, the external long or internal courts (Myers, 2001):

concentrated on the last lumbar vertebrae with the upper part tending to straightness;
"spread" along the entire lumbar spine (Pacini, 2000).

In the ideal posture, the general center of gravity of the body (corresponding to the center of gravity, the point where the resulting forces of gravity acting in the different points of the human body are applied) is anterior to the third lumbar vertebra and aligned with the center of gravity of the upper body (anterior to the first dorsal vertebrae) Thanks to this ideal alignment of the body's center of gravity, all the curves of the spinal column are physiological. In most cases, lumbar hyperlordosis determines a retreat of the general center of gravity of the body (Pacini, 2000). This alteration affects, like a wave, the whole body (occlusion included) and is posturally compensated in a completely personal way. Very often a "type (A) hyperlordosis implies a hyperkyphosis in the upper part of the back (flat back, sway back) while that of type (B) a" wide radius hyperkyphosis. Alterations in the sagittal plane can, as often happens, be accompanied by those in the transverse plane. The final goal, albeit sought in a not very physiological environment, remains the possibility of turning one's gaze to the horizon and performing a walk of relative maximum effectiveness. There are numerous potential muscle-fascial-articular and organic problems arising.

"The flat floor is an" invention of the architects. It is suitable for machines - not humans.

People have not only eyes to enjoy the beauty they see, ears to listen to melodies and a nose to smell pleasant scents. People also have a sense of touch in their hands and feet.
If modern man is forced to walk on asphalt and concrete floors, as they are recklessly designed in designer offices, estranged from the primordial relationship and contact with the earth, a crucial part of it withers and dies. This has catastrophic consequences for the "soul," balance, well-being and human health. Man forgets how to experience new things and becomes emotionally ill.
An irregular and animated pavement is the reconquest of the "mental equilibrium" of man, of the dignity of man, which has been violated in our "leveling", unnatural and hostile urban network system.
The irregular floor becomes a symphony, a melody for the feet and brings the natural vibrations back to man.
Architecture must elevate and not subdue man. It is "good to walk on uneven floors and regain our human balance"
F. Hundertwasser (April 1991).

Occlusal support (stomatognathic apparatus)

The head, with its 4-6 kg in an adult (approx. 8% of body weight), represents the heaviest body extremity. Furthermore, the cranio-cervico-mandibular unit cannot but possess a very high proprioceptive system. efficiency and sensitivity given the enormous vital importance of the organs and structures it contains. Its incorrect alignment, on any level, caused by stomatognathic and / or extrastomatognathic problems (descending and / or ascending), inevitably determines mechanical and reflex postural compensations that they affect the whole body to varying degrees.

The two mandibular hemi-arches (right and left) together with the 1st cervical vertebra (atlas) constitute the "tripod" on which the skull rests every time the teeth come into contact with each other (swallowing, chewing, etc.). It is thanks to this stable temporary support that our balance system, through the neurosensory receptors and the myofascial system, keeps the head in suspension. The vertical occlusal dimension is therefore a particularly critical parameter for correct cranial alignment and, consequently, for the health of the organism in general (Formia, 2009).

As we have seen, lumbar hyperlordosis usually involves a general center of gravity of the body in an upright position posteriorized with respect to the ergonomically correct values (Pacini, 2000).

As a consequence of this from an early age, in order to avoid falling back, there is a tendency to compensate by placing the head first, very often creating a straightening of the cervical tract and, in the most serious cases, an inversion of the cervical lordosis.
The mandibular positions are controlled by the muscles of mastication, swallowing and phonation and their recruitment requires, given the innumerable structural variables (in particular the muscles of the anterior neck area insist on the hyoid bone and mandible thus presenting mobile insertions) and functional ones of the "stomatognathic system, a complex and refined control and balance.

In addition to this, it should be remembered that the tongue represents, together with the foot, the most important organ-functional conformator (theory of organ-functional conformers by Delaire, Petrovic and Moss et al). In fact, lingual functionality directly influences mandibular and maxillary growth and the morphogenesis of the dental arches. Eg. an early use of the bottle as well as a malpositioning of the head can alter the functionality of the 17 lingual muscles.
Finally, it should be noted the existence of a small area (approx. 1 cm2), called the "spot" or "lingual spot", located between the base of the upper central incisors and the first palatine wrinkle, rich in terminal exteroceptors of the nasopalatine nerve. (branch of the trigeminal nerve) involved in the mechanism of postural information (Halata & Baumann, 1999). In physiological conditions, the tongue rests on the palate in a state of rest while during the swallowing act (which usually occurs in humans 1000-2000 times a day) its anterior end rests precisely on the "spot point" thus carrying out a sort of postural reprogramming (which can alter in case of atypical swallowing). It is the same process of reprogramming, of reconvergence between man and environment that takes place at every step thanks to the foot (Ferrante, 2004).

The dysfunctions of the stomatognathic apparatus and of the breech support are therefore linked to a double thread and significantly affect our posture and therefore our entire health.