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Common Biomechanical Deficiencies

Weaknesses Inflexibilities Postural Deficiencies The biomechanical deficiencies are listed for precautionary measures only so they may be identified and possibly corrected in attempt to prevent athletic injuries during exercise or physical activity. These deficiencies are possible risk factors for injury and may only increase injury when combined with other risk factors. physician may need to establish if a biomechanical deficiency is structural! muscular! neuromuscular! or due to some other pathology. The corrective exercises assume deficiencies are due to a muscular imbalance "flexibility and strength#. $nly a %ualified physician should diagnose and give prescription for an existing injury. In some circumstances! an attempt to correct a biomechanical deficiency may irritate the injury and prolong recovery! particularly if certain therapy exercises are used inappropriately or initiated too soon after an injury has occurred. &ven after an underlying biomechanical deficiencies has been improved! a preexisting injury may re%uire the attention of a physical therapist under the advise of a physician to restore total functionality.

Abdominal Weakness
Increased risk of lower back injury can occur during hip flexion! extension! stabili'ation and back extension activities. &rector (pinae muscles can hyperextend lower back more than usual if abdominal muscles are weak. The abdominal muscles tilt the pelvis forward! improving the mechanical positioning of the &rector (pinae! specifically when the lumbar spine becomes straight. When abdominal strength)endurance is not ade%uate to counter the pull of the antagonist &rector (pinae under load! these low back muscles are put at a mechanical disadvantage "active insufficiency# further placing additional stresses on these very same lower back muscles. Iliopsoas can pull on the spine during hip flexor activities if the abdominal muscles are weak. *isk is compounded when abdominal weakness is combined with hip flexor inflexibility. &xamples of affected exercises+ (%uat Deadlifts ,ilitary Press "standing# -ying -eg *aise "full extension#+ hands may be placed under lower portion of glutes to decrease tilt of pelvis and subse%uent hyperextension of spine. &xample preventative ) corrective exercise+ .runch

Object 1

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Hamstrings Weakness
Increased risk of knee injury "instability# occur during knee extension activities! specifically when knees are flexed more than 123. When hip and knee are simultaneously extending during a compound movement! hamstrings counter the anteriorly directed forces of 4uadriceps. lso see 5nee (tability and ngle of Pull for force vector explanation. 6amstrings ) 4uadriceps strength ratios should be greater than 708 to 928 depending on the population tested. &xamples of affected exercises+ (%uat -eg Press &xample preventative ) corrective exercises+ -eg .urls (traight -eg Deadlift

Supraspinatus Weakness
Increased risk of shoulder injury during shoulder flexion and abduction activities! specifically when the elbow travels below the shoulder during shoulder abduction. *isk is compounded with a winged scapula condition. Paradoxically! avoiding full range of motion "i.e. not initiating deltoid exercises from a fully adducted position# may not allow the (upraspinatus to be fully strengthened since it is more fully activated at these initial degrees of shoulder abduction)flexion. $nce an injury has occurred! however! range of motion is typically restricted on the shoulder press. (ee shoulder abduction force vector diagram. &xamples of affected exercises+ (houlder Press :pright *ow -ateral *aise &xample preventative ) corrective exercises+ ;ront -ateral *aise -ying -ateral *aise

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Infraspinatus Weakness
Increased risk of shoulder injury occurs during throwing and shoulder transverse flexion and transverse adduction activities! particularly when the elbow travels behind shoulder. *isk is compounded with a protracted shoulder girdle. The strong stabili'ing and dislocating forces of the Pectoralis ,ajor "(ternal and .lavical# is counteracted by the Infraspinatus! Teres ,inor! and to a lesser extent! the rear deltoid and long head of the triceps brachii. This counter force is most crucial during+ initiation of a transverse adduction)flexion elbows behind shoulders stabili'ing force during the end of a throwing movement high deceleration dislocating forces re%uired of the posterior cuff can cause breakdown in their tendons near their humeral attachment. &xternal rotation=muscular endurance ) internal rotation=muscular endurance should be greater than >28. &xamples of affected exercises with suggestions for high risk individuals+ ?ench Press+ ?ring bar lower on chest! keeping elbows closer to sides. .hest Press+ &levate seat so elbows are closer to sides *ange of motion may need to be limited so elbows do not go behind shoulders &xample preventative ) corrective exercises+ -ying &xternal *otation *ows

Erector Spinae Weakness


Increased risk of lower back injury occur during lumbar spine extension or stabili'ation activities. ?ack extension exercises involving complete lumbar spine range of motion have demonstrated primarily excellent or good results for those with chronic lower back pain. &xcellent or good results by diagnosis+ >08 ,echanical ) (train! ><8 Degenerative! >98 Disc (yndrome! >78 (pondylo. In contrast! ,c@ill condemns the use of isolated lumbar spine exercise apparatuses and argues erector spinae endurance is more important than strength. (ee -ow ?ack Debate. &xamples of affected exercises (traight -eg Deadlift (%uat Deadlift &xample preventative ) corrective exercises+ ?ack &xtension "novice# .able *ow "with spinal articulation# "novice to intermediate# (tiff -eg Deadlift "advanced# A ) /0

Vastus Medialis Weakness


Increased risk of knee injury "chondromalacia# occurs during knee extension activities. The patella becomes laterally displaced with the pull of the vastus lateralis. This patella tracking problem can produce wear on the inferior patellar surface. @reater pain is usually experienced during leg extension activities in which the knee is a greater than a <2 to A2 degree angle. voiding full range of motion "i.e. not locking out# during 4uadricep exercise may not allow the Bastus ,edialis to be fully strengthened since it is more fully activated at these final degrees of knee extension. &xamples of affected exercises+ -eg Press (%uat -eg &xtension &xample preventative ) corrective exercises+ (ingle -eg &xtensions "last <2 degrees of extension# -eg Press "last <2 degrees of extension#

Hip Abductor Weakness


$ne hip can sag when weight is shifted to one leg. Possible increase risk of Iliotibial band friction syndrome "IT?;(# when combined with @luteus ,aximus and)or Tensor ;ascia -atea Inflexibility ";redericson! et. al. <222#. &xamples of affected exercises+ -unges C (tep=:ps *unning C (tair .limber C @auntlet C &lliptical &xample preventative ) corrective exercises+ -ever (eated 6ip bduction &ventually reintroduce effected exercises in a progressive manor

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HI e!ternal rotators
"ther #ames (ix Deep -ateral *otator 6ip ,uscles

Heads
/. <. A. D. 7. 0. Piriformis @emellus (uperior $bturator Internus @emellus Inferior $bturator &xternus 4uadratus ;emoris

Mo$ement
6ip &xternal *otation E/! <! A! D! 7! 0 F Transverse bduction E/! 7 F Internal *otation E/F "see comments#

Attachments
$rigin (acrum nterior E/ F (acrotuberous -igament E/ F Ischium Posterior Portions Ischial (pine E< F Ischial Tuberosity Posterior Portion ED F &xternal ?order E0 F $bturator ;oramen E7! 0 F Ischium and Pubis Inside (urfaces and $bturator ,embrane EA F 7 ) /0

Insertion ;emur @reater Trochanter ,edial (urface E<! A! D F (uperior),edial (urface E/ F Posterior (urface 4uadrate Tubercle E0 F Trochanteric ;assa E7 F

Comments
@emellus (uperior E< F and @emellus Inferior ED F also known collectively as @emelli. Insertion of piriformis is high up on greater trochanter! so it assists in external rotation from anatomical position! but when it hip is flexed! piriformis assists in internal rotation of hip.

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C"MM"# "%&H" AEDIC I#'(E)IBI(I&IES


Hamstrings Infle!ibilit*
Increased risk of lower back injury during hip extension activities when knees are straight. If hip flexion "eccentric phase of hip extension#! is inhibited by hamstrings inflexibility! the lumbar spine may compensate by flexing more than usual. The risk of injury is increased if the lumbar spine is not accustomed to this movement or workload. lso see ctive Insufficiency. &xamples of affected exercises+ (traight -eg Deadlift @ood ,orning ?arbell ?ent=over *ow &xample assessments ctive -ying 5nee &xtension Test Passive -ying -eg -ift Test &xample preventative)corrective exercise+ (eated 6amstrings (tretch -ying 6amstrings (tretch

+luteus Ma!imus or Adductor Magnus Infle!ibilit*


Increased risk of lower back injury during hip extension activities when knees are bent. fter complete flexion of the hip "eccentric phase of hip extension#! the lumbar spine will flex if movement is continued. The risk of injury is increased if the lumbar spine is not accustomed to this movement and workload. :ntil flexibility can be restored! recline leg press back support to furthest position and base hip flexion range of motion criteria just before hips tilt. lso see ;ull (%uat ;lexibility 4G . &xamples of affected exercises+ -eg Press (%uat (ingle -eg (%uat &xample ssessment Deep (%uat Test &xample preventative)corrective exercise+ @lute (tretch dductor ,agnus (tretch

Hip 'le!or Infle!ibilit*


Increased risk of lower back injury during hip flexion and extension and overhead standing activities. During > ) /0

extension activities! the lower back can hyperextend more than usual if the hip cannot fully extend. During hip flexion activities! the Iliopsoas can hyperextend spine during hip flexor activities. *isk is compounded when hip flexor inflexibility is combined with abdominal weakness. &xamples of affected exercises+ ,ilitary press "standing# Decline (it=up -unge "rear leg# -ever ?ack &xtension "fulcrum near hip# &xample assessments -unge Test Thomas Test &xample preventative)corrective exercises+ 5neeling 6ip ;lexor (tretch 4uadriceps (tretch

Shoulder &rans$erse Abduction , &rans$erse E!tension Infle!ibilit*


Typically due to insufficient flexilibility of pectoralis muscles. *esults in decreased range of motion during chest exercises. 6igh risk for behind the neck exercises particularly when combined with external shoulder rotation inflexibility. exacerbated and often accompanied by protracted shoulders girdle. &xcluding cases with particular orthopedic problems "e.g.+ infraspinatus weakness#! participants should be encouraged to perform chest exercises through &HIE% full range of motionH shoulder transverse extension ) hyperextension until a slight stretch is felt. (ince the shoulder can typically hyperextend further than it can transverse extend! the exerciser performing a bench or chest press will be able to bring bar closer to body when elbows are positioned closer to body "shoulders more abducted#. &xample of affected exercises+ ?ench Press .hest Press .hest ;lies ?ehind Ieck (houlder Press *ear Pull=down &xample assessment Passive .hest ;lexibility ssessment &xample of preventative)corrective exercises+ (traight rm .hest (tretch

Shoulder 'le!ion
In ability to raise arm forward overhead or undue exertion re%uired position arm in vertical position.

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&xamples of affected exercises+ Dumbbell (houlder Press .able (houlder Press $verhead Triceps &xercises $verhead (%uat Power .lean

&xample assessments (houlder mobility "open hands# (houlder mobility "closed hands# Prone (houlder ;lexion $verhead Deep (%uat &xample of preventative)corrective exercises+ ?ent=over -at (tretch "on chair or bench# Wall -at (tretch $verhead (%uat Dumbbell (houlder Press

Shoulder E!ternal %otation Infle!ibilit*


Increased risk of shoulder injury during activities involving external rotation of the shoulder. *isk is compounded with a winged scapula condition or kyphosis. :ntil full range of motion is restored! individuals with external rotation inflexibility should be advised to perform pull= downs and shoulder press with the bar in front of the head. Those with more severe cases should perform overhead presses with angled back support "eg+ /22=//23 incline bench#. &xamples of affected exercises+ ?ehind Ieck (houlder Press -ever (houlder Press "torso upright facing away from lever# *ear Pull=down -ever ;ly "on pec deck# $verhead (%uat (natch &xample assessment Passive (houlder &xternal *otation ssessment &xample preventative)corrective exercises+ (ubscapularis ?room (tick (tretch

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Shoulder Internal %otation Infle!ibilit*


Increased risk of shoulder injury during activities involving internal rotation of the shoulder. When the shoulder is flexed and internally rotated! pressure can be created between the insertion of the supraspinatus and acromion or coracoacromial ligament. Incidentally! pain in this position can be indicative of impingement or rotator cuff tendinitis "6utton G Julin /11>#. Tight internal rotators can contribute to protracted shoulders. &xamples of affected exercises+ :pright *ow "narrow grip# &xample assessment Passive (houlder Internal *otation ssessment &xample preventative ) corrective exercises+ Infraspinatus ?room (tick (tretch

Iliotibial Band &ightness


Increased risk of lateral knee injury during knee extension activities. Iliotibial band friction syndrome "IT?;(# is a cause of diffuse tenderness over the lateral knee. While weight bearing during knee flexion! the Tensor ;ascia -atea contracts to assist the other hip abductors stabili'e the pelvis from lateral movement and the @luteus ,aximus extends the hip for forward locomotion. ?oth the Tensor ;ascia -atea and the @luteus ,axiums can place tension on the Iliotibial tract which produces repetitive friction on the lateral epicondyle. ;urthermore! hip abductors weakness can exacerbate this pull on the Iliotibial tract by allowing the hip to sag slightly when standing on a single leg! or during locomotion ";redericson! et. al. <222#. &xamples of affected exercises+ -unges (tep=:ps &xample assessment $berKs Test &xample preventative ) corrective exercises+ Tensor ;asciae -atea (tretch @luteus ,aximus (tretch -ever (eated 6ip bduction

Ankle Dorsifle!ion Infle!ibilit*


Dorsiflexion flexibility is re%uired during the lower phases of the s%uat and leg press! so nkle Dorsiflexion inflexibility can make it difficult to perform s%uat and leg press exercises in full range of motion. If the range of motion of the ankle is limited! hip flexion may be exaggerated and knee flexion is often inhibited. To maintain normal range of motion in both the hip and knee! the heel may have a tendency to leave the /2 ) /0

floor or platform. &xamples of affected exercises with suggestions for affected individuals until range of motion is restored -eg Press+ place feet higher on the platform (%uats+ wider stance or elevate heels slightly on board or weight plates *ange of motion may need to be restricted so heels do not raise at lower portion of exercise &xample ssessments Deep (%uat ctive ?ent 5nee ;oot *aise Test &xample preventative ) corrective exercises+ @astrocnemius (tretch (oleus (tretch .alf *aise .alf Press

lantar 'asciitis - 'oot Dorsifle!ion Infle!ibilit*


6igh incidences of plantar flexion strength deficits and dorsiflexion range of motion limitations are associated with Plantar ;asciitis. Plantar ;asciitis is a common overuse syndrome occurring in runners and walkers. This syndrome is associated with microtears in the plantar fascia at its insertion into the calcaneus. If allowed to progress to the point when bone spur "calcium deposit# forms on the underside of the calcaneous "heel bone#! surgery may be re%uired. Individuals with excessive pronation "feet rolling inward#! flat feet! or knocked knees have increased risk for plantar fasciitis. These conditions force the plantar fascia to stretch more during weight bearing activities placing increased pressure where it attaches to the heel bone. 6igh arches are also associated with plantor faciitis. &xamples of affected exercises

Walking "particularly upon awakening# *unning Jumping


&xample Preventative &xercises

(eated Plantar ;asciitis (tretch .an ;oot *oll

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C"MM"# "S&.%A( DE'ICIE#CIES


Standing ostural Muscles
The diagram to the right illustrates how the body is held erect. The thick black lines represent the principal muscles involved in standing. The vertical dotted line indicates the center of gravity. Iote this line falls behind the axis of rotation of the hip and in front of the knee. This renders the ligaments of the joints tense! which are represented by dotted lines passing in front of the hip "ilio=femoral# and behind the knee "posterior ligament#.

osterior el$ic &ilt


(ometimes referred to as flat back! posterior pelvic tilt involves the reduction of the natural lumbar curvature. This posture is characteri'ed by the shortening of the hip extensors "6amstrings G @luteus ,aximus inflexibility#! tight abdominals! and lax hip flexors. (itting on the back of the hips may indicate a posterior pelvic tilt. It is rarely brought about by lack of muscular strength. The posterior pelvic tilt is less common as the anterior tilt as seen with lordosis. &xamples of affected exercises+ -eg Press (%uat (traight -eg Deadlift &xample preventative ) corrective exercises+ 6ip ;lexor+ -ever 6ip ;lexion 6amstrings+ -ying 6amstring (tretch @luteus+ (eated @lute (tretch bdominal+ bdominal (tretch

(ordosis
Pelvis is positioned forward and downward. 6ips are slightly flexed and lumbar spine is excessively hyperextended. 6ip flexors! erector spinae are short. bdominal! hamstrings! gluteus maximus muscles may be weak. Increased risk of lower back injury during standing or lying hip extension! flexion! or stabili'ation activities! and weighted overhead activities. (ee abdominal weakness and hip flexor inflexibility. &xamples of affected exercises+ (%uat 6ack (%uat ! *oman .hair (it=up ,ilitary Press "standing#

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&xample preventative ) corrective exercises+ 6ip ;lexor+ 5neeling 6ip ;lexor (tretch &rector (pinae+ -ower ?ack (tretch bdominal+ .runches 6amstrings+ -eg .url @luteus+ (eated -eg Press

/*phosis
&xaggerated anterior=posterior curvature of the vertebral column! most often involves an excessive forward bending in the thoracic area. 5yphosis occurs in older adults! particularly women with osteoporosis and osteoarthritis. 5yphosis is sometime accompanied with other posterior problems such as posterior or anterior pelvic tilt "compensates for altered line of gravity# and protracted shoulder girdle "unrelated#. 5yphosis makes it difficult to include overhead exercises particularly when combined with a winged scapula condition or shoulder external rotation inflexibility. &xamples of affected exercises+ (houlder Press (eated Triceps &xtension ;ront (%uat $verhead (%uat .orrective exercises for gravity induced kyphosis+ (trengthening of thoracic vertebral column extensors (tretching of thoracic vertebral column flexors

'or0ard Head osture


n anterior positioning of the cervical spine is characteristic of forward head posture! or protracted neck. ;orward head posture may make it more difficult to perform exercises with the bar in front of head or neck. &valuate neck position at night since elevating head too high with additional pillows may act as a continuous neck stretch throughout the evening exacerbating the forward head posture. &xamples of affected exercises+ (houlder Press .orrective exercises for gravity induced kyphosis+ (trengthening of cervical vertebral column extensors Isometric Ieck *etraction (tretching of cervical vertebral column flexors Ieck *etraction

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Winged Scapula
,edial border or inferior angle of scapula protrudes slightly from body. winged scapula condition may be accompanied by a protracted shoulder girdle. *isk of shoulder injury is compounded with a supraspinatus weakness or an external shoulder rotation inflexibility. ?ecause of the forward tilt of the scapula! complete flexion or external rotation of the shoulder may be seemingly restricted. winged scapula condition indicates a serratus anterior weakness. The rhomboids may be weak and the pectoralis minor may be short. winged scapula is considered normal posture in young children! but not older children and adults. &xamples of affected exercises+ (houlder Press Pullovers Pull=downs &xample preventative ) corrective exercises+ Incline (houlder *aise .able *ow Pectoralis ,inor (tretch Wall -at. (tretch

rotracted Shoulder +irdle


The shoulders are pulled forward. ,edial border of the scapula may also protrude slightly from body. Increased risk of shoulder injury during shoulder transverse flexion and transverse adduction activities! specifically when elbow travels behind shoulder. (capula protraction can also decrease width of subacromical space! possibly increasing risk of subacromical impingement "(olem=?ertift &! et al. /11A#. In both cases! risk of shoulder injury is compounded with a infraspinatus weakness. Possible limited range of motion during retraction of the shoulder girdle. protracted shoulder girdle may be accompanied by a winged scapula condition or transverse adduction ) flexion inflexibility. The subscapularis and Pectoralis minor and clavicular G sternal heads of the pectoralis major muscles may be short. The trape'ius "middle fibers# and particularly the rhomboids may be weak if the medial borders of the scapula also protrude slightly from body.

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&xamples of affected exercises+ ?ench Press .hest Press ;lies ?arbell 6ack (%uat :pright *ow "particularly close grip# ;ront -ateral *aise "with internal shoulder rotation# &xample preventative ) corrective exercises+ .able *ow or -ever *ow "do not hold protracted position# Doorway ,odified .hest (tretch Wall (houlder @irdle (tretch Doorway (ubscapularis (tretch Work through full range of motion on chest exercises just to position that slight stretch is felt. If lying on oneKs side! position upper arm under head "with or without pillow in between# since lying on oneKs side with oneKs arm down or in front "protracting shoulder girdle# may act as a continuous stretch throughout the night exacerbating this condition. -ikewise! those with a protracted shoulder girdle should avoid stretches that protract the shoulder such as *ear Delt (tretches or holding a protracted position during rowing resistive exercises. Iormali'ing this postural deficiency can improve mechanics of the shoulder and provide a fuller appearance throughout the chest.

Scoliosis
,ediatorial curve of the vertebral column. .ongenital scoliosis develops before birth and is caused by a defect in the formation of the spinal column. &ither parts of the vertebrae are missing or vertebrae fail to separate! leading to asymmetry and une%ual growth of the spine. (coliosis develops because one side grows more than the other! causing the spine to curve. Degenerative scoliosis occurs in adults for two main reasons. ;irst! scoliosis may have started when the patient was younger "starting as adolescent idiopathic scoliosis# and may have worsened with increasing age. The second degenerative! or de novo! type of scoliosis starts after D2 years old and is thought to be the result of arthritis or degeneration of the spine! with changes in alignment caused by degeneration of the discs and the facet joints. Degenerative curves might also progress a few degrees per year! particularly if the patient has osteoporosis and a se%uential collapse of the vertebrae. In about 928 of all scoliosis cases there is no known cause. This type of scoliosis is called idiopathic scoliosis. /7 ) /0

Idiopathic scoliosis can be described as early onset or late onset. It is surprisingly common although most patients need no treatment or do not realise that they have a curved spine. .urves measuring up to //1 are considered normal. $bservation is the mainstay of management in most patients! and bracing or plaster casts are sometimes used. (urgery is reserved for those curves that are symptomatic or are at high risk of becoming symptomatic because of the si'e that they have reached. The term neuromuscular scoliosis is used to describe curvature of the spine in patients with any disorder of the neurological system. .ommon categories include cerebral palsy! spina bifida! muscular dystrophies! and spinal cord injuries. In most of these children the unifying feature is weakness of the trunk. Ierves can be affected from the brain "eg! cerebral palsy# down to the spinal cord "eg! poliomyelitis#. If the muscles do not work! such as in spinal muscular atrophy or Duchenne muscular dystrophy! then scoliosis can develop. Patients with these conditions often develop scoliosis or kyphosis "round back#! or both. s they grow and their trunk muscles get weaker! the spine progressively collapses! producing a long! .= shape scoliosis. The curvature of the spine worsens during growth spurts. These curves tend to be progressive! with the rate of progression becoming worse during rapid growth. ;or children confined to a wheelchair! progressive curves can affect the childKs ability to be seated comfortably! thereby affecting their %uality of life and function. progressive or large curve can affect a childLs pulmonary function by leading to collapse of the torso and raising of the diaphragm! which reduce the space for the lungs. This reduction in space can manifest itself in recurrent pneumonia "chest infection#. (cheuermannLs kyphosis is a structural curvature of the thoracic or thoracolumbar spine that develops before puberty and deteriorates during adolescence. It is the second most common cause of back pain in children and adolescents with spondylolysis "defect in the vertebral arch# and spondylolisthesis "displacement of a vertebra or the vertebral column in relation to the vertebrae below#. The age at onset is about /2M/< years! but a subset of patients present in adulthood. The condition occurs in 2.D=9.A8 of the population! though its true incidence is probably underestimated because it is often attributed to poor trunk posture. It affects e%ually male and female patients. (coliosis can occur as part of a recognised syndrome. ;or example! people diagnosed with ,arfanLs syndrome! *ett syndrome! or ?ealeLs syndrome are likely to develop scoliosis. &xtensive research and recent experience of certain physical and complementary therapists supports ideas around alternative scoliosis long=term management and possible treatment using alternative or complementary therapies such as gentle bone setting or other joint corrections methods. $ne of the examples of a safe non=manipulative method is the Dorn ,ethod or Dorn Therapy. Dorn ,ethod may be the only existing safe method suitable for non=medical environment which does not involve any manipulations or forced movements or use of excessive leverage in the process of correcting alignment of any vertebral joints. It involves active therapy and self=help routines for long=term management. Dorn ,ethod can potentially be taught to sensitive carers who could use it fre%uently on their family members! clients or patient as appropriate.

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