tructural ntegration S ® I THE JOURNAL OF THE ROLF INSTITUTE JUNE 2011

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Structural Integration: Columns The Journal of Rolf Movement® Faculty Perspectives: 2 ® The Rolf Institute Orientation and Empathic Resonance June 2011 ® Vol. 39, No. 1 GAIT AND ROLFING SI Elastic Walking: The Fascial Engine 5 Publisher Adjo Zorn and Kai Hodeck The Rolf Institute of Natural Walking and Running 9 Structural Integration® Owen Marcus 5055 Chaparral Ct., Ste. 103 Dr. Strangegait, Or 13 Boulder, CO 80301 USA How I Learned to Stop Worrying and Love Hip Extension (303) 449-5903 Matt Hsu (303) 449-5978 Fax Your Fate Is in Your Gait 17 (800) 530-8875 Brian Fahey On Gait: It’s Hard Looking from the Inside Out 21 Editorial Board David Clark Craig Ellis Jazmine Fox-Stern CONSIDERING THE FEET Szaja Gottlieb Anne F. Hoff, Editor-in-Chief The Arches of the Feet in Standing and Walking, Part 1 22 Linda Loggins Lael Katharine Keen Heidi Massa Four Fundamental Relationships in the Foot 28 Meg Maurer Michael Salveson Robert McWilliams, Managing Editor Deanna Melchynuk Barefoot Walking Inspires Healthier Shoe Choices 31 John Schewe Karin Edwards Wagner Why I Got Foot Surgery 33 Layout and Rob McWilliams Graphic Design INCORPORATING VISCERAL WORK IN ROLFING® SI Susan Winter Widening Our View of the Fascial Net 36 Articles in Structural Integration: The Peter Schwind, Allan Kaplan, Anne Hoff, Gabriela Arnaud Journal of The Rolf Institute® represent the The Culture of the Viscera 40 views and opinions of the authors and Liz Gaggini do not necessarily represent the official positions or teachings of the Rolf Institute Pelvic Organization and Psoas Function as 44 of Structural Integration. The Rolf Institute Influenced by Inflammation and Pregnancy reserves the right, in its sole and absolute Dorit Schatz discretion, to accept or reject any article for publication in Structural Integration: The Assessment and Thoracic Viscera in SI 46 Journal of The Rolf Institute. Jeffrey Burch

Structural Integration: The Journal of The An Informal Case Study of Using Other Maps 50 Rolf Institute® (USPS 0005-122, ISSN 1538- to Explore the Rolfing® Territory 3784) is published by the Rolf Institute, Allan Kaplan 5055 Chaparral Ct., Ste. 103, Boulder, CO 80301. Postage paid at Boulder, Colorado. PERspectives POSTMASTER: Send address changes to Comments on the World Congress on Low Back and Pelvic Pain 51 Structural Integration: The Journal of The Bruce Schonfeld Rolf Institute®, 5055 Chaparral Ct., Ste. 103, Boulder, CO 80301. A Commentary on Stecco’s Fascial Manipulation Work 53 Russell Stolzoff Copyright ©2011 Rolf Institute. All rights reserved. Duplication in whole or in part Institute News in any form is prohibited without written permission from the publisher. Research Update – Rolfing® SI for Children with CP 55 “Rolfing®,” “Rolf Movement®,” and Graduates 56 “Rolfer™”are service marks of the Rolf 2011 Class Schedule 56 Institute of Structural Integration. Contacts inside back cover C olumns

with those for which its physical shape, Rolf Movement length, and density are appropriate. With biological systems, resonance is different than with inanimate objects. One Faculty Perspectives can describe many forms of resonance between and within cells, plants, and animals. We watch life forms mimic and Orientation and Empathic Resonance dance with, or repulse away from, other Considered as Psychobiological Elements nearby life forms. Two plant stems may grow around each other. A dog and a cat in Structural Integration may learn to share close proximity, but perhaps only at certain times and places. By Kevin Frank, Certified Advanced Rolfer™, Resonant behavior in biology is selective Rolf Movement® Instructor and specific, like guitar strings. Resonance relevant to somatic work is the Rolfing® [Structural Integration] is about good technique, and rapport, and rapport, combination of psychology and biology and rapport, and rapport . . . . (psychobiology) called empathic resonance. Empathy is a capacity to feel in one’s own Gael Ohlgren body what another is doing or feeling in his/her body. Empathic resonance is when two persons (or a group of people) sense rientation is the basis for how we response, orientation and the physiology of the empathic exchange, consciously or (mammals) do anything at all. First, motor control, and “psychology” because O unconsciously, and find mutual interest without exception, we need to know where we work with perception, meaning, and the in the exchange. This can, in turn, evoke we are in relation to gravity or “up and belief construct around “having” a body. a sense of “shared attention.” This quality down.” Then we perceive. We assemble The SI process is a format where we can of shared attention, this resonant state, our perceptions. With our perception, we examine and evoke what are normally can be sustained as both people allow build and populate a world to which we invisible threads of communication. it. An empathic resonant state supports orient, and then we go about our business. Synergies of communication around somatic work because it is a state where As we do our business, communication is body awareness are themselves shifts in body patterns that are normally fixed are also critical. consciousness. These shifts of consciousness more plastic. Communication in somatic (body-oriented) are opportunities to remake the inherent therapies such as structural integration (SI) sense of body, to loosen beliefs about Empathy is about more than words. Communication, body limits, and to revive body-friendly We live at a time when empathy between in the somatic context, embraces all the coordination. Communication that supports animals and/or human beings finds channels of sensory awareness: skin takes shifts in belief, and change in body shape, is scientific credibility. There is, for example, part in communication, the breath is part necessarily a cooperative event, one where the “mirror neuron” effect. Neuroscientists of communication, the intellect participates client and practitioner manage somehow, observed, first in monkeys and then people, in communication, and movement is part consciously or unconsciously, to share brain activity that indicates empathic of communication. Sounds (not limited to awareness with each other or to resonate activity. We now know that a person words) are part of communication. Silence with each other. Thus, resonance suggests observing another person’s movements will is also filled with communication. itself as a metaphor, a way to refer to a exhibit sensory and motor brain activity phenomenon that can’t be fully explained, that corresponds with the brain activity The back and forth of communication links but is nonetheless a vital part of the work. of the mover. We see a movement and we necessarily back to orientation – gravity feel it, at an unconscious brain level. We orientation and general orientation – how Resonance can also learn to feel another’s movement we locate this body in space. We literally consciously, at a sensory level. We can, in “hold the space” for our work through Resonance, in the language of physics, is a fact, learn to empathize specifically and orientation. Successful negotiation of matter of waves and specific harmonies of somewhat reliably. Skillful empathy is part orientation and sense perception is a movement that can occur within a system. of empathic resonance but the latter is a step central ingredient in client-practitioner If you pluck a guitar string, other strings further along in the skill set. As structural communication and rapport. Successful move. You hear the harmonics as other integrators we learn to empathize with communication and rapport is worth strings vibrate. A key feature of resonance another person’s experience as a part of examining when we think about the process is the specificity with which one object learning to do the work. of educating SI practitioners. has the freedom to respond to certain wave frequencies exclusively from others. An example of empathic skill in SI is “body A body-oriented look at communication All objects are filters of energy. An object reading.” Empathic body reading is a between client and practitioner highlights effectively “filters out” those waves passing skill that structural integrators develop to what has been called the psychobiology of through it that don’t resonate, and resonates determine what needs work, what effect SI – “biology” because we work with gravity the work has had, and what to do next.

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It helps to be able to “see” what is alive What evokes willingness to allow this level the container. Stable orientation tends to and differentiated, and what is less able of intimacy? What evokes empathy? What reduce ungrounded reactivity. Ungrounded to move in a client, so one can assist the qualities of attention in the practitioner hold reactivity means my personal reaction to client to move more freely, and with more a container for empathy-based work? Does your experience, which is not relevant to clarity of function. We “see” or “see/feel” the way we orient and attend affect those your process (and not relevant to my support another’s places of ease, or places of effort/ in our presence? These questions lead to of your process). Reactivity, such as eager compression because our body senses considering one’s attentional field. enthusiasm or subtle recoil, tends to pull subtle motor activity within ourselves that clients out of their experience. Reactivity is imitates the person observed. The capacity Shapes of Attention typically the enemy of resonance. to imitate gives us a capacity to see. The goal Empathy is affected by the shape of our Inclusive Attention is to acquire the capacity for the process to field of attention. Every moment our become conscious and deliberate. “movement brain” maps the space around The capacity to empathize while Empathic body reading is meaningfully us with a combination of conscious and simultaneously sustaining a broad and enhanced through differentiation of one’s unconscious orientation. We can’t turn this stable orientation to context supports body map, the motor and sensory mapping off. Orientation happens as a background deepening of the re-mapping process that is of one’s body at conscious and unconscious to our other forms of consciousness. We at the heart of SI. To grow a new map, one levels. My map of you can only be as can, however, influence parts of orientation needs continuity of direct observation, which good as my map of me. If I can’t notice through conscious perceptive attention. most people are not used to. We support the client’s sustained observation through an articulation, a plane of movement, or a How we orient, or formulate our shapes of sustaining our own attentional field. spatial awareness in my body, I probably attention, can be described geometrically: won’t be able to see it present or absent in for example, as a sphere, an ellipse, a As the process continues, clients recognize yours. Mapping is another way to speak line, plane, or as a shape with missing or that the field of inquiry shared with their about embodiment. We can define SI as enhanced quadrants. Geometry is used to practitioner is a space that, at least at times, the work of differentiating the body’s map describe the shape of space that includes helps open new dimensions of awareness. of itself – the body/action space. Whether our orientation. I can ask, “Does the shape As clients get used to a quality of shared we call it embodiment or mapping, the goal of my attention feel spherical, equally observation, a feeling we call “resonance” is the same: to restore the body to operate omnidirectional, or does it feel like an or “empathic resonance” develops. more intelligently by opening to better data. ellipse in one particular direction? Does Clients can also start to feel the power of my attention include space behind me or Empathy’s Role in SI “inclusive attention,” in which one balances behind the one I face, or does the attentional awareness of one’s own body sense with Before going further, it must be space close in around my body, or my awareness of the other person. Inclusive acknowledged that one can use empathic partner’s body?” “What is the shape of my attention isn’t unique to SI. However, the body reading as a tool of “power” over kinesphere?” would be another way to ask skill can be named and taught as part of the clients, certainly, or for any number of these questions. somatic set of skills one learns in SI. It is, in self-interested purposes. Such pitfalls The geometric shape and perceptive details fact, part of reviving core stability in which are briefly mentioned later in this article. of our orientation influences how others psychology and biology are not separate. As a therapist, however, the best use of feel in our presence. An omnidirectional this skill is to help evoke new places of field of attention to the space around Our Varied Availability aliveness/awareness in the client or student, oneself, a bidirectional sense of axis, and to the Idea of Somatic as a “listening” skill, and for modeling balance of weight and space orientation Resonance differentiated awareness in oneself. transmit the message that the practitioner Many factors affect rapport. Some have to SI practitioners often demonstrate to a client is stable, because he/she is present in his/ do with mirroring, or with simple listening how it looks to evoke or inhibit particular her own gravity orientation. Similarly, and pacing, and some are as basic as good sense perceptions. For example, one might sensory awareness in the hands and feet practice/office habits. Empathic resonance demonstrate perceptually inhabiting a signals stability. A broad spatial orientation, is a particular quality of rapport that specific region of kinesphere, such as the in contrast to pointy reactivity, offers a makes somatic education possible. At the space above one’s head, to show the client place of ground for the work. As with the same time, we come to this aspect of the how it looks to move with this perception. physical ground we stand on, we want work with different backgrounds. Some This, in turn, stimulates the client’s empathy our practitioner’s ground to feel reliable practitioners come to somatic trainings to see/feel the practitioner’s sense perception and stable. strongly developed in skills of grounded and movement. Stability of attention especially matters empathic resonance. For others, it can Here is another aspect of empathy at when we meet sensitive moments in feel new and unfamiliar. Some students work in SI. The client is effectively asked the work. As a client opens to a new feel understandably suspicious of the to empathize with the practitioner. Client experience, pleasant or unpleasant, how do terminology, hearing terms like somatic or capacity to “body read” the practitioner we, as practitioners, respond? Optimally, empathic resonance. The label can sound depends on the client being open to doing we maintain a broad, self-referential “new age” and distinctly ungrounded, so. The client, in effect, has to allow the orientation; a stable background to the for example. In fact, empathic resonance practitioner’s movement to touch him/her, client’s new experience. Attention to gravity is a way to describe how all mammals, for the demonstration to have any impact. orientation is an essential part of holding including people, develop social bonds,

www.rolf.org Structural Integration / June 2011 3 C olumns and is increasingly recognized in the Can we fool ourselves? Yes, the thinking/ stability and confidence in our perceptual behavioral and neurological sciences. emoting mind is often fooled. To clarify and postural attitudes. We find out how Empathic resonance is a quality that has orientation, practitioners benefit from perceptive attitude affects our own posture been cultivated in many cultures far back feedback, feedback from partners and and how perceptive attitude affects the in recorded history. At the same time, observers in courses that embrace experience of our practice partners and, it’s helpful to respect the pace at which psychobiological aspects of the work. We ultimately, our clients. SI students are ready to learn about may not notice “leaning in” to the client orientation and the more subtle levels until it is pointed out to us. We may not The Psychobiological Idea of communication. notice loss of gravity orientation and Empathic resonance points to dimensions sensory awareness of our own body until The good news is we can develop empathic of SI that involve supporting perception, we are asked, kindly and with curiosity, to resonance through training and practice. coordination, expressivity, and self- notice what we sense in our body. Invited Our brain is eager to be exercised in this regulation. We ask clients to explore in such a way, we may actually be willing way. We learn to differentiate our map of themselves in ways that are new and to look and see what can be noticed in body and space by having course time in unfamiliar. We ask them to walk, or sit, this moment. which practice is part of the curriculum. or feel in ways that put them on the spot. We learn to build skill with our attentional Can we still fool ourselves? Yes. Somatic How do we support this challenging field through partnered tracking exercises: work is inherently risky. Stacey Mills, learning situation, so that a client feels safe exercises in which the tracker’s perceptual one of the early Rolfers, and a Rolfing® enough to sincerely explore? All of us are, posture is a tracked parameter observed, Structural Integration teacher, said, “Rolfers first of all, animals. We are expressions ideally, by a third person. We learn through are [people] willing to take all risks.” We of mammalian biology and, as such, skillful feedback, feedback that is delivered are hugely vulnerable, in large part due we orient. And primarily, we orient to in language that separates observation from to our eagerness to do work that is deep gravity. We want to track how our client/ inference (observed facts from assessment and fundamental to improved function. creature is orienting and we will do this or judgment). Feedback, too, is more helpful For whatever reason, there are times we best by observing how we, ourselves, are in a field of empathic resonance. “go to sleep” and wake up in trouble. orienting – at each moment. Psychology What is the answer? There is, of course, no is informed and supported by the biology Empathic Resonance answer. Daily practice of perceptive and of empathy and orientation. We don’t and Integrity coordinative skills and daily opportunity have to do psychological analysis to do psychobiological work. Psychobiological As mentioned earlier, empathic skill does to become present to oneself helps. Yet there is no passive security we can relax work happens as we support the conscious not automatically confer therapeutic and unconscious work of empathic resonant integrity. There are many examples of into. We all benefit by collegial support and continuing education in a mode that allows exploration, and by bringing sensory empathic skill gone awry, when used by perception to conscious awareness. unhealthy personalities. How do we define us to receive safe mirroring, along with any integrity in somatic work, a field that is all other choices for self-care. An Exercise about subtle and intimate communication? The Role of Empathic with Orientation What do we teach students as a basis for Resonance in SI Education safety and appropriate boundaries? Imagine you are about to meet a client to Empathic resonance is a theory. It is do an SI session. What is your orientation? Simply put, empathic resonance is a based on the science of empathy and the Notice your orientation without edits. To grounded activity. We are grounded when subjective experience of resonance when what does your mind associate? What the ground of our orientation is stronger two people share attention, when two captures your attention? How does your than our focus on the client. Adequately people attend to a somatic experience in a body feel? Start from your actual baseline, grounded, we offer a container that is nuanced way. Educating practitioners about without judgments. less susceptible to unconscious projection empathic resonance offers skill sets that are and transference because our clients don’t Then, take time to notice your gravity straightforward and specific. These skill substitute for our ground. The client stays orientation. Where do you find a sense of sets overlap with the basic skills of being figure, as in the phrase “figure and ground.” weight in your body? Take time to allow a structural integrator: we differentiate A broad attentional field – one informed weight to register in your system. What is the map of our body and the space around by gravity orientation, a backfield and your sense of body volume? Breathe into us at a detailed level, and we come back side field, and differentiated perception of your volume. again and again to gravity orientation. We bodily sensation – is not an attitude that develop the capacity to describe our map How do you notice your balance of “back “leans on the client.” Grounded resonance of sensory awareness, and to ground our space” (space behind you), front space, side is a field of inquiry; inquiry is an attitude experience in sensory language. We develop space, overhead space, and “below you” of curiosity. With stability, one doesn’t lean the capacity to hold “fields of attention,” space? Is the shape of your kinesphere a forward to look for stability, physically meaning background orientation to weight rounded bubble or an ellipse? If it is an or psychically. We notice the ground and space and to dimensions of space, of ellipse, what direction does the ellipse beneath the work – the client, for all his/ inside and outside, so there is a broad and elongate to? What helps you to balance your her fascinating details or dramas, is not stable container for our inquiry with people. shape of spatial orientation? What makes our ground, but a figure within it/upon it. Finally, we practice with each other to build it easy? How might you invite rounding awareness toward an omnidirectional

4 Structural Integration / June 2011 www.rolf.org C olumns/Gait and Rolfing SI sense of the space around you? Follow any exhalation pause, in the absence of effort? is your sense of body and orientation to impulse that feels easy and interesting. What supports inspiration, inspiration for weight and space? inhalation? Is there a sense of interest to Where are the places of finely differentiated Now imagine: How might it feel to greet space, to horizon, to sky? mapping within your body? Where are the your client from this sense of body, weight, places you can sense bony articulations, How does breath touch your body? How and space, this sense of up and down that easily? Where are the places where you can does your body respond to breath, in you notice at this moment? How might you make fine movements, easily? standing or sitting? How does your body imagine finding this broad orientation, at respond to the anticipation of breath? times, during your work? Can you invite How is your axis differentiated and this possibility? oriented? Is there a directionality of head What movements follow easily and and tail into space? Is there a bidirectional naturally from what is alive for you right What was most easy or interesting to notice sense to your axis? now, in sensation? in this exercise? The most easily noticed details may be your best entry point to Return to the question: How do you notice Let yourself move as an expression of what orientation, places to which you can check weight, in any part of your body? How you sense. Can you permit yourself to allow in during work. do you notice breath? How does your sound? How does the resonance of sound breath land? What is the quality of post- land in your body and in the space? What

to consume energy. In the convention of gait analysis, these two mechanisms – lifting Elastic Walking: and lowering, and braking and accelerating – are considered to consume considerable energy. Were our ancestors stupid to choose The Fascial Engine such a seemingly costly style of locomotion in a hot, arid environment? By Adjo Zorn, Ph.D., Certified Advanced Rolfer™, Rolf Movement® Practitioner and Kai Hodeck, Ph.D., Certified Rolfer™

Note from Robert Schleip, Ph.D., Director of Fascia Research Project at Ulm University (Germany), Rolfing® Instructor: The presentation of Dr. Adjo Zorn at the World Congress on Low Back and Pelvic Pain in Los Angeles in November last year was, for me, one of the highlights of that highly esteemed conference. Coming from his perspective of being both a long-time practitioner of Rolfing Structural Integration as well as an established scientist, Adjo’s lecture presentation on “Walking with Elastic Fascia: Saving Energy by Maintaining Balance” suggested nothing less than a paradigm shift in classical gait theory. The article below sets forth some of the same ideas Figure 2: Besides the inverted pendulum he presented at the Congress. of Figure 1 (the stance leg with its up and down), a second inverted pendulum exists – the upper body – which must be kept in balance although getting faster and e have been studying human slower all the time. W walking with the tools of mechanical engineering. Our work suggests a unique Errors in the Conventional principal mechanism of walking that has yet Model of Human Walking to be properly understood. This mechanism requires precise action of the psoas muscle Here we identify what we believe to be and the lumbar fascia. erroneous in the conventional model of human walking. The Problem Figure 1: An almost stiff stance leg moves the body mass up and down. In gait 1. The upper body is thought to make The human way of walking is strange. Not no active contribution to walking. In the only does no other animal uses such a stiff analysis, the “inverted pendulum” is the commonly accepted model for the basic conventional model of human walking, stance leg, but no other animal moves its pattern of human walking. the fundamental pattern is the inverted mass up and down so much with each pendulum. The HAT segment (head, arms, 1 step (see Figure 1). Generally speaking, Due to gravity’s action on the upper body trunk) is considered no more than a passive to lift mass consumes energy, and no other mass, during the ascent the hip joint passenger, just a center of mass being firmly animal voluntarily transforms flat land into slows down, while during the descent it attached at the top of the pendulum (see, for hill country. accelerates. To maintain balance, these example, Perry’s Gait Analysis: Normal and Moreover, a closer look shows that the changes in velocity must be transmitted to Pathological Function2). the upper body (see Figure 2). Alternately upper body not only is lifted and lowered, 2. Elasticity is thought to have no role in braking and pushing the combined mass of but also changes its velocity in each step. walking (part 1). At one time, scientists the trunk and head would also be expected

www.rolf.org Structural Integration / June 2011 5 Gai t and Rolfing SI discussed at length whether or not walking To maintain tension in any such role in walking. It functions as a heavy is an elastic action. The single exception tendon an active muscle contraction counterweight for the hip-extensor and to the rule that lifting weight burns is therefore required, and this -flexor springs. This would explain the lots of calories is where elastic recoil is involves such a large expenditure of human peculiarity of balancing a heavy involved. For example, bouncing high on energy that the idea of elastic energy weight high above the hip joint. Identifying a trampoline takes little effort because of storage in the usual sense seems to springs in the upper body instead of in the trampoline net, which brakes the falling lose its meaning. . . . The limbs do the legs also resolves the problem of the weight, stores the energy, and recycles not ‘bounce’ from their tendons and force directions. it again for the acceleration of the body the body does not bounce from one While Fenn and many others considered upward. In the 1940s and 1950s, with the step to another however ‘elastic’ the absurd the possibility that in walking, evolution of modern muscle physiology step may appear to be.6 tendons function as elastic springs held in and the availability of EMG measurements, Consequently, to explain the “wasteful” tension by actively contracting muscles, it scientists discovered, much to their surprise, muscle activity shown by EMG studies has been demonstrated as a reality for the that the walking body uses its muscles to of walking, scientists like Hill and Fenn gastrocnemius aponeurosis.10 The situation decelerate limbs almost as much as to were seeking “chemical springs”, i.e., might be clarified if we can learn more propel itself forward.3 It seemed that this muscles that work “inversely” to produce about isometric muscular contraction, would be a waste of energy unless elastic chemical energy like accumulators when especially in the tonic, slow-twitch muscles. structures were involved, and the search for stretched eccentrically.7,8 Surprisingly, there is virtually no research elastic structures began. The researchers, about the energy consumption of a muscle who were mainly physiologists, concluded The Role of Fascia acting isometrically, far below maximum that there was simply not enough elastic contraction force. If it turns out that this is material in the body for walking to be By accounting for the role of fascia, we highly energy efficient, it will cast a whole an elastic action. Having examined can correct these errors and solve the new light onto endurance activities. And, muscles, bones, ligaments and tendons puzzle. Let’s try a new hypothesis: that the it might also be that most muscles act this involved in walking, they stated that those lumbodorsal fascia, with a huge number way in proper walking. structures would contain only a negligible of collagen fibers, acts as a tendon in percentage of elastic fibers. Even today, counterpoint to the psoas major tendon, The Hypothesis of an both of which are highly elastic and most physiologists agree that collagen Elastic “Bootstrap” Design fibers, which predominate in tendons and function as huge strong springs connecting fascia, are not elastic fibers. the stance leg to the trunk (see Figure 3); Have a look at Figure 4. In grey is the and that these springs do most of the work inverted pendulum of the conventional 3. Elasticity is thought to have no role of walking. model of gait analysis. Superimposed on in walking (part 2). Meanwhile, other it in black is a representation of what our researchers, whose focus was biomechanics, calculations have shown happens when were exploring running. They concluded the upper body is included. The stance leg that running bears a strong resemblance to moves up, thereby losing momentum and bouncing on a trampoline in that it seems slowing down. Due to inertia, the HAT mass 4,5 to employ elastic recoil. Because walking tends to maintain its speed. With no brake and running use the same muscle, tendon, for the trunk, the walker would stumble and ligament structures, this conclusion forward. The opposite would happen was at odds with that of the physiologists. when the stance leg goes back down: However, the angles of the legs in running because of the weight it is supporting, the and walking are not the same, and the Figure 3: A stance leg and a balancing descending stance leg would accelerate angle of the legs in walking is such that upper body, connected by the while the trunk would stay behind, making elastic rebound would propel the body not lumbodorsal fascia and the gluteus the walker stumble backwards. As the forward but backward – which makes it maximus muscle. conventional stance leg inverted pendulum unlikely that any elastic recoil mechanism is does not work very well for the walker, it is employed in walking. Thus was established Some silly notions never die – and the non- evidently misleading. a gait analysis dogma (in full conformance elasticity of collagen is one of them. While with the former conclusion): While running the almost perfect elasticity of collagenous is regarded as an elastic activity, walking is tissue has been proven repeatedly beyond described as a pendular action. any doubt and has been tacitly understood 4. Elasticity is thought to have no role by many researchers, most physiologists in walking (part 3). What’s more, were still either deny outright that collagen is elasticity involved in walking, something elastic or implicitly distinguish between 9 would keep a tight hold on the strings of the collagen and “elastic fibers.” However, trampoline. As the well-known physiologist tendons and fascia actually consist of almost nothing but elastic collagen. and biomechanist W.O. Fenn concluded, Figure 4: An upper body without extra from general considerations and with In our hypothesis, the HAT segment is support for balance (black) superimposed utmost finality: not just a passenger, but plays an essential upon the conventional inverted pendulum (grey). 6 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI

Our hypothesis is that springs acting on the Not surprisingly, our calculations show 6a 6b hip joint balance the weight of the upper that the success of the design depends body and avert the stumbling. To test our on the precise adjustment of the springs, hypothesis, we developed the new model which would be achieved in the real shown in Figure 5. This figure represents world by fine-tuning the pre-tension of only the idealized single-stance phase the relevant tissue structures. This tuning of a step; the double-stance phase is not might be accomplished by muscles working considered here. The springs counteract isometrically under the control of accurate the inertia of the upper body, allowing it motor intelligence. As is the case with a to maintain its balance on the alternately fine musical instrument, effortless balance rising/decelerating and falling/accelerating demands perfect harmony. Figure 6a: The proposed hip erector spring – lumbodorsal fascia plus gluteus hip joint base. At the same time, the springs We consider our hypothesis to be a maximus muscle. pull the leg upwards in both phases, thereby “bootstrap” design – a term derived from also counteracting both the acceleration and an 18th century German tale of one Baron Figure 6b: The proposed hip erector and deceleration themselves. Münchhausen, who reputedly pulled hip flexor springs – lumbodorsal fascia himself out of a swamp by his bootstraps. plus gluteus maximus and psoas major 5a 5b The same idea was introduced in English by (tendon and muscle). James Joyce in Ulysses: The bootstrappers literature about the psoas addresses its “had forced their way to the top from the assumed function as a stabilizer of both lowest rung by the aid of their bootstraps. the hip joint and the lumbar spine (e.g. this Sheer force of natural genius, that. With source14). Bogduk disagrees. He reports, brains.” In engineering, a “bootstrap” is “A striking feature of the fascicles of psoas a device that feeds part of its output back major is their similarity of length. This into its input. Such devices are rarely so suggests that the psoas is designed to act close to the original gravity-dependent from the lumbar spine on the femur. With Figure 5a: The first half of a step. A meaning as ours. stance leg rises, due to kinetic energy all fascicles of similar length, they would and the action of the hip extension The Anatomy all undergo the same relative shortening spring, which spring also decelerates the of Elastic Walking and would share to the same extent the balancing upper body. linear excursion of their common site of We propose that the combination of the attachment on the femur.”15 This seems Figure 5b: The second half of a step. A lumbodorsal fascia and the gluteus maximus to support our assumption that the psoas stance leg falls, accelerated by the body muscle serves as the hip erector spring muscle acts mainly isometrically as an weight and decelerated by the action (see Figure 6a) Indeed, EMG recordings activator of the tendon spring. of hip flexor spring, which spring also of gluteus maximus activity support our accelerates the balancing upper body. hypothesis: maximum activity occurs at the Given the location of the psoas, EMG beginning of the upward movement shortly measurements in walking are rare. 16 In our model, the inertia of the torso’s high after heel strike at maximum hip extension, However, Keagy implanted electrodes and substantial mass is absolutely necessary when in our model the spring is stretched into the psoas muscle during lumbar as a counterweight for the pull of the spring. to its maximum length.11 sympathectomy surgeries on five patients, Observe also that this mechanism requires and reported regular psoas activity in “horizontal” levers, which the shape of the Most likely, the psoas muscle and its long each patient during heel-rise. Guided human pelvis furnishes. tendon serve as the hip flexor spring by an ultrasound technique, Anderson17 (Figure 6b). Unfortunately, little is known inserted needle electrodes from the back What makes our model revolutionary is about the function of the psoas major in in four subjects. At 1.5m/s walking speed, the absence of energy-consuming engines walking. Data on the “iliopsoas” almost he measured activation duration times (contracting muscles). If it is congruent in always relates to the iliacus. Based on approximately 70ms while the muscle its fundamental principles with reality, his observations of poliomyelitis victims, was elongating. Both studies support it explains a way of walking free of Duchenne12 concluded that the only muscles our hypothesis. energetic cost. Because we are not aware indispensable for walking, with or without of any theoretical discussion or empirical mechanical support devices, are the hip When the psoas is stretched most in documentation of such a design in human flexors. Duchenne, by the way, because he walking, the hip is in internal rotation. biomechanics, engineering, or physics, we could not use electrodes to stimulate the “When through secondary muscle group refrained from offering our hypothesis psoas itself, is responsible for popularizing action the hip is stabilized in a position until we were absolutely certain of our the confusing term “iliopsoas.” Even when of internal rotation, the action of the calculations. At first, we doubted that it was the function of the psoas major as a hip Iliopsoas is enhanced. At this time, the possible to maintain upper body balance flexor is examined, its performance at an lesser trochanter is posterior and medial to with no more than these two springs. extended hip (Figure 6b) is often ignored the axis of the femur, and contraction of the However, our calculations show that when (e.g., as in this source13). Iliopsoas when riding anteriorly over the the spring tension is correct, the design crest of the pubis produces reinforced and works perfectly. In fact, the function of the psoas in walking more deliberate lateral flexion and rotation is rarely examined at all. Most of the of the spinal components through the

www.rolf.org Structural Integration / June 2011 7 Gai t and Rolfing SI transverse processes, which are posterior to succeed: the project is funded by the (Ed.), Tissue Elasticity. Washington, D.C.: and lateral to the central axis of the vertebral German government. American Physiological Society, 1957, pp. bodies.”18 Because this rotation between 98–101. Our research has led us to a new and pelvis and spine enhances the stretch of unexpected understanding of what 7. Ibid. the lumbodorsal fascia on the other side, “balance” actually means for the human we speculate that the degree of rotation 8. Hill, A.V., “Production and Absorption body – an understanding reinforced by might indicate the degree to which both of Work by Muscle.” Science, 131, 1960, pp. our practical experiments. The subtle the psoas and lumbar fascia are utilized; 897–903. adjustments to the springs before the i.e., minimal rotation might indicate low start of each step are required in order to 9. Zorn, A., “Physical Thoughts about utilization of the psoas and lumbodorsal maintain not only spatial balance, but also Structure: The Elasticity of Fascia.” IASI fascia, while the considerable rotations temporal balance. This has compelled us 2008 Yearbook of Structural Integration, we have observed in walkers in remote to adopt a much more dynamic view of Missoula, MT: IASI, 2008, pp. 68–71. Africa might indicate high utilization of what human structure is about. As Rolfers, those structures. 10. Fukunaga, T., Y. Kawakami, K. Kubo, perhaps we should learn to perceive the and H. Kanehisa, “Muscle and Tendon specific appearance of elasticity in walking Practical Experiences Interaction During Human Movements.” ­– i.e., the high-frequency oscillations at Exerc.Sport Sci.Rev., 30, 2002, pp. 106–110. Because we speculate that improper or heel strike (and the resultant waves that inadequate use of fascia might lead to ripple through the tissue) – as well as the 11. Winter, D.A., The Biomechanics and back pain, we are experimenting with both appearance of harmonics and resonance. Motor Control of Human Gait: Normal, Rolfing structural work and Rolf Movement Perhaps we should be more attentive in Elderly and Pathological. Waterloo: Waterloo education to help our clients use the fascia general to the dynamic features of the body Biomechanics, 1991. to achieve what we see as an elastic style structure; as Bernstein observed as early 12. Duchenne, G.B., Physiologie des of walking. It is difficult, given the subtlety as the 1930s, the human body structure is mouvements. démontrée à l’aide de of the adjustments, the need to involve the four-dimensional.19 whole body, and the fact that “putting a l’expérimentation électrique et de l’observation spring into the step” seems to produce – or Zorn and Hodeck are physicists as well as clinique, et applicable à l’étude des paralysies perhaps to demand – a change deep in the Rolfers. Further information on this model is et des déformations. Paris: J.-B. Bailliere et client’s personality. available online at www.swingwalker.net and Fils, 1867. in the upcoming book Dynamic Body, edited If indeed the lumbodorsal fascia is by Erik Dalton. 13. Yoshio, M., G. Murakami, T. Sato, S. rhythmically stretched during walking, Sato, and S. Noriyasu, “The Function of we would expect it to produce a swing in All images in this article are by the authors. the Psoas Major Muscle: Passive Kinetics the lumbar region (see Figure 7). Of course, and Morphological Studies Using Donated Endnotes this reminds us of Ida Rolf’s ideal of the Cadavers.” J.Orthop.Sci., 7, 2002, pp. “psoas walk.” We are now developing an 1. Alexander, R.M., “Bipedal Animals, and 199–207. optoelectronic device, with which we will Their Differences from Humans.”Journal of 14. Gibbons, S., “Clinical Anatomy and be able to measure the swinging of the Anatomy, 204, 2004, pp. 321–330. Function of Poas Major and Deep Sacral lumbar vertebrae. We have no choice but 2. Perry, J., Gait Analysis: Normal and Gluteus Maximus.” Vleeming, A., V. Pathological Function. Thorofare, N.J.: Mooney, and R. Stoeckart (Eds.), Movement, SLACK Inc, 1992. Stability and Lumbopelvic Pain. Edinburgh: Churchill Livingstone, 2007, pp. 95–102. 3. Eberhart, H.D., V.T. Inman, and J.B. Saunders, J.B., Fundamental Studies of Human 15. Bogduk, N., M. Pearcy, and G. Hadfield, Locomotion and Other Information Relating to “Anatomy and Biomechanics of Psoas Design of Artificial Limbs. Prosthetic Devices Major.” Clin. Biomech. 7, 1992, pp. 109–119. Research Project, University of California 16. Keagy, R.D., J. Brumlik, and J.L. Bergan, Berkeley, 1947. “Direct Electromyography of the Psoas 4. Cavagna, G.A., and M. Kaneko, Major Muscle in Man. J.Bone Joint Surg. 48, “Mechanical Work and Efficiency in Level 1966, pp. 1377–1382. Walking and Running.” J.Physiol., 268, 1977. 17. Andersson, E., J. Nilsson, and A. pp. 467–481. Thorstensson, “Intramuscular Emg from 5. Alexander, R.M., “The Spring in Your Step: the Hip Flexor Muscles During Human The Role of Elastic Mechanisms in Human Locomotion. Acta Physiol Scand., 161, 1997, Running.” Groot, G. de, A.P. Hollander, pp. 361–370. P. A. Huijing, and G.J. Ingen Schenau 18. Michele, A.A., Iliopsoas. , Springfield, Ill.: (Eds.), Biomechnics XI-A. Amsterdam: Free Thomas, 1962. Figure 7: A periodic stretching of the University Press, 1988, pp. 17–25. lumbodorsal fascia during walking should 19. Bernstein, N.A., The Co-ordination and 6. Fenn, W.O., “Some Elasticity Problems reveal itself by swinging lumbars. Regulations of Movements. Oxford: Pergamon in the Human Body.” J.W. Remington Press, 1967.

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get it. When you tell them that we’re meant not to fight gravity, we’re meant to use it, Natural Walking they get it. People want easy, low-tech, and inexpensive ways to enjoy their bodies. and Running From a professional and marketing prospective, I found working with runners By Owen Marcus, M.A., Certified Advanced Rolfer™ very rewarding. Yes, some can be neurotic about running. The upside of that is they all are very aware of their performance, so Introduction Starsong (Wing). Both instilled in me how when you improve their performance, they to have gravity work for me. I’ve practiced know it! Over the years I have done running The first thing I teach all of my clients is Rolfing® Structural Integration [SI] for more clinics teaching Natural Running to clients how to breathe. When I can get my clients than thirty years, with no injuries to myself, and non-clients. Everyone gets it. breathing correctly, it helps them manage and I credit them. I also credit them with As you start teaching Natural Running, their stress, and hopefully they won’t need planting the seeds of “Natural Walking.” me anymore. After breathing, the next you’ll become a local expert and resource thing I work on is walking. Breathing is an Soon after I opened my practice in for the running community and beyond. instinctual behavior; walking is only partly Scottsdale, Arizona, in 1980, I started My Phoenix practice took off once I started instinctual – much of it is modeled. We seeing runners as clients. Their injuries helping local runners. Until they receive this watch our parents walk, and we copy their taught me what not using gravity can do to kind of help, runners’ injuries will continue movement style as well as the emotional a body. Regardless of orthotics, new shoes, to get worse and worse. Eventually, some style embodied in their movement. Some or knee surgeries, their injuries would will have to stop running. The runners you of us may rebel against our parents to return. And it wasn’t just my clients: up help will become your best advertising, create an opposing style (think about the to eight out of every ten runners are hurt telling all their injured friends how you did rebellious, slouching teenager). Either every year. Rolfing SI and reorganizing their more good than the six pairs of orthotics or way, we are in some manner being affected structures weren’t enough. With Rolfing SI the running coaches. they improved more, and they went longer by how and why our parents walk a The Development particular way. between injuries, but the injuries could still return.3 I tried teaching our movement of Natural Walking In this culture we study walking and work, but I wasn’t getting through to them. and Running running biometrically, yet we still don’t Maybe it was too theoretical, or maybe it I will not go into the biomechanical theories understand how to do either correctly. was how I was teaching it. Regardless of For whatever reason we adopted our or research behind Natural Walking or why, I needed to come up with a way to Running as Rolfers Gael Ohlgren and walking style, we invariably create a build on the principles of Rolfing SI and limited approach to dealing with gravity. David Clark wrote a thorough article on the Rolf Movement that these runners would science behind it.4 I used my clients as my To compensate, we created high-tech shoes understand – and practice. that soften our walk and encourage us to beta testers, and began to see that the more walk and run incorrectly. Propelled by Maybe it’s my dyslexia, but I’m a simple I simplified what I told and showed them, these shoe companies and our mechanistic man, so I look for simple solutions. One the quicker they got it. I knew I was getting paradigm of human movement, we created day as I was explaining these principals it when these clients were teaching their reductionistic models of how humans are to a runner, I showed him how to just friends what they had learned from me. meant to move. fall forward. In my exaggeration, he After a few years of success with runners, understood. He tried it a few times in my Why the Natural Walk? Arizona State University’s Exercise office. When he came back the next week, Physiology Department approached me As Rolfers, we all tend to agree that he was starting to embody the fall. Over the about doing a study with elite runners. this “civilized” model of walking is not course of a few more sessions, he mastered They randomly divided the participating working. It might be good for generating falling forward. I knew I had something men into three groups: a control group, clients for our practice, but it’s not good for when he reported that he was running who received no treatment; a group who human bodies. We’ve forgotten something pain-free, faster, and enjoying it once again. received ten regular massages; and the so simple: how to walk and run like an Why Now? Rolfing group, who each received ten indigenous person.1,2 Rolfing sessions. With the resurging interest in Rolfing SI and Possibly the most brilliant focus of Dr. Rolf’s the barefoot running craze, there is a new I warned the researchers that their work was her emphasis on gravity. As fish opportunity to step in and help runners in measurements, such as shank angle (angle aren’t aware of water, we were not aware a simple way. Who better to speak about of the ankle), were just measurements of of gravity before Rolf championed the gravity, structure, and movement than a the parts and not the functioning of the importance of not just relating to gravity, Rolfer? I suspect you’re also seeing clients whole body. They assured me that these but using it. Back in the 1970s when I was more frustrated than ever before with the biomechanical measurements would show training to become a Rolfer, I had sessions institutional answers they have been given any improvements there were. As it turned ® in Rolf Movement (or, as it was called then, for years. People are smart. When you out, there were no significant differences Patterning) with Megan James and Heather explain to them how something works, they in measurements between any of the

www.rolf.org Structural Integration / June 2011 9 Gai t and Rolfing SI groups, yet every runner in the Rolfing Breath: A relaxed breath is required to fully • When you have surrendered, that peak group saw his injuries disappear and embody this walk: experience can show up. This is where set new personal records. Unfortunately that runner’s high comes in. • A relaxed breath goes from the floor of the researchers were focused entirely the pelvis up the front, side, and back of on biomechanical indicators, and did Cues and Shoes the trunk to the neck. not measure the injury reductions or the I tense every time I hear “experts” give performance improvements. • Allow yourself to feel whatever is postural and movement instructions like tense, and then relax it. Once you relax Principles this (ostensibly about natural walking): one area, you may feel another tense “Pull your shoulders back slightly. Keep It’s All About Gravity area. Relax it. This doesn’t mean you your body perpendicular to the ground and are holding: It means either your old walk tall. If you walk in a confident manner, Using gravity to move forward is a simple unconscious pattern returned and now you will gain confidence. With each step, concept, but teaching it can be tricky. The you are aware of it, or that the next layer land on your heel. Flex your foot and allow part my clients find the most difficult is to of chronic tension wants to release. it to roll from heel to toes.”5 Through the surrender to gravity, letting go and falling Rolfing process, I make a point of correcting forward. It’s difficult to shift from decades • Holding tension is wasted energy that misconceptions around good posture and of leaning back (“Stand up straight!” restricts the body, making it less efficient. proper walking. “Square those shoulders!”) to leaning into By letting go, your body eventually life, trusting that if you lean forward, you becomes more efficient. I found that trying to teach the Natural won’t fall. It’s no different than a new skier • Breathe like a baby. Walking directly rarely worked, and learning to lean into the “fall-line,” that that practicing an exaggerated form of imaginary line of gravity pulling him down Use gravity: Let gravity do the work by it is the best way to create a new default the mountain. Every cell in your body is pulling you forward. walking form. By going overboard, you quickly extinguish the old proprioceptive saying, “If I lean forward, I’ll fall flat on • Feel how gravity wants you to move anchors of what alignment is and what the my face.” forward. correct walk is. When I demonstrate the I use Natural Walking as an opportunity • Imagine you are a caveman man out for exaggerated version, clients’ first comment to increase the ease of breathing and body- a walk. Forget all the other instructions is usually, “No way. I’m not doing that. I’ll awareness clients have developed from others told you about how to walk. Go look like a dork.” But then I contrast this Rolfing SI. As they start to get the walk, primitive. to the “shoulders back” command quoted I keep reminding them to breathe a full, above, and show how this forces the head relaxed breath. I want their walk to be a • After breathing, learning to use gravity forward and trunk back, while restricting subtle meditation of breath and gravity. was the next behavior you started breathing even further. I show clients that This is a great way to metaphorically set learning. Now you get to master it. when we walk while leaning back, there the person up for bigger surrenders and • To run, lean forward more, surrender is a natural tendency to counterbalance changes. Inevitably, as a client starts to more, and you’ll go faster. Let your legs by holding the shoulders. Understanding get the walk down, he or she starts to lean be spokes on a wheel. that shoulder, upper back and neck tension more into life. can come from their walk, and that they • Allow your body to be erect and relaxed can release that tension just by moving Core Movement while leaning forward from your ankles. correctly, clients are more receptive and less Now that every trainer is a “core strength • Don’t work. Let gravity do it. worried about looking stupid. trainer,” we see clients come to us shortened and tightened from “strengthening their Find your sweet spot: Go to where you There’s also much to consider about our core.” I use Natural Walking and Running are in your zone of minimal effort and choice of shoes. Up until the 1950s and to teach clients what the core muscles are maximum results. 1960s, high school cross-country teams and how to use them for the ultimate core training barefoot was a commonplace • Keep letting go with your breath, lean exercise. Sometimes, I tell them stories sight.6 Heel-striking became popular into gravity and let it get easier and about Rolf’s “psoas walk.” When they when that was what runners were told to easier. relax and let gravity do the work, the body do – particularly with the introduction of is positioned in such a way that the core • Use the negative feedback of tension or high-tech shoes. But heel strike transmits muscles are used and the sleeve muscles are pain to direct you to pleasure and ease; all the force of impact directly up through only secondary supporters on level ground. i.e., when it hurts, readjust. (I have a the leg, hip, and lower back and, over time, Walking and running correctly will make client who knows when she is forgetting the weak links in a person’s structural chain a person’s core stronger without making it to lean forward while running, because start to break. (As Rolfers, we are about the shorter or tighter. she starts to get a headache. She adjusts only practitioners who don’t keep trying to her stride, leans into it again, and her repair the weak links; rather, we strengthen Simple Concepts headache goes away.) the whole chain while, more importantly, decreasing the stress on it.) A simple model allows the client to focus • The entire experience becomes a more on his body. These are the ways I movement meditation, surrendering We continue to create shoes either for the communicate my key points: and surrendering more. aesthetics (e.g., high heels), or we attempt to develop shoes to fix problems stemming

10 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI from our stride.7 But recent research shows Vermonter, he told me he’d tried Nordic Fall forward from the ankles that the more expensive the running shoe, skiing, but could never get the hang of it. It • It’s all in the setup. Get straight – not the worse the runner’s injuries: was obvious why when you saw him walk what you thought was straight, but the – if he’d been leaning any further back, he Dr. Daniel Lieberman, professor of Rolfing straight, where there is a sense would have fallen over. He struggled with biological anthropology at Harvard of lift. the walk for several weeks. As his body University, has been studying released and realigned, it became easier. • Imagine there are two sheets of plywood, the growing injury crisis in the One day he came in to proudly show me one in front of you, one behind you, both developed world for some time and that he finally had it down. The Natural hinged where your ankles are. Start has come to a startling conclusion: Walk had helped him in other areas too. He gently rocking where only that hinge “A lot of foot and knee injuries told me that for the first time, he was able to moves – only your ankles are moving as currently plaguing us are caused practice what he was preaching to his golf you stand tall. by people running with shoes that students: he could now easily get over the actually make our feet weak, cause • Surrender, let gravity do the work. Let ball and swing from his lower body. us to over-pronate (ankle rotation) gravity pull you forward as you relax and give us knee problems.”8 With skiers, I tell them to walk like they and breathe. ski. Lean into the fall line. I steal Moshe As if the return of the Earth Shoe, with • Lean forward and let gravity pull your Feldenkrais’s line “stand like you are going its negative heel, were not bad enough, back up and straight. When you lean to jump” as the setup for taking the first now we are seeing the rocker sole shoes forward there is a natural tendency to step, which is not a step. I show the client with rounded bottoms meant to make the move out of a collapsed state and into that the first act is not a step that puts him walker roll through her stride. Obviously, straightening and lengthening. back; it’s falling forward, which puts you they must work for some people in the in front of the vertical axis. We all want to • Fall. short-term – and the promise of a tighter start the movement with a controlled stride butt is a strong selling point. They certainly • Allow one leg to be like a pole when you of leading by extending the leg forward, are not promoting a natural stride or the pole vault. You pivot over that leg as you rather than a fall. When the leg is forward, development of a person’s soft tissue and fall. The other leg remains behind you, the torso shifts back behind the centerline. structure, however. As the antithesis of the not pushing off. Then that second leg With the leg forward, we are leaning back Vibram Five Fingers9 shoes, they take away becomes the pivoting leg as you continue – being pulled back by gravity, rather than all instinctive muscular development. to fall. leaning toward where we want to go and Nevertheless, long-held beliefs about having gravity propel us forward. • When the natural stride kicks in there walking and running are being questioned is no sense of pushing off with the back I kid with clients that I am teaching them now with the popularity of barefoot leg on level ground. That leg pushes to to regress back to their ancestors. Our running and the book Born to Run.10 Writing pick up speed or to climb a hill. On level developed world is finally taking an about his experience with Vibram Five ground you feel very little effort coming important step backward in our ability to Fingers®, one of the barefoot runner’s shoes, from the rear leg. It is more like a rudder walk and run: our ancestors and the few a popular blog author relates: “The way to guiding the forward movement. indigenous peoples left are the ones who walk, these new experts claim, is to shorten know how to walk and run efficiently and the stride, keep the hips over the feet as • The hind leg first starts bending not in correctly. Humans evolved to be runners much as possible, and to land on the ball the knee, but in the toes, foot and ankle. as much as we evolved as thinkers or of the foot with the heel striking second. The knee only bends once the weight is tool-users with an opposing digit. It was This method uses the foot and lower leg as off the leg at the end of the stride for the our ability to outrun any animal with our 13 nature intended – natural shock absorbers rear leg. endurance that allowed us to survive.12 I to minimize impact.”11 tell my clients to run like a hunter chasing Once you are doing the stride, then focus on secondary areas However, they’re still missing the most down a gazelle. important piece of the puzzle: the secret is Putting It Into Practice • Keep your eyes on the horizon. Train leaning into gravity. yourself to increase your peripheral I never see a client get the Natural Walk or Metaphors vision. Learn to trust that you don’t need Run without practice. There are a few that to look down. You will see what you In teaching new concepts I always look get it down in a week with minimal practice. need to see. And because you are leaning for metaphors that people understand Most, particularly us men, take weeks of forward, you will actually be better able experientially. One I use for Natural exaggerating the walk or the run. I tell my to recover if you lose your balance. Walking and Running is Nordic skiing. clients to go someplace where they won’t • Elbows are out to your sides, not I explain that your stride will look much be recognized so they don’t worry about pointing behind. (Elbows rotated back like the stride of a cross-country skier looking stupid. I also emphasize practicing promotes adducting the scapulae along who is leaning forward, stretching his leg on a flat surface; walking or running up or with rotating the shoulders back. This out behind him. The skier wouldn’t get down hills is a different stride. Irregular pulls your whole body back as your anywhere if he were leaning back. surfaces will be a distraction at first. head goes forward.14) As you run, your Many years ago while in Arizona, I had thumbs should point towards each other, a golf instructor for a client. A fellow not up.

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• Your knees are headlights – have them Common Symptoms and Benefits to a friend. Once they get it, they won’t need shine straight ahead. Everyone has some to concentrate on it. Again, exaggeration eversion of their feet. Don’t be concerned After years of leaning back, with the calves is the key. As strange as it feels and looks, where your feet go. Focus on your knees never moving in a full range of motion, it works. It takes time to unlearn a strong going straight.15 Natural Walking or Running may leave the unconscious movement pattern and to client feeling discomfort or a pulling in the stretch out restrictions.19,20 The biggest • Relax your feet. Let them flop. At first, calves. As I tell my clients, if you went to complaint I hear is that it doesn’t feel you have to make them flop. This is the gym and did bicep curls by only lifting natural. I say, if it felt natural, you would the high point of the exaggeration16 – the dumbbell two inches, your bicep would already be doing it. We are creating a new making a flopping sound as you walk. shorten. Well, that is what happened to the set point for natural. Or more accurately, Slap your feet on the floor. Don’t force calves; they shortened from years of never recreating an old, correct set point them, just pretend you’re a kid trying being fully extended. (In a supine position, for natural. to make as much noise as you can. If you see that their calves pull their heels you’re flopping, you’re leaning forward up, causing their feet to point down.) It’s Conclusion properly, and you aren’t lifting your as if we all wore high heels for years. After 17 The beauty of Natural Walking and foot or toes, which is a consequence a few sessions of Rolfing SI and several Running is how simple it is. Clients might of leaning back. Virtually everyone weeks of practice, the calf muscles will start resist the exaggerated practice form, but mistakenly holds their feet when they to lengthen. walk or run.18 they all understand it and feel it. Most will A similar thing can occur with the plantar practice it. Many have transformed their • Push a cart. For my elderly clients surface of the feet: the feet might ache as bodies with it. Several of my clients who (or anyone unsure of their balance), I they release, particularly feet with high never thought they could run are running encourage them to go to the supermarket arches. One client gained two shoe sizes races and marathons. and push the cart around to get the from Rolfing work, and from doing the Many years ago, I had a client who was a falling forward. A client who had been walk as his feet unclenched and stretched business executive in his sixties. Earlier in a marathon runner finally got the walk out. Another client created a sustainable his life, he’d been a professional athlete. In one day when she found herself running arch from developing his intrinsic muscles. his sixties, he was still athletic and loved through an airport, pushing a luggage Frozen joints can break loose. At first his daily walks. Flat feet and back pain cart. She finally got what it was to fall it’s painful, but once released, clients eventually brought him to me. Being a forward. become ecstatic. walker, he had ample time to practice the • The forward falling momentum keeps This walk will take a posterior pelvis and Natural Walk. As a fellow flat-footed man, us up, just as a bike will stay up once it make it horizontal, thereby creating a I knew it could be a little more challenging is moving forward. lumbar curve. Some people worry about to master this walk with flat feet, but he was Let go that, because they were told to tuck their determined. Every week he would come pelvis to reduce its curve. People who never in showing me his latest accomplishment. • Use pain or discomfort as a signal to let had a butt develop a butt. As the pelvis finds He was slowly getting it. About seven go or remember the Natural Walking and a balanced position, the lateral structures of weeks into the series, he came in beaming Running form. the legs cease to propel the person forward, like a ten-year-old boy who’d hit his first and the core muscles guide the fall, cellulite homerun. You would have thought he’d • Don’t push through pain. It’s telling you will often disappear. (This will be last thing had his first orgasm with how he described something. Figure out what you need to to happen, usually from months of doing the first peak exercise experience of his life: relax or fix in your form to get the pain the walk). that day he’d gone for his walk and he fell to go away. For example: into a zone where time and space ceased to Sometimes clients report their shoulders – feels jarring – you’re landing on your exist; he said he could have been out five or necks hurt when they didn’t before the heels minutes or five hours and he wouldn’t have Rolfing sessions. I show them how in their known how long it was. – breathing is a strain – you’re holding old posture and walk, they were always your breath, tensing your shoulders, holding them. After the Rolfing process You are welcome to take what I have maybe you’re hunched over, or your releases the shoulders and neck, they are written and use it or experiment with it. stomach is tense feeling the effects of the habits still being I created a free short ebook for runners there. As they master falling forward that is equally applicable to walkers. Go to – knees hurt – you’re not leaning forward, and breathing, the shoulders find a new, www.RunningFlow.com to download the you’re lifting your toes, not letting hips relaxed home. Other than a frozen joint in ebook. Feel free to share it with your clients. and legs swing naturally, or taking too the foot releasing, there shouldn’t be joint wide of a gait Owen Marcus, MA is a Certified Advance discomfort. If there is, it’s usually a sign that Rolfer in Sandpoint, ID. His blog and website, – shins hurt – you aren’t flopping; rather, the person is not doing the walk correctly. www.RolfHub.com and www.align.org discuss you’re lifting your feet and possibly Even five minutes per day of going out Rolfing SI. He writes about men’s issues at your toes and practicing the Natural Walk for a few www.owenmarcus.com. weeks is usually sufficient to get it down right. I encourage people to learn it by themselves – not walking a dog or talking

12 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI

Endnotes this stride. The weight is on the pivot leg, Dr. Joe Vigil, about the Tarahumara Indians: where the knee is straight. This can be “Look how they point their toes down, 1. McDougall, Christopher, Born to Run: A the key to eliminating a runner’s chronic not up.” Hidden Tribe, Superathletes, and the Greatest knee problem. Race the World Has Never Seen. New York: 18. Lifting the foot causes the anterior Alfred A. Knopf, 2009, pg. 40. 14. Twenty years ago, an Olympic marathon tibialis to feel like the tibia. Eventually, runner came to me complaining about many runners develop shin splints from 2. Ibid., pg. 9. McDougall gives a beautiful “weak shoulders.” I assured him the the fascia being torn off the periosteum description of a Tarahumara Indian running his problem wasn’t weakness; it was tension of the tibia as it keeps being traumatized natural run. from holding them up and rotating his arms and thickening from the micro-traumas of 3. Ibid., pg. 170. “Every year anywhere back. Once he learned to drop his arms and a muscle doing a job it is not meant to do. his shoulders, his exercise asthma was gone. from 65 to 89 percent of all runners suffer 19. McDougall, op. cit., 170 on how an injury.” 15. The Olympic marathon runners I had as stretching does not work. clients had the straightest legs I have ever 4. Ohlgren, Gael and David Clark, “A 20. van Mechelen, W., H. Hlobil, H.C.G. seen, yet they had a little eversion. Anyone Rolfer’s Response to Gracovetsky.” Kemper, W.J. Voorn, and H.R. de Jongh, I see with straight feet is working at it – Structural Integration: The Journal of the “Prevention of running injuries by warm- ® torquing their feet and ankles to create a Rolf Institute , vol. 37, issue 4, Dec. 2009, up, cool-down, and stretching exercises.” straight or inverted foot. pp. 31-37. Also available at http://rolfhub. Am J Sports Med, Sept. 1993, vol. 21, no. 5, com/2010/03/05/natural-walking. 16. Not allowing the foot to land in a relaxed 711-719. Available at http://ajs.sagepub.com/ 5. Sravani, “The Natural Way to Walk.” and natural manner tightens the foot, content/21/5/711.abstract?sid=2ed54888- Alternative Therapies, March 29, 2010, www. particularly the plantar surface. Plantar b116-4237-a122-7d6ba3df12d6. This study, drgranny.com/fitness/the-natural-way- fasciitis and heel spurs develop from the with a follow-up study at the University of to-walk. fascia becoming short, thick, and brittle. Hawaii, showed how stretching produces Flopping the foot allows its twenty-six bones the same results as no stretching in 6. McDougall, op. cit. to start articulating, as well as allowing the terms of injury prevention. I continually 7. Ibid., pp. 168-179. The author weaves in ankle to increase its range of motion. see that stretching does not release the chronic fascial adhesions – and not just several studies, expert opinions, and stories 17. McDougall, op. cit., 91. There is a quote with runners. to show how the better the shoe, the worse from the highly-respected running coach, the injury. 8. McDougall, Christopher, “The painful truth about trainers: Are expensive running shoes a waste of money?” Mail Online, Feb. 22, 2011, www.dailymail.co.uk/home/ Dr. Strangegait, Or How I moslive/article-1170253/The-painful-truth- trainers-Are-expensive-running-shoes- waste-money.html. Learned to Stop Worrying 9. See examples at www.vibramfivefingers. com/barefoot-sports. and Love Hip Extension 10. McDougall, op. cit. By Matt Hsu, Certified Rolfer™, 11. Hozaku, “Natural Walking and a Vibram Certified Egoscue Posture Alignment Specialist Five Fingers Experiment.” Hozaku: Random ruminations” [weblog], July 1, 2009, http:// hozaku.com/post/Natural-Walking-and-a- spent many an evening with classmates Why Gait Is Important Vibram-Five-Fingers-Experiment.aspx. at the Rolf Institute® walking down I Gait tells us about the functional ability of 12. Parker-Pope, Tara, “The Human Pearl Street in Boulder, making “Rolfer- the entire structure. It tells us what the body Body Is Built for Endurance.” The New esque” remarks about people’s supinated can and cannot do. Knowing that a body York Times, Oct. 26, 2009, www.nytimes. and everted feet, hunched shoulders, and will conserve as much energy as it can in com/2009/10/27/health/27well.html?_ wonky knees. But beyond being able to see motion, we look for dysfunctions that cause r=4&ref=health. those quirks of people’s gait, we weren’t able to talk in detail about what was going the body to work inefficiently (i.e. in ways 13. With short, tight calves, the knee will on and, more importantly, what to do about that put excess wear and tear on the body). bend early. But with this walk, the calves it. This article’s goal is to give you a quick If we can address these dysfunctions, we and plantar surfaces of the feet will release overview of why gait is important, why we can improve a client’s sense of well-being and lengthen, often more than from should break it down and analyze its parts, and integration. stretching, or as much as from Rolfing SI. what to look for in a client’s gait, and how Before anything else, we should recognize Additionally, even if there is a torque in to begin to understand why someone’s gait that every individual’s gait is unique. the knee, it often doesn’t matter because is the way it is. Even two fully functional people would the knee is not bearing any weight in

www.rolf.org Structural Integration / June 2011 13 Gai t and Rolfing SI have different gaits based on their own a functional shoulder from a dysfunctional would take about six years to catalogue and emotional and physical predispositions. shoulder and how it relates to a possibly analyze and distilling it into a lightning- No two people walk alike (unless one is compensating pelvis. We need to know fast response requiring no deep analysis. a particularly skilled ninja deliberately these things to be able to bolster our abilities It’s a very handy tool, but it is by no means mimicking the gait of the other). This to make speedy, intuitive, well-grounded perfect, particularly when looking at gait. helps our brains not only identify different judgments in our practices. As society becomes more technologically people but also identify specific traits about advanced and more chair-dependent, different people. Intuitive Gait Analysis in the Real World it’s getting harder and harder to get In other words, we look for quirks to a good intuitive gauge on what good identify people’s moods, motivations, and If a small, scrawny guy comes limping at structure and posture really looks like. As states of health. For example, we all know you, it’s not nearly as threatening as a big modern sitting life foists abnormal structure that the way a woman moves her body tells burly guy bounding at you with six-foot and gait on a shocking majority of the you something about her internal state. If strides and a set of bulbous and well- population, our brains have a harder time she’s got her arms crossed, tapping her foot, defined arms punctuated with clenched measuring bodies in front of us against a chin up, and her brow is furrowed, you are fists. The former is clearly and immediately truly functionally normal gait (or even probably late for date night. In this case, preferable to the latter. No careful analysis static standing posture for that matter). we are looking at moods and motivations. is required because your intuitive sense, Instead, our minds become numb to the If a man is unable to get his shoulders back based on years of experience, tells you very common rounded shoulders, gorilla where they belong, if his pelvis is stuck in that the latter character is a serious threat hands, pelvic rotations and elevations, and a tuck, if his head juts out like a piece of a to the integrity of your body and life. The deactivated hip muscles that create gaits Liebeskind building, and he’s telling you former is someone you may be able to filled with strong compensatory motions. that he suffers from constant fatigue, pain, simply sidestep. We are also plied everyday with truisms and stiffness, then we’re talking about Let’s look at another example. From a about the body like “always bend at the health. We are talking about functions and distance, you can very easily spot someone knees because backs are bad at lifting,” dysfunctions that affect the way this man walking with a freshly sprained ankle. Even “your posture is genetically determined,” feels physically. as a child, you were likely able to see when “your clavicles sometimes grow too long Dysfunctions are deviations from normal a friend or family member had a sprained and impinge on nerves,” and – my favorite biomechanical average potentials for ankle, even if he or she wasn’t using a – “flat feet are of no consequence.” These movement – abnormal range of motion crutch. There is a telltale limp that alerts truisms normalize and discount the effects and usage of joints. We are looking for you to something being wrong somewhere of chronic and progressive deterioration the things that cause pain, discomfort, in that person’s body. Intuition is a handy of one’s posture, making it difficult for and dis-integration in our clients’ bodies. tool for analyzing gait in these cases; but everyone to see clearly what declining A functional glenohumeral joint, for for many clients, this level of intuitive posture tell us. This difficulty arises for our example, should be able to get 90 degrees understanding isn’t enough to help them clients (e.g. “I always figured this limp was of abduction with no problem. We’ve all really change their bodies for the better. genetic since my dad also limps”), and it can seen the glenohumeral joints that get to Worse still, relying on this basic intuitive happen with Rolfers (e.g. “Your kyphosis is only 60 degrees before pain sets in. That’s a sense for more complex gait patterns may as good as it’s going to get because it’s part dysfunctional glenohumeral joint. If the left completely mislead us into thinking that of your pattern.”) quadratus lumborum contracts to sidebend many gait patterns are perfectly functional. So let’s look at a very clear example of a the trunk and elevate the arm to create Why Intuition Is Not Enough gait with dysfunctions: a limping man with the illusion of abduction, we then have a shoulder pain. On first examination, we’ll compensatory movement. Intuition, as a growing body of brain notice he looks slow and has that sense of research tells us, is the shorthand syntheses When we look at gait, we are looking “drag” about him. We can tell something’s of what we know, have experienced, and for similar red flags. We want to know a going on with his leg. His gait pattern have imagined or extrapolated. In any given functional hip from a dysfunctional hip so clearly deviates from what a normal moment of decision or observation, we are from a compensating hip. We want to know walk looks like that most people with no taking a mass of data in our brains that professional training at all can figure out in a quarter second that he has a foot or ankle issue. But what does it have to do with shoulder pain? If we break things down to Recently, a video shot from a trolley car traveling down San Francisco’s Market more detail, we’ll notice things in a way Street at the turn of the 20th century surfaced online and circulated through the that can help us to guide him to a better Rolf Forum email list. The video (www.youtube.com/watch?v=NINOxRxze9k) understanding of his shoulder pain. shows an incredible amount of good posture and good gait. What you see today, in We might notice that the hip freezes in comparison, is astounding: the “normal” that’s out there on Pearl Street in Boulder 30 degrees of flexion, and the knee stays bent to keep weight from going into the (a fairly active and athletic community) is pretty darn dysfunctional. immobilized ankle. His head juts forward, and, with each step, the shoulder and

14 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI torso rotate in the transverse plane to get to scapula and shoulder), and the head differentiate the deep-rooted dysfunctions extra forward momentum. He rotates level (see Figure 1). from the compensations that will unravel asymmetrically. One of the scapulae sits in once you’ve dealt with the dysfunctions. constant protraction. This is the side where It’s called the Hands-On-Head test, and it’s he feels pain in the area where his trapezius a fantastic sleuthing and client-education resides. On palpation, you can feel the hard, tool. It helps you determine how much dense, inflamed feeling that tells you some of a role the shoulder girdle and thoracic soft tissues are working too hard. You now flexion are playing in what’s happening in need only determine what it’s going to take the pelvic girdle and the range of motion in – globally – to get the shoulder complex the hip joints in gait. moving the way it should to reduce the pain Let’s say you have someone come in who, in the shoulder. from the A/P view, has an asymmetrical Functional Gait transverse plane rotation in the pelvic girdle (left ilium stays more anterior than For an in-depth view of gait, I recommend right ilium), a left knee and foot that stay the book Observational Gait Analysis from laterally rotated throughout most of the the Pathokinesiology Service and the Figure 1: Correct gait posture. gait, a slight trunk lean to the left (abduction Physical Therapy Department at Rancho of left hip joint and adduction at right hip), Los Amigos National Rehabilitation Center. A great many modern walks lack real hip a trunk that is slightly flexed, shoulders that It’s very detailed and helps you mentally extension. Without that, any significant are rounded forward, and forward-head break down the different phases of a gait forward push off the back foot is impossible. posture (see Figure 3). so that you can develop a more thorough Common compensations include trunks understanding of the intuitive sense of flexed forward and/or rotating and “huh?” that you get when you see someone pelvises rotating in the transverse plane with a quirky gait. in an attempt to elicit forward momentum Let’s see what a functional gait looks like. (see Figure 2). After a quick, simplified explanation, we’ll look at a quick assessment tool you can use to begin to figure out what’s going on with someone’s gait and how you can start your work with him. Here are our two basic points when looking at gait: 1. A functional gait is symmetrical: From the anterior and posterior views, you should Figure 3: Pre-test pattern. not see shoulders drooping to one side, elevation of a hip, asymmetrical rotation To start the test, you need a baseline to of the hips in the transverse plane (or much make a comparison. Therefore, have your transverse plane rotation for that matter, as client walk back and forth. Ask questions will be clarified later), or asymmetrical arm Figure 2: Compensation pattern. about how things feel, how his weight is swing. Feet and knees should be tracking being distributed, how the bra strap feels mostly in the sagittal plane. If the knees and None of those compensations are great for as she’s walking, whether his shoulders feel feet are always laterally or medially rotated, the long term (inefficient energy expenditure or look even, etc. there is a dysfunction. and lots of myofascial compensations that This is a very easy process for clients 2. A functional gait provides smooth pull will eventually become range-of-motion with a good kinesthetic sense. Often, the and push: From the side view, watch one and pain issues of their own). kinesthetically aware client will tell you leg. It should swing forward in the air and Being able to see deviations from proper that he feels like he’s leaning to the right, land on the heel as the knee extends. The gait helps you understand not only the pain that his legs aren’t doing the same thing hip joint should extend to about 20 degrees your client reports, but also where to start (e.g., it’s almost as if one leg is longer than as the body’s weight comes onto the toes. looking to make some big changes. the other), that he feels like he’s slouching, At that point the hip joint flexes, the knee and that some body part or segment feels flexes, and the forward swing begins. When A Functional Test like it’s taking on lots of strain. That is the left foot is forward, the right hand to Identify Dysfunction your baseline. and arm swing forward (contralaterally) without a significant amount of rotation or Here is a general test from Egoscue® If you get a more visually oriented client, flexion of the upper body. The chest should posture alignment therapy that is extremely you’re going to need a mirror or be very remain up, the shoulders back (so that you useful for building an understanding of comfortable taking videos and showing see mostly shoulder and chest as opposed your clients’ structures. It will help you them to your client. If you don’t already

www.rolf.org Structural Integration / June 2011 15 Gai t and Rolfing SI have it at your disposal in your office, I’d Understanding the recommend having a full-length mirror Hands-On-Head Test with a decent amount of open distance in front of it so that your client can walk in When you have the client position the front of it. With the mirror, she’ll be able to hands and elbows behind the head, you’re spot what’s going on. You may need to cue requiring some thoracic extension and her for landmarks to watch and compare scapular retraction/stabilization. This as she’s walking. Remember, she’s probably gives you and your client the chance to never done this before. Break it down using see what effect improved shoulder girdle some of the information you now know stabilization will have on the body below. about proper gait. Have her watch knees, Again, if there is improvement in the feet, hips, shoulders, or any other bony lower body, you have a positive sign that landmark that appears to be relevant. shoulder-girdle work will give you big Figure 4: Interlocking fingers. bang for the buck – whether you’re working If the client is not kinesthetically in-touch in the Ten Series or going non-formulaic. and can’t really see what you’re talking Congratulations, you just saved some sweat about, she may be more auditory oriented, on your brow and skin from your knuckles in which case you can try cueing her in to and elbows! You’ll probably still have to the sound of her gait or the internal sound spend time on the pelvis (as it’s almost of the impact of her joints or body segments. certainly not going to just mend itself right Failing that, you may just have to start back to perfect function without some telling her what you see. nudging in the right direction), but you’ll Now that you have your baseline (make be working much more efficiently. sure you take notes so you don’t forget If doing the Hands-On-Head test doesn’t what you saw), you’re ready to do the change the gait, then you know that test. In Seeing Made Easy (the workshop whatever the dysfunctions of the shoulder I co-teach with Isaac Osborne), we talk girdle and thoracic spine may be, the ones in about this as a very useful alternative to the pelvic girdle are not going away by just the “crest test” of the eighth session of the Figure 5: Pre-test position. working on the upper body. That may be ® Rolfing Structural Integration Ten Series, no fun, but at least you’re now armed with as it shows you whether working on the connection between the upper body and some knowledge that will help you make shoulder girdle or the pelvic girdle will lower body will literally change their informed decisions about the relationship have a more significant effect. understanding of their pain. I’ve had people between the pelvic and shoulder girdles with sciatica who were absolutely “gob- 1. Have your client interlace his fingers and how to proceed with the planning of smacked” by the fact that their nerve pain (see Figure 4). your sessions. suddenly decreased by doing this simple 2. Have your client put his palms on the test (and could be aggravated by dropping Further functional tests can then help you back of his head and pull his elbows their arms again). This is a huge educational assess to what extent the pelvic girdle is posteriorly (see Figure 5). piece that demonstrates the beautiful ways responsible for the shoulder girdle’s issues. in which the human body can accommodate This exploratory process with your client 3. H ave your client walk again and adapt to varying dysfunctions. helps her understand the value of seeing while maintaining the hand and the body as an integrated unit and helps elbow positioning. For a visual client, that mirror will come you train your analytical and intuitive in handy. Have him compare and contrast Observe what difference this makes to brains. And it all starts with a little walk the walk in front of the mirror. If the knee the client’s gait. Is there is a noticeable in your office. and foot no longer rotate laterally as much or significant change in the gait that you (or at all), you have yourself a great sign. Matt Hsu is a Certified Rolfer and certified or your client feels, sees, or hears? If so, If the pelvis stops rotating the way it was, Egoscue Posture Alignment Specialist in San you know you have a pretty significant you have a good sign. Those are things your Diego, CA. He co-teaches Seeing Made Easy, relationship between the shoulder girdle client will be able to see and tell you. Just a class designed to help structural integrators positioning, the thoracic spine flexion, make sure you ask him questions to get him make accurate assessments, formulate effective and the pelvic girdle. It means that for to pay attention to those things. Again, once intervention strategies, and become better this particular client, the dysfunctions he sees the difference, you’ve helped him resources for their clients. More information is in the upper body are causing the lower discover something priceless. available at http://seeingmadeeasy.com. When body to compensate in significant ways not working with clients, Matt is an active part while in motion (and very likely while For auditory clients, the sound of foot fall of the local ice hockey community and has the standing still). might sound more even, and that’ll be a stitches to prove it. great victory. Otherwise, you may just have For kinesthetic clients, this can be a to tell them what you see changing and be revelation on par with the introduction okay with that. of the iPhone. The obviousness of the

16 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI

somewhat variably over a short period of time, it probably will not affect global Your Fate Is in Your Gait cohesion. If a knee joint continues to move By Brian W. Fahey, Ph.D., Certified Advanced Rolfer™ out of a functional, tracking plumb line over time, this influence will spread to adjacent myofascial structures and cause a reduction Life is only an idea until you feel it in your body. in global cohesion/integration. Zeb Lancaster For a high level of integration in movement, the local parts must “remember” their connections to the whole and stay aware hen we observe the animal kingdom transfer creates a continual motion cycle of their “neighbors.” Whether or not a high W in its natural habitat, we see that the that is constantly interacting with all of the level of integration exists is dramatically more agile, the more fit, and the more swift matter, information, and energy flowing revealed when you watch a person walk. an animal, the longer its life expectancy, as it through our world. The more we keep the In healthy gait dynamics, we can see that can maneuver better and avoid being killed perpetual return cycle flowing, the more each part gets to do its own local thing by other predators. Modern science suggests dynamically balanced we will be. Healthy as long as it contributes to the greater a similar scenario for human beings. Many systems are in a state of perpetual motion, whole. Intercommunication is the key to studies conclude that the quality of human perpetual interconnectedness, perpetual a reciprocally maintained system and the gait dynamics is a marker of a person’s expansion, perpetual intercommunication, key to dynamic balance in our movement current state of health and a predictor of perpetual spiraling motion, perpetual life. Too much local freedom in any body degeneration and aging processes in the polarization – and perpetual pulsation structure or function creates an enclosure 4 future. A recent report in JAMA: The Journal in their journey through space. The state in which the “free” part loses its of American Medical Association found that the quality of the energy flowing through integrative connection with the whole, speed at which people walk is an excellent our perpetual-motion system is directly thereby diminishing global cohesion, flow, indicator of their well-being and longevity. related to the quality of organization in our adaptability, and connectivity in the entire “Researchers found that predicting survival body’s structure. system. Fortunately, Rolfing® Structural based on gait speed was as accurate as Everyone creates their own structural Integration (SI) can alter how people predictions based upon age, sex, chronic organization from the movement patterns organize themselves and provide a more conditions, smoking history, blood pressure, they repeat over time. The gait that each efficient way of using space, which will body mass index, and hospitalization.”1 of us has is not a random act. Healthy gait result in a more integrated gait dynamic. Scientists recently discovered that the angle dynamics are a direct reflection of healthy and variability of our stride while walking Complexity Rules energy metabolism. Healthy structural can tell us a great deal about how our systems organization keeps energy flow coherent Surprisingly, scientists are now telling are aging. If your stride angle, variability, gait in the body, which means energy can be us that homeostasis is not a hallmark of cadence, and speed diminish, you may be stored and then effectively metabolized to healthy physiologic function.5,6 The steady on the fast track to physiologic breakdown. do work. Structural disintegration/disorder state may not be a healthy state. Instead, The new biomedical pioneers even go so far can cause energy to become incoherent, the new physics postulates that system as to postulate and statistically demonstrate stagnant, sporadic, or randomizing, which self-regulation is maintained through that by analyzing gait dynamics they can contributes to dysfunction and inefficient complexity and variability. New science predict the future health of other physiologic motion. Coherent energy has a centralizing is suggesting that when human systems systems.2 Some data suggest that evaluation quality, whereas incoherent energy is more become more periodic and rhythmic in of gait dynamics over time is a more effective diffuse and unconnected. Most human their energy dynamics, and too constant in predictor of cardiovascular and neurological systems are a blend of centralizing and their movement dynamics, over time this well-being than more traditional systems of diffusing forms of energy. A balance of local can be predictive of system abnormality measurement. “Aging is associated with a freedom and global cohesion is a defining leading to pathology, disease, system number of neurophysiological changes that quality of a successful aging process and failure, and accelerated aging. Medicine may alter the locomotor system’s ability to represents a harmonic blend of centralizing is using the wrong term by calling disease generate stride-interval correlations.”3 and diffusing energy flowing through a “disorder” when, in fact, breakdown in Energy Cycles our bodies in a balanced equation. The the body arises out of too much order and expression of local freedom and global a loss of complexity – often referred to as If you want to know how efficient and cohesion, or its lack, demonstrates the “pathologic periodicity.” A body that has effective someone’s structural organization quality of integration in a person’s structure become too regular and too rhythmic in its is, just have him walk. Movement quality and movement function. How well one movement dynamics loses its cadence of demonstrates how well energy is being is organized determines how well that centralizing and diffusing rhythms. used in each of the body’s systems. Energy person will use space in the present and Excessive regularity in movement and constantly flows in and out of our bodies. in the future. As long as there is no loss in structural order may be a precursor to Our bodies capture, store, and transfer integrative, physiological responsiveness, breakdowns in the functional capacity of energy. The human system is a perpetual the local components of movement in other body systems. Diminished variability motion – perpetual energy return system. the body can do their individual thing. and short-term excessive regularity is The energetic flow of capture, storage and For example, if a knee joint is tracking

www.rolf.org Structural Integration / June 2011 17 Gai t and Rolfing SI referred to as “mode-locking,”7 which we We can conclude from this new information all have the shuffle of the elderly in their see in joint wear-patterns and changes in that the laws that support optimal functioning gait patterns as a common denominator. fascial pliability resulting from repetitive in healthy human systems are: the greater They usually exhibit a significant forward usage. A shuffling gait is an example of the variability in a system, the greater the lean of the head and a subsequent drop in “mode-locking.” I have, for example, complexity; the greater the complexity, the their visual horizon line with a narrowing repeatedly injured my ankle while playing greater the adaptability; the greater the of peripheral vision and a retraction of their sports, which caused torn ligaments and adaptability, the greater the polarization;9 personal kinesphere. This forward lean puts created bone spurs in my left ankle. Over the greater the polarization, the greater the increased strain on the cervico-thoracic the years, I experienced a mode-locking sustainability; the greater the sustainability, junction leading to myofascial splinting, phenomenon in my gait pattern, such that the healthier the aging process. fibrosis, and compression of discs/vertebrae I could not fully articulate through my and a shortening of the anterior longitudinal lateral and transverse arches. Rolfing SI Functional Plasticity ligament creating the classic “dowagers and backward-walking patterning have Along with a breakdown of functional hump,” a common site of osteopenia and restored normal motion and variability to order and integrative motion we also see osteoporosis. These adaptive changes my movement rhythms in my ankles and in our age-fifty-plus clients a breakdown in influence their balance function and feet, allowing me to move more like my muscle/fascia/ligament/tendon composition cause increased susceptibility to falls younger self and no longer need an ankle (sarcopenia) as well as bony changes and fractures. It is hard to conclusively brace when I play competitive sports. (osteopenia). Structural disintegration can determine the line of cause and effect in this scenario, but we know that structural Systems seem to have an inherent drive for be seen as a functional marker or predictor disintegration was a primary contributor organizing themselves toward increased of bone and muscle changes. Structural to the lessening of gait variability and complexity and variability in their structural order and function break down first. A subsequent lessening of adaptive capacity and functional geometry. A certain portion loss of functional plasticity or adaptability during movement. of irregular fluctuation is normal for a precedes disease processes or conditions healthy, complex, variable system. We can’t that eventually get labeled by western The new science suggests that the gait rely on short-term evaluations of anyone’s medicine. Structural disintegration begins variability of these seniors diminished body as our only assessment. Variability in a and balance and stride variability start before their bodies manifested various system must be observed over a long range to falter way before the bones thin out or pathological states, which were then given of time. For example, in the short range, the muscles shrink, eventually causing labels by a medical doctor.10 Bodies that mild irregularities in beat-to-beat intervals osteoporosis and the increased likelihood break down with age are dominated by a in our heart rhythm may be seen as negative of fractures. From the molecular to the steady-state frequency instead of a variable or unhealthy, but if it occurs only from time organismic level, healthy function is best frequency. As we have all observed in our to time and not over the long range, it is supported by complex, dynamic, nonlinear, practices, as structural integrity, flow, and probably a sign of healthy variability in multidimensional performance in any connectivity diminish, the functioning of the system.8 Science is finding that human of the body’s systems (cardiovascular, human gait dynamics (stride length, stride systems function best through short-term neurological, musculoskeletal). This is best angle, stride variability, stride tempo, variability in structural and functional maintained through SI. and stride tracking) rapidly disintegrates components within long-range parameters In our work of improving structural order and these imbalances quickly spread of order. It has been observed that bodies and function, physiologic laws of variability compensatory responses to other joint fluctuate over short-time intervals and and integrated complexity are beautifully and myofascial structures. Observing gait then become more rhythmic when a illustrated in the observation of human dynamics gives us information on how behavior (heartbeat, breathing cadence, gait mechanics over varying time periods. the system is using energy, the degree of stride interval) is viewed over a longer Complex fluctuations are part of healthy variability and adaptive capacity in the time-frame. Human beings are pattern gait dynamics. We need only watch people structure, and it gives us predictive clues makers and pattern seekers. Some patterns in our practices walk a little bit and the as to where the body is starting to break are more functionally efficient in the short- movement focal point of their complaints down and how it will progress in the future. term evaluation – but, if they become begins to emerge in their gait dynamics – SI increases movement variability through too periodic, linear, and predictable, and and, as the scientists say, we can predict ordering, realigning, and improving diminish complexity, they will actually future disintegration in their systems. In functional relationships in the human reduce system variability and function observing the phenomena of the aging- system. Structural order and function, quality over time. This suggests there is a predictive value of walking style in the as represented by gait dynamics, is the range of healthy fluctuation, but there are larger population, just watch young children movement metronome synchronizing also limits to the structural and functional move, then observe teenagers walking, then and entraining other systems of rhythmic variance any given system can handle. observe the “weekend warriors” on your cadence in the body (heart, lymph, nerve, So a healthy heart rhythm is a variable local softball team, and finish up with a cerebrospinal fluid, etc). Human gait heart rhythm within an acceptable range, visit to an assisted-living facility. Each of dynamics can be regarded as a physiologic a healthy respiratory rhythm is a variable these groups exhibits different patterns of control system (the conductor of the breath cycle within acceptable ranges, and gait variability. The residents in a nursing orchestra, the regulator of all body systems) a healthy gait rhythm is a variable gait home may have a variety of conditions keeping us in a complex, nonlinear, variable, rhythm within acceptable limits. from arthritis to Alzheimers to chronic and dynamic state of health. These new pain to congestive heart failure – but they

18 Structural Integration / June 2011 www.rolf.org Gai t and Rolfing SI discoveries as to the role human gait variability within ranges of predictability. dynamics, these may be healthy variants. dynamics plays in overall health moves Long-term ordering dynamics are often Perhaps we need to look for what is the next the benefits of SI and function to the head hidden by short-term patterns of disorder step into variability as opposed to looking of the line for health enhancements. This and the longer-term ordering influences for the next “recipe” point towards imposed information should be shared with health tend to be governed by fractal ratios or order. Rolfers must flow back and forth professionals as being a first priority in intervals. If our gait patterns start to violate between local and global vision and touch seeking and maintaining health. The natural fractal ratios, we will age more to achieve a balance between a form-based narrower our functional responsiveness, rapidly. Because all of the systems are and flow-centered perspective of balancing the faster we age. Functional plasticity is looped together, changes in gait fractals structural elements while enhancing a hallmark of healthy aging and indicates will influence fractal-ordering properties functional processes that support system enhanced structural and functional in other body systems, causing them to complexity and adaptability. With this integration – and this is what we provide age prematurely. Because physiologists type of focus we are more likely to assure with our work. are finding out that gait dynamics are so a holistic outcome from our input. We important and predictive of future health, need to be able to find the long-term order Fractal Motion it won’t be long before health assessments beneath the short-term confusion without There is a mathematical formula for will include something that we do every suppressing or imposing limitations upon efficiency in human systems. To understand day in our Rolfing studios – observation and the system variability. We need to help our how dynamic functions are represented recording of gait dynamics (stride angle, clients stomach the short-term dissonance in the body we need to know a little stride length, stride variability). to achieve the long-term harmony that the experts say will lead to the healthiest about fractals – very little, as I am not a The findings that conclude that gait aging scenario. mathematician. A fractal is a geometric dynamics reveal health status are good or functional pattern that repeats itself at news for our profession, as we do more Retromotion many scales of magnification. Science tells than any other modality to enhance SI us that the body is very fractal at the level of and function and thereby improve healthy Understanding the predictive nature of gait structure, and it also appears to demonstrate gait dynamics. Rolfing SI is a structural dynamics has led me to spend a lot more of fractal characteristics in its functions as and functional anti-aging technology. The my session time on the legs and feet than I 11 well. The fractal dimension of the body goals of SI should not just be to maintain was originally instructed to do by Ida Rolf’s shows up as self-similar geometry and constancy in structure and function, “Recipe.” I follow the instructions that Jan function which displays itself in a variety but, rather, to support the expression of Sultan gave (from my notes during my basic of size scales – e.g., the branching pattern of complexity and variability, which, experts training in 1977), “Be observant and adapt capillaries, fascial bundles and planes, and are now saying, is the hallmark of healthy accordingly.” My new understanding that neurological wiring in the brain as well as human functioning. gait dynamics are predictive of functional cardiac bundles and the tracheobronchial aging has also led me to develop and tree. From the fractal perspective, the We’ve always known that our work promote to my clients a variety of walking whole movement of the system is taking is important, but incorporating the integration/locomotion exercises designed place continuously in the parts at any implications of the new biomedicine to restore complexity and variability to their size scale we wish to observe. Anatomic information makes me even more impressed gait patterns. fractal-scaled geometry allows for very with the crucial role that SI can play in Of all the new movements that I have fast and efficient transport of all kinds of promoting human well-being. Our system been sharing with my clients, the one that communication through our physiologic has a greater likelihood of contributing stands out as being the most beneficial and and structural systems. Fractal ratios to human functional plasticity (and, by achieves the quickest results is teaching govern healthy states in major systems of extension, anti-aging properties) than any them backwards-walking patterns. In my the body – cardiovascular, neurological, other therapy. We are trying to organize thirty-four years of practice, prescribing and biomechanical. Fractals seem to be human structures, not only to prevent different patterns involving backward- a mathematical property of order and injury or alleviate symptom complaints walking, skipping, short- and long-diagonal functional control in human systems. When and pain, but also to promote dynamic and contralateral striding, high-leg side- the fractal geometry of body structures responsiveness and rapid integrated striding, and spiralic eversion/inversion starts to degrade through repetitive recovery when the system is challenged by foot plants with backward striding has patterning, people come to us with a variety illness, injury, or disease. Each person has a provided wonderful results for a variety of of symptomatic complaints. With structural unique harmonic, or signature, frequency knee, hip, ankle, and low-back problems, disintegration, complexity and variability that should inform his body’s movement as well as improving stride-angle, stride- degrade, leaving all systems diminished rhythms. Supporting this unique frequency length, and stride-variability and creating in the quality of their intercommunication should be a major goal of our work. more integrated and dynamic movement. and movement synchronization. This loss In our movement and structural work of proper mathematical relationships in our we need to capitalize upon the inherent One of my clients was scheduled for a structure and movement leads to accelerated yearning for connectivity, flow, and high- lumbar fusion and a knee “clean up” aging and an increased likelihood of level integration in our moving bodies. surgery in mid-July of 2010. He agreed to developing disease. Rolfers’ eyes are trained to see when use the six weeks prior to his surgeries to follow a five-day a week backward-walking What the system seems to be demonstrating distortions of norm stand out – when, program in a swimming pool and to get a is that it functions best through degrees of in fact, from the perspective of fractal

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Rolfing session once a week. His results were If we want to move through life in a state Movement is the freedom between so great that he canceled both surgeries and of complexity, variability, and dynamic time and space. as of the writing of this article (February balance, our movement repertoire must Ann Ree Colton 2011), no surgeries are planned. I strongly be more variable. The more variable our believe that the backward-walking patterns movement activities, the more complexity Endnotes he practiced enhanced the structural work we add to our nervous system, and the and broke him out of longstanding patterns better our balance and gait dynamics will 1. Sudenski, Stephanie, “Gait Speed and of inefficient movement. Backward-walking become. To break old patterns we must Survival in Older Adults.” JAMA, January breaks down inefficient patterns by eliciting find new forms of movement input. The 5, 2011; 305 (1), pp. 50-58. novel movement in underused structural/ quality of the input that flows into our 2. Goldberger, Ary et. al., “Fractal Dynamics functional relationships. Backward- nervous system determines the complexity in Physiology: Alterations with Disease walking fits the criteria for high-level of our brain structure and body integration and Aging.” Colloquium of the National integration by supporting variability, function. The law in neurology is “as you Academy of Sciences, March 2001, Irvine, complexity, adaptability, polarization, fire so shall you wire.” Our nervous and CA. and sustainability in our moving bodies. balance systems become smarter when we To break old patterns, our systems need introduce new variability and complexity 3. Hausdorff, Jeffrey and Susan Mitchell, novel input that challenges our nervous, into our movement repertoires. This et.al, “Altered Fractal Dynamics of Gait” vestibular, and musculoskeletal systems. leads to a more adaptable, integrated (abstract). Journal of Applied Physiology 1, Backward-walking engages ligaments, and sustainable system. Any lessening of September, 1996. tendons, and fascial planes through the dynamic balance and movement variability 4. Laszlo, Ervin, Science and the Akashic Field. major joints in unique ways, and recruits in our bodies is a signal that our functional Rochester, NY: Inner Traditions, 2007. new levels of movement integration that capacity is being lowered and that the aging challenge the vestibular system and create process has sped up in that area. 5. Walleczek, Jan (ed.), Self-Organized neural complexity. Biological Dynamics and Non-Linear Control. It also seems to me that we could be doing Cambridge: Cambridge University Press, One of the highlights of backward-walking more in promoting walking as a way for 2000. is that we get out of our eyes and into our clients to enhance the benefits of their our vestibular and kinesthetic systems SI work. You may wish to try taking your 6. Goldberger, op. cit. and begin to trust the feedback from our clients for a short walk during the first 7. Ibid. feet as a primary mode of perception. session, and you will learn all you need to Visually-dominant perceivers have a more know about their alignment, gait dynamics, 8. Buzzi, Ugo and Nicholas Stergiou, et. difficult time inhibiting their over-aroused and general functional adaptive patterns in al., “Nonlinear dynamics indicates aging nervous and vestibular systems, and their motion. Exercise, such as walking, is great on affects variability during gait.” Clinical structure and function tends to age much so many levels, but walking in a structurally Biomechanics, vol. 18, issue 5, June 2003, pp. more quickly. Backward-walking interferes integrated, dynamic body is bliss! We must 435-443. Available at www.sciencedirect. with the visually dominant paradigm and see ourselves as providing benefit way com. makes you start exploring and trusting beyond the medical model of symptom 9. Polarized function refers to the quality of your vestibular integration capacity. Our alleviation and educate our clients as to structural and movement integration in a relationship to gravity and space through how they can achieve health enhancement body. Systems that manage space effectively our balance system is critical to the health and longevity promotion as suggested will perform better in gravity and hence age of all movement patterns. Good vestibular by the research cited in this article. Our more efficiently. A body that can polarize balance helps to maintain a harmony profession is ready for a breakout in its space is effective at maintaining balance between signals that facilitate, and signals recognition as being invaluably important between alternating states or forces: e.g., that inhibit, movement adaptability. If our to contributing to the well-being of human yin/yang flows, contraction/expansion, balance system is on hyper-arousal, our systems by improving our clients’ gait centralizing/diffusing energies, core/sleeve, nervous and muscular systems idle at too dynamics with SI. left/right sides of the body, front/back high a pace and we will get tired more As I was completing this article, more embodiment balance, trunk/leg integration, quickly, as we are pressing on the brakes articles related to the beneficial effects of axial/apendicular stability, inflow/outflow and the gas at the same time. When we walk healthy walking style came across my desk. of metabolites, uplift/grounding thrusts, backwards, the back of the body becomes These articles report that regular walking local freedom/global cohesion. the predominant kinesthetic perceiver can improve brain volume (nerve growth in and tracker of movement and spatial 10. Goldberger, op. cit. the hippocampus, the learning and memory dynamics. We are such a front-dominant area),12,13,14,15 diminish memory loss, and 11. West, B.J. and L. Griffin, “Allometric culture. Anything we can do to improve lower ratios of dementia and other forms of control, inverse power laws and human the embodiment quotient or capacity of the cognitive decline – all valuable contributors gait.” Chaos, Solitons, & Fractals, vol. 10, back body will improve general functional to human well-being. Perhaps these articles issue 9, Sept.1999, pg. 1519. integration in all structure and movement. are a confirmation or just a coincidence. At Backward-walking is fun. It makes you any rate, for now, I’m going to relax and laugh (or be laughed at by others as you take a brisk walk! walk “against the grain” or dominant motion paradigm).

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12. Park, Alice, “Want to Improve Your Feb. 7, 2011, www.nytimes.com/2011/02/08/ 15. Melnick, Meredith, “Study: Walking is a Memory? Try Taking a Walk.” TIME. health/research/08fitness.html. Brain Exercise Too.” TIME.com, Oct. 14, 2010, com, Jan. 31, 2011, http://healthland.time. http://healthland.time.com/2010/10/14/ 14. Parker-Pope, Tara, “Taking your Brain com/2011/01/31/want-to-improve-your- study-walking-is-a-brain-exercise-too. for a Walk.” The New York Times [Internet], memory-take-a-walk. Feb. 7, 2011, http://well.blogs.nytimes. 13. Span, Paula, “Fitness: A Walk to com/2011/02/07/taking-your-brain-for- Remember?” The New York Times [Internet], a-walk.

different field. The software program Poser® version 6, offered by SmithMicro,4 is a three- On Gait dimensional CGI rendering and animation program optimized for models that depict It’s Hard Looking from the Inside Out the human figure in three-dimensional form. The program is easy to use, but it has By David Clark, Certified Advanced Rolfer™ one requirement: one of the segments into which the CGI body is broken up must be fixed. The default is the pelvis, betraying hen first asked to do an article about walk is launched.” For Rolf Movement® the underlying cultural bias. W gait, I wondered what could be practitioners, the action of the holding is So why all this in a piece to Rolfers about added to what we already have recently said the “pre-movement,” the preparation for gait? Simply that we are looking at gait from 1 about Natural Walking without “jumping movement that we learn to watch for. the inside out. We are immersed in and part the shark.” Then as I fretted about this, it Do all humans, being bipeds, hold against of the background of obviousness. If we are occurred to me that Natural Walking is the action of walking in the same place? Not to offer to our clients something more than really the “zero gait” in a potentially infinite at all. I love Gael Ohlgren’s statement that pain relief, something toward the promise series of possible gaits. The Natural Walk “. . . our walk is our signature in space.”3 of Rolfing SI, we need to become aware of is the gait where there is no active holding That signature is composed of many layers. our own gaits. Daily. We have the laboratory against the action and, therefore, it is the Injury, both traumatic and degenerative, in our own bodies to experiment endlessly most economical way for humans to walk. causes unique adaptive changes that with our own theories of motion. We have That is not to say the only way. The most influence the signature. (An example would to know our own assumptions, and it’s hard economical is not the wisest choice when be a limp.) While genetics may contribute looking from the inside out. it comes to getting out of the way of a bus. a part of the signature – in the length of David Clark has been an Certified Advanced How would holding against the action help the bones and mass of muscle – body Rolfer/Rolf Movement Practitioner for thirty you get out of the way of an oncoming bus? image/personality is a huge and preciously years. He lives and works in the Tampa, Florida It’s like when an inexperienced person (though unconsciously) held part. area, occasionally taking time out to assist in gets out of a small boat at a dock without Our signature communicates not only our teaching Rolfing classes. first tying it off. As he steps forward the identity, but also our condition, to our boat moves back (Newton’s Third Law Endnotes group. Certainly culture has a huge impact of Motion), sometimes with hilarious that is at first difficult to see. The human 1. Ohlgren, Gael and David Clark, “A consequences. If, however, he ties the boat tendency is to assume the self as the norm, Rolfer’s Response to Gracovetsky.” off first (holds against the action of stepping and the enculturation process ensures that Structural Integration: The Journal of the Rolf off), then he may step off the boat as if he the “norm” gets spread throughout the Institute®, vol. 37, issue 4, Dec. 2009. were on land. So the muscles that act to subgroup. Some norms are very local, like “hold against the action” aren’t holding 2. See http://en.wikipedia.org/wiki/Gait. accents, and some are very widespread, like back the movement of other muscles; rather, holding patterns in the body. In western 3. Private conversation. they are acting to stabilize a base of action civilization there has taken root a holding so the other muscles can accelerate some 4. See http://poser.smithmicro.com. pattern in the pelvis – a holding against the part of the body, just like tying off the boat action that I assume is from our walking at the dock. patterns, since that is the primary action The holding against the action actually of the pelvic girdle. This holding has gives us a basis for a definition of gait. spilled over to become a norm, and even Rather than “the pattern of movement of a trademark, of western civilization. We the limbs of an animal, including man, have proof of this everyday in our Rolfing® in locomotion over a solid substrate,”2 Structural Integration [SI] practices, where we could say something more useful to all roads lead to the pelvis. Rolfers: “Gait is the pattern of movement Since I believe this point to be important, that develops in the whole structure, from I offer another proof from an entirely the holding point outward from which the

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and eversion. According to Kapandji,1 The Arches of the Feet in inversion/eversion occurs at the subtalar (subtalar: the articulation of the talus and calcaneus) and midtarsal (midtarsal: the articulation of the navicular and cuboid Standing and Walking, Part 1 on the talus and calcaneus, respectively) By Lael Katharine Keen, Certified Advanced Rolfer™, joints. The midtarsal joint is also known as Rolfing® SI and Rolf Movement® Instructor Chopart’s joint. Inversion is composed of supination, adduction, and plantar flexion, Author’s note: I would like to thank Hubert Godard for his vision in synthesizing a model of understanding while eversion is composed of pronation, that has contributed so much to Rolfing Structural Integration (SI), and for his help with this article. In Part 2 abduction, and dorsiflexion. of the article, in a future issue, the relationship of the foot to the rest of the body will be discussed. For structural integrators, the movements of inversion and eversion represent two different qualities of support, which affect The Feet cuboid and the fourth and fifth metatarsals the entire structure, and they also represent and phalanges. The lateral arch maintains distinct moments in gait. The foot was made The feet are a fascinating and vital part of contact with the ground and gives support to be able to move easily between these the human structure. They have the double to the entire lateral line of the body. two extremes, allowing the capacity for the function of adapting to the transmission of The medial arch is composed of the best possible stability and the best possible weight from above and the irregularities of calcaneus, the talus, the navicular, the mobility. It is common, however, to have a the ground below. As adaptive structures three cuneiforms, and the metatarsals and preference for the movement of inversion they will shape-shift to reflect what goes phalanges of the first through third toes. It is or the movement of eversion, and this on above them in the rest of the body, built for and rests upon the lateral arch. The preference will set up a series of predictable and as support structures they are also transverse arch consists of the navicular, the changes throughout the rest of the body. responsible for the quality of movement cuboid, the cuneiforms, and the metatarsals. When the foot moves into inversion it that ensues throughout the body during Its function is to transfer weight, support, stiffens, becoming a structure that is built gait and other activities. In this article, and propulsion, and to modulate the for stability and cohesiveness. When the we will be considering the arches of the relative softening or stiffening of the foot foot moves into eversion, it becomes looser feet to better understand how the feet in the various moments of the gait. function in standing and walking, and and more elastic. Both of these qualities are how we, as Rolfers, can intervene to help Many times the study of the feet and needed for a healthy functioning foot. them. We will also be taking a look at the the gait is limited to thinking of the Inversion and eversion are movements in three-dimensional movement that occurs anterior/posterior movement that occurs which the tibia participates as well. Inversion throughout the foot in all of its functions. across the feet as we walk. However, involves the external rotation of the tibia, there is a finely orchestrated and eversion the internal rotation of the movement of the foot that tibia. Psychobiologically speaking, inversion occurs in all three planes 5th Distal and eversion each have their own character. Phalanx that helps the foot to propel Those clients that have difficulty in finding 5th Proximal the leg forward and adapt the ground often have feet that have a Phalanx to the ground and that 1st preference for inversion. Thus, the functions sets up core stability and Metatarsal that come with the movement of grounding, contralateral movement 5th such as the capacity to let down, breathe out, throughout the rest of the Metatarsal and to surrender may be more challenging 1st body. For discussion of this Cuneiform 3rd (Lateral) for them. Clients who find it hard to engage 2nd Cuneiform tri-planar movement, we space orientation often have a preference for Cuneiform will speak of the foot in Cuboid eversion. With space orientation comes the Navicular three different sections: capacity to move up and out, to breathe in the hindfoot (composed of Talus and to engage relationally – and the client the calcaneus and talus); who gets held in eversion may find these the mid-foot (composed of functions more challenging. Calcaneus the navicular, cuboid and three cuneiforms); and the The alternation between inversion and forefoot (composed of the eversion that happens within each step metatarsals and phalanges). cycle is also the alternation between the Figure 1: The right foot. active movement of touching the ground The Hindfoot, the Mid-foot, and the passive movement of allowing and the Movements of oneself to be touched. When the foot is in Inversion/Eversion The feet have two longitudinal arches and inversion the rigidity needed to support one transverse arch. The lateral arch of The hindfoot and the mid-foot are built to the weight of the body and lever it forward the foot is composed of the calcaneus, the move between the movements of inversion across the foot makes for a movement where the client has the active sense of touching

22 Structural Integration / June 2011 www.rolf.org C onsidering the Feet the ground with his foot. As the foot goes with the fifth metatarsal. This creates a Now, maintaining the contact of the into eversion, phenomenologically the suction-cup-like dynamic that makes the lateral arch, lift the first and second tide turns. This is a moment when the foot metatarsals into a coherent, diaphragm-like rays (metatarsals and phalanges) all becomes receptive; thus, the foot has the dome, lifting and narrowing on plantar the way back to the articulation of sense of being touched by the ground. Only flexion, and dropping and widening on the metatarsals with the cuneiforms. then can it make the necessary adaptations dorsiflexion. This movement accompanies Slowly, keeping the contact of the lateral to the irregularities of support and surface inversion and eversion and lends support arch and especially the cuboid on the that come from below. The elasticity of and stability to the hindfoot. The suction ground, lower first the second ray and eversion happens when the sole of the cup lifts to accompany inversion and drops then the first ray, allowing the base of foot is alive and sensing, as the firmness of to accompany eversion. the metatarsal to lengthen floorwards inversion happens when the foot is actively out of the cuneiforms, until the whole If the first and second rays are not able to reaching towards the ground.2 first and second rays come to rest on the drop, creating the inside of this suction cup floor, long and easy. The “Suction Cup” – when weight comes into the foot, then the The Three-Plane Movement whole diaphragm action of the forefoot will If you managed to keep the contact of the of the Forefoot become unavailable, and the calcaneus will lateral arch while you did this, you will lose the support of the forefoot and fall into feel the suction cup activate. After doing The forefoot – the metatarsal-phalangeal a valgus pattern.4 If the first and second this one or two times, stand up and walk region – is a key area of support for the metatarsals lose their reach – their capacity and notice what changed. whole foot and the stability of all three to lengthen out of the mid-foot, then the arches. If we look at Figure 2, we will see mid- and hindfoot get caught in the high What Happens in that because the joint space between the fixed pattern of inversion preference.5 the Feet During the Gait? first metatarsal and the first cuneiform is Now that we have reviewed the tri-planar diagonal, when the first metatarsal plantar movement, we are ready to discuss what flexes, the movement of plantar flexion is occurs in the feet during the various accompanied by pronation and abduction moments of the gait. The movement (movement of the first metatarsal towards of walking is a continuous alternation the center line of the foot). Likewise, the between stability and elasticity, rotation and joint interspace of the fifth metatarsal is also counter-rotation, and active and receptive oblique, in such a way that when the fifth sensing functions. metatarsal plantar flexes, it is accompanied by supination and adduction (movement The biggest factor that determines the of the fifth metatarsal towards the center structure of a foot is the way that it is used of the foot).3 Figure 3: Position for feeling the suction cup. during the gait.6 According to Dananberg,7,8 Exploration – during a day that includes only eighty minutes of weight-bearing activity, each leg Feeling the completes 2500 cycles. It is easy to imagine, Suction Cup from a Rolfer’s viewpoint, how even a small This exploration can be used dysfunction in the feet can create problems to experience the suction cup throughout the body, as it is multiplied by for oneself – it is also extremely constant use. It also makes sense to think useful for working with clients that a healthy functioning foot, with its in the sitting position. movement repeated many times can be a potent force for well-being. Start by sitting on a surface that allows your weight to The transfer of weight and the foot’s rest in front of your sit bones. responses to it are different in walking and Axis of Plantar Flexion From here, lean forward, running. In this section the responses for for 1st Metatarsal propping your elbows on your a slow to moderate pace of walking will Plantar Flexion knees and resting your head be discussed. Abduction Eversion Axis of Plantar Flexion in your hands. This places a for 5th Metatarsal We can think of this trajectory of weight and significant portion of your Plantar Flexion movement across the foot in terms of five Adduction Inversion weight into the feet. Allow different moments in gait: the whole foot to lengthen • Heel strike Figure 2: The “Suction Cup”. Right foot, and flatten. seen from above. Play with one foot at a time. Find the • Preparation for receiving the weight of lateral arch. Make sure that it has a solid the center of mass (COM) of the body When the metatarsals plantar flex on the contact all along the outer edge and that directly over the foot mid-foot, the second metatarsal pronates the cuboid is firmly planted on the floor. • Full weight-bearing (COM directly over along with the first metatarsal, and the third the foot) and fourth metatarsals supinate together

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• Preparation for toe-off has been pressed downward and returns toe-off.11 The alternate pulsing and releasing upwards on its own. of the psoas, as it stretches, contracts, and • Toe-off then releases for the leg to swing through, Moving towards Toe-Off: The COM Heel Strike: As the foot prepares for heel is an important factor for maintaining a continues to move forward over the foot. strike it supinates, and as the weight comes healthy lumbar spine. It is dependant on the As the big toe begins to dorsiflex, the plantar down at heel strike it moves into inversion. functioning of the toe hinge. Any curious aponeurosis (which attaches at the base of As the foot impacts the ground, it needs Rolfer can feel this for himself, simply by the calcaneum and the proximal metatarsal a certain quality of stability to sustain walking with the toe hinge immobilized phalangeal joint of the big toe) is passively it. The impact of the foot at heel strike is and noticing what happens to the action stretched. This creates a tightening that an important moment in the walk, and of the psoas. travels along the sole of the foot and brings has been shown to be a factor in creating force closure (healthy, physiological joint healthy bone mass in the leg. The Feet in Standing compression) at the calcaneal-cuboid joint. and Weight-bearing Preparation for Receiving the Weight This stabilizes the foot from ankle to mid- of the COM – Softening, Palpation and foot and to forefoot, just as it is undergoing In this section we look at what happens in Adjusting: Immediately after heel strike, a considerable amount of force, caught the feet while standing, weight-bearing, as the weight of the body begins to transfer between the resistance of the ground and the and in the crucial moments of preparation forward over the foot, the tibia rotates transfer of the COM forward.10 This keeps for, and full support of, the COM over the internally creating a movement towards the foot from wobbling as it goes into toe- stance foot in the gait. This is the moment eversion (not full eversion, just enough off. The foot remains firm, while the plantar when the weight of the whole body is to soften the foot).8 This is a moment aponeurosis stretches like an elastic band – a supported over one foot so that the other where the foot becomes flexible, a moment movement that will release kinetic energy at leg can swing through. The quality of where it receives the information from the toe-off and help propel the body forward. support in the foot in this instant either ground, almost as an organ of palpation.9 sets up or breaks down core stability As the heel begins to leave the ground, This sensing capacity in the foot is essential throughout the rest of the body. It is also the fully extended stance leg internally for the foot to be able to adapt to any the beginning of contralateral movement rotates at the hip joint, a movement that irregularities in the terrain. Without it, the and an important factor in balance of the transmits down through the tibia into smallest pebble can be a cause for injury pelvic floor. A stable relationship of the the medial arch, creating a movement of or loss of balance. In a healthy foot, at this arches at the moment when the weight of eversion. The forefoot, which is still in moment, the lateral arch is planted on the the body is supported on one leg engages weight-bearing function, continues in the floor and the medial arch softens down the transverses abdominus / multifidus stiffer, suction-cup mode that accompanies towards the ground. As the foot palpates system, allows the hip joint of the swing inversion. There is a twist that occurs the ground, it is able to adjust to any leg to release, and the psoas to work. By along the longitudinal axis of the foot, as irregularities in that surface. The midtarsal the same token, if the foot wobbles at this both the mid-and hindfoot soften evert, region widens and drops and the foot moment or is unable to soften towards counter-rotating to the forefoot which is lengthens longitudinally. This widening the floor, the global muscles will grab and still in the high narrow movement of the and dropping sets off a stretch reflex tighten, the hip joint of the contralateral leg suction cup. This counter-rotation stores that causes the stirrup muscles (tibialis will shorten, and the psoas will not be able kinetic energy and moves the weight of the posterior and peroneus longus) to contract, to perform its function. COM forward across the foot, and medially taking the foot into its next moment. The towards the big toe and in the direction As the alternating movements of inversion lateral arch plants first, then, as the medial of the other foot as the other lower limb and eversion happen when we are walking, arch comes down the palpation and prepares to become the new support for the so this dynamic relationship also comes into adjustment happens. body weight. play when we are standing. Remember that Full Weight-Bearing (COM directly movements in the direction of inversion Toe-Off: At toe-off, everything changes. over the foot): As the COM comes to be stiffen and raise the arches and movements Going into toe-off, the spring of the foot, supported directly over the foot there in the direction of eversion soften and along with the release of the plantar fascia, is a movement back in the direction of lower the arches. As weight comes into the propels the lower limb into the swing inversion – once again, not full inversion, foot, the lateral arch is meant to support phase of the walk. As the leg begins the just enough of the turning of the bones to the medial arch and the forefoot is meant swing phase, the knee goes from full make the foot a more stable structure for to support both of them. In the mid-foot extension to flexion, the hip also flexes, weight-bearing. The tibia begins to rotate and subtalar region, this support for the and the gastrocnemius gives a phasic externally, taking the hindfoot and mid-foot medial arch from the lateral arch occurs burst of activity, just before the foot leaves into inversion. The stirrup muscles help where the talus rests on the calcaneus, at the ground. This, because the knee is now this by lifting the transverse arch of the the sustentaculum tali, and also where the flexed (and the weight of the body is being mid-foot, while, as the weight crosses the navicular and third cuneiform articulate supported on the new stance leg), causes the foot, the forefoot becomes active in a slight with the cuboid. If you look at the medial leg to swing forward. There is a short burst plantar flexion that causes the transverse face of a cuboid bone you will see that it of psoas activity at this moment as well, arch in the forefoot to lift and narrow. The falls in a diagonal line, and that it contains which was ideally set off by a stretch reflex whole movement can be viewed somewhat two articular surfaces, one for the navicular as the psoas was passively lengthened by like what we see in a toilet plunger that and one for the third cuneiform, which rest the extension of the hip in preparation for upon this diagonal support from the cuboid.

24 Structural Integration / June 2011 www.rolf.org C onsidering the Feet

In terms of the myofascial elements, there arch falls. By the same token, if we think of Flat Feet (Flat Shins) are many that contribute to the support of the longitudinal medial arch of the foot as an the three arches. Some of the best-known architectural arch, we will understand that In the flat foot, the main issue is in the are the spring ligament and the deltoid the keystone (the navicular) is able to stay stirrup muscles of the lower leg. Palpation ligament, which support the medial arch, at the apex of the arch exactly because of of the space between tibia and fibula will the flexor digitorum brevis and the plantar the downward movement of the calcaneus reveal that the tissue over the interosseous fascia, which act like bowstrings to the bow in the hindfoot and of the first and second membrane is in need of differentiation. of both of the longitudinal arches of the metatarsals in the forefoot. If the first and The plantar fascia, too, will be hardened, foot, and the tibialis posterior and peroneus second metatarsals become held – either although there is more of a tendency in longus, which act as “stirrups” underneath by coordinative habit or structural fixation this foot towards eversion. This is the the transverse arch of the mid-foot to – in a pattern of dorsiflexion, then the front classic example that Rolf describes of flat support and connect. When Dr. Rolf spoke pillar of the medial longitudinal arch gets feet coming from flat shins, and the most of the problem of flat feet really being “flat lost. This leads to valgus (pronation) of the important aspect of treatment is to get the shins,” she was speaking about these stirrup calcaneus, and collapse of the medial arch. stirrup muscles functioning again. muscles.12 When the tibialis posterior and the peroneus longus become incapacitated Three Variations on by an immobile interosseous membrane, the Theme of Less-than- caused by lack of appropriate motion Optimal Function through the foot, ankle, and leg, the arches For the purposes of this article, we will of the feet lose their right relationship. examine three patterns of less-than-optimal In the best of all possible worlds, function and discuss some tips for working when weight goes into the foot there with them. is differentiation and width across the 1. The flat foot – the one that has little arch transverse arch in the mid-foot, and in the or spring in either the lateral or the medial metatarsal arch as well. Each longitudinal arch. In weight-bearing we do not see the arch is able to maintain its function and diagonal line of collapse towards the inner has enough elasticity and spring to release arch – instead both arches are fully in contact towards the ground with loading. The with the ground. This is the foot that makes a lateral arch gets longer and makes contact footprint where the whole sole of the foot is with the ground – the cuboid, specifically, visible in the sand. In medical literature this resting more floorward. The lateral arch foot is not distinguished from the valgus foot stays in contact with the ground and the (the collapsing inner arch), but for the Rolfer, medial arch is also able to lengthen and it is worth making a distinction release its weight floorward, while still remaining on top of and supported by the 2. Varus – the high fixed arch. There are two lateral arch. The whole mid-tarsal region kinds of high fixed arches, one in which widens. The forefoot activates, supporting the immobility of the arch is the baseline the mid-and hindfoot. pattern, and another in which the high, rigid structure of the arches is a reaction to an The action of the transverse arch, both underlying pattern of collapse. (The latter in the mid-foot and in the forefoot, is an will be discussed in Part 2 of this article in essential part of the relationship between a subsequent issue.) The high fixed arch the longitudinal arches. When the mid-foot foot has a preference for the movement of is not able to widen, either the medial arch inversion. Both arches are rigid: the lateral collapses inward, pulling the lateral arch up arch is in contact with the ground, but the off the floor as it goes down, or the lateral medial arch does not release its weight arch holds the medial arch captive, not floorward. The footprint that this foot leaves allowing it to soften and lengthen. When the on the beach is one in which only the lateral forefoot is not able to activate, support for border of the foot and the toes appear. the rest of the foot is lost. The importance Figure 4: Flat shins. of the forefoot as support for the mid- and 3. Valgus – the collapsing arch. In this case, hindfoot can be understood if we use the when the foot is in weight-bearing mode, the When doing tissue work, concentrate on analogy of an architectural arch. In an weight falls in a diagonal line towards the getting the interosseous membrane to architectural arch the keystone – the stone inner arch, and as the weight falls into the “breathe” again and softening the plantar that sits in the middle of the arch itself – is inner arch, the outer arch loses its stabilizing fascia. Coordinative work is very important held in place by the balanced gravitational contact with the ground. This is the foot that as well to get the stirrup muscles working forces coming from the two lateral pillars has a strong preference for the movement of again. A good coordinative exercise for of the arch. If you remove the keystone, eversion. It is a soft elastic foot and generally this is to have the client stand on a step, the lateral pillars fall and, likewise, if you goes with valgus knees (‘X knees’). with his heels hanging off. He can hold remove one of the lateral pillars the whole one tennis ball between his medial malleoli and another between his knees (this helps

www.rolf.org Structural Integration / June 2011 25 C onsidering the Feet maintain the alignment of the joints of the of allowing movement to flow through leg as he works on waking up the stirrup the places that he tends to brace and hold muscles). He starts the exercise with his rigid. This addresses the coordinative, heels hanging down below the level of the proprioceptive component together with step and then rises up until all his weight the structural component. At the end of is on the balls of his feet. Then down, and the session, to take this a step further, you up again. When teaching this exercise, the can work with the client seated on the best results will be obtained if the Rolfer edge of the table: have him rock forward educates the client to pay attention to the in such a way that his weight falls into his overall alignment of his body. If help for feet, and use the loading of the feet to help balance is needed, the client can steady him feel the mobility that can occur in the himself with a hand on the wall. joints where his tendency is to not allow movement to occur. Remember that the client who has a preference for inversion often has the tendency to touch the ground with his foot but not to allow himself to be touched. Thus any work that helps him to feel with the sole of his foot, and notice the nuances of movement that are available, will be welcome. Often, the problem begins at an even more basic level – the client with an Figure 5: Exercise for developing the inversion-preference foot is often a client stirrup muscles. who has difficulty allowing the weight of his body to reach the ground. He holds Figures 7a and 7b: The collapsing arch. High Fixed Arches (Varus) himself up off the ground and braces in may prevent the first two metatarsals from the hip, knee, and ankle joints so that the When working with high fixed arches, a plantar-flexing. In the valgus foot, the need weight does not flow downward. This habit lot of soft-tissue and articular intervention to increase stability is a very big part of the is something that needs to be addressed is needed to soften the plantar fascia and conversation and this is an issue that has a throughout all interventions with the client. interosseous membrane and to mobilize large coordinative component. joints of the feet that may have become Paradoxically, there are a certain percentage When speaking of stability for the valgus fixated. This is frequently accompanied by of clients with high fixed arches who, once foot, there are two issues: one is the a coordinative pattern in which the client they allow weight to come down through relationship of the lateral and medial has become accustomed to using his foot the feet, will manifest collapsing arches. arches, and the other is about the stabilizing more like a hoof than like a foot. Once the In this case, the underlying pattern of the activity of the forefoot for the calcaneus. mobility of the joints of the feet and the collapsed arches will have to be addressed When the diaphragm of the forefoot is myofascial elements have been addressed, for the client to be able to stop holding working, there is support for the mid- and it may be necessary to spend some time himself up through his arches and be able hindfoot portion of the medial longitudinal helping the client to feel how his foot is now to find the ground. able to work and how to incorporate that arch. The capacity of the first two rays to into his daily movement patterns. The Collapsing Arch (Valgus) drop towards the floor creates the front end of this arch. When the first two rays lift up The client who has a collapsing arch is a off the floor, the arch falls, the calcaneum client whose foot has a preference for the rolls medially, and the mid-foot portion of elastic moment of the gait when the foot the medial arch collapses. Thus, although adjusts to the ground. In the mid- and it may seem counterintuitive, the problem hindfoot we find eversion, and in the behind many collapsing inner arches is forefoot a tendency for loss of support the incapacity of the first two rays to come from the first and second metatarsals. In the down towards the floor. client with valgus feet, tissue work needs to address the alignment of hip, knee, and Support for the medial arch also comes from ankle, with special attention being paid to the lateral arch. In Rolf’s words: “As we the adductors and their connection into the have observed, the inner arch rests on the pelvic floor – the classic “Fourth-Hour” outer arch. Contrary to the usual notion, it line work. is the latter that breaks down first, the inner Figure 6: High fixed arches. arch follows. Establishment of a normal In this foot type, which tends to be overly foot demands a secure establishment of the A very simple solution to this is to ask the flexible, attention needs to be paid to outer and lateral arch first.”13 client to do the movement of toes up and any eversion fixation in the subtalar or down while you are working with the sole midtarsal regions, or joint restrictions What is it, however, that securely establishes of his foot, and to help him to be conscious between cuneiforms and metatarsals that the lateral arch? Often it is a coordinative

26 Structural Integration / June 2011 www.rolf.org C onsidering the Feet issue, which involves the client learning Meditation for Stabilizing Note: All images in this article are by the author. to contact the ground with the lateral arch the Valgus Foot and maintain this contact as weight loads Endnotes This meditation is done standing. Start standing into the rest of the foot. It has to do with the 1. Kapandji, I. A., Physiology of the Joints: with one hand on the wall or some kind of relationship of medial to lateral arch and the Volume 2 Lower Limb. London: Churchill stabilizing surface. You are going to lift one foot capacity for the suction cup of the forefoot Livingstone-Elsevier, 1994 English edition. to activate while the transverse arch in the off the ground and notice what happens in the mid-foot widens. It also has to do with the supporting foot. What happens here will tend to 2. Author’s notes from a class with Hubert size of the neutral zone of the subtalar joint be what happens in the one-leg-stance portion Godard. of the gait, which either sets the stage for core and the joints between the third cuneiform 3. Kapandji, I.A., op. cit. and navicular with the cuboid. stability throughout the body or breaks it down. 4. Hamill, Joseph and Kathleen M Knutzen, The most important moment to notice is the The neutral zone of a joint is defined as the Bases Biomecânicas do Movimento Humano moment that the stabilizing foot prepares to range of movement near the joint’s neutral (translated from English by Lilia Breternitz receive all of the body’s weight. This is the position where minimal resistance is given Ribeiro). Sao Paulo: Editora Manole Ltda, increment of time before the other foot comes off by the osteoligamentous structures. Once 1999. movement of the joint takes it out of the the floor. What happens in the supporting foot neutral zone, the elastic zone is engaged. as you prepare to take the other one off the floor? 5. Private conversation with Hubert Godard. Do you feel a wobble? Do you see the tendons The elastic zone is the part of movement 6. Ibid. that goes from the end of the neutral zone on the anterior face of the ankle pop up? If you to the physiological limit of the joint.14 In have a valgus, collapsing foot, chances are that 7. Dananberg, H.J., “Lower back pain as the elastic zone the myofascial elements you will notice one or both of these phenomena. a gait-related repetitive motion injury.” In Vleeming, A., V. Mooney, T. Dorman, that come into play on the joint are engaged. Now, to play with the new option, start by C. Snijders, R. Stoeckart (eds.), Movement When there has been injury, degeneration, standing in such a way that you can feel the Stability and Low Back Pain. New York: or simply poor coordination patterns, the forefoot engage with the floor. This may mean Churchill Livingstone, 2001. neutral zone becomes too wide and the that you need to shift the weight of your upper joint becomes less stable. There is a longer body forward enough so that you can feel the 8. Hamill and Knutzen, op. cit. interval of time between the beginning of pad of each toe come alive as it takes its share 9. Private conversation with Hubert Godard. movement and the action of the stabilizing of the weight. Next, find the cuboid bone with structures around the joint. In the case of your awareness and notice how it, and the 10. Dananberg, op. cit. the foot, what this means is that as the foot whole lateral arch, rest floorward when you let 11. Ibid. prepares for loading, there is a wobble that the weight of your upper body come through it. destabilizes the foot and sets off a chain of 12. Rolf, Ida P., Rolfing: The Integration undesirable reactions throughout the rest With full engagement of both forefoot and of Human Structures, Santa Monica, CA: of the body. lateral arch with the floor, prepare to raise your Dennis-Landman, 1977, first edition, other foot, while maintaining this contact. The Chapter 4. This configuration needs to be addressed second you feel a wobble, stop, go back, and find at the coordinative level, by helping the your contact of lateral arch and forefoot once 13. Ibid. client, to establish a firm connection of again, until you can maintain the presence of the lateral arch with the floor and activate metatarsals and lateral arch while the medial 14. Lee, Diane, “An Integrated Model the forefoot. Once this support is in place, arch softens and drops. When this works, you of Joint Function and Its Clinical without losing that connection he allows will feel stable and solid in the whole foot as Application.” Paper presented at the Fourth the medial arch to receive the weight the other foot comes off the ground. You will Interdisciplinary World Congress on Low and release groundwards. The decisive probably also notice a sense of lifting and Back and Pelvic Pain, Montreal, Canada, moment comes when the lateral arch and lengthening that occurs through the whole body, November 2001. the first and second metatarsals are in which we Rolfers call “finding the ‘Line,’” and contact with the floor and the medial arch which happens as the major coordinative players prepares to release – this is the moment that of core stability come on line. A hand on the wall the stabilizing muscles need to engage a can lend support while you play with finding millisecond earlier so that the medial arch the stability of the foot. widens but does not collapse and the lateral arch maintains contact while the whole foot stabilizes. This new coordination needs to be taught to the client and then practiced on a regular basis until the client’s system has had time to own the new possibility and make it part of daily movement.

www.rolf.org Structural Integration / June 2011 27 C onsidering the Feet

working at the level of ligaments and joints. It also turns out that work at this level is Four Fundamental usually necessary to normalize structural displacements that occur within the larger segments of the body that Rolf was working Relationships in the Foot to balance, as depicted in the Little Boy Logo (Figure 2). And Why You Need to Work with the Ligaments of the Foot to Effect Change

By Michael J. Salveson, Advanced Rolfing® Instructor

ll Rolfers™ know that the feet are To do this we rely on the assumed plasticity A important for structural integrity. of connective tissue. Rolf told us we could Looking at the feet pictured here, you can change tissue with our hands and we have predict that there will be trouble above, at been doing it for fifty years. It is important the knee, pelvis, spine, thorax, and neck. to remember, however, that the laboratory You could even make inferences about evidence of the plasticity of connective the way in which structures above the feet tissue is sparse. Only recently, at the 2008 would be displaced based on how the feet research conference on connective tissue Figure 2: Little Boy Logo. are distorted. at Harvard Medical School has evidence been presented that connective tissue can For example, it is often difficult to get alter in ways and at speeds that we assume the pelvic segment horizontal or the we see in our practice. The osteopath John feet balanced without working on the Upldedger has made a good case for the relationships within the pelvis or within viscoelastic nature of connective-tissue the foot, i.e., torsions between the two ilia, membranes, which will allow for some sacrum, and lumbars or rotations between responsiveness and movement, but not of the talus and navicular, etc. To do this the degree that Rolfers regularly produce. requires working with ligaments, which We need more evidence here. together with the anatomical shape of the joint surface define the motion of the body’s Rolf taught us that the work of the basic Ten Figure 1: Disorganized feet. joints. (This article is too short to go further Series is designed to go only to a certain depth into the very interesting properties of motion All Rolfers also know that it is possible to in the body. Going deeper, into the complex that occur at this level in the body, and I change the structure of the feet so that they structures of ligaments around joints was, am hoping to expand on this discussion in distribute the weight coming down from she said, territory “where even angels fear another article in a future issue.) to tread.” She designed the basic series in above in a balanced way. Dr. Rolf taught us I can briefly say that normal motion of the how to do it by using our hands to alter the this way to protect the practitioner and client from the destabilizing and decompensating joints of the body depends on the ability structure and tonus of the connective tissue of any joint to move equally in all the that is holding the feet in an aberrant pattern. consequences that can result from careless release of deeper ligamentous structures. dimensions that the shape of the articular In the ten-session series that Rolf originally The goal of the basic series is to create a web surface of the joint and the associated taught and that forms the basis of the Rolf of organized tissue that reaches down to the ligaments allow. This will often involve Institute’s® basic training, the work in the deep fascia and its interface with the body’s mobilizing a joint and its associated second session on the feet is designed to bony surfaces. Organization at this level will ligaments in ways that are not possible release strictures in the compartments of provide a profound supportive matrix for using the voluntary musculature that the lower leg and the retinacula of the ankle deeper structures, which will mostly adapt controls the joint. For example, normal, that prevent full range of motion of the foot by releasing and mobilizing. voluntary motion of the knee joint is in plantar and dorsal flexion. Additionally, flexion and extension, with slight internal this work will allow for the relatively When Rolf created the advanced training, rotation of the femur on the tibia on independent motion of the tibia and she advertised it as training in taking the full extension. However, in releasing fibula across the interosseous membrane work of Rolfing Structural Integration to ligamentous restrictions that are inhibiting of the lower leg. Directly working in the a deeper level. The question, of course, is: normal motion of the knee joint, it is foot is focused primarily on the release of “What did she mean by a deeper level?” usually necessary to subtly shear the knee restrictions in the retinacula around the There is much to discuss here, which this joint in the transverse plane from lateral medial and lateral aspects of the malleoli, article is too short to contain. But, staying to medial or medial to lateral. This is a across the dorsal surface of the foot, and with the connective-tissue hypothesis, non-anatomical motion, meaning that the along the plantar surface of the foot. it is obvious that going deeper into the client cannot do this voluntarily. It can only connective-tissue system would involve be done by the application of an outside

28 Structural Integration / June 2011 www.rolf.org C onsidering the Feet force. It turns out that working at this level distribution when can also be very useful when balancing the talus rotates disorganized feet, such as we see in Figure even slightly. 1. With this in mind, I will discuss four Rolf emphasized fundamental joint relationships in the foot: the disorganizing tibial-talar, talo-navicular, talo-calcaneal, consequences of a and calcaneal-cuboid. fibula that has slid The basic “Recipe” works primarily with downward, which the talo-crural joint, also called the tibio- always happens in talar joint, where the tibia sits on top of a sprained ankle. and to the side of the talus, the site of As the fibula slips dorsal and plantar flexion of the foot. But, downward, it will the significance of the talus for normal also usually rotate function and structure in the foot goes far slightly posterior beyond flexion and extension at the ankle. and the tibia rotates The talus is the central structure in the foot slightly anterior, guiding the weight coming down from causing a twisting above appropriately onto the medial and on the talus. This Figure 4: Talus and calcaneus relationship lateral arches and the anterior and posterior is routinely corrected by Rolfers by putting (from The Body Moveable by David weight-bearing structures. It also has no an elbow or knuckle on the anterior surface Gorman (www.bodymoveable.com), used muscular and hence tendinous attachments, of the distal tibia with the client standing with permission). so it is not available for voluntary motion. and asking the client to bend at the knees, Its ligamentous structures are complex. while the Rolfer holds the distal tibia back The calcaneus is subject to significant against its tendency to move forward, thus Because the talus articulates with the tibia distortions coming from above via the taking some of the rotation out of the tibia above and with the fibula laterally via common gastrocnemius-soleus tendon, on the talus, which will take the talus with ligaments, it is important to notice that any and from the plantar fascia. What is most it, de-rotating the talus. torsion in the lower leg will displace the disorganizing, however, is abnormal talus, by twisting the tibia on the superior It is not possible to put your hand directly adduction or abduction of the calcaneus on and medial surface of the talus, which on the talus. It is buried deep in the foot, the talus. This is seen most easily from behind will significantly alter the way weight is between the distal ends of the tibia and fibula with the client standing. We have all seen distributed in the foot, forward to the toes and concealed behind the navicular bone it many times. The calcaneus can be either and backward and inferior to the calcaneus. in front. When Rolf emphasized releasing pulled medially and forward, such that it rolls and organizing the medial and lateral toward its lateral surface into supination, or retinacula, she was indirectly making the calcaneus can be pulled laterally, rolling space for the talus to normalize, toward its medial surface, which will give as the tibia and fibula are freed to the foot a tendency to move into pronation. separate from the talus, especially Much of the distortion in the calcaneus can in dorsal and plantar flexion. I use be relieved by organizing the connective- an additional technique designed to tissue pulls coming from the common release the ligaments linking the talus gastrocnemius tendon above and from the with the tibia and fibula. It involves plantar fascia in front. However, it is usually simultaneous compression of both necessary to release the ligaments holding the medial and lateral malleoli inward the calcaneus in its aberrant position at the toward the talus, while rocking the inferior surface of the talus. To do this, I hold lower leg along its longitudinal axis to the calcaneus in one hand and compress the initiate movement in the interosseous navicular toward the talus with the other membrane of the lower leg. hand. This will disengage the ligaments and The central role of the talus in create a momentary “neutral” position of normal motion of the foot is further the subtalar joint, which will initiate slight emphasized by its relationship with involuntary movement of the calcaneus on the calcaneus via the subtalar joint. the talus. We refer to this as “motility” or The calcaneus sits beneath the talus, “inherent motion.” This inherent motion will Figure 3: Weight distribution through talus which rides on the calcaneus much as a have a direction. By following the direction (from The Body Moveable by David saddle rides on the back of a horse (see of the motion and adding a well-timed Gorman (www.bodymoveable.com), used Figure 4). Again, Rolf’s prescription to impulse in the direction of normal, it is with permission). work the fascia on the medial and lateral possible to release the ligaments and restore sides of the calcaneus directly affects the normal motion to the joint. In Figure 3, imagine what happens relationship of the calcaneus to the talus. to the arrows representing weight

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foot and passively moving it into inversion and eversion and by observing the motion of the navicular and cuboid bones. I almost always find either the navicular or the cuboid restricted, and often both. I have not been able to mobilize restrictions of these significant bones in the foot without using techniques designed to work with the ligamentous matrix in which they are embedded. Knowing the nature of normal motion for any bony ligamentous complex will allow you to infer what needs to happen when normal motion is not present. Just restore normal motion. In the case of the Figure 5: Anatomy of the medial and lateral arches (obscure French anatomical text). navicular bone, I often find it stuck in a position that prevents the full range of Normal motion of the foot relies on a of the possibility of movement across this motion in inversion – meaning that the combination of inversion/eversion and joint space. In inversion, the navicular navicular does not move easily all the way pronation/supination. Normally, inversion moves inferior and medially on the talus down and medially through its range of and supination are linked and eversion and and the cuboid moves medially and rotates motion. Careful positioning of my fingers pronation are linked. It is useful to look at internally on the calcaneus. They move and compression of the navicular against these two motions separately because it together. This movement occurs across the the anterior surface of the talus will initiate reveals the importance of normal motion of transverse tarsal joint. The movements are inherent motion and I can then begin what the navicular bone on the anterior surface reversed in eversion. I call the “stuck drawer” technique. Like of the talus and the normal motion of the This means that restrictions of the navicular a stuck drawer that you cannot just pull cuboid bone on the anterior surface of at the anterior surface of the talus and straight out but have to jiggle, the bony the calcaneus. restrictions of the cuboid at the anterior and ligamentous elements of a stuck joint Remember that the foot has a very distinct surface of the calcaneus have significant will not usually release if you just pull on structural division between the medial consequences for normal motion in the foot. them. You have to compress the joint, wait longitudinal arch and the lateral longitudinal This can be easily observed by taking the for a hint of inherent motion, follow into the arch. As you can see from Figure 5, the direction you think it is pulling you, wait medial arch is formed by the navicular on again, look for a sense that the joint takes the anterior surface of the talus and the three a breath or sighs as it moves into a sort of cuneiform bones on the anterior surface of neutral position, and then coax, wiggle, and the navicular bone, with the first three toes push it home. off the cuneiforms. The lateral arch is formed This is the essence of working in the by the cuboid coming off the anterior surface ligamentous bed. The technique is the same of the calcaneus, with the lateral two toes for all joints and the ligamentous matrix in coming off the front of the cuboid. There which they are held. It has great advantages is much to discuss here but what I want compared to the high-velocity techniques to briefly emphasize in this article is the of other bodywork schools in that it works movement of the navicular and cuboid when directly with the tonus of the controlling the foot moves into inversion and eversion. ligaments. By tailoring our touch to these We will also make a distinction here between deep connective-tissue structures and the front of the foot and the back of the foot. working in a way that restores motion of the The front of the foot is anterior to the anterior joint through all its axes of motion, we restore surface of the talus and calcaneus. This is the neutral position of the joint, which will an important distinction as the anterior make for a more stable correction. Working surface of these two bones lies on the same with joints and ligaments in this way is also transverse axis. This is shown in Figure 6. consistent with our fundamental way of touching, which we learn when we are first There is a joint space formed by the anterior taught to restore order to the connective- surface of the talus with the posterior surface tissue matrix. Once one is intimate with this of the navicular and the anterior surface of Figure 6: Bony anatomy of the foot, aspect of structure it becomes second nature the calcaneus with the posterior surface showing Chopart’s junction (the transverse to modulate touch to include ligamentous of the cuboid that lies in the same frontal tarsal joint) anterior to the anterior surface restrictions that prevent normal motion plane. This is called Chopart’s junction or, of the talus and calcaneus (illustration of joints. more simply, the transverse tarsal joint. by John Lodge from Rolf’s Rolfing: The Inversion and eversion are possible because Integration of Human Structures).

30 Structural Integration / June 2011 www.rolf.org C onsidering the Feet

obvious consequences, and perhaps this Barefoot Walking Inspires pull from the calves could even cause neck tension and headaches. Healthier Shoe Choices By Karin Edwards Wagner, Certified Rolfer™

Author’s note: This article is based in part on the work of Dr. Ray McClanahan, DPM.

he advantages of barefoot walking of lifting the arch of the foot, but will tend T can teach us how to choose footwear to be lazy if there is a lack of appropriate that follows the body’s biomechanics. sensory information. When the tibialis A detailed look at foot biomechanics posterior is doing a poor job of raising guides the recommendations for the arch, it is often further weakened by Figure 1a: Nonminimal shoe choices. minimalistic footwear. wearing shoes with too much arch support. The arch is meant to be supported by The foot has twenty-six bones, and each of the foot’s bone structure, ligaments, and these bones should move separately when muscles (tibialis posterior and flexors you walk. For a hands-on experiment, hallucis and digitorum longus). When twist your foot to see how much motion the arch of the foot is not undermined by is possible. Now turn your shoe upside artificial arch support, it will be stronger down and twist it. Grab it at the heel with and more capable. A stiff arch support one hand, and just two inches toward the interferes with the natural pronation stage toe with the other hand, then twist. You of walking, when the medial arch of the are checking for torsional rigidity, a trend foot spreads and flattens. The peroneal in shoes that limits the ability of the tarsal muscles will still attempt to pronate the bones to move naturally. Shoes need to be Figure 1b: Minimal shoe choices. foot against this obstacle, which can cause flexible to allow your foot and ankle to adapt peroneal tendinitis and even IT band strain. to the ground. Most shoes that are flexible Athletic shoes can set runners up for plantar Your foot will be allowed to regulate its own will also be lightweight, which allows fascia pain. In one case, an athlete had arch support when you choose shoes with natural hip and leg motion. run many marathons and even a 100-mile minimal arch support. race, and wore athletic shoes daily with no As you walk, your brain seeks proprioceptive The next step in following foot biomechanics problem. However, spending just one day information from the ground. When is to seek a shoe with a completely neutral barefoot at a water park triggered severe, footwear is too cushioned or supportive, heel. Most athletic shoes, sports sandals, lasting plantar fascia pain. The tissue had those sensations will be dulled and you will and even “flat” dress shoes have a half-inch been overstretched by normal motion after subconsciously strike the ground harder. heel. (Look at Figure 1a to see examples being held short for so long. The typical This causes damaging weight load in the of nonminimal shoes, and Figure 1b to podiatric recommendation is to avoid knee, increasing the risk for osteoarthritis. see examples of minimal shoes.) Even a being barefoot, but that answer is only a A scientific study (see references) shows small heel contributes to tight calves and makeshift solution. A better healing plan increased joint shock when wearing over- hamstrings and increased heel strike. would be to calm and free the tibial/plantar supportive sneakers or stiff clogs but A “negative heel” is also not neutral, nerve (between the gastrocnemius heads significantly less when barefoot or in flip- and I have not heard a scientifically- and along the inner ankle), to lengthen the flops. When walking barefoot, these heavy based argument for why it would be an calf muscles and fascia, and to transition to steps are punishing, so you quickly adjust improvement over nature’s design for the neutral footwear to support full calf length. your gait. For this reason, it’s essential to heel. Exercising in an athletic shoe causes feel the ground through your shoes. As athletes transition to reduced heels and the calf to be strengthened in a limited then neutral heels, proper stretching is There is a second reason why this is range of motion. Outside the gym, muscles necessary to avoid injury. Stretching should important. Sensory feedback from your shorten if your daily footwear has a raised occur after calf exercise that fully warms the feet is essential for the correct firing of heel. When the calf is short, the Achilles muscle tissue. Stretch the calf by dropping motor nerves. The nervous system demands tendon is vulnerable to tears instead of the heel off the edge of a curb. Start slowly, quite a bit of sensory data to guide its being strong and resilient. Shortened feeling for the first place of resistance, and motor commands: the neural bandwidth calves limit ankle freedom, and also pause for ten to twenty seconds to let that for sensory data is about five times more impact the rest of the body. Since there is resistance ease. Sink deeper and look for than for motor data. Your brain wants to a continuous line of fascia from the bottom the next resistance. Once in the full stretch, sense your environment before deciding of the foot up the back of the body to the hold the position for sixty seconds or more. how to move, so it can make adjustments forehead, it makes sense that short calves This measured approach to stretching accordingly. One example of this is the could contribute to many problems. Tight will prevent injury and support the calf in tibialis posterior muscle, which does the job hamstrings and lower back trouble are adjusting to shoes with a neutral sole.

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A neutral sole will also be flat through the to be wide at the end of the toes. Narrow the natural position, the big toe helps limit toes. In the past decade, athletic shoes toe boxes cause bunions, neuromas, and pronation to an appropriate level. commonly feature a 15 degree upward distorted toes. Watch out for a toe box that Poor-fitting sandals or flip-flops can also slant, called toespring. Toespring was narrows too quickly. Athletic shoes are contribute to deformed toes. Footwear added to facilitate the rolling action of the commonly wide at the ball of the toes but needs to stay on your feet without having to foot, but our legs naturally perform this narrow at the tips of the toes. If you remove use your toes. Common culprits can include motion without changing shoe shape. If the the insole and stand on it, check whether flip-flops, clogs, Crocs®, and Birkenstock© shoe is flexible, toespring can be reversed your toes go over the edges of the insole. shoes. Over the years, gripping or lifting by bending the shoe in the other direction Avoid sandal straps that cross the toes and your toes will contribute to hammertoes, for a half hour. Toespring may contribute pull the toes inward. Narrow toe boxes are a claw toes, and squished-together toes. to deformed toes because it holds the toes sneaky contributor to overpronation. If the Choose a version with a heel strap, or with in a lifted position. Toespring also limits big toe is pushed toward the other toes, the a design that stays on easily as you walk. the ability of the flexors and extensors of foot is more likely to overpronate. Try it by Examples would be a Birkenstock or a Croc the toes to work properly. holding your big toe in toward your other with a strap behind the ankle, or Mary Jane toes, and then out away from your toes, and Your toes will enjoy having a foot-shaped style dress shoes. attempt to collapse into your medial arch. In toe box, which means the toe box needs Indigenous peoples who have been barefoot since childhood show us how to walk and run correctly. Allow your foot to stay on Bringing This to Our Practices the ground longer, rolling through the toes, then swing your leg forward only to the point where it is just a little in front of your ® I use this information in my Rolfing Structural Integration practice to educate clients body. (Contrast this to reaching the foot about their shoe choices. Feel free to pass out this article to your clients (or use the far in front of the body, striking the heel, short client-friendly two-page version entitled “Healthy Shoe Choices” on my website and pulling the rest of the body forward.) This new stride will be shorter but with a www.portlandrolfer.com/index_Workshops.html) so they can make educated faster cadence. Each step will feel lighter, decisions when purchasing shoes. Besides working with individual clients, I also minimizing both impact and effort. Keep teach a ninety-minute class on healthy footwear that I call a “Shoe Clinic.” This is the feet fairly close to your midline, in line a hands-on lesson in evaluating shoes and even modifying them to optimize foot with your center of gravity. This prevents health. I ask people to bring an assortment of their shoes (one shoe per pair is side-to-side rocking, for reduced impact and improved balance. fine). The shoes are a great visual aid as we go through the various points in this article. People leave the clinic motivated and clear on how to improve their foot Say you’ve found shoes that are wide at the end of the toes, but when you take out the health through their daily shoe choices. My target audience for this class is young insole and stand on it, your big toe or little people with healthy feet who want to stay active their entire lives. toe still extends past the edge. Your toebox needs a little more room. You can re-lace Then, for clients making the transition to minimal shoes, I find the following Rolfing the shoe, skipping the first pair of eyelets, work very helpful. to allow more room at the toes. You can try to stretch the leather in specific places, • Freeing the calves – including gentle work to free the tibial nerve deep between using a tool such as the blunt end of a pen. the heads of the gastrocnemius and at the inner ankle – will help the calves If the toebox is spacious but your toes are still be able to operate at their full length, instead of the shortened position when inactive, you can wake them up by wearing wearing athletic shoes with a raised heel. The result should be improved talar toe socks, which have a separate pocket glide, easier hip extension, and less effort in walking. for each toe, like a glove. This stimulation will increase sensory information coming • Sculpt the metatarsals into their natural transverse-arch shape. Some Rolfers from your toes and help you learn to use do this using both hands, the fingers creating the shape by pushing into the them. Injini® brand (www.injinji.com) has bottom of the foot. I find it easier to put the knee up, foot flat on the table with longer toes, neutral colors, and wicking fibers appropriate for sports. Sock Dreams a racquetball ball under the transverse arch. Then both of my hands are free, (www.sockdreams.com) has many styles and I can even use my elbow if needed. for women, with shorter toes and fun colors. Of their products, Feelmax anklets have an • Awaken the toes with detailed work to help each toe find its own role. Simply excellent fit for average-sized women. Toe having the sensory input from your work will help the toes operate independently. shoes by Vibram Five Fingers® are available • Look closely at clients’ shoes and socks. Perform “fascial release” on the toe online and at REI. The original four models (Classic, Sprint, KSO, and Flow) are built seam of tight socks, and teach clients to do it. Encourage them to cut, stretch, with extra-long toes, while the newer and otherwise modify their shoes to fit their feet and optimize their foot function. models fit people with average toe length.

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Men’s and women’s designations simply indicate a slight difference in width. Why I Got Foot Surgery New shoe purchases need not be expensive. Just keep these principles in mind as you shop, and you will find many minimalistic Hallux Rigidus and Functional Hallux Limitus shoes for $80 or less. Look first for shoes By Robert McWilliams, Certified Advanced Rolfer™, that have a reasonable toe box and a neutral Rolf Movement® Practitioner heel. Pick up each of these shoes, turn them over, and twist specifically at the tarsal- bone area to check for flexibility. If they pass the twist test, pull out the insole (if Introduction not glued in), which allows you to see how In this article, I describe hallux rigidus and the shoe is constructed and whether it can functional hallux limitus from a clinical be worn without the insole for increased perspective, as well as from my own sensory feedback and toebox room. (Doing experience with the condition, and my these tests, you are spared trying on shoes recent surgery and postoperative regimen that may seem initially comfortable but for recovery. My wish is to educate work against your biomechanics.) Then, practitioners so that they can potentially try on final candidates for fit and comfort. recognize budding symptoms in clients and You don’t need to throw away any of your address underlying conditions and causes, perhaps preventing the full onset of this shoes, just put some of them in the back of Rob McWilliams dancing with the Murray debilitating condition. your closet, and be reasonable about when Louis Dance Company (photo by Fritz Lehrer). you wear them. If you have healthy feet, you Pre-surgery Notes may wish to use non-minimalistic shoes Hallux rigidus is actually a form for specific activities. Examples include: From Figures 1a and 1b, the boney deformity of degenerative arthritis. . . . Many tall heels for tango, salsa, or flamenco; and limit to my left foot’s range of motion patients confuse hallux rigidus with hiking boots for extreme mountaineering, (ROM) are apparent. The bunion (hallux a bunion, which affects the same especially using crampons for ice; work valgus) is sizeable on the right foot (Figure joint, but they are very different boots for climbing ladders, using a shovel, 1a), but it gives me no pain in any direction conditions requiring different or other dangerous tasks; rock climbing of motion. On the left foot, Figure 1b treatment. Because hallux rigidus shoes, which pinch the toes; and ski shows that I was unable to hinge in big-toe is a progressive condition, the toe’s boots, which closely resemble an ankle extension at my first metatarsal-phalangeal motion decreases as time goes on. In cast. For people who love these activities, (MTP) joint on that side. X-rays revealed it to its earlier stage, when motion of the it is even more important that the rest be a hallux rigidus condition, an obstruction big toe is only somewhat limited, the of your shoe wardrobe is minimalistic. in the joint caused by spur growth limiting condition is called “hallux limitus.” Bring a lightweight shoe to change into toe extension. Note that the shape of the But as the problem advances, the immediately after the activity, or go bone spur reaches upwards, not sideways toe’s range of motion gradually barefoot if possible. Spread your toes and like the bunion on the right foot. This is one decreases until it potentially reaches stretch your calves to restore full motion to of the key identifiers of the condition, as well the end stage of “rigidus,” in which your legs and feet. as ROM testing showing the restrictedness the big toe becomes stiff, or what is in extension, as in my case. sometimes called a “frozen joint.” Please contact me at 503-230-0087, or see my website www.portlandrolfer.com for more The Medical Perspective Common causes . . . are faulty information, including a link to a thirteen-page function (biomechanics) and list of recommended shoe brands and styles with According to the website of the American 1 structural abnormalities of the foot photos, as well as links to scientific studies on College of Foot and Ankle Surgeons: feet and shoes. References Lieberman, Daniel, et. al., “Foot Strike Patterns and Collision Forces in Habitually Barefoot Versus Shod Runners.” Nature, November 2009. Shakoor, Najia and Joel Block, “Walking Barefoot Decreases Loading on Lower Extremity Joints in Knee Osteoarthritis.” Arthritis & Rheumatism, Sept 2006. Figure1a: Right foot – no pain. Figure b: Left foot – pain, extension restriction in big-toe, swelling.

www.rolf.org Structural Integration / June 2011 33 C onsidering the Feet that can lead to osteoarthritis in the at the MTP joint: cevical flexion; limited Analysis from big toe joint. This type of arthritis ipsilateral shoulder mobility and hip a Full-Body Perspective . . . often develops in people who extension; overuse of ipsilateral iliopsoas have defects that change the way and contralateral quadratus lumborum and By the time I finally went to see a doctor their foot and big toe functions. For gluteus maximus/iliotibial band complex. about this, I was assessed at about 5 example, those with fallen arches or I think of this as using these structures to degrees of passive motion in the joint, excessive pronation . . . of the ankles haul the other leg, absent the normal pivot and in pain with simple walking for short are susceptible to developing hallux over the MTP joint of the affected leg. distances. Kapandji shows normal passive rigidus. In some people, hallux bending in the joint as about 90 degrees, This use pattern sets up a lack of appropriate 3 rigidus runs in the family and is a for comparison. The pain and decreased balance of forces for normal sacroiliac joint result of inheriting a foot type that is ROM was due to a substantial boney spur closure that, over time, can be a cause of prone to developing this condition. on the left first metatarsal and a smaller low-back pain. Sacral nutation is necessary In other cases, it is associated with one at the first phalange of the great toe. for the appropriate force-closure of the overuse – especially among people X-rays also showed practically zero space sacroiliac joint (SI) joint, and Dananberg engaged in activities or jobs that at the MTP joint, implying a practically total shows that in FHL, lack of ipsilateral hip increase the stress on the big toe, lack of cartilage. The podiatrist gave four extension and the inability to close the such as workers who often have options: doing nothing, and dealing with angle between the posterior thigh and the to stoop or squat. Hallux rigidus the worsening of pain and stiffness; getting ipsilateral ischial tuberosity in the toe-off can also result from an injury, such a fusion surgery (installing an appliance to part of gait also creates excessive tension as stubbing your toe. Or it may be fuse the joint); getting revision surgery that in the ipsilateral biceps femoris. This caused by inflammatory diseases would have left me with a “nubbin” big in turn causes holding in the ipsilateral such as rheumatoid arthritis toe; or getting a Cheilectomy, a procedure sacrotuberous ligament, blocking sacral or gout. . . . to remove the boney spur, hopefully nutation on that side. giving me several years of improved ROM. Early signs and symptoms include: This description describes my current, In order for this last strategy to work, I • Pain and stiffness in the big toe post-operative gait very well! Elements of would be required to go though painful during use that pattern, especially contralateral QL rehabilitation work, and my lack of cartilage meant that there would likely be some pain • Pain and stiffness aggravated by tightness, have long been present, if masked in the joint. I opted for the Cheilectomy, in cold, damp weather by other factors in my movement. I got the surgery because I felt that my “world the hope that I could train the rest of my • Difficulty with certain activities of activity” was shrinking alarmingly body to adapt, holistically and fluidly, to (running, squatting) quickly: no more walks or hikes, and the changes. • Swelling and inflammation always needing to plan around a sore foot. I believe that my hallux limitus, and around the joint As a former professional dancer, I actually later hallux rigidus, condition arose as a had a fair amount of skill in dancing As the disorder gets more serious, combination of an initial turf-toe injury around this deformity, but even that was additional symptoms may develop, (intense squatting dorsaflexion with full getting more and more limited, with the including: weight into the toe hinge) that was never pain, and limitation on motion worsening. able to heal properly due to heavy repetitive • Pain, even during rest Concern over long-term problems with SI use as a long-time professional dancer. In • Difficulty wearing shoes because joint instability, potential back problems, addition to this direct source of irritation bone spurs . . . develop and a desire to better embody and model to the MTP joint, I feel that my use patterns structural integration (SI) for clients and were further complicated by a bad hip injury • Dull pain in the hip, knee, or dance students were some of the factors early in my career: on stage at City Center lower back due to changes in the that led me to get the surgery. Theater in New York City, I apparently way you walk Dananberg’s position is that this functional popped the head of the femur fully out of • Limping (in severe cases) condition cannot be treated by exercises the socket (and immediately back in!) with a low-pitched, loud noise, different from Recommendations for treatments alone, using the example of treating visual “cracking” sounds that one might normally range from painkillers, orthotics and disturbances with eyeglasses. It might experience. (For quite some time afterwards, shoe modifications, steroid injections, be interesting to elicit studies testing the I was unable to fully lift that leg to the side ultrasound, to surgery. efficacy of SI treatments – including but not limited to work on cervical spine, shoulder in a turned-out position. I just figured out Most of the symptoms listed above can be girdle, quadratus lumborum, iliopsoas, how to lift it using increased anteversion mimicked by a functional hallux limitus biceps femoris, interosseous membrane in the hip, but with more medial rotation (FHL) condition. This dysfunctional use and deep into the MTP joint ligamentous in the thigh. That improved in a relatively subverts many normal gait patterns that bed – to see if hands-on work coupled with short time. It helped that I was twenty-two.) I support healthy alignment, although Rolf Movement’s sensory, perceptual, and believe that this led to a strain in the anterior there is no apparent obstruction in passive coordinative work, and appropriate gait ligaments (which help to hold the pelvis in 2 toe-extension ROM testing. Dananberg concepts, could help correct this. a functional degree of anterior tilt) and a shows the compensations in gait that flow seemingly permanent laxity there, which from the lack of normal sagittal motion appears to have caused me to unconsciously

34 Structural Integration / June 2011 www.rolf.org C onsidering the Feet posteriorly tilt my pelvis through that side of toe extension with me in a totally the investigation of fuller foot motion and more than the other. This put even more unconscious state. This is approximately coordination through Rolf Movement work strain into the toes and forefoot in many five times the ROM I had there before the and other forms, such as Chi Walking.6 The frequently performed dance movements surgery, though far short of the normative latter is a technique that de-emphasizes that involved rising on the toes and forceful 90 degrees in passive bending. It should, the toeing-off gesture in favor of a well- deep squats. however, hopefully improve my walking supported forward lean at the ankle, gait enough for more normal activities, like allowing transverse-plane rotation of the The Surgery and Aftercare hiking, and walking with my clients. shoulders and hips, while de-emphasizing sagittal plane rotation of hip, and of I decided to try visualization work with the Psychobiological Musings toe to begin a process of “re-membering” the foot (and ankle) over the MTP joint. the foot even before surgery. Basically, At this writing, I am about ten weeks along Though not allowing the fully upright this involved imagined movement into a in my recovery, and it feels slow. I can report spiraling undulation movement through fabulously free toe hinge, accompanied that weight-bearing stretching in the joint the spine/pelvis sagitally and coronally by micromovement through the bones of is just now becoming tolerable – which is that is considered a hallmark of Ohlgren the feet in all directions. I also decided, in a huge improvement, even compared to and Clark’s Natural Walking,7 Chi Walking advance, to use all painkillers offered, as my condition pre-surgery. Emotionally, does potentially activate the “smart spring” studies show that this seems to improve I have had to come to grips with the fact necessary for SI-joint force-closure (referred recovery.4 I was supposedly going to be that, because I have very little cartilage in to in Vleeming and Stoeckart’s discussion conscious during the procedure; it was done my MTP joint, I may never really have a of gait in a broader article on lumbopelvic with a nerve-block injection plus Versa, a full pain-free gait again, let alone be able to stability8). In any case, I know that in mood altering narcotic that was supposed return to a higher-demand use in dance. I teaching dance, demonstrating movements to only relax me, but seemed to put me realize that my sense of calling as a dancer, may prove difficult sometimes. I trust right to sleep. In the first five days of post- teacher, and choreographer intensifies my ability to adapt, in movement, while operative recovery, I experienced flu-like this for me, though it perhaps does not adjusting performance expectations shivering, which felt to me like a trauma make me unique in this world of avid according to the healing and adaptability release. I used pain meds for the first three skiers, runners, and others with physically in my left MTP joint. days, mainly to help me sleep in a position demanding, and often injurious, pastimes. The long-term results from the procedure that allowed the substantial postoperative My preference for dance forms that used a are not to be seen for at least six months swelling to drain (supine, knees and feet lot of thrust through the toes (modern dance afterwards, according to my surgeon. Not raised on pillows). and contemporary ballet) certainly played all of the “word on the street” is good, into my situation. I imagine that someone As time went on, limping with weight as evidenced anecdotally by Internet very involved with post-modern dance (as 9 only going through the heel gradually postings. Because I do not have the same represented by the likes of Trisha Brown or progressed into more and more normal condition on the other foot, I should not Yvonne Rainier), contact improvisation, or motion through the foot in gait. After require surgery there, and I believe this is African dance could also incur a turf to-type about three weeks, notable swelling was because my condition was caused by use injury that could cause this, as opposed to still there, though a lot less, and I could get patterns and as a result of injuries, rather minimal risk for someone whose passion into soft slip-on shoes. Physical therapy than being an inherited, bilateral issue. is, say, ballroom dance. self-care treatments as instructed by my Endnotes physician have me working to deeply From a philosophical perspective, two stretch and distract the joint, working at things seem to have been the root causes of 1. See www.foothealthfacts.org/ the ligamentous and joint capsular level.5 my long-term MTP joint damage: the basic footankleinfo/hallux-rigidus.htm. (Like treatments received from a Rolfer objectification of my body as a Kunstfigur 2. Dananberg, H.J., “Gait style as an etiology before I got the surgery had given me a at the service of dance as an art form, and to lower back pain” in Vleeming, A., V. glimpse of the added freedom in my hip, a general “tough-it-out attitude” common Mooney, and R. Stoekhart (eds) Movement, spine, and ankle obtained from freeing the to gainfully employed yet financially poor Stability and Lumbopelvic Pain, 2nd Edition, MTP joint by even a very small amount. professional dancers. If I could, I would do New York: Churchill Livingstone-Elsevier, Unfortunately, it was clear to me at the over my earlier approach to this, and other 2007, pg. 253; and Dannenberg, H.J., “Lower time that the boney block to normal motion dance injuries. I can still hope to find ways back pain as a gait-related repetitive was too great for these treatments to suffice to help people in similar circumstances motion injury” in Vleeming, A, V. Mooney, without surgery.) I continue to perform make better, healthier choices. I believe that T. Dorman, C. Snijders, and R. Stoeckart these prescribed “distract and stretch” better and earlier treatments of my turf-toe (eds) Movement Stability and Low Back Pain, exercises on an “as tolerated” basis, as they and hip injuries – rest, manual therapy, New York: Churchill Livingstone, 1997, are pretty painful. The podiatrist told me rehabilitation, and muscle repatterning pp. 253-267. that this was to prevent the stiffening of scar (especially in regards to pelvic tilt) – would tissue in the ligaments and joint capsules. probably have prevented the degree of 3. Kapandji, I.A., The Physiology of the I can now allow more and more weight tissue damage, bone spur formation, and Joints: Volume Two, Lower Limb. New York: through the joint, hopefully moving into a arthritis at my left MTP joint. Churchill Livingstone, 2005, pg, 196. fully normal gait pattern. The postoperative My main goal now is to be able to enjoy 4. Møiniche, Steen, Henrik Kehlet, and Jørgen X-ray shows my MTP joint capable, when walking and hiking again, and continuing Berg Dahl, “A Qualitative and Quantitative manipulated by the doctor, of 30 degrees

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Systematic Review of Preemptive Analgesia 6. See www.chiwalking.com for info on perspective on pelvic stability.” In A. for Postoperative Pain Relief, The Role of classes, workshops, books and more. Vleeming, V. Mooney, and R. Stoekhart Timing of Analgesia.” Anesthesiology, March (eds), Movement, Stability and Lumbopelvic 7. Ohlgren, Gael and David Clark, “Natural 2002, vol. 96, issue 3, pp. 725. Pain, 2nd edition. New York: Churchill Walking,” Rolf Lines, March 1995, Vol. XXIII, Livingstone-Elsevier, 2007, pp. 131-134. 5. Conversation with my podiatrist, no. 1. referencing “Foot Care” handout from 9. http://workoutmommy.com/2010/05/20/ 8. Vleeming, A. and R. Stoeckart, “The Kaiser Permanente. hallux-rigidus-your-questions-answered. role of the pelvic girdle in coupling the spine and the legs: a clinical-anatomical

person and find inside the neck of the same individual strong motion restrictions of the Widening Our View facets of the whole cervical spine. And then he would say, “What the hell am I doing when I mobilize the cervical spine – the of the Fascial Net cause of that motion restriction seems to be visceral.” That was the starting point. There The Significance of Visceral were certainly other people who worked on organs before, he has always stated and Cranial Work for SI that very clearly. For example, the famous doctor Ludwig Schmidt in Germany was a By Certified Advanced Rolfers™ Peter Schwind, Allan Kaplan, pioneer like Ida Rolf in the 1930s – he was Anne Hoff, and Certified Rolfer Gabriela Arnaud teaching what he called “gymnastics for organs,” which was a sort of modified yoga. Editor’s Note: The following dialogue took place in Seattle in October 2010 when Advanced Rolfing® But somebody like Barral had to come who Structural Integration (SI) instructor Peter Schwind was on his way to Mexico to teach his fascial had this tremendous capacity for practical and membrane technique curriculum at Haramara Retreat Center for the Barral Institute, assisted research, going so deeply into the system by Gabriela Arnaud. that he could make it into something that is simply not comparable any more to what the others tried to do. Anne Hoff: I notice that Rolfers who have until people became aware that visceral done visceral work for a long time and are work is more than a technique, that it is I want to go back to your question of why teaching it have a form of it that fits in the a meaningful concept for various schools visceral work found its way into Rolfing [SI] Rolfing paradigm. Except for you, Peter, I of bodywork. and actually stimulated something while don’t get a sense that people are doing that cranial remained cranial. I started cranial AH: Was there any visceral work back in with cranial. It seems like there are Rolfers work before I knew there was cranial work. the original days of osteopathy? teaching cranial, but they are teaching When I was a very young Rolfer – after [standard] cranial rather than a form of PS: Definitely. When you look at the one year – I treated a person who had an cranial work seen through the Rolfing lens. first class that Sutherland taught you see accident. I tried everything, and was not manipulation of the liver, mobilization successful. Then I put my hands on the Peter Schwind: I think that happened of the kidney, and there were certainly frontal bone and I realized that one half probably out of the fact that the original healers in Europe who did that. But it seemed to come up and down after a while visceral approach was already pretty close never went to this level of sophistication but not the other side. I fiddled around a to what Rolfers have been doing anyway and general application to the complexity little and the other side also came up, and – we have been treating viscera without of the whole organ system that Barral then the person said his headache was knowing it. I can tell you a funny little found. The roots of it were pretty much gone. That was for me sensing something story that will tell you what I mean. When that Barral was working in a hospital where like cranial motion. Then I heard about I first had my first contact with the visceral many [patients] were from the French cranial work in 1980, Upledger had just modality as Jean-Pierre Barral developed colonies and were suffering from very founded the Upledger Institute [and I it, and I was with one of my friends who severe diseases, and quite a few would immediately contacted him and organized studied osteopathy in the U.S. way back die pretty quickly. Because Barral worked a sequence of classes in Munich]. I was in Kirksville, he told me “that stuff fits closely with the dean of the hospital, who fascinated by that work, but I never gave much more in what you are doing; I’m just was a fanatic about doing dissections, they up Ida Rolf`s traditional “Seventh Hour,” shifting around bones, what the hell am I did a lot of dissections of fresh cadavers, [which I came to think had] a potential going to do with all those organs?” That and Barral was able to recognize that what to evolve: a hidden dimension to it, more was his impression and there’s a little bit he palpated as articular restriction was than what we understood from Ida and the of truth in it. You should not forget that embedded within a context of visceral teachers of the first generation. And then Barral ran into a tremendous resistance in strain. He would see the signs of heavy later, much later, when I realized that some the osteopathic community when he started tuberculosis in the right lung of the dead European osteopaths started to use a much visceral manipulation, it took quite a while

36 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work more intense touch in cranial work, that a little, and possibly inadvertently have moves. The machine is so good we can watch encouraged me to go further, far away from moved the kidney. [Visceral and cranial the individual fibers of the psoas and see if Sutherland’s and Upledger’s concepts and work are] dealing with those parts of the there’s a spasm of a subgroup of psoas fibers see in which direction the original work, fascial net that we weren’t really aware of and how we affect that. I’ve just taught a two- Ida’s seventh hour, will guide us. or taught about – it’s just the other end of day course in how to use the ultrasound to the whole body of knowledge that you can’t observe what we do with the psoas. As important as visceral work seems to be fit into the training. Back when Ida was for me, my fascination for cranial work has AK: I remember back in the late 80s around, she knew about cranial and visceral become almost an obsession during the last Emmett Hutchins telling me – we must work, but it wasn’t her forte. thirty-two years. What excites me the most have been doing a Fifth Hour – “if you is how the cranial system is not separate PS: In the old days we would have tried to feel this, that’s the root of the mesentery; from the fascial system, the cavities inside solve that situation of your client by working before we knew what that was, we used the body, and the visceral system, how it on the psoas, and sometimes we were to try to ‘Rolf’ it away.” It’s the influence of actually interacts with those systems and successful and sometimes not. I know from visceral manipulation – if nothing else – to how the fascial system plays the role of a practical research – using ultrasound – that give a picture of what’s going on inside the mediation between all those systems. most of the time when we try to work on the abdomen or thorax. As I was taught, we were psoas we had an effect on the kidneys but not dealing more with the outside of people. But Allan Kaplan: There’s been a discussion on the psoas – especially when I think about if the strain is going through the abdomen, for years of what is the place of visceral, the techniques from the old days where the it’s going through the abdominal structures what is the place of cranial, what is the place client would sit on the bench and as [he which are the suspensory structures of the of Rolfing [SI], how do you incorporate leaned] forward you went way in – where organs, so you have deal with that stuff. It’s it into your practice, when do you know Ida would say “think horizontals and lift like the organs are the handles or a lever when to use this or that. For me it’s not a up.” Hopefully our fingers were underneath to deal with things – like the cranial work. question, because the perspective I come the kidney and not on the kidney and we That’s what that osteopath told me in that from is that it’s all fascia. It’s a continuum. would mobilize the kidney. I remember one session – “it’s like you get a long lever, I could If you talk to the cranial osteopaths (the of my first teachers saying “whenever you do work it down there, but I can work it up here French tradition and Canadians), they are the psoas the vitality goes up” – but it’s not and often get a better result.” talking about fascia, whether it’s visceral the muscle that came to life, it’s the kidneys or cranial. I think the big problem is we are PS: He was not treating the cranial system that came to motion. isolating them as three separate entities as as a separate unit from the rest of the opposed to saying “we are talking about the The great thing is that many times during body, he was using it as an entrance into fascial system that involves the organs and the old days we had little understanding of everything that is present, working from the fascial system that revolves around the that what we did, but quite often we arrived there to connect into other systems that are cranium.” One of my biggest awakenings – intuitively – at great results. That was such not part of the cranial system but related in terms of cranial work was when I first a great inspiration that I got from these to it. went to a cranial osteopath. I was saying guys in America, a practical inspiration, as AK: Exactly. He told me about a seminar my lumbars or knee or something was I came more from an intellectual European with a bunch of osteopaths – some were bothering me, and he did his thing and then background. Once I got in contact with the direct students of Sutherland. He said with went to my head and was working on my French osteopaths, it was interesting not some patients the long-time students of knee or lumbars from my head. I said “what to kick out what we Rolfers were doing, Sutherland couldn’t resolve the problem, are you doing?” and he said “I can feel the like the “Fifth Hour” or the psoas work, and when he looked at it, it was a very connection [through many places] and I’m but to say “How could we do Rolfing simple visceral problem. My question was dealing with the whole strain pattern.” He [SI] differently, more efficiently?” Certain “How could this person who is so good at wasn’t just doing cranial work on my head things we don’t do anymore, but quite a cranial not be able to treat that thing?” He with the sutures and making sure the bones few things we may have to continue while said, “It just wasn’t within the paradigm” were free, he was dealing with the entire looking at it differently. For example, I’m still – it just didn’t even register. It’s as though pattern. And that’s [what we do in Rolfing investigating how the psoas interacts with if you are listening to an orchestra and all SI] at its most sophisticated. Think of it as, the kidney, how does a psoas spasm act in you ever hear are violins, you don’t even “we have the fascia of the body: what’s the relationship to a kidney that is in external notice the trumpet over there. best way to get to what we want to get to?” rotation and ptosis; how does the psoas interact with the kidney, and how does the PS: I like that! – We only see what we I had a client last week whose chair had kidney interact with the connective-tissue know to look for. I remember one dissection collapsed in a meeting and her back was campsites in the retroperitoneal space and course where I asked a very experienced killing her. When she hit the ground her with the fat? Personally, I benefit because professor of anatomy – who had been doing left kidney kept on going and ptosed and I share an office with an internist and we dissections for twenty-six years – how to find was pulling into her lumbars. I mobilized have an excellent ultrasound. So if I diagnose the suspensory ligaments of the lungs, and the kidney, and that was 80% of the trauma a motion restriction of the kidney, we do he looked at me and said “Are there any? right there. Then I did some back work an ultrasound and can see on the screen I have never seen them.” He doubted that and this that and the other. If I’d gone at it whether my diagnosis was right, and we do there are suspensory ligaments of the lungs.. through the traditional Rolfing way, I would a manipulation and see whether it moves, But we had four cadavers, and we found have done a lot of stuff out on the surface, and whether four, eight weeks later it still the ligaments, it wasn’t that easy but we and gone in and maybe worked in her belly

www.rolf.org Structural Integration / June 2011 37 I oncorp rating Visceral Work found them. And he realized that his way of the speed of how we try to use things coming dimensional perspective, are units that are looking at that region of the neck and upper [from outside]. In my view, visceral and cavities into cavities into cavities, and their thorax was prescribed through a certain cranial and movement work are certainly inner subdivisions. So there are cavities tradition where you wouldn’t look for that, the main modalities that add to our original and there’s a container around them, and so he didn’t even know they existed. In the work without leaving the field of it. the container is mostly the muscle fascia, German-language literature about anatomy the bones act as spanners as Ida Rolf said. AH: Peter, I took a class with you in Santa Fe there is only one book, from Switzerland, in the early 90s where you taught what you For a long time we treated only the where this anatomical unit is mentioned. called the “drum technique,” which seemed container, mainly muscle fascia. When AH: The way you are talking about this to work with strain patterns in the thorax you look at certain traditions of osteopathy it’s a whole fascial system, visceral fascia, but didn’t name specific organs. I’m curious you see that they treat the contents, they cranial fascia, musculoskeletal fascia not how much can we accomplish in the visceral look at one unit and see how it moves in being different things. It seems obvious that layer with a general picture if our touch relationship to the other. But on both sides as Rolfers that would be part of our territory. and sensitivity are precise, and how much there is something missing, because there we need the precision of understanding must be something like the maintenance AK: We preach that there’s a fascial the visceral anatomy, inspir/expir of the of human form, not just of movement continuum through the body but we limit individual organs, things like that. and function but also of form. If there how far that goes. The truth is that it goes weren’t form and inner shape, one evening through the body. PS: The drum technique was a very the liver would be on the right side and simplistic first approach for me to go Gabriela Arnaud: What’s really another evening on the left side, or inside especially in the inner depth of the thorax, interesting for me about how Peter works the buttocks. I think that the human body because I knew that Ida Rolf had stated is the relationship between the container doesn’t manifest in straight lines – you can that she always felt like something would and the contents. For me what is interesting relate it to a line, but there are no straight pull her down inside the thorax behind the in Rolfing is [that] the fascia is all over, I’m lines in the body. It’s all curvatures, cavities sternum. When I looked at photos of her, I dealing with the whole human being, I’m and curvatures. always felt people did great work with her not closed to anything. The fact that Ida but nobody knew really how to go inside For me the most interesting thing to say Rolf didn’t have the time or the clarity or the thorax and release its inner dimensions. is “How does the container, which is the whatever to pass it on doesn’t mean that she So the drum technique was a very naïve muscle fascia, relate to the contents? And didn’t take it into account, that she didn’t feel – efficient up to a certain degree – first how does the membrane system on the it. For me [Rolfing SI] is the widest door to approach to get inside: subtle compression, inner walls of those cavities build a bridge body therapy. These things – cranial work, support from behind, compression from between the container and the contents? visceral work –make my work richer, I can the front or the side, modification of the And how do I find those important areas help more people because I can listen to different directions, getting releases in of transition where one container meets the more things, I have to listen to the system as there. My interest was not to reproduce other container? – like the peritoneal meets a whole. I like the concept of the tensions of what I had already learned from Barral the subperitoneal, and the peritoneal meets the inside – how much should I work with about the organs, I was trying to work with the retroperitoneal, and the peritoneal meets the viscera that the outside can adapt to that. the inner walls of that drum and the inner the endothoracic, and the endothoracic goes AH: Would the Rolf Institute® faculty like to subdivisions – what I call nowadays the in the pipe of the neck goes into that cavity bring more of this into the trainings? inner shape of the thorax. Those two Santa of the head. What is extremely important to Fe workshops were a starting point to say investigate is that at those areas of transition PS: We are starting a dialogue. I think there must be more than anatomy, because we find key points where we are able all of us are aware that we need to widen anatomy helps only to localize certain through touch to treat the container and our perspective a lot. We are sometimes layers. Anatomy is very important to know, the contents at the same time. That’s very concerned about the identity of our own especially anatomy of the living body, to different both from traditional osteopathy discipline, because the discipline itself may recognize where we are with our hands, and traditional Rolfing work. We try by be enriched by other methods, techniques, but anatomy does not teach us what to do, minimalizing our approach in a very precise and perspectives, but it does not grow per that’s a big illusion. Anatomy is important way to treat the container and the contents se through that enrichment. Some of us are just for the topographical orientation. at once. really aware that there is another step that is also important, not only putting more and AK: “The map is not the territory.” At the level of the spine, that means that more tools in our bags, but that we must we don’t need to get lost in the individual PS: Exactly. What started in Santa Fe understand what it means for our method fixation or rotation or translation of a was a very stimulating investigation. We if we put this tool in our bag, what is the few bones; it means that we are treating had this very simplistic block model at impact it has on the basic and advanced curvatures instead of joints. So we treat the beginning, and I think behind it there concepts of our method. There are two larger units but in a very precise way. That was a true question of what are the most dangers: one is blind orthodoxy, and the means we are looking at how one cavity of significant components of shape that make other is just copying whatever is up, then the body meets the next cavity of the body. the organism – and that’s not anatomical everything seems to be structural integration Why is it still Rolfing [SI]? – Because it’s units, it’s not the muscle starting here or – I can do plastic surgery, energetic massage related to gravity. Just as we look at cavity this and that. These components of shape, at a distance from the body, cold laser, to cavity, we look at the curvatures in the when we put it down to a very simple three- anything. I’m sometimes not so sure about back, we have a bunch of kyphosis and

38 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work a bunch of lordosis there. My experience are connected to all the other subsystems something else. A good osteopath leaves the tells me that quite frequently if we try [to in the body at the same time. So while we system the way that it is, and will only go to make] those transitions from one curve are working in one place, and might feel the most significant restriction and trust that into the next curve more fluent (instead of some opening there, we will not be able to with the minimum of stimulus the organism throwing everybody into more extension feel the whole body at the same time, but will repair itself up through the level that is and making them longer and straighter, what we should try to feel is how the main necessary. That’s a beautiful concept, and it’s or reducing spinal curve), if we just focus restrictions of that body, that shape and very, very efficient when it’s done precisely. on the transition between one curve and individual pattern of strain, how those react However, it is a therapy of the status quo. It another, we get very stable results. to what we are doing in that local place; we is fantastic to get the person who is totally sense whether those restrictions close down stuck in certain inner dimensions out of this When I talk about shape, the body is more or open up a little bit more. Then being stuck, but it does not necessarily mean composed of bags into bags into bags, we can modify what we do locally in that that there is any personal evolution. And this and I have to recognize the innermost ligamentous strain between the calcaneous is the big challenge of the Rolfing concept. construction of the most important spacious and talus in a way that they open more [Putting aside the] naïve development of the containers and how they wobble on each and more. human potential movement of the 1960s – other. The peritoneum is like a fluid-filled which was a funny combination when you synthetic bag that balances on another bag AH: So what you are saying is very much think that Ida’s early ideas were in the 30s, which is the subperitoneal space, and then like what Allan described the osteopath and in the 60s we tried to be opposite to the there’s the retroperitoneal, and they have doing, except he was using the head to reach 30s, politically – aside from this illusionary a micro-capacity of motion up and down. through, but you are saying you could just as aspect of trying to create a better human If one slides, for example if the peritoneal easily be at the foot and work through that. being, there are a few grams of truth that slides down as a whole bag in a relationship PS: I agree, however we go far away from we should not lose, which have nothing to to the whole retroperitoneal space (where the true area of conflict, like sneaking into do with the desire to create a better human you have the psoas and kidney) and gets the system, and talk to these very few being but have a lot to do with the desire stuck there, and you cannot make it slide critical places. to create more inner freedom – and that’s up again, you can do whatever you like something different from helping somebody for the individual restrictions inside of the AH: Peter, you said it doesn’t matter where to be able to raise his right arm again after container, or you can work for ten sessions you start. One thing I wonder about is with it was stuck with a frozen shoulder for two on the outside container, but you will never certain clients, is a certain doorway “better”? years. For me, a good practitioner should arrive at a true improvement. That’s my PS: I think that if you want to have an be able to deliver both, or at least offer both, very personal statement about the shape of impact, you need a handle. There are people be able to help [the client] use the shoulder the body and how to do Rolfing [SI] out of who have absolutely no visceral restriction again and still offer to the organism a few this. How does this sound to you? and if you start to work there you have items that offer a little bit more of freedom AK: Having done several of your classes, I simply zero results. When I said before you in expressiveness, movement, emotion, like the idea, and it’s part of the continuum. can start wherever you like, that’s not the whatever. That’s of course a very big project Even if you have restrictions between full truth. You can start wherever, if there is a that we have to be very careful with. organs within the bag, you can work on manifestation of the strain. And you might use GA: For me, that’s what’s different, that’s the bag for a long time and if you don’t deal that strain far away from the larger strain the inspiration that made me study this. I with the restriction you aren’t going to be as an entrance. There are some people who think that’s the difference between Rolfing able to change the shape of the bag. you might just touch related to the viscera, [SI] and other methods. If you get the and there’s a beautiful door, and if you don’t PS: If you come from the right angle, and shoulder free in one session in osteopathy, walk through that door you won’t get any you talk to the inside of the bag and the that’s it, but you don’t see the development result at all. Or there are some other people outside of the bag, you may be sometimes of the client. [Rolfing work] is a chance to where the cranium has been nailed together lucky that that very specific fixation of the feel different. Why else would someone go like a coconut for fifty years and you can do organ will let go. to a Rolfer? I work in Mexico City . . . whatever you do but if you don’t go to this AK: That brings us full circle back to [the specific layer of fixations there will be no PS: . . . She’s the only Rolfer in all Mexico . . . question of] what is the best way to enter results. But even this person, if you find a GA: . . . [I’ve had a client] tell me it’s the the body, whether through this system or true restriction, even in a ridiculous detail, first time he’s been touched like that, just that system or that one. And is there one like let’s say in the right cuboid, there is from me putting my hands on his back. best way – it depends on the person, it a chance that if you talk from the cuboid That’s worth it, when I doubt what I’m depends on the strain. . . . fixation to the coconut head and you get doing, whether I’m really helping people, it somewhat to open, and then you work PS: I have a very provocative answer for when I encounter this kind of “thank you” diagonally from the right foot to the left that. I would say you can enter it from in a deeper sense. It’s not that [the client’s] side of the cranium all the way through. wherever – as long as while you work at knee doesn’t hurt anymore, it’s something We need a handle. the entrance point, touching one system healing inside. But how do you talk about (for example, a boney articulation and its What’s funny about the Rolfing approach why do people go to Rolfing sessions? related ligaments, like between the talus that’s certainly different from any good AH: Maybe that’s back to what you said and calcaneous in the foot), you talk to that osteopathic approach is that aside from the about process. Maybe part of why we hold connection, those units, in a way that you most significant restriction, we want to do to the ten-session model is not just because

www.rolf.org Structural Integration / June 2011 39 I oncorp rating Visceral Work of its formality as a model but because and respecting the fact, to quote Hans Flury, AH: Already so many Rolfers in their the ten sessions allow us a process, which that every human structure is individual. individual practices are doing their own potentially allows something to happen The aim is to find the best solution for that interpretation. The question is how much that does not happen necessarily if you are, one individual structure in the field of room do we have to keep a cohesiveness say, just trying to fix somebody’s shoulder. gravity that has a certain amount of ease but also allow an evolution to incorporate and balance between all the subsystems, things that Ida Rolf didn’t have time herself AK: One thing with “fixing,” say you are whether the lymphatic system, the arteries, to develop and incorporate, to bring in other dealing with someone’s knee, there’s a the nerves, the membranes, the organs, the people’s mastery. We have a lot of brilliant difference between just concentrating on fascial containers of the muscles. To use that people in our community. the knee and that’s the session and looking fascial system as the mediation between at the knee in the context of the entire body. PS: It’s very interesting, this question these systems so that they all work together That’s the Rolfing approach to dealing with of how much we can open ourselves. I in a better way. We want to teach people to an injury. You might make the knee feel remember one of my teachers in the field treat the organism as an orchestra, not as better,and you instill a lift or integration to of psychotherapy, before I became a Rolfer, single voices or single instruments. the body. I think it’s important for people said: “A therapy is a contract between two who don’t buy into the idea of Rolfing first For me the fascination has never stopped people and nobody from outside has the aid to consider that approach, because that’s about this project. I am still – after twenty- right to intervene in it, otherwise you can’t where it’s really effective. three years – a student of Barral, and I teach master the psychotherapeutic situation.” some of my stuff for his club, and I have so For me that’s true, if somebody is certified PS: Like some of us I do two completely much respect for his mode of working. But as a Rolfer, they can do what they like to do different things in my practice. I have a I am as well interested in another concept. If in their office, they do their best from their straightforward Rolfing practice, that of I would name that concept it has to do with perspective. The problem arises as soon as course uses other things I have learned, the fact that on a very modest level I want to you have an organization and you are a but the people come for a sequence of give my very personal interpretation of Ida’s teacher, you have a responsibility not only treatments, many for ten, sometimes it’s thought. Barral told me one day, “of course for what you like to do and think you are only seven or eight; for post-ten [work], Ida was very good, but nobody knows what good at, but you also have a responsibility usually three maximum. And aside from she was doing, we only got interpretations for the concept, otherwise the concept that I have a practice of what you could of that” – that’s a great statement. gets lost. call manual medicine, where doctors send people with very specific issues. For me it is really two very different things. I do manual medicine with very limited intervention for a certain problem, and that sometimes works quite well, and sometimes it doesn’t The Culture of the Viscera work, where people need more all-over By Liz Gaggini, M.A., Certified Advanced Rolfer™ treatment to have a stable result, and then I ask them to come for Rolfing sessions. I do Author’s Note: This article assumes a basic knowledge of the relationships of viscera to structure these two different things, and I teach these and structure to viscera. If you would like to learn more about that, see the Appendix “Why and two different things. When I teach for the How the Viscera Affect Structure” at the end of this article. Munich Group and for the Barral Institute, I teach my personal approach to manual medicine – which is strongly influenced by orking with the viscera requires that barriers between muscle groups, and osteopathy and other disciplines, but mostly W we develop our kinesthetic abilities the connective-tissue bags that wrap techniques I developed myself that come to sense a more complex arrangement individual muscles. out of thirty-two years of practice. I think of textures, densities, and movements. • Kinesthetically we have become Rolfers can benefit, but it’s not necessarily a Understanding the tissue qualities completely familiar with the gradual part of Rolfing [SI], it just makes your Rolfing of visceral anatomy can help us. The changes in density and elasticity as we work more effective if people have very fundamental materials and organizing feel from the insertion to the body of heavy symptoms which can’t be resolved principles of these tissues are the same as a muscle. Our touch can discriminate with traditional Rolfing sessions. In Rolfing those of the myofascial tissues we know as between bone, ligament, tendon, spindle, sessions I of course [will include these other Rolfers. Yet the tissues of the myofascial and sheath. techniques] but the goal is really to treat the system are exponentially more homogenous overall fascial and membrane system. than the tissues of the visceral system. • We can kinesthetically sense adaptability between muscle compartments, and see I just announced an advanced Rolfing Let’s look at what we have come to adaptability in muscle lengths and the training together with Christoph Sommer understand and be able to sense about range of motion in joints. in Europe for 2012. The theme of this class tissue quality from working with the is: “what does alignment mean for the myofascial system. • We can trace with our hands and see with container and the contents?” – alignment our eyes long lines of connective tissues • There are many layers of connective tissue in the sense that a human being can be that connect and define the shape and wrapping and compartmentalization upright not using permanent control or alignment of the major sections of the from superficial fascia, septum struggling, but somehow settling down – extrinsic structure.

40 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work The Qualities of the Visceral Tissue S cope of Practice Let’s look at how the visceral body is composed and arranged. There are many When working with the viscera it is important that we keep our goals and techniques organs with many different shapes, within the structural integration (SI) scope of practice. In SI we use fascial densities, and functions all packed together manipulation, movement education, and awareness to achieve improvements in inside compartments that are all different somatic alignment, function, and presence. These improvements can lend to, but as well. Some of the compartments are hard, some soft; some are adaptable and not guarantee, a better quality of life. some hardly adaptable at all. Inside of the compartments, the organs are rubbing Our work is with those elements that give shape and function to the architecture against one another, folding over and of the body, the connective-tissue matrix, and the nervous system. Visceral work, around one another, and accepting and though it often utilizes indirect assessments and treatment techniques, remains a adapting to the passage of various materials and fluids necessary for life’s processes. The work with, to, and for the connective-tissue matrix and autonomic nervous system. compartments are held close to one another and close to the boney and muscular People often ask if work with the viscera can help with physiological illnesses. If surfaces of the structural body. Some the physiological problem is caused, in whole or in part, by fascial restrictions, organs can be found tightly attached to then visceral work might help. Any promise beyond that is beyond our scope of compartmental walls and some are floating free of such attachments. practice. As most standard and complementary medicine is biochemical and/or energetic, structural improvement can be a vital contribution There are tubular passageways, functioning as both conduits and support structures that interconnect all of the organs and compartments. Sometimes these tubes • And we can feel with our hands and see There are some qualities in visceral tissue are firmer than the organs they connect with our eyes areas of ease and tension. that make it a little simpler, relative to the and sometimes softer. Some organs join Over time we come to know, or at least myofascial system, to identify and assess: together into systems and subsystems to suspect, which of these places of ease and • Much of the visceral tissue, both of the handle various physiological functions. tension are beneficial and which are not. organs and their attachments to the The compartments separate these There are kinesthetic challenges when structure, is highly elastic allowing functions from one another and the tubular approaching the viscera: for more adaptability and movement. conduits connect them in precise and However, there is an important purposeful ways. • There are many abrupt changes in the characteristic we see in the visceral core, textures, densities, and adaptabilities of Visceral Culture more so than with the extrinsic body: any the tissues. So we cannot be looking for organ will still itself to match another We can understand much about the organic homogeneity. organ, particularly if it is in the same qualities of the visceral body by studying • For the most part we get little assistance vicinity as or in the same system with the its structure and function in words and from our sense of sight. primarily restricted organ. Some bodies images. However, working with the viscera we are trying to assess have multiple can teach us about the deeper culture • In many cases there are boney or visceral dysfunctions. In these bodies organizing these tissues and systems. muscular structures extrinsic to the the expression of visceral adaptability Over time, the visceral body can show the viscera that we need to feel through can be seriously diminished. receptive and polite tourist how to interact or around. with its culture if that tourist wants to • Many organs feel distinctly different • The viscera are also layered and become a welcome agent of change. In the from one another. For instance, it is much intertwined so that we often need to manner in which the organs are arranged, easier to tell the liver from the stomach, feel through one organ to sense another. and in the composition of the various even where they cross one another, than tissues throughout the visceral region, we it is to tell one adductor from another. • The organ tissues are far more fragile can begin to know the primary tenets of this than myofascial tissues. To find and • Any part of the extrinsic structure that culture. This culture has come about by the assess them we are have to change the is near to an organ or its primary or process of evolution selecting out the most pressure and pointedness of our touch. secondary attachment sites will become sustaining designs and arrangements and • The visceral system is more autonomically firm and protective if that organ has occasionally making a fortuitous mistake. innervated than the myofascial system. lost its normal adaptability. This can Two qualities seem to be fundamental to This requires us to be selective, as help us know where to expect a loss of this culture. First, a precise and unrelenting well, with the speed and amount of adaptability in the viscera.1 discrimination has to be primary and our probing. sacrosanct for the organs of the viscera to contain their different tissues and perform their different functions while residing so

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capacity for motion will mean a change in the overall health of the body. Because the body honors the needs of the viscera as primary, the extrinsic body will not place demands for motion on distressed organs. Liver Spleen Integration Gall Bladder Stomach Integration is the harmonious working Colon together of distinct parts. Integration is an ongoing give and take between Small Intestine discrimination and harmony. With

Appendix structural integration we are used to balancing the capacities and needs of one Bladder part of the body with the capacities and needs of another. This is also what needs to happen if we are going to attempt to Figure 1: Visceral body anterior. transform the visceral tissues. We have to take into consideration the needs and close to one another. Then, in order for all Harmony capacities of all of the parts in transforming the different components and processes any one of them. Without that type of care to occur in these compact spaces and There are many different functions striving we may get a random freedom but we will still sustain life, an ongoing harmony of to happen within the visceral cavities. not assist with integration. the whole must rise above the needs or There are bags that can fill and empty by capacities of any one part. respiration, peristalsis, blood circulation, Working with and consumption. All of the organs are in Discrimination continual production of vital substances Discrimination and Harmony that need to be transported and arrive on The organs discriminate themselves from The challenge in working with the viscera time. At the same time, the organs need one another by distinct differences in their is to honor the fundamental capacity and to allow the movements of the extrinsic tissues. To maintain these distinctions in need of each organ for discrimination and structure to shift them around. Many close quarters, the fascia that externally harmony. One reason this is so important organs are involved in tightly orchestrated wraps each organ prevents adhesion to is that if we do not work within these physiological processes that need to other structures. Effectively, the boundary limitations, we are more likely to create have the steps occur in the appropriate of each organ is saying to the other, “don’t distress and disease. Another reason is that sequence to adequately handle the body’s become me.” The stomach can lie next to we can accomplish more transformation nourishment and cleansing. If any one the spleen for a lifetime and never become and integration for the organ, the viscera, organ would perform inappropriately for adhered. The tubes of the small intestine and the entire body if we work these the situation, illness and even death could entwine with one another and within and primary tenets. occur. This cohabitation and sequencing around the tubes of the colon and remain requires that a guiding harmony be Basic Guidelines free. The flexures of the colon come up maintained throughout the visceral core. behind the liver on the right and stomach • Get to know each organ. Learn where on the left and never adhere. The harmony of the visceral core is regulated it begins and where it ends, where it is by a vast number of neurological and attached and how it moves. These boundaries can be violated with biochemical factors. A primary mechanism injury and illness. The organs can become • Don’t mistake one organ for another. This by which the status of any part of the viscera adhered to one another by the introduction may sound obvious, but when it comes is communicated to the whole is mobility. of a binding connective tissue, i.e. blood to hand placement, etc., it can take some When an organ is not able to function well from internal bleeding or from blood spills care to not mistake a rectum for a uterus (whatever the causal agent), there will be a during surgery. Prolonged inflammation or a transverse colon from a stomach and change in its capacity for motion. Peristalsis can also cause a proliferation of binding so on. can slow with constipation or speed up with connective tissue between organs. If an poisoning. The liver can become sluggish • Don’t assess just one part of a system or organ is inflamed for some time, gossamer with cirrhosis and toxicity. The kidneys one organ in a “neighborhood.” Before fibers of connective tissue can attach can become sluggish with injury or over- you create change, understand the needs between it and the other organs in constant activated by imbalances in the blood. No for change in the entire system and contact with it. Blood adhesions are like matter the cause, when an organ becomes neighboring organs. thick scars or wads that lie between the more or less mobile it has an effect on the organs they are adhering. Adhesions from • Include in your work, or at least stay organs (and the extrinsic structure) near inflammation are not as profound but still in touch as much of the entire organ as to it and within the same system as it: serve to create immobility between two possible. Don’t break the organ apart those neighbors and family members will organs that once were able to freely slide with your touch or with your intention. respond, and their capacity for motion by one another. You don’t have to be physically in contact will change as well. These changes in the with all of an organ to be in touch

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with its entirety. With referential touch Liz Gaggini is a Certified Advanced Rolfer the visceral ligaments, which allows the (sometimes called “end feel”), we can who practices in New York. She teaches viscera to move with the myofascial and create a kinesthetic field that has great a series of basic and advanced classes on bony structure without injury or inhibition. acuity in sensing what is beyond our her own approach to visceral work. She When there is a restriction in an area of physical touch. also teaches a series of basic and advanced the visceral fascia, it will interfere with classes in biomechanics. Information on her that area’s capacity to move with the body. • Use the long-tide motion of an organ to classes can be found at her website www. Any forced movement through the visceral assess and to treat whenever possible. ConnectiveTissue.com. Her previous articles on restriction could injure or greatly inhibit the Long-tide assessments give information visceral work and other subjects can be found function of the viscera. It is rarely the case about the whole organ while keeping online at the Ida P. Rolf Library of Structural that the body will allow the viscera to be it discriminated from its neighboring Integration (www.pedroprado.com.br) and at affected in this way. Instead, the body will organs. Long-tide inductions have more www.ConnectiveTissue.com. inhibit the myofascial and bony structure integrative potency and potential than to protect the viscera. do mid-tide inductions.2 Endnotes The body will go even further in its • The Rule of Percentages: when we get 1. For a more thorough discussion of the protection of the viscera. It will actively a certain percentage of change for one interaction of the extrinsic structure and use the structure to create ease and assist part of a system, we should try to get the viscera, see the following articles by Liz with the function of a restricted organ. One same amount of change for the rest of Gaggini: “Including the Viscera in the common instance of this active use of the the parts of that system within the same Work of Rolfing,” Rolf Lines, Winter 2000 structure for the benefit of the viscera is seen session. The time available for work will (vol. XXVIII, no. 1); “Visceral Manipulation when there is tremendous restriction in the determine how much transformation in Structural Work,” The 2005 Yearbook of stomach. The myofascial and bony structure we attempt in any one part. It will be Structural Integration, published by the will bend and twist to put the stomach into more harmonic for the body if we get International Association of Structural a position that creates ease for the stomach 30% improvement throughout a system Integrators; and “Visceral Patterns in tissue and creates an optimum position for or neighborhood than if we get 100% Scoliosis,” Structural Integration: The Journal the stomach’s function. It is a hierarchy in improvement in just one organ. ® of the Rolf Institute , September 2008 (vol. the effort for survival – stomach function is • The Rule of Feathering: If you do get 36, no. 4). more important than joint alignment. a good deal of change in a part of a 2. For further information on long-tide As structural practitioners who work to system or neighborhood, you can make techniques, see Liz Gaggini’s article, align the myofascial and bony structure, we it more acceptable to the body if you get “Advanced Indirect Techniques” are often frustrated when all of our good diminishing amounts of change out from available on the Articles page at work to resolve the sidebends and rotations that one part. That is, don’t open up one www.ConnectiveTissue.com. or to create support and transmission seems spot and leave it sitting next to totally of no avail. In these cases, we are often unaddressed tissue. Appendix: Why and How the working against the survival hierarchy. • When releasing parts of a system, work Until visceral problems are resolved, with the expelling end of the system Viscera Affect Structure structural changes will not hold. first. If you are not going to be able to There are two very significant ways in which modulate your percentages of change, the viscera affect the structure. One is that try to make the greatest percentage of the body will shape itself, even to the point change at the expelling end. of misalignment and restricted movement, to protect and assist an internal organ. It is • Always work with both organs of a as if the body honors visceral ease first and bilateral pair or bilaterally balancing pair. structural wellness second. Secondly, the For example, if you work with one kidney, viscera reside in the center of the body. Any In Memoriam work with the other; if you work with the restrictions in visceral fascia are directly stomach, work with the liver also. Structural Integration: The Journal of the transferred to the myofascial and body Rolf Institute® notes the passing of the • Begin with, end with, and utilize structures of the torso. This is especially following members of our community whenever appropriate whole-body true of the pelvic, respiratory, and thoracic (in alphabetical order): assessments. Whole-body assessments diaphragms. The brain is also a visceral include holding on to the feet and sensing organ. The relationship of restrictions in Richard Hoska, Certified Rolfer™ through the body, diaphragm holds, the intracranial fascia to the structure of Nina McIntosh, Certified Rolfer and walking assessments, fold tests, etc. the cranium has the same local and global author of The Educated Heart: Professional consequences for the structure. The major • If you have used a technique to assess Boundaries for Massage Therapists, diaphragm of the cranium is the fascia a dysfunction, always do the same Bodyworkers, and Movement Teachers. associated with the sphenobasilar junction. assessment again after you addressed that dysfunction. . This is truly the only way we The organs are designed to cooperate with ever learn to work in any way, with any the body’s needs for alignment, balance, type of tissue, in any part of the body. and movement. In general, there is a high elastic component to the visceral fascia and

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responses, or there can also be a remaining Pelvic Organization and protective pattern of avoiding any tonus of the surrounding musculature and fascia in order to inhibit further responses of the organs, muscles, and tissue and in Psoas Function as residual scars. It seems to me that many imbalances in the Influenced by Inflammation body are caused by remaining patterns of functio laesa, where body and often psyche are stuck in the stage of an inflammation and Pregnancy or trauma reaction and have somehow not come to the full end of the healing cycle. By Dorit Schatz, Certified Advanced Rolfer™, Thus body and soul have not come to the ® Rolf Movement Practitioner realization of the fact that it is over. If we have a look at the effects on the surrounding tissues, we find that n this article I want to facilitate an all of them leading to swelling, redness inflammations have a tendency to travel Ienhanced awareness of major and heat. along certain routes. Different bodies physiological conditions the body goes • Pain coming from inflamed nerve seem to have different preferences. For through that highly influence the internal endings. some it will mostly be the lymphatic and external organisation of pelvic structure travel-paths, including interstitial liquids; and psoas function. Some of the bony and • Functio laesa, meaning inhibited function for some, the nerves or blood vessels; for functional dysfunctions are protective of the organ / muscle / tissue to ensure some, the ligaments, and for others the patterns associated with organs ranging the healing process. muscular fascia. from kidneys to the ovaries and the • Accumulation of inflammation cells. prostate. These patterns allow for better Glands normally will have a lymphatic activation, but the prostate, for example, organ function. If eliminated without first • Activation and genesis of richly often causes direct co-inflammations of the helping the inner tissues, this will cause capillarized reparative tissues. an inflammatory episode of a chronic ligaments from sacrum to prostate/urethra • Proliferation of fibroblasts leading to scar inflammation or malfunction of the organ. If (the male equivalent to the sacrouterine tissue. treated with respect and care for all tissues, ligaments). Inflammations of the intestines or tubes / ovaries, spermatic ducts / we can help the body to come to a higher • Sometimes necrosis, if all reparative prostate, and even bladder have a tendency level of reorganisation and recuperation of skills of the body fail. its own healing properties. to be stronger on one side of the body There are different courses an inflammation than the other. The inflammation will first The Case of Inflammation can take: cause an activation and shortening of the ligament. Thus a co-inflammation of these Inflammation can be caused by microbes Acute: the inflammation goes through all ligaments will cause an inner pull on the (such as bacteria, virus, fungus, etc), typical stages and heals mostly completely sacroiliac joint that leads to a block of physical trauma, and overuse of tissue. (restitutio ad integrum). movement there. The sacrum will deviate All of us have undergone intestinal Subacute: the presence of an inflammation from its normal position, and all muscles inflammations; many of us have had does not become as clear, the bodily of the area will have to form stabilization infections of the bladder, kidney, ovary, responses are often not strong enough to chains to counterbalance. Due to the inner spermatic duct, prostate, and others that completely heal, persistent defects occur. swelling of the tissue in the whole area and directly influence the organization of the the increased circulation, there will be a dull pelvic ligaments and musculature crossing Chronic: not completely healing, pain in the lower back. Figure 1 shows the the pelvis and thus the spatial arrangement reoccurring episodes, persistent defects uterine ligaments. of the pelvic bones. Many of us have gone may get stronger with each episode. through inflammatory processes caused by With a chronic inflammation the body Subsequent: other tissues get overused physical trauma of various origins. can come to the other extreme of reaction: by trying to bridge joints that are lacking repressing all nerve information coming All of these inflammations have typical normal motion and function of tissues in a from an area and deactivating the local stages with typical physical reactions to functio laesa-state or after necrosis. ligaments and structures to stop the them: Typical persistent defects are, among constant alarm. A reactivation through • Acute exudation phase: increased others: ongoing chronic inflammations, Rolfing® Structural Integration and Rolf circulation in the area of microcirculation, with swelling, heat, pain; and adhesions Movement® work thus might reawaken change of the permeability of the in the surrounding tissues, which cause an old pain or cause an episode of a blood vessels, leakage of the exudate, irritation and pain. These irritations trigger chronic infection. Both have to be seen as emigration and transmigration of uncoordinated muscular activity, fascial opportunities for healing. In case of the inflammation cells to the area of lesion, strain patterns, and exaggerated muscular chronic infection, the body might finally

44 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work have the power to heal, or the person can Figure 2). It can either be stuck in hyper- other ligamentous and muscular balances see a health practitioner who treats the or hypotonus. It can also be completely of the pelvis. disease. Reorganizing the area through deactivated, generally on one side more fourth-, fifth-, and sixth-session work from than the other. Delicately applied psoas The Influence of Pregnancy the Rolfing Ten Series might help bring the work can considerably help a kidney that Another example I want to roughly organ to a spatially more healthy position, is in trouble. As we all know, when a psoas sketch out is changes due to pregnancy. where the body’s own properties of healing is not active, the iliacus will try to help the Ligamentous stretch through the influence can work better. situation; thus, depending on which portion of the hormones starts right at the beginning of the iliacus is more active, the ilium might With kidney infections, or trauma in of the pregnancy. Muscular stabilization get pulled into anterior tilt or the hip joint the back at the level of the kidneys, we has to take over. Some women create might get fixated. This will influence the often have an influence on the psoas (see stabilization in upright position more position of the sacrum and influence all through muscular action, while others lean into their ligaments a lot. For the latter, already in early pregnancy, this represents Lig.suspensorium ovarii Lig.cardinale a big shift in the method used to stabilize (Lig.infundibulopelvicum) (Mackenrodt) Lig.sacrouterinum Rektum the body. They have to relearn stabilization, Tube and will have a tendency to sacroiliac joint problems early in pregnancy, when the increasing weight cannot yet play a sufficiently explicative role. The pubic symphysis can increase its physiological deviation from a few milimeters to a whole inch (2-3 cm.) and in some cases up to 2 inches. This of course influences all surrounding tissues and is a major task for stabilization in motion. In utero, most babies have a preferred Lig.ovarii proprium position. If the baby’s back is on mother’s Lig.vesicouterinum (Lig.uteroovaricum) left side, the mother’s psoas on that side will Lig.teres uteri have to react, because the head of the baby (Lig. rotundum) Blase Fundus uteri is being pushed towards the ilium more often and more strongly than on the other Figure 1: Uterine ligaments (from Martius Hebammenlehrbuch, Thieme-Verlag, 1984). side. At first that muscle might react with contraction, but over the course of time it will become more deactivated. According to gynaecological literature, 60% of babies prefer their back to be on mother’s left side.1 The push of the baby’s head will often cause the ilium to come into anterior tilt: the ligaments of the sacrum, and the organization around the sacrum (including the piriformis), will try to counterbalance. Many times these patterns will persist after delivery. Rolfing work can help a lot to support the client coming back into balance. Conclusion Knowing our clients’ histories will help us to make an informed assessment of where to work and what to expect as probable reactions to our work. It will also help us prepare our client’s awareness for physiological healing reactions.

Figure 2: Inside the pelvis (from Iconografia d’Anatomia Chirurgica e di Medicina Operatoria, by Dr. J. M. Bourgery, Serantoni Editors, Florence 1856, courtesy of Pierpaola Volpones).

www.rolf.org Structural Integration / June 2011 45 I oncorp rating Visceral Work Endnotes 1. Pschyrembel and Dudenhausen, Assessment and Praktische Geburtshilfe. Berlin, New York: de Gruyter, 1986. References Thoracic Viscera in Barral, J.-P. and Pierre Mercier, Visceral Manipulation. Seattle, WA: Eastland Press, Structural Integration 1998. By Jeffrey Burch, Certified Advanced Rolfer™ Barral, J.-P., Viscerale Osteopathie in der Gynaecologie.Munich: Urban & Fischer, 2004. onnective tissue in the human body question, “Where can I work on this person Calais-Germain, Blandine, Le perinee C is a single three-dimensional web that will make the greatest positive change feminine. Micropolis: Edition Desiris, 2000. comprising approximately 20% of the weight for the whole system?”2 This article will of the body. Dr. Rolf taught that, collectively, illustrate how additional assessment Carrier, Beate, Beckenboden. Stuttgart: this web is the organ of support, defining methods become necessary to answer this Thieme, 2003. and maintaining spatial relationships among question of where to work most fruitfully, Hees, Sinowatz, Allgemeine und Spezielle the other 80% of our body’s constituents. In when additional portions of the connective- Pathologie. Cologne: Deutscher Ärzte- her work, Rolf worked with much less than tissue matrix are to be addressed. Aspects Verlag, 1996. this essential 20% of the body. This article of organ support membranes, vasculature, humorously explores more of this splendid and dura in the thorax will be reviewed as Martius, Hebammenlehrbuch. Stuttgart: connective tissue. a platform for illustrating this viewpoint Thieme-Verlag, 1984. on assessment. Rolf’s doctorate was in biological chemistry Meert, Guido, Das Becken aus osteopathischer and most of her published scientific work is Sicht. Munich: Urban & Fischer, 2003. Thoracic Organs: on transformations of the lecithin molecule. Pleura and Walls Pschyrembel and Dudenhausen, Praktische During her biochemical studies she gained of the Mediastinum Geburtshilfe. Berlin, New York: de Gruyter, no more than a passing acquaintance with 1986. human anatomy, nor is she known to have The thoracic contents include the lungs, taken any coursework in anatomy. Her heart, and thoracic duct as well as portions Schultz, R. Louis, Out in the Open. Berkeley, human anatomy, learned largely or entirely of the aorta, esophagus, vagus nerves, and CA: North Atlantic Books, 1999. after she received her doctorate, was self- phrenic nerves. A partial description of Tanzberger, Kuhn and Moebs, Der taught, and her knowledge of anatomy these and some of their support membranes Beckenboden- Funktion, Anpassung und remained limited.1 will be given. Therapie. Munich: Urban & Fischer, 2004. When Rolf began working with human On the inner surface of the chest wall lies structure, she first worked as an artist the endothoracic fascia, which is well- with a visual perspective. She maintained adhered to the periosteum of the ribs and throughout her Rolfing ® Structural the myofascia of the intercostal muscles. Integration (SI) career that it was possible It also continues above the first rib as part to know everything one needed to know of the pleural cupola. Just deep to this lies

Errata to structurally integrate a person from the parietal pleura. The parietal pleura visual inspection of contour alone. In her is adhered to the endothoracic fascia; “Becoming a Rolfer: An Instructor’s work she demonstrated the truth of this however, in dissection it is substantially Overview, a Student’s Project, and statement; however, Rolf was working with easier to separate the parietal pleura from Mentoring” myofascia, superficial fascia and investing the endothoracic fascia than it is to separate In the December 2010 issue of fascia, a fraction of the body’s connective- the endothoracic fascia from the ribs and Structural Integration: The Journal of tissue matrix. In recent years, Rolfers have intercostals. the Rolf Institute®, an error appeared begun to work with additional portions of To trace the principal membranes on page 8 in Table 2 in the article the connective-tissue web – meninges, bone, supporting the thoracic organs, imagine “Becoming a Rolfer: An Instructor’s joint capsules, organ support membranes, a small creature, which will crawl along Overview, a Student’s Project, and nerves, and blood vessels. When these the membranous surfaces. This creature, Mentoring.” The second column other, and often deeper, portions of the Geekus Anatomicus Rolfinensus, somewhat of data should have had the connective-tissue matrix are included, resembles a centipede but has interesting heading “% of Activated Students visual inspection of contour remains an behavior – it has great curiosity, but is also Experiencing Sign.” We regret any essential feature of SI assessment, but is no monomaniacal; it likes to walk, but only confusion this may have caused. longer sufficient. knows how to walk in a cardinal plane, Sufficient in what sense? Rolf also taught and will always keep its feet on the same that we should continuously ask the surface, never picking up all of its feet to

46 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work switch to a different surface. While Geekus follow the inferior surface of the lung, Also in his travels Geekus noted that will only walk in a cardinal plane, it will first laterally and then inferiorly, along portions of the parietal pleura were stiffer occasionally change to a different cardinal the respiratory diaphragm to the person’s and more fibrosed than its neighbors. He plane, but only at its birth place – which, for back. At the inferolateral margin of the also walked past areas where the parietal the particular specimen in question, is on lung, our creature, feet still on the lung, pleura and visceral pleura were adhered to the interior of the lateral wall of the thorax. begins to crawl superiorly until it reaches one another. Fortunately, Geekus did not the oblique fissure. Entering the fissure it walk directly into one of the adhesions, as Our Geekus begins its journey at its walks superomedially until it encounters then, in order to stay in the same plane, he birthplace on the lateral aspect of the a different surface of the hilum of the lung would have had to reverse direction much inner surface of the left chest wall. Its than before. Here it must make a quick turn as he did at the hilum. feet are on the lateral aspect of the left so that it is now walking inferolaterally on parietal pleura along which it begins Geekus further noted the presence of the the inferior surface of the upper lobe of to walk anteriorly. At the sternum the internal thoracic artery running vertically the lung. parietal pleura reflects posteriorly to form on the inner surface of the anterior thoracic the left wall of the mediastinum. The Arriving again at the lateral surface of the wall, connecting to the subclavian artery left wall of the mediastinum is followed lung, the creature continues its superior at its superior end. This artery gives more or less posteriorly. Through the journey, feet still on the lung. Rounding off branches laterally and medially in translucent membrane of the left wall of the apex of the lung the creature again each intercostal space and diverges into the mediastinum our small creature may walks inferiorly to the hilum of the lung, the muscolophrenic artery and superior see under its feet the mediastial contents where it must make another quick turn hypogastric artery at the inferior margin including the heart, esophagus, aorta, to resume its superior walk, feet on the of the thorax. thoracic duct, and portions of the phrenic wall of the mediastinum. This transitions and vagus nerves. As the left wall of the superolaterally into the inner surface of the Thoracic Organs: mediastinum reaches the spine, it follows pleural cupola where Geekus now finds Contents of the Mediastinum the anterolateral curve of the bodies of the itself with its feet toward the sky, assuming In a series of text messages, Geekus vertebrae until it transitions again onto the the person being traversed is standing. learns from his cousin, who inhabits the parietal pleura. With variations in contour, Continuing inferolaterally from here, our mediastinal space, that the pericardium, this circumferential path may be followed creature walks, feet on parietal pleura, esophagus, and aorta all lie adjacent to each in the transverse plane at any level in the back to the starting point of its journey on other within the mediastial space. These thorax. On the right side the same essential the left lateral chest wall where it takes a bits of plumbing have some loose tethers continuity and contour exists modified only well-deserved rest. between them that allow substantial glide. by the asymmetric positioning of the heart. In its travels Geekus has seen that the As in the lateral compartment of the chest, Beginning at the original position on the parietal pleura, the walls of the mediastinum, contractures in each of these structures are inner surface of the left chest wall, our and parietal pleura are all continuous, the observed as adhesions between tubes. creature, still with its feet on the parietal various names describing geographic The two phrenic nerves are also found pleura, can walk inferiorly to the lower limit regions, not discontinuous structures – just in the mediastinal space. These appear of the rib cage where the parietal pleura as one can drive from Scotland to England to terminate in the musculature of the reflects superomedially on the superior without leaving the United Kingdom. large central portion of the respiratory surface of the respiratory diaphragm. Pushing its way through these tight places, diaphragm, but from a half sibling Following this membrane superiorly and Geekus has also seen how these various residing in the abdomen Geekus also then medially along the superiorly curving surfaces lie essentially adjacent to each other learns that the phrenic nerves penetrate surface of the respiratory diaphragm, our separated only by a thin film of serous fluid. the respiratory diaphragm to innervate crawling creature arrives again at the left With its feet always on one portion of the most of the abdominal organs, including, inferolateral margin of the left wall of the surface, Geekus’ back was always against among others, the liver. In the specimen in mediastinum. Turning superiorly to follow another portion. question the right phrenic nerve is observed the lateral surface of the left wall of the Since this terrain is a living person, Geekus to be quite tight and, intermittently along mediastinum our creature will arrive at has also observed how these membranes are its course, adhered to the wall of the the hilum of the lung where the bronchial in constant motion. During inhalation the mediastinum, and thus unable to glide. tree, the pulmonary vein and artery, the parietal pleura moves superiorly along with lymphatic vessels, and nerves enter and Also from his mediastinal cousin in the the ribs while the lung elongates, stretched exit the lung. lung, Geekus learns that the two vagus inferiorly from its functional fixation within nerves innervate the heart and lungs and Now, with its feet facing superiorly in the the pleural cupola. As the person who then both nerves disappear into the walls person, our small creature walks briefly Geekus inhabits looks over his shoulder to of the esophagus. The mediastinal Geekus laterally on the inferior surface of the hilum back up the car he is driving, the parietal has gone so far as to carefully shine light of the lung until it must turn inferiorly to pleura and visceral pleura glide over each into the wall of the esophagus revealing walk along the visceral pleura of the lung other more or less in a transverse plane. that the two vagus nerves spread out with its feet facing the left side of the person. Similarly, with any movement that changes and interweave with each other to form the shape of the thorax, there is glide in the Arriving at the inferomedial surface of a lace-like network within the wall of the fissures between the lobes of the lung. the lung, Geekus now turns laterally to esophagus. From his abdominal sibling Geekus learns that the two vagus nerves

www.rolf.org Structural Integration / June 2011 47 I oncorp rating Visceral Work emerge from the wall of the esophagus, not Assessment and Treatment among these osteopaths – and exactly left and right as they were at the superior who originated them is lost in the mists of end, but anterior and posterior. From there If the Rolfer is aware of the thoracic contents time.3 Barral is the first to teach these in an the vagus nerves diverge to innervate a list and their powerful role in shaping bodily organized way to a larger audience. Still, of abdominal organs, heavily overlapping alignment, and if he has learned effective there is little written about these methods.4 with, but not quite identical to, the phrenic treatment methods for these, the question There are several variations of the listening nerve. Portions of the vagus network within remains, “Which bits of the thoracic assessment methods, all of which must be the esophageal wall are observed to be contents should be worked with?” It is learned and used in concert to discover fibrosed, thereby reducing the apparent possible to just treat them all. Another which area to work on to achieve the elasticity of the esophagus. possibility is to mobility test each internal structure and treat the tight ones. Neither of most benefit for the whole person. Major The subspecies Geekus Anatomicus these solutions turns out to be satisfactory. variations include: general listening, local Rolfanensus has that name because it is listening, and layer listening. The basics telepathically connected to Rolfers with Treating all the structures is a great waste of of these methods are described below. whom it communicates the anatomical time, not following Rolf’s directions to work Much more can be learned – the various information it collects, including pathologies with that bit of the body that will produce courses offered by the Barral Institute are and anomalies. This is a great advantage to the most change in the whole structure. highly recommended. the Rolfer. Imagine the plight of a Rolfer Treating everything in the neighborhood viewing a body from the outside. With will also irritate tissues that should not have General Listening been treated, leading to unfortunate results. visual inspection alone he would not be able To perform general listening, the therapist This is bad enough when myofasciae are to tell if a vertical contracture in the front stands at arm’s length facing the client’s involved, and if nerves, arteries, and organ wall of the chest is due to local stiffening of back. The therapist checks himself to make support membranes are more reactive, the parietal pleura, or to contracture of the sure he is at an energetic neutral, neither unpleasant fireworks can be expected from right thoracic artery. He would be unable to projecting into nor drawing energy from gratuitously treating, or over-treating, them. know if there was also a parietal pleura-to- the client. The therapist’s hand is placed visceral pleura adhesion in this area, or an Compared to treating everything in the on top of the client’s head and a slight adhesion in any combination of these three neighborhood, treating the tightest bits has compression is given straight down. Within tissues. Similarly, how would the Rolfer the advantage that fewer parts are treated, so the first five seconds, and usually less, the distinguish a contracture in the right wall of fewer delicate tissues are ruffled. However, client’s body will bend. The client’s body the mediastinum from a tight phrenic nerve ineffective and/or undesirable results will can be considered as a structural column – to the liver, or a tight aorta with a tensional still frequently follow. The tightest parts are in response to the downward pressure the continuity into the hepatic artery? seldom the most effective parts to treat. This column will fail at some point. This lack of support (lift) points to the most fruitful All of the issues described previously will is key. We are looking for structures we can place to work on the body. produce shortening in the front of the work on where the change will spread out through the rest of the person in the most thorax. With this thoracic foundation the The deflection, in response to the downward beneficial way. Working on the tightest, head will be displaced forward. If the issue load, may be in any direction. The deflection most defended areas is seldom the answer. were in superficial fascia or myofascia, may occur at any level between the point of As an example, in paired structures such as classical Rolfing approaches, guided by contact on the head and the floor. This point the facet joints at a particular spinal level, visual assessment, would be marvelously of deflection is detected by the therapist it is usually advantageous to free the less- successful in lengthening the front of the using two senses: proprioception and bound side first. This will soften the more chest. If the central issues lie in the thoracic vision. A check is performed by contacting bound side and make it more accessible for contents, tension in the muscles and the client’s body at the presumed point of change. However, this is not always true – myofascia on the front of the chest will be deflection with the therapist’s other hand. occasionally it really is best to work on the compensatory and defensive. For example, If this subtle support results in the body tighter side first. if the phrenic nerve has reduced stretch righting itself back closer to vertical (or at and glide, it will be vulnerable to tearing in The question then is, “How do we gain least its original alignment), then the area of any event that snaps the head back. A torn the assistance of a Geekus Anatomicus interest is confirmed. The second contact for phrenic nerve is potentially lethal, so the Rolfinensus to tell us which bit is most confirmation is called an inhibitory contact. body, in its wisdom, will tighten muscles fruitful to work on at any given moment?” The image is that the lesion is temporarily and myofascia to protect this crucial nerve. A solution lies in the listening assessment taken out of the system. In effect, an “as if” The body will not easily give up this methods taught by Jean-Pierre Barral, D.O., treatment is performed. General listening protection, and if this protection is softened developer of visceral manipulation and its can usually narrow the field to a few cubic through the persistent and vigorous efforts outgrowths: vascular manipulation, joint inches of the body. Local listening and layer of a Rolfer (they are like that), the body will mobilization, and neural manipulation. listening can be used to refine this. promptly put the protective shortening These listening assessment methods, Local Listening back in a well-considered effort to protect discussed below, were originally developed the person’s life. in the 1930s by high-level osteopaths in To perform local listening the client may the United States. Very little has ever been be in any position – standing, seated, or written about them – for a long time they lying down. The therapist contacts a part were passed around by word of mouth of the body with the heel of his hand. If

48 Structural Integration / June 2011 www.rolf.org I oncorp rating Visceral Work immediately upon contact the client’s tissue hand. In a moment make contact with the assessment methods is imperative for engages the therapist’s hand and pulls it in, hand again with a combination of depth of efficient and safe work. Working with these this indicates there is an active lesion in the touch and intent focus on the skin. Is there tissues, the listening assessment protocols area. An active lesion is one that is in the a tissue engagement pulling your hand discussed in this article become the primary process of change. Two characteristics of into the skin? If so, does it have the same guide to treatment order. The “Recipe,” areas that will produce the greatest change direction and speed as before? If so, treat the which has value when working only with for the whole person are: skin. If not, gently sink into the superficial myofascia and superficial fascia, is not a fascia. Does it have the speed and direction useful guide when the rest of the body’s a) the restriction is already in the process of the tissue pull originally felt? If so, treat membrane systems are included. Following of change (as therapists we can assist the superficial fascia. If not, proceed to the the listening assessment methods, the the body with this change and provide investing fascia with the same questions. hallmarks of SI will efficiently appear, it with information on how to change If the investing fascia does not have the but in an order unique to each person, even better), and original pull, continue layer by layer into generally not the order described in the b) the restriction is well-connected to a the body until the layer is found that has Rolfing Recipe. substantial number of other restrictions, the original pull. This is the layer-to-layer Jeffrey P. Burch, Certified Advanced Rolfer, allowing pathways for the benefit to treatment protocol. has been in practice since 1977. He is also spread out. Mobility Testing trained to the instructor level in Barral Visceral When an area of tissue pull is found, the Manipulation and teaches introductory Once the most fruitful area to treat has speed and direction of the tissue pull are CranioSacral Therapy classes for the Upledger been found by the different listening noted. The therapist’s hand is lifted from the Institute. He is a past member of the Rolf methods, mobility test the tissue found, body. A new contact is made nearby to see if Institute® Board of Directors and Ethics as well as neighboring tissues. Details of there is a different pull there. A succession Committee and is the founding editor of theIASI mobility testing will depend on the type of nearby points is tested in this way. If a Yearbook. He practices in Portland and Eugene, of tissue found. After the tissue is treated, second point is found, the two points can Oregon and offers continuing education classes again mobility test it and the neighboring be compared to find out which of the two to structural integrators and other practitioners. tissue. Also stand the person up to look for will be the more powerful in changing For more information see www.jeffreyburch.com. alignment change. Do this after every move the whole body. For convenience, in this to gain adequate feedback on the effects of example, one point is given the name Sally Endnotes the intervention. and the other Morris. To compare the two, 1. Richard Demmerle, D.C., N.D., personal touch one of them, for example Sally, and Additional Thoughts communication. As a physician, Demmerle feel the direction of tissue pull. Leave the has a solid grasp of anatomy. He describes On the way to developing Rolfing® SI, Rolf hand in contact with this point and continue conversations with his mother (Ida Rolf) studied extensively with several osteopaths to observe it while touching the other while he was assisting her in teaching including prominent osteopaths Kenneth point (Morris) with the other hand and Rolfing classes, in which he asked her why Little, D.O. and Amy Cochrane, D.O., as following any movement. If Sally moves she did not quiz student Rolfers on anatomy, well as John Wernham, D.O. Everything in again, changing her position in response to to which she replied, “Because I am not Rolf’s philosophy of working with the body contacting Morris, that means that if Morris qualified.” He gave other illustrations for is osteopathic. Her genius was to bring the is treated Sally will also change. If on the the fact that her knowledge of anatomy relationship of the body in gravity to the other hand Sally does not respond in any was limited. way to touching Morris then treating Morris foreground, a minor and often forgotten will not alter Sally, and Morris is clearly aspect of osteopathy. 2. Author’s notes from a basic Rolfing training with Peter Melchior, held in not the most fruitful point to work on. Pair The listening assessment methods described Boulder, Colorado in July and August wise comparisons can be made between any in this article were in use among high-level of 1977. Melchior repeatedly quoted this number of points. osteopaths at the time Rolf was developing statement of Rolf’s during the training. Layer Listening her work; however, these methods were not widely known and were treated almost as 3. Personal communication with Alain Once the most fruitful area has been found secret inner knowledge, and it seems Rolf Croibier, D.O. After fruitlessly searching first by general listening and then refined did not have access to these assessment the osteopathic literature for the origins of with local listening, a question remains methods. The listening methods were the listening assessment methods, I finally – at what depth in the body to treat. To originally developed for working with consulted Croibier in 2008. He gave the determine this, note the direction and speed musculoskeletal issues. Barral adapted description used in this article. of tissue movement when it first engages the listening methods for use on other 4. Personal communication with Jean-Pierre the hand. If this is not felt within five tissues, first the internal organs and later Barral, D.O. Barral graciously supplied seconds of contact, break contact and start neurovascular structures. again. After five seconds other movement me with the descriptions of the different may occur as part of unwinding but this is Conclusion listening assessment methods. not useful for the present assessment. When meninges, organ support After the direction and speed of movement membranes, nerves, and blood vessels are noted, break contact by removing the are included in SI, use of the listening

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resolved. It was one of those times one An Informal Case Study of kicks oneself in the butt for not having taken photos. Granted, his lordosis was still present, perhaps not as acutely, but the pain was dramatically reduced and Using Other Maps to Explore mobility dramatically increased from the normalization of the upper lumbar and ® ancillary areas. We were both happy. As the Rolfing Territory he was leaving, the gentleman slung on By Allan Kaplan, Certified Advanced Rolfer™ his shoulder bag, the carrying of which perfectly reinforced his injury posture. I cautioned him and recommended he do his best to change that habit, which he hrough her study of Alfred Korzybski of another nine sessions, it didn’t seem promised to do. He flew out of town the T and General Semantics, Dr. Rolf appropriate to follow that tack. To my eye, next day. became familiar with the catch phrase, “The cracking loose the deep restriction was key, map is not the territory.” While one could and I had a hunch that a restriction of the As it happened, I was able to do a follow- apply this to Rolfing® Structural Integration left kidney was a major contributor to the up session with the man on his way back (SI) in the sense of keeping our conceptual pattern. through Seattle two and a half weeks working frameworks relative to the reality later. He related to me that, while he was I used osteopathic listening techniques to of what is presented in the individual, by a little stiff that day from travel, he had confirm that indeed, the left kidney was extension I find that it is often useful, or realized huge improvement from the primary. Its motion was restricted, being even essential, to use multiple maps to get session and was in much less pain, and pulled superiorly, and it was adhered to a clearer picture of the territory in question. he’d been diligent about limiting wearing the stomach indirectly through the lesser his shoulder bag. I saw that while he still I recently had a fellow who was going omental bursa (an uncommon pattern, walked with a bit of a forward lean to his to be in town from Europe email me for in my experience), creating a very tight posture, his side/side balance was still an appointment. He was in chronic back shortness close to the spine. I found other significantly improved. I estimated he pain, stemming from a luggage-carrying restrictions in his body, but this major had retained about 75% of the gains of the incident coupled with heavy coughing problem was at the top of the list. previous session, which I considered quite from pneumonia after a case of swine flu. I started the session with some prep a success. He had exhausted the possibilities of his work to take some stress off the kidney/ country’s health system, and was finally I found that the visceral work had held stomach lesion and prepare some space to getting some relief from his second or third well. This time, the left kidney was slightly accommodate its release. I found that there physical therapist and a chiropractor he’d superior, but was not adhered to the was also a dural adhesion at the level of the happened upon previously in Seattle. The stomach, and the stomach itself was upper lumbars, anchoring the vertebrae D.C. suggested that he check me out. sticking superiorly to the diaphragm. there that would also inhibit release. My take was that these restrictions were I had the opportunity for one session, with After attending to the dura restriction remnants of the original lesional pattern a possibility of a follow-up, to do what I and cranium, I did a little traditional that I had not completely resolved. After could to help the fellow’s situation. He was Rolfing work to the posterior diaphragm releasing these restrictions, I dealt more 6’3”, 250+ pounds, noticeably overweight area, including the areas of the erectors, in the sleeve, working in the quads and with a large belly, not in the best of physical quadratus lumborum, and more superficial quadratus lumborum to ease the lumbars shape, fed up with allopaths, and somewhat structures, but found that these levels and horizontalize the pelvis, and in the left frustrated. His thorax was acutely left- of the fascia weren’t really contributing iliotibial tract and hamstrings, giving more rotated and forward bent, with his lumbar to maintaining the problem; the kidney/ pelvic balance and a little length for the spine reflecting this leftward, forward lean, stomach lesion still appeared to be the main shortened left side. and had a sharp recovery of his spine to the event, and it released fairly readily at his vertical at the level of about L2-L3. This was point after the preparatory work. I then On standing, the client had once again in addition to a strong lordosis exacerbated normalized both the kidney and stomach evened-out side to side (where was the by the pull of the bulk of his abdomen. individually, and integrated the client camera?) and the lumbars showed less with a pelvic lift, focusing on releasing strain, but by no means had the lordosis It was apparent to me on looking at him whatever compactions or distractions I disappeared—the two sessions had only that the major postural restriction was found between T12 and S1. I followed up made a dent in that situation. Nevertheless, deep. There was something very deep with neck work from T3 up to the occiput, the sessions were a success, and an email inside associated with the dramatic, sharp being sure that the occiput and the upper once the man returned to Europe confirmed bend in the lumber spine that was hanging cervicals were free. that he was still maintaining his gains. He things up, and that doing a “First Hour” or was going to seek a Rolfer near home, and superficial work was not going to address The moment of truth was when my client contact me again on his next U.S. trip. the problem with lasting results. Certainly, stood after the session. I have to say that doing a Ten Series would do this fellow I surprised and impressed myself when I My work with this client reinforced for me a ton of good, but without the luxury saw that all his side/side aberration had the importance of seeing, discerning, and

50 Structural Integration / June 2011 www.rolf.org P erspectives working at different depths within the body, and served as a reminder that the continuity of the fascial network spans the entire Comments on the World organism, in niches not examined within the traditional Rolfing concept. It is tempting to speculate on the changes that may or may Congress on Low Back not have occurred had I never learned visceral and cranial manipulation. I don’t think I would initially have been drawn and Pelvic Pain deep, or targeted the region around the By Bruce Schonfeld, Certified Advanced Rolfer™ kidney so specifically, and I certainly would not have identified the dural adhesion for what it was. I think the approach would have been much more centered about he Seventh Interdisciplinary World top-notch research project involving the balancing the general shape, and would not T Congress on Low Back and Pelvic RISI if we could organize an appropriate have incorporated as much specific work Pain, which was held November 9-12, 2010 effort. His perspective is multi-factorial within the abdominal cavity. Certainly, in Los Angeles California, was an excellent and he completely gets it that structure and without awareness of the anatomy and event and experience for this Rolfer and function are interrelated. visceral and cranial relationships, at best, I first-time attendee. The spirit of sharing information and helping others rang Prospects for would not have been as efficient in working; Rolfing® Research at worst, I think I would have been orders through the entire event. It was a wide-open of magnitude less effective. I absolutely window and multidisciplinary forum into Given this favorably developing cross- believe that the degree of lasting resolution many different aspects of evidence-based disciplinary milieu, this author believes the we achieved would not have been realized. research as well as an opportunity to peek time is ripe to organize a fascial research While initial results of sessions may have into the current culture of integrative- project either as an organization (RISI) showed some resolution, I think the gains medicine professionals interested in and/ and/or for those who independently are so would have rapidly dissipated, owing to or clinically working with fascia. In fact, inclined and have the time and resources. the nagging deep restrictions that would between the Fascia Research Congress that For example, perhaps the RISI could have remained unresolved. was initiated in 2007, this World Congress run a research project or start collecting that happens every three years, and other case studies involving the people who I think this case could have been one of those complementary and alternative medicine participate as Ten-Series models in the basic never-ending, ever-frustrating scenarios of (CAM) research projects being funded and/ trainings, and move towards establishing “do the work and pray,” hoping that one or watch-dogged by NIH grants, fascia a SI baseline of usual outcomes. Boulder finally hits the magic session that nudges research is truly in a major developmental would seem to be a good place to find an progress forward, rather than being a growth phase. interested Ph.D. student for this kind of situation of recognizing the problem from a research project. With a deeper blending wider perspective of inquiry. But it’s really a At the World Congress, many top now of the science with the art, SI looks like moot point, because we haven’t yet figured scientists and researchers were available it has a bright future in this fantastic milieu out how to do multiple, parallel approaches for unguarded dialogue and frank of integrative medicine. The best scenario on the same client and compare results! conversation in a luxurious setting. would be that RISI could both continue to be In the mean time, I think the solution is Avenues for exploration, education, and a leader in the field of fascial manipulation to broaden our perspectives; sometimes bridge building were open-ended. I had and education while we additionally start we need to utilize a different viewpoint to many fortunate opportunities to chat making strides in evidence-based research access the same territory, and being able with interested allopaths and scientists ® and, as Robert Schleip likes to humbly to approach the project of instilling the about Rolfing Structural Integration phrase it, “to make a contribution.” balance, alignment, and order of Rolfing (SI) as well as membranous and visceral SI by referencing multiple maps can enable manipulation (VM). A great example Tozzi’s Kidney Presentation much more effective results. was meeting and chatting with Moshe Solomonow, M.D., a member of the Rolf During the Congress, I attended a Allan Kaplan has been a Rolfing® practitioner Institute of Structural Integration’s® (RISI) presentation by Paolo Tozzi, D.O. entitled since 1988. He has studied visceral manipulation research committee, about mechanisms of “Evidence-Based Correlation Between with Didier Prat, D.O., and assisted him low back pain onset, Rolfing SI, Allopathic Low Back Pain and Reduction of Renal teaching several classes. More recently, he Medicine, New Orleans culture and cuisine, Mobility, Assessed by Dynamic Ultrasound completed osteopathic studies at the Canadian and – of course – our old friend, fascia. Topographic Anatomy Evaluation College of Osteopathy. Dr. Solomonow, whose presentation on (D.U.S.T.A.-E): Local Kidney Manipulation November 9 was in the context of movement Improves Kidney Mobility and Decreases stability and lumbopelvic pain and was Pain Perception.” It was of particular entitled “Biomechanics, Electromyography, interest to me because it was the only Stability and Tissue Biology of Cumulative presentation that correlated an organ with Low Back Disorder,” lives near Denver and low back pain, and it also involved fascial could be an instrumental component in a manipulation specifically.

www.rolf.org Structural Integration / June 2011 51 P erspectives

Tozzi, who is based in Rome, gave with physicians like Tozzi on board, I (As a comparative note, on the subject of his presentation within the context of think visceral manipulation has a bright movements and motion in three dimensions Parallel Session IV, which was entitled future too. that can potentially make people seriously Movement Stability and Lumbopelvic skeptical and/or uncomfortable, I used Pain: Clinical Anatomy and Biomechanics. Seeing Our to observe a very similar disorienting The presentation coherently broke down Different Perceptions phenomenon with some new arrivals to the Tozzi’s theory, methodology, and technique. I also had the amazing opportunity to Continuum Movement studio in the 1990s, He revealed findings of decreased pain compare and contrast my subjective who were disturbed when confronted with perception in a significant percentage perceptions of the elegance and excellence three-dimensional motion and people of subjects that were tested and treated. of Tozzi’s intervention with those of other moving, from their perspective, in such Tozzi additionally showed a video of a allopaths and/or scientists who have little an unusual, non-linear, and seemingly manual-medicine intervention with him or no manual medicine component in their unpatterned manner. Such individuals performing osteopathic manipulation on educational background, current clinical often had no personal body-based context a patient’s kidney in conjunction with his practice, hospital environment, integrative- or history for themselves, or exposure to study. While there is a wide spectrum medicine outlook, and/or referral networks. other people moving unconventionally, and of pressure used in the various manual- For me, Tozzi’s demonstration was quite simply could not make sense of what they medicine communities, ranging from efficient, extremely well orchestrated, saw moving and undulating in slow motion. gentle to strong, not to mention an equally and of expert caliber in terms of direct Continuum’s three-dimensional nature, diverse spectrum of strategic approaches, application of three-dimensional fascial in the author’s opinion, makes it a close semantics, and techniques, Tozzi utilized manipulation technique. For some others, cousin of three-dimensional manipulation, what looked like a no-nonsense, SI- by comparison, it was an unusual and a kind of functional approach to three- friendly direct technique approach to novel sight, potentially disorganized, and dimensional manual medicine, functional fascial manipulation. a little disorienting to comprehend and osteopathy if you will.) Tozzi’s technique featured very specific logically follow. Scientists are trained (and Whether three-dimensional movement biomechanical engagement of the kidney right) to say “prove it” as a critical part is assuming the form of Continuum, and related renal fascia as the principal of their vocation and methodology, and I Butoh dance, or sophisticated fascial aspect of the initial part of his treatment. think from their perspective the simpler manipulation, its good to remember that With neither too much nor too little force, the variables are to quantify the better, in these forms often appear unusual and out he deftly put one hand directly on the terms of doing evidence-based research of the norm to others not specifically in kidney and literally embraced it both in anyway. Some allopaths, including several these fields. This potentially disorienting the depth and shape of the organ and its physiatrists I chatted with, shared that phenomenon is additionally compounded related physical restriction. Then, in the they found Tozzi’s manipulation style to and heightened by the fact that we also second part of the manipulation process, be potentially very difficult to quantify speak in a unique and different lexicon he incorporated a related restriction in his and measure in technical terms. It did not when talking about the body, often trying patient’s leg as a long-lever component translate along a linear axis. I found this to describe things that others have no point to utilize and further leverage into the to be a wonderful reality check in terms of reference for. kidney’s relationship with the pelvis and of how far whole-body three-dimensional lower extremities. He expanded his scope manipulation (that may or may not involve Conclusion of treatment and impact from regional to a visceral component) still has to go in We are riding the wave of this new era of integral anatomy by engaging the bigger terms of making sense to many allopaths, fascia research and encountering a genuine “systems anatomy” strain pattern. The effect academics, and evidence-based individuals. interest from many scientists and allopaths of this seemed to be greater precision and I think direct technique manipulation to understand what SI is and does, for relevance to both local orthopedic issues conceptually makes more sense to they too are curious about and inspired as well as the adaptive process translating rationalists who believe in a biomechanical by tricky clients where the status quo through multiple body segments. There model and the idea that the positive isn’t working. We are an integral part of a was a rhythm, coordination, and refinement application of force, as a linear mechanism broader conversation that serves to educate of his technique; to my perception, it left for change, can produce therapeutic results. all parties involved and build bridges with nothing to the imagination in terms of Once the conversation ventures into other people and professions about the manually translating enough force and concepts like “liquid osteopathy,” indirect nature of physical manipulation and the accessing enough depth, but it also had technique, feeling at a distance, or working worlds of converging integrative medicines. an ease and grace to it. The video visually through structures and/or systems, the So, let’s chat. demonstrated the correlation between plausibility and validity of these working the kidney and lumbar spine: they are premises and claims often and quickly in such close proximity it’s hard to deny becomes highly suspicious to people with what the eye plainly sees. Tozzi is part a background in science. It’s not a good or of the new wave of European physicians bad thing as I interpret it, just a point of doing evidence-based research involving orientation and sobriety as to where the organs as well as correlating structural conversation is regarding the body and and visceral anatomies. While it is in its three-dimensional manipulation technique infancy in terms peer-reviewed research, and where the research isn’t.

52 Structural Integration / June 2011 www.rolf.org P erspectives

manipulation” (FM) method would also yield an integrated structure. Similarly, A Commentary I remain curious as to whether the SI approach reliably delivers the pain relief of FM. The Steccos’ pain-relief approach on Stecco’s Fascial fits squarely into what Rolfing colleague Jeff Maitland described as corrective, or “second paradigm,” but their correlation Manipulation Work of pain with three-dimensional patterns of myofascial dysfunction echoes the holistic By Russell Stolzoff, Certified Advanced Rolfer™, “third paradigm” argument that integration Rolfing® Instructor is necessary to relieve pain. My personal belief is that all effective s a Rolfing® Structural Integration SI as an influence among other modalities methods have a significant degree of A (SI) instructor I am keenly aware of such as trigger point therapy, shiatsu, overlap with other methodologies. The the limitations of our training process. By acupuncture, etc, In spite of this failure to Steccos’ work supports this idea with any measure Rolfing and other SI trainings properly attribute Rolf’s contribution, these innovative descriptions of fascial anatomy are too brief, unable to expose students to books deserve to be incorporated into the and physiology and intriguing perspectives even the relevant knowledge that has been curriculum at the Rolf Institute® and every on pattern and function. Taken together accumulated in the thirty-four years since other SI training program as they offer an these works come closer than any I have Ida P. Rolf wrote Rolfing: The Integration of updated and detailed refinement to our seen to describing the body and method Human Structures. In addition, one often understanding of the role that fascia plays that SI practitioners work with every day. hears about the pressures of competition in the body and how to treat its dysfunction. At the heart of the Steccos’ presentation lies and market forces constraining the ability For experienced practitioners who have a detailed description of myofascial and of the SI practitioner to deliver the breadth an interest in the phenomenology of the musculoskeletal architecture. These are and depth of the true SI experience. And, body and a desire to know the body as it is, not mechanical, textbook origin-insertion- it is often said, with a note of resignation, devoid of conceptual abstraction, these are action descriptions! Rather, they offer a that the real education of a Rolfer happens must-read volumes. For those who welcome new perspective that precisely describes the on the job, through experience and personal rigor and complexity, the volumes present an twisted-body patterns every SI practitioner study, and is augmented by workshops and, opportunity to dig deeper and increase the is keenly aware of. For example, the tissues eventually, advanced training. precision of their knowledge. While these of the leg do not descend in straight Thus, it is rare and fortuitous when an volumes require time to digest and consider, lines from the knee to the foot. Nor do instructor discovers two books by an they reward anyone who commits the individual muscles fire along their whole author that he knows will be transformative necessary time to study and learn from them. length. Instead, coordinated portions of in creating a higher baseline of skills for new muscles are activated along with portions Each volume presents detailed descriptions, and even experienced SI practitioners. Such of other muscles, at the same time that useful charts that illustrate complex are these two volumes, Facial Manipulation corresponding portions of antagonist concepts, and excellent photos of fresh for Musculoskeletal Pain and its awkwardly muscles lengthen. To describe this in detail, cadaver dissections that expose important titled companion Fascial Manipulation the Steccos had to create a new way of elements of fascial architecture and Practical Part (both published by Piccin in talking about the body’s musculosketetal correlates them with structural, energetic 2004 and 2009, respectively). The first is structure and the way it functions. Because (acupuncture), and trigger-point patterns. authored by relentlessly studious Italian anatomical names and descriptions have a The first volume is primarily concerned physiotherapist Luigi Stecco, and the tendency to conflict, Stecco presents a new with describing the form and function of second is coauthored by Stecco and his anatomical nomenclature that describes myofascia, while the second is a manual daughter Carla Stecco, an orthopedist. both segmental and whole-body myofascial for how to evaluate and work with the These two volumes are major contributions patterns. Simply put, function is described in myofascial patterns that produce pain. to the field of structural integration and terms of the directions that segments move. Further, he proposes using Latin terms to should be included in every practitioner’s A New Nomenclature core library. describe the direction of limb movement. To be clear, the Steccos’ goal in these two Don’t worry, you won’t need to learn Latin Upon first encountering these books, volumes is not SI but the reduction of to use the Stecco system, but you will need anyone familiar with SI will naturally musculoskeletal pain. However, their to learn a few easy abbreviations like “ante” wonder why a work that is so akin to SI has perspective on mechanisms that produce (forward) and “retro” (backward). The only a slight reference to Ida Rolf and her musculoskeletal pain are so similar to the Latin, he contends, makes for easier cross- scientific contributions in understanding perspective of SI that it stimulates questions cultural understanding. No longer will we the importance of fascia. It is well-known about the similarities and differences be confused by knee flexion and hip flexion that Stecco knew of and was influenced between the two approaches. Throughout describing motions in opposite directions. by Rolf’s work, but he pays her scant my reading, I found myself wondering All sagittal-plane motions are either “ante- homage. He describes her contribution as if treating the body with their “facial motion” or “retro-motion.” “posture modification,” and lists Rolfing

www.rolf.org Structural Integration / June 2011 53 P erspectives

Myofascial Units, Centers of and where to treat larger body patterns. astounded that the demonstrator showed Perception and Coordination Our colleague Robert Schleip wrote the no interest in anything more than the MF forward for this edition, which does a that was being manipulated, and whether Following the introduction’s excellent splendid job of encapsulating the Steccos’ it was reducing pain. Admittedly, it was a description of fascia (it should be required contributions to the field. In fact, it was this short demonstration, but my body reading reading for every new student, and is introduction that first got me interested of the subject from afar was inclusive an enlightening review for the old pro), in the books themselves. Just the pictures of far more information than the tests the first chapter of Fascial Manipulation of fresh cadaver dissections – which show were revealing. for Musculoskeletal Pain describes the fascia somewhat close to how it exists in the There is much more to find in the pages of interrelationship of muscle, nerve, fascia, human body – make these volumes worth these books: I can’t say enough about them. and bone, called a “myofascial unit” (MF). adding to you library. Still, pictures, as good If you are a serious student of the body and This is the kernel of Stecco’s approach: “A as these are, should not be mistaken for the a serious practitioner of manual therapy, myofascial unit is composed of a group of tissue we touch every day. As Schleip warns, you must read and digest these books. motor units that move a body segment in “these pictures, as beautiful as they are, You will not agree with everything they a specific direction, together with the fascia show a drier body than the one you are living contain, but I promise you will learn things that connects these forces or vectors. The in and the one you are touching [in] your you never knew. These material in these myofascial unit is...the structural basis of clients. Please keep the fluid dynamics of the 1 books, if adopted, can revolutionize the the locomotor system. living body in mind and in your touch when way the larger world understands human you turn from this book to the properties of A MF creates movement of a musculoskeletal structure and function – they are that fascia in a real living person. Fascia in living segment in a particular plane. Within each innovative! Naturally, I have, in this brief bodies is much more slippery and moist than MF are “centers of coordination” (CC) that review, skipped over much for it is hard to you may tend to imagine.” organize motor vectors, and “centers of encapsulate a life’s work in a few pages. My perception” (CP), which perceive a joint’s The Method hope is that what I have communicated to movement. In fact, Stecco asserts that six you will scare and inspire you to not rest, as unidirectional myofascial units coordinate After describing each of the body’s eighty- the Steccos have not rested, in your pursuit every joint movement. CCs and CPs are four myofascial units, in Chapter 7 the of understanding the body as it is. found in the fascia of each MF unit and “act Steccos present an elaborate method for as peripheral references for the nervous assessing the body. MFs corresponding to Here I will leave you again with the words system: the first [CC] interacts with the each plane of motion are motion tested to of Robert Schleip: muscle spindles and the second [CP] see which ones elicit pain symptoms. They If you are a beginner with the field of provides information to the various joint are then considered together as part of physiotherapy . . . be prepared that receptors about the directional significance agonist/antagonist pattern of dysfunction. it is not a book to skim over lightly 2 of each movement.” These distinctions form Once the therapist has determined while watching TV. It is a gold mine the basis for separating symptoms from which MF sequences are involved in the of condensed information. If you their causes. Centers of perception (CP) pain pattern, he then searches for tissue mistakenly skip over a sentence, are where sensation is felt, while centers of “densification” near the CCs. Once found, it may easily occur that you will coordination (CC) “direct muscular forces.” these densification zones are treated using miss this information later, when manual-therapy techniques that resemble According to Stecco, the whole body trying to understand the logic of deep cross-fiber friction. One technique the following pages, as there is not is comprised of eighty-four myofascial is used to treat CCs that produce pain in units, each with a name that describes its much redundancy in this book. Yet a single segment, and a slightly different I give you my word that even most anatomical, or segmental, location and the technique is employed when trying to tease motion it makes. For example, the MF unit experts in this field will look at apart “centres of fusion” or places where and read this book with immense he calls retro-cubitus (re-cu), straightens planes of fascia are interwoven. or extends the elbow, is described as excitement and a state of joyful being composed of monoarticular (lateral At a one-day workshop on the FM method, discovery. While other books have and medial heads of the triceps and I was very impressed by the assessment been written on fascia from several anconeuous) and biarticular fibers (long process, and equally unimpressed by the different angles, this one clearly sets head of the triceps). The CC for the re-cu is treatment process – a rather mindless a new standard. application of rubbing vigorously with at the level of the deltoid insertion, between Endnotes the long head and the lateral head of triceps. the knuckles. The technique is justified by This CC corresponds to acupuncture point theoretical assertions that fascia requires 1. Stecco, Luigi, Fascial Manipulation for TE1 and to the 1º trigger point of triceps. tissue to be contacted at a certain angle Musculoskeletal Pain. Padova, Italy: Piccin, with a certain amount of force in order for 2004, pg. 23. The Big Picture it to change. I was astounded that some 2. Ibid. The second volume, Fascial Manipulation of the latest research suggests the old gel Practical Part, focuses on multi-segment to sol approach might be right after all! Special offer: The publisher of these titles has patterns of dysfunction and how to treat The techniques being used did not seem generously offered a discount to Rolfers. Please them. This volume reiterates some of what to require the therapist to connect with the contact Paolo Roselli, Director of Piccin North is in the first book and then presents how client or feel the effect propagate through America, at [email protected] to place an order. the client’s fascial network, and I was rather

54 Structural Integration / June 2011 www.rolf.org Isn titute News

meeting in Vancouver, BC in May 2010 and presented a poster on its work. Price Research Update – expresses her gratitude to the Ida P. Rolf Research Foundation, which provided ® a travel grant for the event, and reports Rolfing SI for that a significant number of pediatricians in attendance were already familiar with Rolfing SI. The poster gave background on Children with CP the fascial nature of the work and discussed methods, outcome measures, and results, including parent comments such as the he Rolf Institute ® of Structural (Level 5 children have severe limitations following: “I was stunned. It is the most Integration is pleased to update and little if any self-mobility, stability T dramatic, quick improvement we have had members on research into the effect of in gravity, or voluntary movement.) In with anything we have tried,” and “He Rolfing® Structural Integration (SI) for addition to taking measurements, the study went through developmental stages he children with cerebral palsy (CP), conducted included photos, videos, psychosocial never experienced before and continues to in Palo Alto, CA. The research focuses on assessments, and parent interviews. Price do so – like he’s catching up with his age.” Rolfing SI and is being conducted by was the only Rolfer in the initial pilot Certified Advanced Rolfer™ Karen S. program and participated pro bono. The The research team is currently applying Price, B.A., Heidi M. Feldman, M.D., results to date are very positive, and the for additional grants and donations to do Ph.D., professor of pediatrics at Stanford team is seeking to publish in a medical a larger and longer study with twenty- University Medical School, and Alexis B. journal later this year, with an article to four children and the involvement of a Hansen, B.S., Stanford University medical follow in Structural Integration: The Journal broader spectrum of health personnel. student. The initial study worked with eight of the Rolf Institute. Any assistance in this project is greatly children ages two to seven with moderate appreciated. Price can be contacted at Most recently, the research team attended CP – GMFCS (gross motor function [email protected]. the Pediatric Academic Society’s annual classification system) 2-4 on a scale of 1-5.

2011 Membership Conference October 26-28

Celebrating 40 Years of the Evolution of Dr. Rolf’s Vision

Hotel Boulderado, Boulder CO

Join us this fall for three inspiring days of lectures and presentations by distinguished Rolfers™, researchers and authors.

Attend the Membership Conference to learn what’s new at the Rolf Institute® and share your ideas. Gather with friends and colleagues to connect and look forward to the future of our field.

www.rolf.org Structural Integration / June 2011 55 Isn titute News

Congratulations to the New Graduates

Europe – October 2010 Faculty: Pierpaola Volpones (Instructor), Ricarda Sommer (Assistant) Students: Martina Abeldt, Eva Blank, Lena Brändlein, Christoph Engel, Claudia Graninger, Julia Hayden, Alexandra Hochrein, Aman Andres Kohlbach, Isabel Alvarez Luque, Chiara Osbat, Klaus Otten, Victor Salinas, Nina Clara Schild, Albert Nebra Trigueros, Christian Vizjak, Holger Wennrich, Stefanie Wittiber-Schmidt Brazil – December 2010 Faculty: Paula Mattoli (Instructor), Pedro Prado (Instructor), Joerg Ahrend-Loens (Assistant), Gillian Kok (Assistant), Phoenix Quetzal (Assistant) Students: Abdullah Almulla, Anne Beasley, Deanna Clasby, Ulrich Demmel, Gillian Duffin, Diane Friedman, Joshua Frohberg, Arthur Gillespie, Kuniho Okada, Adam Persinger, Adam Polanski, Jeremy Roland, Sheri Sewell, Julia Zatta Europe – March 2011 Faculty: Pierpaola Volpones (Instructor), Carla von Vlaanderen (Assistant) Students: John Armstrong, Frank Bauche, Cora Beier, Andrea Graziadei, Dr. Ralf Jungbluth, Takami Kamata, Juraj Korec, Elisabeth Merckens, Boris Petrovic, Vivien Skelton, Imke Sonnemann, Janco Volk, Rosa Vreeling U.S. – May 2011 Faculty: Kevin McCoy (Instructor), Ramone Yaciuk (Assistant) Students: Carolyn Biano, Clay Evans, Thomas Gilliford, MingLi Jiang, Elaine Lee, AnnaKate Moore, Steve Moore, Takashi Moribe, Fred Nehring, Jesse Norton, Mira Wood

2011 Class Schedule

BOULDER, COLORADO Los AngEles, California Germany

Phase I: Foundations of Rolfing® Advanced Training Basic Rolfing Training: Intensive Structural Integration Phase I: June 13-30, 2011 Phase 1: August 1 – 20, 2011 Monday – Thursday / Friday – Sunday off Phase 2: October 3 – November 23, 2011 June 13 – July 25, 2011 (Jun 13-16 / Jun 20-23 / Jun 27-30) Coordinator: Adam Mentzell & Michael Polon Phase 3: January 30 – March 21, 2012 Phase II: October 24 – November 10, 2011 September 5 – October 17, 2011 Monday – Thursday / Friday – Sunday off Unit III Coordinator: Michael Polon (Oct 24-27 / Oct 31 – Nov 3 / Nov 7-10) September 26 – November 18, 2011 Instructor: Jan Sultan Phase I: Accelerated Foundations of ® Rolfing Structural Integration Rolf Movement Training Holderness, New Hampshire Phase I: April 2-10 August 14 – August 27, 2011 Phase II: June 9-19 Instructor: Michael Polon ® Rolf Movement Certification: Instructors: Pierpaola Volpones & October 30 – November 12, 2011 Perceptive Core Stability Giovanni Felicioni Instructor: Suzanne Picard September 9-15, 2011 (Sept. 12 is off) Advanced Rolfing Training Phase II: Embodiment of Instructor: Kevin Frank Rolfing Structural Integration Phase I: April 13-25, 2012 in Italy & Rolf Movement® Integration Phase II: July 16 – August 1, 2012 in Salt Lake City, UTAH Germany

August 15 – October 6, 2011 ® Instructor: Peter Schwind Instructor: Ray McCall & Jon Martine Rolf Movement Certification: Principles Instructor: Carol Agneessens Breathing and Walking: Movement Education to Support the SI Series South Africa Phase III: Clinical Application of Rolfing Theory November 30 – December 5, 2011 Unit III (Dec 2 is off) September 5 – October 27, 2011 June 6 – July 29, 2011 Instructor: Mary Bond Instructor: Larry Koliha Anatomy Instructor: John Schewe Brazil October 17 – December 16, 2011 Instructor: Valerie Berg Unit III Anatomy Instructor: John Martine September 5 – November 10, 2011 Instructors: Tessy Brungardt & Pedro Prado

56 Structural Integration / June 2011 www.rolf.org Contacts

Officers & The Rolf Institute® European Rolfing Board of Directors 5055 Chaparral Ct., Ste. 103 Association e.V. Boulder, CO 80301 Patricia Pyrka, Executive Director Hubert Ritter (Europe/Chairperson) (303) 449-5903 Saarstrasse 5 +49-30-4435 7473 (800) 530-8875 80797 Munchen [email protected] (303) 449-5978 fax Germany www.rolf.org Peter Bolhuis (At-large/CFO) +49-89 54 37 09 40 [email protected] (303) 449-2800 +49-89 54 37 09 42 fax [email protected] www.rolfing.org Rolf Institute Staff [email protected] Audrey McCann (Eastern USA) Diana Yourell, Executive Director (443) 850-2728 Jim Jones, Director of Education Japanese Rolfing [email protected] Heidi Hauge, Manager of Membership Gena Rauschke, Accountant Association Kevin McCoy (Faculty/Secretary) Trace’ Scheidt, Admissions Counselor Keiko Segami, Foreign Liaison (862) 202-2222 Brandi Smith, Enrollment Advisor #607 1-11-30 Kichijoji-honmachi [email protected] Ray Viggiano, Clinic Coordinator/ Musashino-shi Tokyo, 180-0004 Marilyn Miller (Central USA) Asst. to Student Services Japan (858) 451-2134 Linda Weber, Office Manager www.rolfing.or.jp [email protected] Susan Winter, Manager of Marketing & PR [email protected] Michael Murphy (Faculty) Australian Group (650) 559-7653 Su Tindall, Administrator Canadian Rolfing [email protected] c/o The Rolf Institute Association Maria Helena (Lena) Orlando 5055 Chaparral Ct., Ste. 103 Kai Devai, Administrator (International/CID) Boulder, CO 80301 615 - 50 Governor’s Rd. +55-11 3819-0153 (303) 449-5903 Dundas, ONT L9H 5M3 [email protected] (800) 530-8875 Canada (303) 449-5978 fax (416) 804-5973 Wanda Silva (At-large) www.rolfing.org.au (905) 648-3743 fax (904) 294-3335 [email protected] www.rolfingcanada.org [email protected] [email protected] [email protected]

Executive Committee Brazilian Rolfing® Peter Bolhuis Association Kevin McCoy Sybille Cavalcanti, Executive Director Hubert Ritter R. Cel. Arthur de Godoy, 83 Vila Mariana Education Executive 04018-050-São Paulo-SP Committee Brazil Ellen Freed, Chairperson +55-11-5574-5827 Duffy Allen +55-11-5539-8075 fax Kevin McCoy www.rolfing.com.br Michael Polon [email protected] Ashuan Seow Russell Stolzoff Non-Profit Org. U.S. Postage PAID Boulder, CO OF STRUCTURAL INTEGRATION Permit No. 782 5055 Chaparral Ct., Ste. 103 Boulder, CO 80301