The spine is a complex, springy structure that balances our body weight, keeps us upright, and absorbs the shock of movement.  The spine twists and moves in all directions, helping us orient, respond, and interact with our surroundings.  How well we age is strongly tied to how well we maintain the integrity of this critical structure.

The spine has a series of curves that function together with many ligaments to form a spring-like entity that enables us to adapt and rebound from our activities. Each curve impacts the other and affects our alignment and posture, potentially causing pain or impaired mobility.

The Spring-Like Nature of The Spine

The curves of the vertebral column act like a spring, stabilizing our body weight as we move.  This spring-like action compresses, rebounds, and distributes our center of gravity so we don’t fall over.  It also protects the body from wear and tear by dissipating the impact of movement.  

The padding (discs) between the vertebrae, held in place by spinal ligaments, act like compression pillows, pushing vertebrae apart.  This pushing apart of the vertebrae, paired with the restrictions of the ligaments, allows the spinal column to sustain what the authors of Yoga Anatomy call intrinsic equilibrium.

The Curves of the Spine

The spine is divided into three sections, each with a clearly defined curve:  

The cervical spine includes the 7 vertebrae of the neck.  This portion of the spine has a natural lordotic curve that bends towards the front of the body.

The thoracic spine includes the 12 vertebrae of the thoracic cavity.  The thoracic curve points to the back of the body; this is called a kyphotic curve.

The lumbar spine includes the 5 large vertebrae of the low back and connects the spine to the sacrum.  Like the cervical curve, this part of the spine bends towards the front of the body, making it a lordotic curve.

Together, these three curves create an S-like column that resembles a sinuous spring.  One might be tempted to look at each curve for pathology.  But consider what happens to the curves of a sinuous spring when it is compressed or stretched.  The spring grows shorter, the curves grow more prominent; the spring is stretched; the spring grows thinner, and the curves are less pronounced.

It’s not a perfect analogy, but it is a good one.  The S-spring image beautifully demonstrates how the curves of the spine are interrelated and respond to one another. 

Common Structural and Postural Spinal Dysfunctions

First, it is important to consider that not all spinal dysfunctions are postural.  Some of them (see scoliosis below) are baked into the way a person was built.  Structural dysfunctions may be congenital (from birth), the result of a permanent injury, or a degenerative condition.  

Postural dysfunctions can potentially be corrected with massage therapy and other supportive measures.  In postural dysfunction, the maladaptive muscle tension and alignment are responding to changeable lifestyle influences.  When we change our lifestyle and address the tension, we can see real results.  We cannot say the same for all structural dysfunctions.  For many structural dysfunctions, these adaptations, while possibly painful, are supporting movement despite limitations rather than being the source of limitation.  

Structural dysfunctions may actually worsen if guarding tissues are released without additional PT measures and medical perspectives to support the process.  That said, massage therapy is not contraindicated for structural dysfunctions; it is an invaluable way to improve a person’s quality of life and reduce associated symptoms, pain, and spasms, especially if it is done in triage with other specialists.  One of the key values of massage in these cases is the increase of awareness – the more information our brain and our consciousness get about what is happening in the body, the more chances we have to adapt, adjust, and heal. 

Lordosis + Kyphosis

Lordotic curves are those that bend toward the front of the body, as seen in the neck and low back.  Kyphotic curves are those that bend toward the back of the body.  When these curves are exaggerated, we call them hyper; when they are underpronounced, we call them hypo.  Often, exaggerated curvature is called lordosis or kyphosis after their respective curves.  

Lumbar lordosis (Swayback posture) – An exaggeration of the lumbar curve can anteriorly affect the pelvic tilt, pushing the hips in front of the midline so that the stomach and buttocks stick out, flattening the lower portion of the kyphotic curve (hypokyphosis).  To compensate, the shoulders hunch, and the head moves forward, resulting in excessive curvature in the upper thoracic and cervical spine.  When lying flat on the floor, those with lumbar lordosis will notice a greater gap beneath the lumbar spine. 

Kyphosis – An overly pronounced thoracic curve flattens the lumbar spine, causing a posterior pelvic tilt that flattens the buttocks and drives the neck forward, flattening the natural cervical lordosis

Scoliosis – A structural dysfunction characterized by additional spinal curves anywhere on the spine.  The cause of scoliosis is not entirely understood, but it can be congenital (at birth) or develop over time due to injury, neuromuscular, or degenerative conditions.  The sideways bend of the spine can result in uneven hips or shoulders. It is important to note that virtually no spine is absolutely “straight” – we all have some side-to-side differences by default. We have a larger liver on our right and a heart on our left that will create some curvature and twisting of the spine. 

Condition	Primary Curve Alteration	Pelvic & Postural Compensation
Lumbar Lordosis(Hyperlordosis)	Exaggerated anterior lumbar curve	Anterior pelvic tilt, abdomen/glutes driven outward, compensatory forward head
Thoracic Kyphosis(Hyperkyphosis)	Exaggerated posterior thoracic curve	Posterior pelvic tilt, flattened glutes/lumbar curve, forward head posture
Scoliosis (Structural)	Lateral curvature with vertebral rotation	Asymmetrical shoulders, rib hump, uneven hip height

What Causes Spinal Curve Deviations?

Spinal curve deviations usually have either a structural root cause (as noted above) or a postural cause related to lifestyle adaptations.  Massage will not stop lifestyle from affecting the body, and it cannot cure structural disorders.  However, it can help restore range of motion, facilitate better posture, and manage symptoms of structural issues.  It always helps in shedding “light” on one’s current state of function or dysfunction.

Structural 

Structural deviations arise in the spine itself, the vertebrae, bones, and connective tissues.  Unlike postural issues that respond to changes in muscular tone, structural deviations require more intensive, clinical, and sometimes more invasive interventions.  

Congenital:  Genetics and congenital factors can cause vertebral anomalies such as scoliosis or Scheuermann’s disease.  

Trauma and Injuries: High-impact damage to bones, ligaments, and vertebral discs can lead to permanent structural issues and misalignment. 

Degenerative diseases and other pathologies:  Age, wear and tear, and other more aggressive degenerative conditions such as osteoporosis or disc degeneration can affect the integrity of the spinal curves.  Note that the simple existence of disc degeneration is no longer always considered “disease.”  It is a very natural progression to lose some disc integrity as we age, and one should not overreact when they see an X-ray of their spine that shows degeneration.  Pay attention to the symptoms!

Postural

Postural deviations are where massage therapy has the most promise.  These deviations can lead to structural issues if they’re chronic, long-term, or progress into degenerative conditions.  They respond to lifestyle changes and interventions that work with the soft tissues, muscles, and fascia. 

Chronic sitting and sedentary lifestyle:  The body is designed to move.  When we find ourselves in the same position for long hours, our muscles don’t move through their full range of motion and can get stuck in lengthened or shortened states.  Sitting, for example, shortens the hip flexors.  Over time, this can lead to chronically shortened hip flexors and a resulting pelvic tilt, which in turn affects the curvature of the lumbar spine.  

Reciprocal Muscle Imbalances:  Muscles usually work in pairs.  When one shortens, another lengthens.  When one muscle becomes overly shortened – as in the aforementioned example of the hip flexors – its antagonist pair can become overstretched and weak.  While causative factors may vary, most postural dysfunctions are, at their core, reciprocal muscle imbalances.

Guarding and Pain:  Sometimes the nervous system becomes overly sensitive to pain or stress.  Our brain can get stuck in a cycle of reacting to an injury site long after that injury has actually healed. This can lead to generalized muscular tension, protective muscular guarding, or even emotional tension around an old injury – even if the acute trauma is fully resolved.

How can Massage Therapy Support Spine Health and Posture?

When spinal dysfunction is driven by poor posture and reciprocal muscle imbalances, massage, especially when paired with exercises to stretch and strengthen imbalances, can be a powerful ingredient in a person’s recovery.  

Massage brings healing energy, blood, and nerve impulses, helps relax tight muscles, and restores range of motion, but it is important to recognize that it cannot strengthen weak muscles and it does not have the capacity to change structural disorders. Scoliosis, for example, causes tight muscles, not the other way around.  

Massage therapy may ease the pain and tension in these tight muscles and benefit a person with scoliosis, but it should not be considered a replacement for more appropriate therapies.  And while those with scoliosis ought not to fear massage therapy, therapists who work with scoliosis clients should be aware that inappropriately intense and aggressive deep work can actually worsen the condition.

References & Further Reading

• Cleveland Clinic. (2022). Lordosis (Swayback): Types, Causes & Symptoms. Cleveland Clinic Health Library. https://my.clevelandclinic.org/health/diseases/23908-lordosis
• Kaminoff, L., & Matthews, A. (2021). Yoga Anatomy (3rd ed.). Human Kinetics.
• Mayfield Clinic. (2018). Spine Anatomy. Mayfield Brain & Spine Health Information. https://mayfieldclinic.org/pe-anatspine.htm
• Nalda, T. (2022). Scoliosis Massage: What is Safe and What Isn’t? Scoliosis Reduction Center. https://drtonynalda.com/scoliosis-massage/
• Henning, S., Mangino, L. C., & Massé, J. (2017). Postural restoration: A tri-planar asymmetrical framework for understanding, assessing, and treating scoliosis and other spinal dysfunctions. In J. Bettany-Saltikov & S. Schreiber (Eds.), Innovations in spinal deformities and postural disorders. IntechOpen. https://doi.org/10.5772/intechopen.69037