Structural Bodywork PDF

Structural
BODYWORK
Structural Bodywork has been written to provide an advanced • Reviews the well-known theories of Rolf and Feldenkrais
introduction to the field of structural bodywork. This is the and shows how they are both relevant to sound practice
book that the author wished had been available to him when • Includes a large practical manual section on techniques and
he embarked on his career as a practitioner in the field. At that models for different musculoskeletal problems
time mu.ch of this information was available only in medically
• Highly illustrated with over 300 photographs and line
oriented books that were often too technical or jargonistic for
drawings
the non-medical reader to understand, or in much-photocopied
'underground compendia' originating from handouts distributed • Readab�e and easy to understand
to those attending training courses. In recent years, however, • Suitable for detailed study and for quick clinical reference.
the techniques of structural bodywork have become common
property. They have moved out of the hands of foun,ding Structural Bodywork is a book for the 21 st century. The field of
institutes and guilds and have been incorporated into a body structural bodywork is moving and developing fast and there
of practice that is now drawn upon by a wide range of manual are no trade secrets any more. There is a real need for a good
therapists. Structural Bodywork is the book to meet the needs introductory work that covers the essential theory as well as
of practitioners in this new environment. It pulls together for describing the techniques and is accessible to all the
professions that use these techniques as part of their clinical
the first time the different strands of theory and practice that
have until now been widely dispersed across many sources. practice. Structural Bodywork meets that need.
Structural Bodywork focuses on issues of posture and structure

Testimonials About the author
and the functional limitations that arise from them. The text
This book is a delight for the John Smith is a practitioner of
builds on the theories of Ida Rolf (Rolfing) and Feldenkrais and
somatic practitioner who has Rolfing® Structural Integration, the
reviews them in the broader context of massage therapy and
wished for a succinct and lucid Feldenkrais Method and other
other complementary therapies based on a wide variety of account of the breadth and depth somatic modalities. He teaches
bodywork techniques including chiropractic. The book is of the field called Structural anatomy for the Rolf Institute of
divided into three main parts: Bodywork. You have complete Structural Integration (Boulder, CO)
access to John Smith's clear and is an executive member ofThe
• Part 1 looks at the background of structural bodywork, how thinking and knowing on this Australian Rolfing Association.
it has developed and how it is understood today. subject. It is eclectic, and
This book is the result of over a
Part 2 looks at the theory of structural bodywork in more refreshingly 'Simple' and practical.
• decade of the author's clinical work
Read an artful exposition of a
depth and relates it to human anatomy and clinical and personal somatic enqUiry,
fascinating field, with great appeal
presentations. It draws together various strands of theory during which time he has attempted
to those wanting to learn about,
to bring a more unified perspective
and practice that have not been considered together before, and apply modem concepts of, the
to structural and functional
but that are all related to structural bodywork practice. structure and function of the body.
bodywork approaches.
• Part 3, a major part of the book, provides a practical guide Dr David Lake MB as
John lectures and teaches widely in
to structural bodywork techniques. This section is highly E.FT Practitioner and
the field of Soma tics and facilitates
illustrated throughout with photographs and line drawings. Psychotherapist
workshops in the Asia-Pacific
Will become a leading textbook on region, teaching various soft-tissue
Key Features Ida Rolf's Structural Integration. techniques as well as structural
approaches to working with· posture.
• Comprehensive, authoritative and academically sound Robert Schleip MA (Dipl.Psych)
Faculty Member ofRolfInstitute (USA) More detail about the author and his
• Grounded firmly in bodywork practice
and European Ro!fing Assoc. Certified workshops may be found on his
• Brings together previously unrelated theories and relates FeJdenkrais Practitioner, Director of website:
them to practice Somatics Academy (Munich) www.rolflngworks.com.au.
T hll product II appropriate for:

• manual therapy
• osteopathy
• chlropractars
• bodyworkers: RoIfers,
Feldenkrall and Alexander
Technique practitioners
ELSEVIER
• massage therapists
CHURCHILL
LIVINGSTONE www.elsevierhealth.com • physical therapists
Structural Bodywork
This book is dedicated to
Dr Jack Haer, who showed me another path,
Robert Schleip and Pedro Prado, who guided my first steps,
and Dr David Lake, who helped me over the first potholes.
Commissioned illustrations by:

Robert Britton
Graeme Chambers
Mandy Miller
Phil West
For Elsevier:
Publishing Director, Health Professions: Mary Law /Sarena Wolfaard
Project Development Manager: Mairi McCubbin
Project Manager: Morven Dean
Designer: Judith Wright
Illustrations Manager: Bruce Hogarth
Structural Bodywork
An Introduction for Students and Practitioners
John Smith
Bachelor of Education (Syd)
Diploma Remedial Massage (NatureCare)
Certified Rolfing Practitioner
Certified Feldenkrais Practitioner
Certified Cranio-Sacral Practitioner
Certified Trager Practitioner
Somatic Therapist, Sydney, Australia
ELSEVIER
CHURCHILL
LIVINGSTONE
Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2005
ELSEVIER
CHURCHILL
LIVINGSTONE
© 2005, Elsevier Limited. All rights reserved.
The right of John Smith to be identified as author of this work has been asserted by
him in accordance with the Copyright, Designs and Patents Act 1988.
No part of this publication may be reproduced, stored in a retrieval system, or

transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without either the prior permission of the publishers or a
licence permitting restricted copying in the United Kingdom issued by the
Copyright Licensing Agency, 90 Tottenham Court Road, London WIT 4LP.
Permissions may be sought directly from Elsevier's Health Sciences Rights
Department in Philadelphia, USA: phone: (+ 1) 215 238 7869, fax: (+ 1) 215 238 2239,
e-mail:healthpermissions@elsevier.com. You may also complete your request
on-line via the Elsevier Science homepage (http://www.elsevier.com). by selecting
'Customer Support' and then 'Obtaining Permissions'.
First published 2005
ISBN 0 443 10010 1
British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress
Notice
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our knowledge, changes in practice, treatment and drug
therapy may become necessary or appropriate. Readers are advised to check the
most current information provided on procedures featured or by manufacturer
of each product to be administered to verify the recommended dose or formula,
the method and duration of administration, and contraindications. It is the
responsibility of the practitioner, relying on their own experience and knowledge of
the patient, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions. To the fullest
extent of the law, neither the publisher nor the author assume any liability for any
injury and /or damage to persons or property arising from this publication.
The Publisher
your source for books,

journals and multimedia
in the health sciences
www.elsevierhealth.com
The
Publisher'S
policy is to use
paper manufactured
from sustainable forests
Printed in China I
CONTENTS
Forewords Vll
Preface xi
Acknowledgements xiii
Introduction 1
Section 1 Background and history of structural bodywork 5
1 Structural bodywork: an overview 7

2 A brief history of structural bodywork 13
3 Structural bodywork in the context of other complementary therapies 21
4 What is structural bodywork? 25
5 Structural bodywork: some frequently asked questions 30
Section 2 Our somatic organization 35
6 Human maps 37
7 The techniques of structural bodywork 43
8 Structure and function 48
9 The connective tissue network 58
10 The oscillatory properties of the fascial network 80
11 The muscular system 83
Section 3 Practical manual 91
12 A catalogue of some common postural dysfunctions 93

13 Some useful models for working with structure 117
14 Practicum: assessment, technique and strategy in structural bodywork 130
15 A first approximation to balancing structure 147
16 Working in the sagittal plane 153
17 Working in the frontal plane 184
18 Working in the transverse plane 204
19 Working with the shoulder girdles 209
20 Working with the external rotation of the leg 218
Appendix 1 Structural and functional bodywork training 222
Index 225
THIS PAGE INTENTIONALLY LEFT BLANK
FOREWORDS
The orthodox helping professions of medicine and psy me back to working with the body, since E.F.T. is a body
chology have neglected almost completely the body's energy technique mainly (with beneficial psychological
role in functional wellness. We all see the same people, consequences). I thus have a new respect for those who
but most practitioners will see only what we 'expect' to have always known the depth of the body's involve
see in our frame or model of illness, and will tend to ment in any emotional problem - especially trauma.
ignore the rest of the information. Nevertheless, I think The concept of the 'inner world', beloved of those
that all helping professions are heading towards a con working in the field of psychotherapy, needs to expand
fluence in the future with the active help of practition further to incorporate the body - and to allow it to 'be'.
ers like the author, John Smith. His unusual ability both This book serves as a bridge between the world of
to collate and teach effectively in this complex field is inhabiting the body, and the work of harmonizing and
demonstrated here, particularly when it comes to the balancing the body. The illustrations alone provide an
'how' and 'where' of intervening to enhance function. example of a striking translation from thought to
Somatic therapists work with the body, but the body understanding without the intervening cognitive inter
is not so easily understood. Only in the West do we so ruption that words so often cause. There is sufficient
easily separate the body from the mind and the world. background and history for a basic work, and the refer
Yet somatic therapists will not be restricted by such con ences are generous.
cepts and are led naturally towards enquiry and explo There is much in this book to expand your awareness
ration - hence the intellectual ferment today within of basic somatic methodologies and interventions. John
fields such as Rolfing and the somatic treatment of has made the rich concepts of bodywork freely avail
trauma. It is imperative that creative concepts are tem able. The very expansiveness of these words and
pered by intellectual rigour. John Smith's clear thinking notions about the body is inviting, for instance, 'struc
and creative mind are not constrained by impractical ture that can be reorganized', 'the plasticity of the mus
dogmatism or orthodoxy in any field - hence this culoskeletal system', 'the fascial web', 'tensegrity
book. structure', body shaping', and from Ida Rolf (the source
By far the best part of working as a medical prac of many such concepts): 'Gravity is the therapist'.
titioner who uses 'alternative' techniques is meeting It is a poetry of the body.
original thinkers. John Smith's book introduces you Ida Rolf stated that a lengthened and aligned body
to him as much as to his thoughtful grasp of complex not only fostered physical health but psychological,
concepts. Naturally, a good practitioner will allow the emotional and spiritual health as well. If I may extend
client's body or mind to integrate at a higher level of this idea - this book represents a symbolic intellectual
function without intruding too much. I am always con 'lengthening' and 'aligning' for the interested practi
scious when talking with John that 'the practitioner is tioner. The book's very functional suggestions and
the medicine' - that you are the cure as much as any interventions will then allow and invite a balanced pers
technique that you use. But of course, John has pro pective on somatic work to emerge. Conceptual inte
vided a wealth of professional material to assimilate. gration occurs at a deeper level of understanding.
The Three Core Complementary Practices (in Chapter The book is far more than an elegant and practical
3) of Constitutional, Psychological and Somatic prac introduction to a complex field. It is a passport to the
tices include the labels of kinesiology, meridian stimu world of lifelong learning about our inner world - which
lation and cognitive techniques that together are must include the body. There is really no room for rigid
known as KF.T. (Emotional Freedom Techniques). I am thinking or concepts - or rigid bodies (!) in this field.
an KF.T. practitioner. The main tenet of this 'psycholog John is pointing the way toward the future of body
ical acupressure' technique is the radical concept that work with his clean, integrative framework that is
negative or toxic emotion is caused by a disruption in informed by the pursuit of excellence.
the body's energy system. My E.F.T. experience in the
world of counseling and therapy in recent years has led Newport, 2004 David Lake MD
FOREWORDS
The book you hold in your hand provides the most continue our explorations both at the center and out to
comprehensive mapping of the world of Structural the edges of what might be called 'Spatial Medicine' -
Integration to date. As such, it serves two purposes: the art and science of transforming inner shape. Osteo
( 1) as an introduction to the wider field of discussion paths, chiropractors, physiotherapists, dance and Pilates
within the field for the 'heirs of Ida Rolf', especially teachers, Feldenkrais workers and Alexander teachers,
those just setting out on the long and rewarding jour yoga adepts and martial artists, as well as teachers of
ney into practice; and (2) as a survey of Structural movement and bodyworkers of all stripes - all these,
Integration for the interested outsider, be they a practi and especially the teachers of movement to children,
tioner or even the interested consumer. work with Spatial Medicine. In fact, this is not a bad list
Dr Ida Pauline Rolf PhD, the pioneer of Structural of those who will be interested in this book.
Integration, was an extraordinary person. Known as We began by saying that this book is a map of the
the 'face that launched a thousand elbows', she did territory, and this is true at many levels. Rolfer® John
more to establish the field of fascial manipulation than Smith - careful to draw the distinction between map
anyone else in the modern Renaissance of natural and territory right from the beginning - is a man with
therapies. Tireless, iconoclastic, generous, curious, and an affinity for mapping, and he guides us clearly
courageous (as well as difficult and peremptory), her through the plains, mountains, and riverbeds of
life ranged over wide territories of both geography and Structural Integration.
intellect, always boiling what she learned down to First he maps out the context in which Structural
a practical application. The practical application that Integration exists, and giving us its history, relation to
emerged is a progressive system of fascial and myofas other therapies. Along the way, his maps expand to
cial manipulation designed to balance and lengthen the include his own overview of complementary therapies
body in the field of gravity, and restore to it its natural as a whole, and quite detailed and to my eye new, dia
moving and righting functions. grams of the process of getting 'stuck' and unstuck in
Aside from the practitioners whose elbows she particular. In the second section, he charts the organiza
launched, Ida Rolf left two legacies, the 'recipe' tion within the standing and moving human body, and
(explained herein) by which she taught her students, how it can be affected by manual work. In the third sec
and her book (Rolf 1977). These were and are valuable tion, the practical application of structural bodywork
maps, but the system requires filling in with both theo is given a full menu, from conceptual models through
retical underpinnings and new applications, as well as bodyreading (visual assessment) basics to actual strate
adaptation to new findings and new models. This book gies for resolution of common postural dysfunctions.
fills that role. Along the way, other maps emerge of the various
Over the years since her death in 1979, in the dozen models that are developing within the Structural
or so schools that follow her work, we have seen Integration community over the years since Dr Rolf's
Structural Integration trainings with a more spiritual death, and these sections will be of great interest to
intent or a more osteopathic slant, each school with its the practitioner, both within and without the actual
unique emphasis on psychosomatic materiat move Structural Integration community, as the exposition
ment orientation, clinical bias, or preservationist fervor. and comparative analysis of these theoretical models
It is a testament to her work that its shoulders are broad gives a sense of the scope of inquiry within this work.
enough to bear all these interpretations and emphases As far as I am aware, this is the first place in which
easily. This book takes a wide and contextual view of these various models have been brought together and
these differing emphases. placed in context.
One day, in one of the last classes she gave before her This book is the result of a lot of analysis, synthesis,
death, I came up to her at the beginning of a break to and plain old hard work on the part of the author. The
ask if she would like tea. Since the others had left and result, like all good maps, is easy on the reader, easy
we were alone, I ventured a question: ' How does it to navigate, and contains the essential information for
feel,' I asked, "knowing that you have invented this fine understanding this interesting and unique approach to
thing, and established it so that it will go on after you the soma.
leave?" Her answer: 'I was just getting going and my
body gave out.' Clarks Cove, 2004 Thomas Myers
Freezing her concepts as they were when she died
would not honor that indomitable spirit. We must
FOREWORDS
Can one become a good bodywork practitioner solely because of our personal imperfections or because cur
by reading a book without any personal hands-on rent knowledge about it is still insufficient.
instruction? Of course not. This would be as difficult as W hen John Smith, the author of this book, went
becoming a good musician or dancer just by studying through his basic training in Structural Integration (SI)
books. Personal experience and personalized coaching more than a decade ago, he was one of the few students
cannot be replaced. Yet for keen and serious students an whose hunger for detailed understanding we could not
excellent text book such as this can be an invaluable aid sedate with this quote. As one of his instructors at that
in understanding some of the deeper concepts behind time, I do remember his enormous mental curiosity
their art. If you are a bodywork or movement prac combined with an almost Buddhist like peaceful hum
titioner of a different modality who has already expe bleness. 'Would it be possible, dear instructor, to read more
rienced this profound work yourself, and you are about this or to even get a hold of the original paper?' Little
interested in exploring some of our concepts in more did we know at that time - yet not unsurprisingly - that
depth, you will like this book; it is what many of you he would be working for the next 10 years to publish
have been waiting for. And for those of you who have the first comprehensive textbook on the theories of S1.
already started a professional training in this powerful Some may criticize that John Smith currently does not
work - because you have been infected by our insiders' belong to the inner most circle of senior instructors that
passion and excitement for this wonderful art - you were chosen originally by Dr Rolf, or who are author
won't have a choice: this is a must have book. ized as such by the current international schools.
The field of structural integration encompasses fas Others I am sure will find details in this book which
cial manipulation and related movement techniques they themselves would have described differently. Yet I
around the basic ideas of the Dr Ida Rolf ( 1896-1979). doubt this book - if it had been written by any of us offi
Since Ida Rolf's era, practitioners have been educated cial instructors - would have ever become as clear and
in this approach mostly in a semi-mystery school-like understandable for outsiders as well as comprehensive
manner, i.e. student applicants are screened and chosen and relatively unbiased. The author 's accomplishment
for personal maturity by senior practitioners, classes is impressive, as he manages to not only include more
are small and expensive, most of the informational of the many important aspects of this field than have
teaching is done in oral form, and practitioners are been ever put into a single book before, yet also does it
reminded not to pass out relevant information to out with a high level of detail, accuracy and in an excellent
siders. Inspired by some of the guilds of master crafts didactic manner.
men of former times, this is how Ida Rolf felt that The foremost highlight of this book, in my opinion, is
learning the complexity and transformational depth of the theoretical part, as practically all the relevant theo
this work could be best achieved. While being criticized retical models as they are currently taught in SI classes
by some as elitist or old-fashioned, this approach is are described. The author has spent years contacting
reflected by Ida Rolf's female emphasis on quality the founders of various concepts to get their latest
rather than quantity reproduction of her seeds. details and their approval for his descriptions. If several
There is a beautiful quote from German poet Rainer alternative models or explanations exist, he often chooses
Maria Rilke, which exemplifies some of the qualities not to take sides himself, but accurately describes their
of this traditional learning approach and which often basic assumptions to include some of the main pro and
has been read to students by their Rolfing instructors contra discussions. His review of the physiological
around the middle or towards the end of their training: basis is the best I have seen so far. Another aspect that
'I want to beg you as much as I can, to be patient toward all adds great value to this book is the author's wider per
that is unsolved in your heart and try to love the questions spective within the somatic fields. While focusing on SI
themselves like locked rooms and like books written in a very as it is currently taught, he also introduces relevant
foreign tongue. Do not seek the answers which cannot be aspects of the wider field of somatic practices such as
given to you because you would not be able to live them. And the Feldenkrais Method® and Alexander Technique as
the point is to live everything. Live the questions now. welcome adjuncts to structural bodywork. Hopefully
Perhaps you will then gradually, without noticing it, live along this will trigger an indepth discussion between practi
some distant day into the answer.' As profound and wise as tioners of structural bodywork and somatic educa
Rilke's reminder is, it has been also tempting for us senior tors/therapists, beyond the still prevalent mutual
instructors to simply disguise our own ignorance about misconceptions. Rather than only summarizing the
aspects which we don't understand ourselves, be it work of others - which he does extremely well - he also
FOREWORDS
includes some of his own contributions, creative charts in me would prefer to turn the wheels backwards or at
and comparative overviews, as well as his practical least stop them from turning so rapidly. Yet there is also
manual with a simple and clear working protocol at a lot of fresh air of rejuvenation and inspiration, which
the end. this new area of opening and the increasing dialog with
It is nevertheless with mixed feelings that I endorse other somatic practices is already creating. If we can
this book. Together with the recent publication of the keep some of the profound transformational qualities
more practical manual of deep tissue techniques by his of learning this work and mix them with more trans
colleague and countryman Michael Stanborough, it parent, academic and practical teaching methods of
looks like most of the informational contents of our modern times, a lot will be gained. The mature and wise
basic trainings are being spilled out. Will this be the end reader, I am sure, will recognize in John Smith's excel
for our nice and almost tribal community of passionate lent book how much more complexity and subtleties
practitioners of this work? Will it speed up the devel are involved that can only be learned in a personalized
opment of cheap weekend courses and E-learning learning process over a longer time period.
classes by average level PT or massage schools that will
try to teach this work? It surely will, and the nostalgic part Munich, 2004 Robert Schleip
PREFACE
Rochester: 'lance had a kind of rude tenderness of heart. When 1 was as old as you, 1 had a feeling fellow enough;
partial to the unfledged, unfostered, and unlucky; but fortune has knocked me about since; she has even kneaded me
with her knuckles, and now I flatter myself that I am hard and tough as an India-rubber ball; pervious, though, through
a chink or two still, and with one sentient point in the middle of the lump. Yes: does that leave hope for me?'
Jane Eyre: 'Hope of what, sir?'
Rochester: 'Of my final transformation from India-rubber back to flesh?'
From 'Jane Eyre' by Charlotte Bronte
This book is a practical introduction to a growing field specialized field. Physiotherapists should find here
of somatic enquiry: structural bodywork. Structural some fresh strategies for dealing with postural dys
bodywork is a 'hands-on' approach that has the funda functions, taking a more holistic view of their clients'
mental aim of alleviating the structural imbalances that progress; they will also find some potent techniques
afflict so many of us today. It was brought to the world which may not be familiar. Students of structural inte
as a fully fledged discipline in the 1960s by Dr Ida P. gration will be orientated towards a structural way of
Rolf, although its historical roots go much deeper. Since thinking and will find here much of the theoretical
its inception, structural bodywork has evolved further background of their chosen discipline. Hence this book
into a complex discipline with a refined body of praxis should be used as a reference, as a means of getting
and a rich conceptual background. This book is an acquainted with a new discipline, and as a means of
attempt to clarify this conceptual background, drawing emiching the body of ideas presented during the
together various strands that can currently only be course of formal training; although, of course, it cannot
found within separate disciplines. It will explore the hope to supplant the ambience, the intensity and the
history and background of the field, sketch the unique learning environment that evolves during the
anatomy and kinesiology of structure, discuss the maps course of a training.
and concepts that structural bodywork shares with My initial somatic training was in Rolfing® Structural
other approaches, and it will explore the unique per Integration. This was a process of deep immersion. Our
spective brought by this bodywork tradition to impor teachers surrounded us with an ocean of ideas, and as
tant concepts such as 'structure', 'integration' and students we were encouraged to plunge into that ocean,
'holism'; it will offer some useful models for under to breast the waves and to play with these ideas like
standing, evaluating and working with structural dys bright and elusive sea creatures. We were tantalized with
functions, and will provide a selection of effective the latest ideas emerging from anatomical, physiological
techniques for structural intervention. and kineSiological research, confronted with the deeply
Structural Bodywork was written with a diverse range challenging concepts surrounding the principles of
of practitioners in mind: somatic therapists, massage structural bodywork and were initiated into the unique
therapists and other bodyworkers who are looking to perspective of human structure that has evolved within
move beyond their present forms; physiotherapists the structural bodywork field. We explored different
who are interested in exploring new ways of working movement approaches, plumbing the relationship
with the body; students who are undertaking a formal between structure and function, and undertook the per
training program in structural bodywork, and for those ceptual challenge of looking deep into the human body
who are simply interested in gaining a new or deeper to glean structural patterns hidden within the flesh.
understanding of their own structure. For bodywork I hope that this book will reflect something of the
ers, it provides a broad introduction to this exciting, richness of this training; that it will provide a pool of
PREFACE
ideas (if not an ocean!), or perhaps it may provide the great need for any practice that can put people more
something to dip into in a more leisurely fashion. Any in touch with their own bodies. Fortunately, there is a
book about this fascinating field of enquiry could not countervailing trend unfolding; an exciting historical
even attempt to be comprehensive, but I hope it will convergence is occurring right now in which many
give a broad and practical introduction to the field, seeming disparate disciplines are all pointing to the
sketch the conceptual background of the discipline, stark fact that we need to live more embodied lives.
offer some techniques to augment your own manual Vastly diverse practices from many different cultural
skills and perhaps encourage you to think in a more milieus are all telling us to live more fully in the body,
structural way about your clients; taking a longer view to live a rich, sensual, embodied life: practices such as
of their process rather than always attempting to allevi Buddhist Vipassana, Feldenkrais Awareness Through
ate their most pressing and immediate problems. Movement, Yoga Nidra, Autogenic training, Hakomi
We live in a world in which people are becoming Integrative Somatics, Mind Body Centering and
more and more divorced from their own bodies. We see Continuum. And the structural bodywork tradition,
disorders like body dysmorphism and anorexia ner too, has a unique place within this movement. In under
vosa increasing disorders in which there is a complete taking to explore the structural bodywork approach, you
mismatch between actual and perceived body image. too will be part of this movement, because this somatic
The rising incidence of repetitive strain injuries is yet discipline is an enormously powerful means, among
another indication that people are simply failing to lis others, that can help people live more balanced, authentic
ten to their bodies; they are not sensing themselves and embodied lives.
as fully as they might; they lack a complete, accurate
internal map of their own bodies. This all highlights Sydney, 2003 John Smith
Rolfing® is a registered service mark of The Rolf Institute of Structural Integration, Boulder, Colorado, USA
ACKNOWLEDGEMENTS
I am greatly indebted to the many people who have My thanks to Shirley Norwood who helped with the
assisted me in this enterprise. I am deeply grateful Hellerwork section, to Michael Trembath who helped
for the constructive comments of those who have with the Zentherapy section, to Jack Painter who
reviewed sections of the manuscript; Leonie Waks, reviewed the Postural Integration section, to Lee
Merry Pearson, Gilbert Schultz and Amber Cameron Marquette, graphic artist, who helped me with the lay
assisted greatly in the early stages, helping me to clar out of the practical section, to Josephine Hardy, librarian,
ify my intentions, organize my thinking and making for her assistance in finding a number of key research
many useful suggestions on points of expression and articles, to Sol Peterson, somatic educator, whose conver
style. sations helped me clarify my views on the place of struc
A number of Rolfers reviewed sections of this book tural bodywork in the context of the complementary
from a Rolfing perspective, and I would especially like therapy movement, to Robert Schleip, Rolfing teacher,
to express my gratitude to the Australian Rolfers who provided the extraordinary quotations from von
Nicholas Barbousos and Chris Eyles, who have provided Bertalanffy and Dr Andrew Taylor Still, and to Michael
invaluable advice, challenged a number of unsupported Stanborough, Rolfing teacher who inspired many of the
ideas, and corrected some errors. myofascial releases shown in this book.
I was privileged in having Michael Ridge review the My thanks also to Kit Laughlin who inspired many
first two sections of the book. Michael, somatic thera of the contract-relax stretches shown in the practical
pist and long-time assistant of Bonnie Bainbridge section of this book and gave me free rein to make use
Cohen, was in a unique position to observe the growth of the stretches that he and his assistants have devel
of the somatic movement over many years in the oped over many years, and to Peter Robinson, the
United States. Having witnessed its dramatic evolution model in the practical section who is a talented body
and having met and worked with many of its key play worker and stretch-coach in his own right.
ers, Michael was wonderfully qualified to provide real I would also like to thank the editorial staff at
insight into the core concepts of this tradition and in Elsevier who made this book possible: Mary Law, Mairi
clarifying its historical context for me. McCubbin, Morven Dean and Ceinwen Sinclair.
INTRODUCTION
When I undertook to write this book, my foremost aim rationale of a holistic framework, it is unlikely to result in
was to produce the kind of book that I needed when I a major structural rebalancing for your clients. If used
began my own studies in this field. Then, there were no with discretion, however, it can lead you to work that
published works written specifically for structural body may relieve your clients' problems for longer periods,
workers. The available texts were often dryly scientific or, certainly much longer than by just 'rubbing where it
on the other extreme, written for 'fringe' complementary hurts'. These successes may thereby alert you to the need
therapists and pervaded with the pop-psychology of the for a fuller training into the principles behind effective
'New Age'. I believe this book steers a middle course and structural bodywork, principles that quite possibly can
presents a balanced perspective that will be accessible only be picked up through the kind of 'apprenticeship'
to all somatic therapists; those with and those without a offered by formal training, through observing experi
scientific background. enced 'elders' of this work and trying to grasp just what
Having once tried to learn the guitar from a book, they are seeing when they look at a body.
I understand the insuperable difficulties involved in The kernel of this book is based on a workbook I
learning any practical skill by the printed word alone. developed for a 3-day workshop entitled 'A Holistic
Practical skills are best learned practically: through Approach to Working with Posture'. I taught this workshop
demonstration, imitation and supervised practice. Why for several years at the University of Sydney's School of
then this book? Practice must be informed by theory, so Health Science, within the Continuing and Professional
Sections 1 and 2 are concerned with sketching the rich Education Unit. This workshop was offered to a wide
conceptual milieu of this field of bodywork. They will range of health professionals: physiotherapists, occupa
examine the structural and functional aspects of anatomy tional therapists, massage therapists, yoga teachers,
and kinesiology, the maps you will need to negotiate this counsellors, psychologists, nurses and Feldenkrais prac
field, and will present an analysis of the relationship titioners. It was interesting to note that, despite the con
between structure and function. Section 3, however, is a siderable combined experience and the varied training
practical introduction to the field and assumes some of these practitioners, a number of the concepts I pre
prior, basic experience in a manual therapy such as mas sented were completely novel to many of them. Even
sage. This section will offer ways of looking at the struc though structural bodywork in its present form has been
ture of your clients; it presents some guidelines for around for about 50 years, many of its key concepts are
strategizing a bodywork session and structuring a series not yet 'in circulation', ideas such as the following:
of sessions, and offers some effective techniques with
• human beings have a structure that can be reorganized
which to address structural dysfunctions.
• the connective tissue network has structural significance
Although this book will not make you a structural
• postural dynamics can vary markedly between
bodyworker, it may help you to experiment with a more
individuals.
holistic way of working and allow you to perform small
scale structural interventions with your clients. This Most current postural models think only in terms of
is not the ideal approach, and without the guiding muscle length and skeletal alignment, and will either
INTRODUCTION
advocate the 'stretch and strengthen' protocol, or will of inquiring into our client's structure and some means
casually suggest that clients adopt and maintain certain of assessing it: of discovering the complex patterns of
postural habits, such as 'You need to pull those shoulders adaptive shortening that can develop within the human
back', 'Keep your tail tucked under' or 'Tighten your organism. Some structural models are needed for this
tummy muscles'. Such postural advice rarely works. purpose. Dr Ida P. Rolf, the founder of Rolfing, provided
Central to the structural bodywork approach is the some useful tools in this regard, and since her death
premise that it is the fascial network that unifies and there has been a great deal of creative thinking within
organizes the entire musculoskeletal system; which net the Rolfing community, resulting in the internal-external
work itself is modified and organized by the functional model, a powerful means of evaluating our client's struc
movement patterns that our bodies experience in daily tural tendencies and of showing what needs to be done
life. It is the plasticity of this network in responding to in order to 'normalize' that structure. Several variants of
the usual stresses of life that allows us to become unbal this model have been developed and some of them will
anced in the first place, and this very plasticity that be examined in this book.
allows us, with some intelligent input, to restore some The approach in this book is an eclectic one, embra
order and balance to the system. The job of structural cing aspects of Rolfing, Feldenkrais, neuromuscular
bodyworkers then is to provide that intelligent input; to techniques and scientific stretching. It is deeply influ
uncover the structural imbalances of their clients and to enced and informed by the Rolfing approach, but makes
use their manual skills to resolve them. no attempt at teaching structural integration. It does not
This approach is recommended for therapists who are teach Rolfing or any of its variants from other schools of
dissatisfied with merely helping their clients cope, and structural integration. It has the more modest objective
who wish to help them achieve real and lasting struc of serving as a practical introduction to the field. To this
tural improvement. Central to this approach is the idea end it will outline a simplified three-level approach that
that the body has many levels of somatic organization, will be accessible to any experienced therapist, and will
and that real and lasting changes can only take place if allow you to encourage stable and balanced structural
we work with as many of these levels as possible. We change in your clients.
must not only reorganize soft tissue; we must also help In this three-level approach, soft-tissue fixations are
our clients to sense, feel and embody these changes; to initially addressed using techniques of soft tissue mobil
integrate them fully into the movement patterns of their ization. Then, new and isolated movement options are
daily life. We must work both structurally andfunctionally to explored using neuromuscular techniques, generally with
achieve enduring change. the intention of increasing the range of motion, improv
In practical terms, structural improvement means ing the quality of movement around specific articu
relieving areas of shortness within the connective tissue lations, or of bringing about a more efficient coordination
network, of giving more length and resilience to the tissue between antagonist groups. Finally, these changes have
precisely where it is needed, whether the tissue has adap to be integrated into whole-body movement patterns
tively shortened through unbalanced usage or as part of of the client; otherwise they will merely provide
a life-long pattern of structural imbalance. This kind of a short-term benefit. Therefore integrative techni
work can make upright posture easier to maintain and ques are included as an indispensable ingredient of this
less stressful to the body; it removes some of the muscu approach.
lar strain that is required to maintain unbalanced, ineffi A variety of techniques are offered in Section 3. A
cient structures against the ceaseless influence of gravity. direct form of myofascial release will be introduced as an
Structural improvements, however, can only be main effective means of giving more length and resilience
tained in the longer term if clients deeply sense the struc to tissue that has adaptively shortened. Contract-relax
tural changes taking place within them, and integrate stretching will be shown as a means of imprinting new
new options into their repertoire of movement and movement possibilities on the sensory-motor cortex; of
postural patterns. This means that some form of pro providing an expanded range of movement, though not
prioceptive education must accompany the structural necessarily in creating new patterns of coordination. An
interventions. array of both passive and active stretches will also be offered
But where exactly do we lengthen? A toolbag of tech as 'homeplay' for your clients. A general protocol will be
niques is of no help if we do not know what to do, where given for all these techniques, but once the principles
to lengthen, and in what sequence - if we have no are known, you can be as creative as you wish in apply
guiding rationale for our work. We need some ways ing them, and in finding your own unique variations.
INTRODUCTION
These techniques are not exhaustive; they are limited perspective is, however, an extremely practical
certainly not the only ones that are effective in structural way to begin to explore structure, while resolving the
work, and they do not invalidate any other techniques front-back, left-right imbalances is a highly effective
and approaches that you have found to be useful. Both way of achieving a 'first approximation' in balancing
myofascial release and contract-relax stretching are gen the structure of a client.
erally useful techniques in the hands of all somatic ther This book talks unashamedly about how structure
apists. Their use is not limited to working with posture may be modified. It acknowledges that emotional and
and structure; they will prove useful wherever soft psychosomatic influences do have a profound impact on
tissue restrictions exist. our bodies and often create the habits of tension and
A limited selection of movement and postural educa muscular armouring that lead directly to much of the
tional approaches will be demonstrated in Section 3. An structural imbalance we see in others and experience
introductory book such as this cannot hope to present within ourselves. T his book, however, touches only tan
a comprehensive approach to teaching movement gentially upon emotional and psychological issues. It is
integration; the Feldenkrais training, for instance, takes my belief that somatic therapy and psychotherapy can
8 full months over 4 years, so only a taste, a represen be combined, however only in a relatively limited way.
tative offering, can be given here. The book will not When you consider the rigour of the apprenticeship
explore the full range of movement possibilities that can necessary in both of the modalities, and the amount of
be enhanced by this work. Instead it will focus on one experience required to be really effective in either of them,
of the most important human moving functions of all: then it is a wonder that anyone would try to combine the
walking. Observing how our clients walk is a powerful approaches at all! What so often happens is that psy
way of seeing their structural and functional fixations. chotherapists learn a little bit of somatic practice and
Walking is a function that can be readily enhanced by incorporate it into their work, or else bodyworkers try to
structural bodywork, and is therefore a convenient 'psychologize' their clients, naively believing that they
starting point for this approach. The text focuses on the can do it all. Both of these approaches can be useful so
three main kinds of pelvic undulation that are inherent long as we realize our limitations and are prepared to
in efficient walking: refer our clients on when we feel we are getting out of
our depth. Indeed, some of the early offshoots from the
• a rocking in the sagittal plane Rolling tradition work very effectively, both psychologic
• the lateral sway of the pelvis in the frontal plane ally and emotionally, in this relatively limited way.
• the counter-rotation of the shoulder and pelvic gird Occasionally, one finds rare practitioners who are exten
les in the transverse plane; a slight twisting and sively cross-trained in both disciplines and who do
untwisting through the longitudinal axis of the body. extraordinary work, but for anyone starting in this field
this is only a future possibility. I believe that if you wish
and will show how these movements can be enhanced to be a structural bodyworker, you must first master
through appropriately applied myofascial release and structure, then if you find that there are deeper issues
stretching, and then how these more efficient patterns that need to be resolved before a client can change, be
can then be integrated into full body movement. prepared to refer your client on, or to undertake further
A simplified approach to postural analysis will also training yourself.
be outlined in Section 3. It will focus on postural devi This book will not make you a structural bodyworker
ations in the sagittal and frontal planes: front-back and as such, but it may help you embark upon some prelim
left-right imbalances, and will look only cursorily at inary, safe experiments in gently reorganizing structure,
rotatory patterns in the transverse plane. However, and help you to alleviate some of your clients' structural
when looking at the total pattern of muscle fibre orien or postural issues in the short- to medium-term. Your
tations in the body, the direction of the 'grain' as it were, success in these endeavours will, I hope, encourage you
it is quite apparent that the human body is designed to sup to consider some of the excellent training programs now
port spiral or helical movement patterns, movement in the widely available in various schools of structural body
transverse plane, so a left-right and front-back analysis work in many countries throughout the world (see
is obviously bound to be partial and limited. This Appendix 1 for training institutions).
BACKGROUND
AND HISTORY
OF STRUCTURAL
BODYWORK
1. Structural bodywork: an overview 7
2. A brief history of structural bodywork 13
3. Structural bodywork in the context of other complementary therapies 21
4. What is structural bodywork? 25
5. Structural bodywork: some frequently asked questions 30

STRUCTURAL
BODYWORK: AN
OVERVIEW
I NTRODUCTI O N connective tissue structures, from the fascial web to the

skeletal superstructure. Structural bodyworkers, how
Human bodies have a structure that can be eased, bal ever, have a particular interest in the fasciae of the body
anced and, to a certain extent, refashioned. Any effects of since, of all the connective tissues, these are the most
structural change will be reflected in all aspects of our amenable to change. Ida Rolf was one of the first of the
being - not only in how we move and function in the somatic pioneers to stress the importance of the fascial
world, but also in how we think and feel. Structural web, calling it 'the organ of structure' (Rolf 1977), and
bodywork is a modern somatic practice that directly since her time structural bodyworkers have been
modifies our structure, evoking within it greater order, refining its meaning. The word fascia has taken on a
length and alignment. Structural bodywork integrates broader meaning than a strictly anatomical definition
the human structure. The emerging structural balance and is often taken to include other connective tissue
brings with it greater freedom and grace in how we structures such as tendons, ligaments, bursae, retinacu
function as human beings. By the intelligent application lae, cartilage, perichondrium, the periosteum, joint cap
of bodywork techniques, both ancient and modern, struc sules, meninges, basal laminae, serous and mucous
tural bodyworkers can align the human structure, reducing membranes and organ capsules - all composed mostly
the biomechanical stresses within it, and helping us to of collagen fibres, all different metamorphoses of 'the
find healthier, more balanced and efficient ways of living. one fascia'.
The changes that arise from structural bodywork can
prompt a radical shift in our awareness and in the quality
of our everyday experience. A body that is structurally STRU CTURAL DYSFUN CTION
balanced will have a freer, lengthened posture, more gen
erous movement possibilities, a greater sense of vitality, If we look around any busy street we will see every
and more resilience to meet the inescapable challenges where what Ida Rolf (1977) liked to call 'random bodies'
and stresses of life. Structural bodywork is at its very (see Fig. 1.1). These are bodies exhibiting the outward
core an embodiment process - a process that can awaken signs of structural dysfunction, with stooped, swayed
the 'self-sensing' of the body (Hanna 1980), that can help or rigidly held backs, collapsed or 'pumped' chests,
us become more centred and comfortable in the body, poke necks, Chaplinesque feet, hyper-extended knees,
that can even help us take joy in our physicality. Such shoulders that are hunched, 'military squared' or too
an awakening can be a vital antidote to the dissociation elevated. In other words, bodies wavering between
from the body that is such a disturbing feature of collapse and overcompensation in their struggle with
modern life. gravity. And these are just the obvious and visible
The word structure has come to have a specialized signs. Less obvious are the hidden structural imbalances
meaning in the realm of structural bodywork. Its meaning that manifest as inelegant and restricted gait, inefficient
will be clarified throughout this book but, in essence, it movement patterns, stressful work habits or an oppres
refers to the integrated wholeness of the body's connect sive sense that this body is just not functioning as it
ive tissue network and includes the whole spectrum of should.
BACKGROUND AND HISTORY OF STRUCTURAL BODYWORK
Figure 1.1 Random bodies (after Rolf 1977).

STRUCT·URAL BODYWORK:AN OVERVIEW
Structural dysfunctions in bodies typically arise from:

Movement restrictions
The moving intelligence opts for a /"-------, Soft-tissue restrictions
• long-term effects of gravity on an unbalanced posture short-term economy in movement, � The fibrotic soft tissues are less
able to yield in certain directions
• poor ergonomic habits, sometimes made inevitable conditioned largely by fibrotic
restrictions in the soft tissues
D
by poorly designed work environments
• asymmetrical patterns of body use - arising either
from habit, from handedness and other lateralized Increased fibrosity
Strengthened habits A sub-optimal pattern of fibrosity
preferences, or from the demands of non-symmetrical Inefficient or aberrant
develops throughout the soft-tissue
activities neuromuscular patterns are
network in response to the
thereby reinforced
irregular patterns of stress
• postural adaptations to injury - typically subconscious
•
attempts of our sensory-motor intelligence to avoid or
minimize pain
postural adaptation induced by diseases and
D
Biomechanical imbalances
D
Stressed tissues
deficiencies
Rotatory imbalances gradually
develop around artiCUlations Y Irregular patterns of stress spread
throughout the soft-tissue network
• gradual adaptation of soft tissues to repetitive strain

or emotional stress Figure 1.2 A vicious cycle showing the interplay of habit and
• congenital and developmental factors such as asym soft-tissue restriction.
metries of the skeleton
• the results of emotional or 'character ' armouring.
posture is, in the shorter term, the most economical way
of being. It would take more energy to 'stand up straight'
Becoming set in our ways
than to submit to the prevailing structural form. So,
All of these conditions encourage and perpetuate move despite the fact that dysfunctional postural patterns may
ment patterns that are inhibited, constrained and ineffi give rise to all manner of secondary problems, such as
cient. These restricted movement patterns will, in their undue stress on joints and soft tissues; compression or
tum, impose an uneven pattern of strain upon the soft entrapment of the nerves, blood vessels and the viscera;
tissues of the body, with some tissues receiving too much restriction in respiration and so on, it is still the most
mechanical stress, and some not enough. Soft tissues, energy-efficient way of existing within the current struc
from the structural bodywork perspective, refer to the tural arrangement. This is why it is so easy to slump,
fascial and myofascial networks of the body. These fas almost unconsciously, into the old patterns - and why
ciae respond to such stress in characteristic ways: there these patterns reassert themselves when we tire or do
is a tightening, a stiffening and an increase in fibrosity, not pay attention to our bodies.
and there may also be an adaptive shortening or length The converse of this disturbing scenario is that if our
ening of the tissue. In all cases there is a diminished cap habitual patterns become more efficient and balanced,
acityfor the tissue to lengthen. An insidious 'vicious cycle' then these too can become consolidated at the tissue
is established (see Fig. 1.2) as this network of soft
- level. It is not just bad posture that can become fixed
tissue restrictions gradually infiltrates the body, it and habitual. Structural bodywork is based on the fun
maintains then deepens the neuromuscular habits that damental premise that this vicious cycle can be reversed;
brought it about in the first place. We become literally that the compromised soft tissues can be mobilized,
'set in our ways', in the same sense that a jelly sets: the establishing more balance within the soft-tissue net
tissues gel, conforming more and more to our everyday work, reducing the overall level of stress upon the soft
postures and habitual patterns of usage. tissues, encouraging more efficient neuromuscular coord
This 'setting' process is a kind of short-term wisdom ination, and opening the way to more generous move
on the part of the body. It is just one aspect of a neces ment possibilities. Hence the fundamental approach of
sary and conservative group of processes within our structural bodywork is to release the compromised soft
overall somatic organization that strives to maintain a tissues and then invite new movement with proprio
homeostasis, to keep us as we are, to maintain a kind of ceptive educational techniques. With a judicious use of
balance, whether or not that balance is healthy in the both structural and functional interventions at different
long run. It is as if our sensory-motor intelligence is stages of this work, structural bodywork can promote
saying, 'This is how this body wants to behave, so let's dramatic improvements in posture and functionality
help it do just that!' This leads to the strange paradox - (see Fig. 1.4 at the end of the chapter). And, as Figure 1.3
that even the most obviously collapsed and habitual implies, functional intervention need not merely assist
Creative movement Figure 1.3 The vicious cycle is reversed.

New options for
Structural
movement can now
Interventions
be freely explored
: I
Movement is unconstrained Compromised soft tissues
Functional The moving intelligence is less � are mobilized
Interventions constrained by fibrotic restrictions�The mobilized soft tissues are more
in the soft tissues able to yield in certain directions
D
Strengthened habits
D
Appropriate fibrosity
Efficient neuromuscular An optimal pattern of fibrosity
patterns are then reinforced is created
D
Improved biomechanics
D
Stresses eased within tissues
Rotatory forces around Balanced patterns of stress
articulations become more spread throughout the
balanced soft·tissue network
in normalizing movement and posture by restoring the complementary approaches to be more consistent with
status quo; it can present the extraordinary prospect of their overall philosophical orientation to life, particu
evoking a true creativity in movement, of allowing larly involving such concepts as holism and self
a higher order of functionality to emerge. New and responsibility. Health consumers are making informed
improved functional patterns will then positively feed choices, believing that both medical and complemen
back into maintaining a more balanced structure. tary approaches can serve different aspects of their
health goals and aspirations at different times. There
is a kind of 'mix and match' philosophy emerging in
S T RU C T U R A L B O D YWOR K - A which consumers do not deny the validity of either trad
CO MPL E MEN TA R Y APPRO A C H ition but use the specific inSights of each to meet their
own requirements. For many, visiting an alternative
There is growing enthusiasm in the general public for practitioner is a positive choice rather than a reaction
complementary (or alternative) therapies, which encom against allopathic medicine (Astin 1998).
pass a dazzling array of methods, both ancient and mod Structural bodywork is not as widely known as some
ern. More and more they are being accepted as benign other alternative modalities such as homeopathy, natur
and effective alternatives to allopathic medicine: the opathy, osteopathy, or even Swedish massage. However,
model of health and treatment that has long been dom in the world of somatic therapies, structural bodywork
inant in the West. This growing acceptance and trust is is widely seen as the pre-eminent approach to easing
mirrored to a certain extent even within the medical structural dysfunctions, and certainly this reputation
profession itself, which is becoming by degrees much has some basis; the pre-requisites for entering structural
less dismissive of alternative approaches and seeing them bodywork training programs are exceptionally high,
as truly complementary to its work. Increasingly, we with entrants often having already successful careers
find multidisciplinary clinics that cross the medical in other somatic fields such as massage or physiother
complementary divide. Surveys in Westernized countries apy. Students emerge from these trainings grounded
show that a substantial proportion of the population in a deep experience and understanding of human
now use alternative practitioners and take unprescribed structure and with a broad knowledge of biomechanics
alternative medicines (MacLennan et a1. 1996). People and scientific kinesiology. On account of this, struc
who regularly use such practitioners generally believe tural bodyworkers tend to be among the most highly
STRUCTURAL BODYWORK: AN OVERVIEW
'- 11
Figure 1.4 Before and after Rolfing.
trained and highly respected of contemporary somatic B O D Y- S H APING T E C H N O L OGIES

professionals.
Historically, the various systems of structural body Historically, most cultures have evolved technologies
work have been administered by official bodies, usually that attempt to alter our physical appearance or structure.
established by their founders to train and certify new Many of these technologies have a cosmetic intent: ran
students. Like all such institutions they tend to be highly ging in practice from corsetry to ritual scarring, from the
proprietorial and to guard their methodologies most neck-lengthening of Nubian women to the foot-binding
fiercely, often patenting their approach and its brand of young females in pre-Maoist China, and from the
name. This attitude is understandable; it is due in part to lip-stretching of Niu Gini tribesmen to the head
the genuine need to protect valuable systems from abuse binding among the ancient Mayan aristocracy. Such
and facile imitation. In many cases, however, this vigi practices modify the body's structure to satisfy a cul
lance has led these organizations to become exclusive, ture's 'body aesthetic', or to formalize aspects of social
self-serving and anti-competitive. Happily though, this status; rarely do they actually improve human func
guild-like mentality appears to be on the decline. tionality. On the other hand, many body-shaping prac
So, at the beginning of the new millennium, it is tices have had a truly therapeutic intent. Among the
'interesting times' in the world of somatic therapies. A ancient Greeks, Hippocrates and Galen advocated stearn
highly creative fusion of techniques and approaches is and traction as a way of dealing with kyphosis, and
now taking place. And as part of this sea change, struc used primitive traction and compression devices as
tural bodywork is becoming more widely recognized means of dealing with perceived deformities such as
by both the general public and other somatic practition scoliosis or 'hunchback'. These practices survived into
ers. Many massage therapists are moving into struc medieval times and were practiced throughout the
tural bodywork as an area of specialization, and many European and Arab worlds (Harris 1993), and indeed
physiotherapists are seeing aspects of this approach as modern variations of the same devices are still in use
an invaluable adjunct to their work. today.
12 ,,'
For centuries, yogic practice in the East has taught the and body image. In recent times, however, this concern
need for structural alignment. Hatha yoga is a highly has become almost obsessive. W hole industries - diet,
evolved and coherent set of practices for producing a gym and fitness, fashion, cosmetics, and cosmetic
lengthened and opened body. Although there has been surgery - have developed to service this obsession. All
nothing comparable to yoga in the West, there exists a of these industries tend to emphasize the most external
long tradition of structural craftsmen and craftswomen and visible aspects of our being and urge us to conform
the 'bonesetters' - working successfully outside the pre to the current body aesthetic. Some approaches, like
vailing medical establishment (Burch 2002). In the late gym work or strict, formulistic exercise systems, can
nineteenth century came the development of osteopathy indeed modify structure, but they often lack a coherent
and chiropractic, as well as the orthopaedic branch of set of guiding principles and are just as likely to
Western medical science led by Dr James Cyriax, Dr reinforce old, unbalanced patterns as to provide any
James Mennell and others. Then, in the 1960s Rolfing® real structural benefits. Although structural bodywork
emerged as the foundational form of structural body certainly has the potential to evoke dramatic and visi
work. Each of these systems has developed a unique ble changes in posture and physical appearance, as an
approach to modifying human structure. Thus, from the approach it is much more concerned with how we
earliest times through to the present, there seems to have move and feel. It has more to do with our sense of ease
been an almost universal understanding that the human and comfort in our bodies, and with our sense of
body is, to a certain extent, plastic. embodiment. Nevertheless, if clients are seeking a cos
The West has always had its cosmetic traditions and metic improvement, then structural bodywork can
technologies, along with concerns about body shape certainly provide it (Fig. 1.4).
REFEREN CES
Astin J 1998 Why patients use alternative medicine: results Harris J 1993 History and development of manipulation and
of a national study. Journal of the American Medical mobilization. In: Basmajian J, Nyberg R (eds) Rational
Association 279: 1548-1553 manual therapies. Lippincott, Williams and Wilkins,
Burch J 2002 Roots, flowers and pollen: an historical out Baltimore, pp 7-19
line of manual therapies. Structural Integration 30(3): MacLennan A et al 1996 Prevalence and cost of alternative
35-40 medicine in Australia. The Lancet 247: 569-573
Hanna T 1980 The body of life. Healing Arts Press, Vermont, Rolf I 1977 Rolfing: the integration of human structures.
pp vii-xiii Harper and Rowe, New York
A BRIEF HISTORY OF
STRUCTURAL
BODYWORK
T R A DITIO NAL A PPROACHES T O lengthened structure, and this is not necessarily an inte
STRUCTURE grated structure.
Osteopathy was the first modern Western approach
Prior to Rolfing®, there were only a few systems that to see structural integrity as an essential component of
had investigated human structure in a systematic and health. It tends to view structure primarily through the
scientific way - chiefly Hatha yoga, osteopathy, and the skeletal system, and in practice works by gently mobil
work of a few isolated therapists such as Fran<;oise izing the soft tissues then freeing up the capsular
Mezieres (Mezieres 1947). Prior to the twentieth cen restrictions around joints. Rolfing, on the other hand,
tury, yoga was without doubt the most detailed and far emphasizes the fascial network of the body. It works
reaching attempt at investigating human structure and through a unique, systematic process of soft-tissue
of devising a systematic set of strategies for changing manipulation, usually much more forceful than the
and improving it. The whole realm of yogic practice is techniques of osteopathy, which is designed to lengthen
vast and all-encompassing and, in truth, the structural the shortened soft tissues and which, when combined
aspect is only a very minor part of this system. Structural with elements of postural and movement education,
alignment is seen as secondary to the spiritual and medi helps to re-align and balance the body's structure.
tational practices of yoga, and the opened body that The twentieth century has witnessed a spectacular
results from Hatha yoga is seen not as an end in itself growth in scientific research and a vast accumulation of
but as a means of enabling practitioners to have a stable information about the human body. Throughout this
seat in meditation. By using a combination of muscular period, the biomedical model has been the dominant
stabilization and skeletal leverage, assisted by specific health paradigm. It is a reductionist approach to under
breathing practices, Hatha yoga is able to open up fascial standing health that focuses on disease and the relief of
planes. As a system, it has been refined over several symptoms, and although it is usually very successful in
millennia, and its technology for change is of a very doing what it does, the larger view of the person is miss
high order. ing from the biomedical world-view. With the growth of
On reaching the West in the nineteenth century, yoga this approach came the seeds of an inevitable reaction
had to adapt somewhat to Western values. Now, classes against its excesses and a questioning of its values. As a
tend to be large and to have more general, and therefore result, alternatives both new and ancient are now offered;
less individualized, instruction. As with all group-based alternatives that speak of health as a complex web of rela
teaching approaches, a student's individual and idio tionships, rather than as an absence of disease.
syncratic problems are often overlooked. Many styles of Parallel with this extraordinary period of scientific
Hatha yoga now exist; some are rigid and formulistic, achievement was a less visible trend. Towards the end of
while others honour the structural individuality of all the nineteenth century a natural health movement was
the students and will modify their practices to suit the appearing throughout Europe. Echoes of this movement
individual. So, although yoga as taught in the West has can be found in such diverse places as the communal the
great potential for improving structural balance, in prac ories of Tolstoy, the Naturism movement, the sanatorium
tice it has often become simply a way of maintaining a movement (with its spas and water treatments), and in
1 4 ·....
·
gymnastic and movement systems such as eurhythmy.

From the turn of the twentieth century through to the
1940s, a scattering of somatic innovators, usually work
ing in isolation and unknown to each other, were quietly
refining their ideas and practices. These men and women
'devoted their lives to developing strategies for recover
ing the wisdom and creativity present in breathing, sens
ing, moving and touching' (Johnson 1995), and included
innovators like Elsa Gindler, EM. Alexander, Moshe
Feldenkrais and Ida Rolf. Some of them were trained in
science but were not afraid of challenging its orthodoxy.
Then, between the 1940s and 1960s, their systems that
had been so long in germination suddenly sprang to life
with startling synchronicity. Many and diverse somatic
systems emerged, and although many of these systems Figure 2.1 Ida Rolf (reproduced with kind permission from
originated in Europe, it was in the United States that this Ronald Thompson).
flowering became most visible. The period coincided
with the human potential movement and the birth of
over', so the word 'Rolfing' was coined and is today a
humanistic psychology. Centres like the Esalen Institute
registered service mark with The Rolf Institute.
in California flourished and there was a widespread
However, her words 'structural integration' remain as
openness to the torrent of new ideas flowing parallel with
the best generic description for this kind of bodywork,
the mainstream. There was a hunger for real alternatives
and this is the name that she preferred.
in all aspects of Western life. It was the dawning of the
Dr Rolf had a profound belief in the ideals of yoga
New Age.
and held that a lengthened and aligned body not only
Elaborate structural and functional bodywork sys
fostered physical health, but psychological, emotional
tems sprang forth during those frenetic times, along
and spiritual health as well. Like the followers of yoga,
with the discovery in the West of a host of alternative
she believed that a body organized around a vertical
systems of internal medicine (though alternative only to
line was freer to respond to all of life's demands and
the Western biomedical model; in their own cultures
better able to accommodate the ceaseless influence of
they were usually mainstream!). There were complex
gravity. She was also inspired by the wisdom and the
constitutional approaches like homeopathy from
holistic vision of Dr Andrew Taylor Still, the founder of
Germany, energetic systems from China and Japan,
osteopathy, and shared his belief that structure and
Ayurvedic medicine from India and the three-humours
function are absolutely interdependent. Having studied
system from Tibet. At that time also, chiropractic and
with some of the 'first generation' osteopaths, she
osteopathy became 'respectable' and Rolfing became
learned their approach to soft-tissue manipulation and
more widely known and practiced, along with a host of
then, over a period of some thirty years, developed and
other somatic approaches.
refined her methods. This culminated in her unique
approach to enhancing the body's capabilities - Rolfing
R O L FING
Structural Integration.
Her approach is admirably summarized by one of
Ida Rolf - somatic pioneer her first students, Jan Sultan:
In this somatic renaissance, an outstanding pioneer of Dr. Rolf's premises held that gravity bore on the body as
structural bodywork was Dr Ida P. Rolf (1896-1979) a major 'environmental' factor in its well-being. She
(Fig. 2.1). She was a brilliant and original American sci observed that to the extent the structure was organized
entist who began her career as a research biochemist around a 'central vertical line,' representing gravity's
and later turned her formidable intellect to dealing influence, it would operate relatively free of compres
with the structural and physical problems of her family sion, actually drawing support from the gravity dynamic.
and friends. She originally called her work Structural Conversely, because of the body's segmental organiza
Integration, but some of her clients at Esalen jokingly tion, gravity will act on individual segments when they
remarked that they were going to be'Rolfed' or'Rolfed are displaced away from the same central vertical axis.
A BRIEF HISTORY OF STRUCTURAL BODYWORK
. .
',". 15'
This adds compressional loading to the structure and Box 2.1 Basic themes of the Rolfing 10-session
sets up an adversary relationship with gravity. recipe
The synthesis of Dr. Rolf's thinking lay in the obser
vation that the connective tissue was the organ of adap SLEEVE SESSIONS
tation to the structural struggles in the gravity field. 1. respiration

This tissue can change the direction and density of its 2. balance through the legs and feet
fibres with changing demands of the body. She saw that 3. lateral line - sagittal balance
this mechanism of adaptation could be used to support a
CORE SESSIONS
higher level of organization in the body if it were manu
ally freed. from its habitual 'set' and the person educated 4. base of core, midline of the legs
to utilize that freedom; to repattern their structure S. abdomen, psoas for pelvic balance
towards alignment with the central vertical axis of 6. sacrum - weight transfer from head to feet
gravity's effect. 7. relationship of head to rest of body - primarily
(Sultan 1986) occiput-atlas (OA) relationship, then to rest of body
Structural bodywork today owes a great debt to INTEGRATING SESSIONS
Dr. Rolf's pioneering work, and much of her rich concep 8. balance between upper and lower girdles
tual legacy remains. Some of her key insights were that: 9. balance between upper and lower girdles
10. balance throughout the whole system
• gravity is the most fundamental (though least
acknowledged) environmental influence upon us
• the body is a plastic medium, due primarily to the them to perform often highly potent work without yet
plasticity of the fascial network having developed the skill of 'seeing' a client's struc
• the fascial network is a seamless whole, and local tural deficiencies. Its refined sequencing of structural
changes will be reflected throughout its entirety interventions seems to help most clients. Thousands of
• structural enhancement evokes functional improve students have embarked upon the uncertain seas of
ment (the most important enhancements being: the structural integration guided by this map (Box 2.1).
generalized lengthening of tissues, an improved The recipe, however, was a standardized protocol
agonist/ antagonist balance, an increased bilateral and as such could hardly be expected to deal with the
symmetry, and the unwinding of torsional patterns) huge range of structural variations found among
• structural improvements will promote a healthier clients; it was bound to fit ill with certain structural or
metabolism and improved tissue nourishment body types. Dr Rolf insisted that her students follow
• incremental small structural changes are integrated the recipe; however, she herself often paid scant heed
more successfully than larger ones to it. There are many anecdotal accounts in which she
• the sequencing of structural interventions is vital, departs seriously from her own protocol, which tends
both within a session and over a series of sessions to support the idea that the recipe was intended as a
• change at the structural level of organization will learning tool that could be modified, or even aban
inevitably evoke changes at all other levels - the doned, once the underlying principles were under
metabolic, the functional, the emotional, the psycho stood. Nowadays there are many variants of the recipe,
logical and perhaps even the spiritual. although most remain very close to Rolf's schema.
Gravity as the therapist

The recipe - --- ------ - - - -- - - - -- - -- -
Ida Rolf felt that many of the dysfunctional bodily pat

Ida Rolf taught Rolfing as a structured series of ten ses
terns found today are the result of the body's failure to
sions, each sixty to ninety minutes in length. Each ses
intelligently negotiate its relationship with gravity. She
sion had a central theme, a number of structural goals,
believed that part of the integration process involved
and a prescribed sequence of structural interventions
the re-establishment of a balanced relationship with
(Brecklinghaus 2002). This was the so-called 'recipe'. As a
gravity, that'Gravity is the therapist'. In her own words:
teaching tool, this recipe was a highly effective means of
empowering inexperienced students at the beginning One individual may experience his losing fight with
of their careers as structural bodyworkers. It allowed gravity as a sharp pain in the back, another as the
unflattering contour of his body, another as constant

fatigue, and yet another as an unrelenting threatening
environment. Those over forty may call it old age; yet
all these signals may be pointing to a single problem so
prominent in their own structures and the structures of
others that it has been ignored: they are off-balance; they
are all at war with gravity.
(Rolf 1977)
Part of Rolf's vision of the integrated structure was

the idea that, within the field of gravity, a body will
work best if organized around a vertical midline and
that there is an ideal structural arrangement that will
support this.
Somatic Platonism
Don Hanlon Johnson (1980), himself a trained Rolfer,

speaks of what he calls the 'Somatic Platonism' of
Rolfing and other systems, which is the belief that there
exists an underlying ideal form for the human structure
and that the job of bodyworkers is to usher their clients
towards this ideal form. Rolf herself speaks of this ideal
form:
Figure 2.2 Typical representation of an ideal alignment, with
Form and function are a unity, two sides of the same the gravity line falling from the mastoid process, through the
coin. In order to enhance function, appropriate form middle of the shoulder and hip joints and in front of the ankle.
must exist or be created. A joyous radiance of health is (Based on photo in Kendall's classic text (Kendall et al. 1971).)
attained only as the body conforms more nearly to its
inherent pattern, this form, this Platonic idea, is the
For instance, the Rolfing approach now has a much fuller
blueprint for structure.
appreciation of different kinds of postural predisposition
(Rolf 1977)
(Sultan 1986), and the postural ideal of the original
For Ida Rolf, this ideal form was a body with minimal Pilates approach has shifted away from its early ideal of
spinal curvature, a reduced lumbosacral angle, a 'hori the 'flat back' towards the more benign 'neutral spine'
zontal' pelvis, and with minimal segmental displace (Latey 2002) (see Fig. 2.2).
ment from a vertical midline - usually referred to as 'the
Line'. This kind of postural 'template', however, was not
unique to Ida Rolf; variations of a similar ideal align EA RLY O FF SHO OT S FROM ROLFIN G
ment are found in many systems, including modelling
and deportment systems, ballet, Pilates, physiotherapy, In somatic as in religious history, schism seems
scientific kinesiology (Kendall et al. 1971, Basmajian and inescapable. A number of Rolf's original students broke
Nyberg 1978), orthopaedic medicine and even in certain away to develop variations and extensions of her work.
monastic traditions. Johnson questioned the practical An underlying factor in all these departures was the
usefulness of this view of human structure, arguing that gradual realization that structural work, despite its
it limits our vision of what can be achieved through this obvious transformative potential, was often not enough.
work, as well as setting us up for failure when we can By itself, it did not necessarily address functional
not help our clients to meet this ideal. The question of an shortcomings, nor did it directly address the wider
idealized human form will be explored in greater detail humanity of clients by considering their emotional
in Chapter 13, but it should in fairness be said that many and psychological wellbeing. At a purely structural
of these systems have evolved since their inception and level, Rolf's work did not seem to acknowledge readily
have undergone considerable refinement from their early, that there might be different structural types, different
often rigid, belief systems around postural 'correctness'. degrees of sensory-motor intelligence, different capacities
to respond to this work. It is clear that Rolf herself came

to realize some of these limitations in her original
approach. She responded by encouraging the develop
ment of a movement-based approach, Rolfing Movement
Integration, to supplement her structural work and to
help clients make that vital transition from structural
change to a higher order of functionality. Although she
believed that structural work could be psychologically
transformative, in practice she never made an explicit
connection between the structural and the psychological
ways of working, believing that those inner aspects
could be left to look after themselves. It is clear that Rolf
herself in no way regarded this as a limitation of her
approach. Her approach is primarily about integrating
structure, and if secondary side benefits arise from the
work then so be it. Her pragmatic viewpoint is summed
Figure 2.3 Joseph Heller.
up in her well-known words, 'All this metaphysics is
fine, but be mighty sure you've got physics under the
metaphysics' (Feitis 1978). taught to perform myofascial interventions that are
There are many offshoots that have developed from virtually identical to those specified in the traditional
Rolf's pioneering system. It is a tribute to the power of Rolfing 10-series, but they also engage their clients in a
her original ideas that so many derivative systems have dialogue around the sessional theme, and with their
branched from the central trunk of Rolfing. We will movement explorations draw from them new ways of
look briefly at some of the more important ones. interacting with their world.
Like Rolfing, Hellerwork also has evolved since its
inception, although students are still taught an 11-
Hellerwork - Joseph Heller
series, which is used as the basic and foundational
Joseph Heller (Fig. 2.3) was one of Ida Rolf's earliest recipe for all their work. It is significant, however, that
students and later became the first president of the Rolf Joseph Heller wished above all that clients be well
Institute when it was founded in 1976. He came to served and he urged his students to apply all their
believe that the process of structural change demanded knowledge and training, such as that which came from
a simultaneous shift in attitudes and core beliefs. other bodywork modalities, from yoga or tai chi, from
Clients needed to feel not only a postural or structural other movement trainings, from a psychological or
shift, but also a shift in how they engaged with their medical background, or from their own intuitive sense
lives. He felt that structural work could be made more of what the client needed. Hellerworkers therefore
potent and vital if it included two other parallel have many options for dealing with the specific needs
strands: an emotional-attitudinal exploration of key of their clients, the only caveat placed upon them is that
life issues, plus some very specific movement explor they declare to their client which system they are using
ations that were intimately related to these life issues. with them at any time during the process.
So, as a result of his broad interest in structural integra
tion, movement education, humanistic psychology and
Postural Integration - Jack Painter
somatic awareness, he synthesized his new form of
bodywork, Hellerwork, and went on to found his own Like Joseph Heller, Jack Painter (Fig. 2.4) is an eclectic
teaching organization in 1978. thinker. Influenced deeply by the psychological ideas of
His approach took the structural themes of Ida Rolf's Wilhelm Reich and their later recasting as Bioenerget
10-series but extended the series to include an eleventh ics, he has explored widely in the fields of Gestalt psy
session designed to assist clients to take their self chotherapy, bodywork and Eastern energetic systems.
discoveries out into the world. Each session was struc Although not a student of Ida Rolf he received work
tured around a potent theme, charged with many levels from her and her students. He integrated the Rolfing
of meaning, and with titles such as 'inspiration', 'standing lO-series recipe into a comprehensive framework for
on your own two feet', 'reaching out', 'holding back', fostering personal growth known as Postural Integration.
'losing your head' and 'coming out'. Hellerworkers are He understood the difficulty that many people have in
18' ;.
Figure 2.4 Jack Painter.
Figure 2.5 Dub Leigh.

making meaningful changes in their lives and felt that
this deep behavioural conservatism is intimately related
to what Reich had called 'body armouring' or 'charac movement qualities, emotional tendencies and habits
ter armouring'. He believes that a more complete of muscular tension.
approach to working with people must include working After practising and teaching bodywork for twenty
with their bodies in order to, as it were, remove the lay years Leigh moved to a Zen monastery in Hawaii. His
ers of armouring (Painter 1987). He does not regard his Zen teacher was Tanouye Tenshin Roshi, a martial arts
approach as belonging to the psychotherapeutic tradi master who had also mastered the movement of energy,
tion, which he believes does not empower the client 'ki', for healing. Tanouye Roshi and Leigh worked
sufficiently. together for six years to develop Zen Bodytherapy, incor
porating Rolf's emphasis on deep work for structure and
I consider myself more a coach or guide to self
Feldenkrais' emphasis on movement exercises for func
regulation ... the expression of our energy, emotions and
tion. Zen Bodytherapy adds the use of focus, breath, and
attitudes is not something added to or coordinated
'ki' to accelerate the change possible with bodywork.
with work on the fascia - it is literally there in the body
or bodymind. In a deep stroke we express in our tissue
what we are and what we feel. Other derivatives of Rotfing
(Painter, personal communication 2002)
Other systems that were inspired by Dr Rolf's work are
So, while clients are receiving bodywork they are given CORE bodywork, developed by George P. Kousaleos,
space to express emotional and life issues, facilitated by and SOMA Bodywork developed by Bill M. Williams,
Gestalt-style dialogue and working 'in the present', one of the first students of Ida Rolf. Both systems retain
while the opening of the body and the emotions is something like a lO-session series and aim at balancing
deepened by Reichian breath work. and integrating the human structure in gravity.
Zen Bodytherapy - William 'Dub' Leigh

T H E PRINCIPLES O F S T RU C T U R A L
'Dub' Leigh (Fig. 2.5) is one of a small group of INTEG RATI O N
individuals who studied Rolfing under Ida Rolf, and
the Feldenkrais method under Moshe Feldenkrais (Leigh So, while some of Rolf's former pupils sought to extend
1987). Taking the Rolfing 10-series as a basic sessional or augment her work, others have aimed to broaden and
framework, he incorporated aspects of joint manipula deepen it. Since her death in 1979 there has been an
tion and trigger-point therapy into his approach. He ongoing process of enquiry and exploration within the
developed a complex model of body reading and Rolfing community. This intellectual ferment has led to
assessment that went beyond a mechanical examina a true evolution of the conceptual framework behind
tion of the clients' postural organization to include their Rolfing.
Some of Rolf's earliest pupils attempted to take her widen their repertoire of skills. Many are incorporating
method beyond a sterile, formulistic approach and the subtleties of visceral man.ipulation and cranio-sacral
enquired deeply into the principles that lie behind therapy. Others are integrating joint mobilization and
effective work of this kind (Maitland et al. 1995). This indirect spinal manipulation into their soft-tissue work
line of enquiry looked to discover and refine the small (Maitland 2001). Erik Dalton has developed a unique
number of principles needed to provide effective, indi synthesis of myofascial and skeletal work in his Myo
vidualized strategies for structural work. They comprise skeletal Approacil (Dalton 1998). Yet others have found
three principles, the adaptability principle, the palil1tol1ic that their experience of structural bodywork, as giver
principle, and the sllpport principle, under a governing or receiver, has acted as an intellectual catalyst, prompt
meta-principle, the wilolislII principle. When under ing them to enquire seriously into related areas of hunlan
stood, these principles can help practitioners decide: function and experience. This explosion of somatic
1) What do I do first?; 2) What do I do next?; and exploration is yet another of the extraordinary legacies
3) When am I finished? (Maitland 1995), without recourse of Ida Rolf's pioneering work.
to a fixed sequence of interventions such as the recipe. Judith Aston, one of Ida Rolf's earliest pupils, struck
It was acknowledged that there was much wisdom out from the Rolfing community to create her unique
inherent in the recipe, and that although it represented approach to exploring movement and posture, Aston
a strategic set of interventions based on principles, it Patterning (Aston 1999). James 0 ehman, cell biologist
was a recipe nonetheless (Maitland 1995). This was and teacher, was inspired by his RoLfing experience to
quite a radical departure from the Rolfing tradition, explore the science of structure and the energetics of
and it was this questioning of the recipe as the central bodywork modalities (Oschman 2000). Other practition
pillar of Rolfing that was one of the main factors that ers have explored deeply into the role that the embodi
led to the creation of the two leading organizations that ment process can play in the heaLing of severe physical,
exist today for training in Structural Integration: Tile emotional and psychological trauma (Levine 1997,
Rolf Illstitllte and Tile GlIild ofStructliralllltegratiol1. Redpath 1995), a path aLso explored by Pat Ogden, for
T hese same pupils also came to see that although the mer structural integrator and the developer of Hakomi
recipe was an effective approach for deaLing with some Integrative Soma tics. Rosie Spiegel, like Ida Rolf herself,
kinds of postural organization, it proved less effective saw enormous health benefits flowing from the Yoga
for other kinds, or even had a disorganizing tendency. tradition and in her book (Spiegel 1994) she shares her
So to have a wider relevance, Rolfing needed a practical insights into the parallel traditions of yoga and Rolfing.
way of understanding the dynamics of different kinds Will Johnson has developed an embodiment-training
of postural organization. This practical need led to the program that integrates a Western somatic embodiment
development of the illtemal-extemal lIIodel, an original approach with Buddhist meditational practice Oohnson
and effective means of assessing clients' postural ten 1993, 1999). Others have used their structural insights to
dencies and of strategizing effective work to balance move into industrial and corporate settings in order to
their structure (Sultan 1986). This model will be explored assist with the burgeoning problems of repetitive strain
more fully in Chapter 13. syndromes (Goodwin 2003, Rossiter 1999). Tom Myers
went on to develop his extraordinarily allatolllY tmills
metaphor, which is an extremely useful way of visualiz
New directions - Renaissance persons
ing the global myofasciallines of clients (Myers 2001).
More recently within the world of structural bodywork, And of course the borrowing goes both ways; many
there has been a movement towards greater interdiscip of the so-called 'deep tissue' techniques that are now
linary contact and cross-fertilization, sometimes even being taught at massage schools have actually been
taking the form of unabashed borrowing - extracting abstracted from Rolfing. Although they are undoubt
whatever works from whichever tradition. Today's struc edly useful in treating regional problems, these tech
tural bodyworkers are looking beyond the boundaries niques can easily be misused without the guiding
of their training and are exploring related disciplines to rationale of a holistic approach.
REFERENCES
Aston J 1999 Aston postural assessment workbook: skills for Basmajian J, Nyberg R (eds) 1978 Rational mam
observing and evaluating body patterns. Psychological Corp Williams & Wilkins, Baltimore, pp 7-19
Brecklinghaus H 2002 Rolfing structural integration: what it Maitland J 1995 T he Ten Series as a set of strategies based on
achieves, how it works and whom it helps. Lebenshaus, the principles of Rolfing. Class notes in Rolfing training
Gundelfingen Maitland J 2001 Spinal manipulation made simple: a manual
Dalton E 1998 Myoskeletal alignment techniques: deep tissue of soft tissue techniques. North Atlantic Books, Berkeley
routines for today's manual therapist. Manual and video Maitland J, Salveson M, Sultan J 1995 The principles of
tape set, http://www.erikdalton.com Rolfing. Class notes in Rolfing training
Feitis R 1978 Ida Rolf talks about Rolfing and physical reality. Mezieres F 1947 La gyrnnastique statique. Edition Maloine,
T he Rolf Institute, Boulder Paris
Goodwin S 2003 Carpal tunnel syndrome and repetitive Myers T 2001 Anatomy trains: myofascial meridians for
stress injuries: ways to avoid it and work with it; a Rolfer's manual and movement therapists. Churchill Livingstone,
perspective. Massage and Bodywork 17(6): 67-78 Edinburgh
Johnson D H 1980 Somatic Platonism. Somatics 3(1): 4-7 Oschrnan J 2000 Energy medicine: the scientific basis.
Johnson D H 1995 Bone breath and gesture: practices of embod Churchill Livingstone, Edinburgh, p 66
iment. North Atlantic Books, Berkeley, pp ix-xviii Painter J 1987 Deep bodywork and personal development.
Johnson W 1993 Balance of body, balance of mind: a Rolfer's Bodymind Books, Mill Valley
vision of Buddhist practice in the West. Humanics Trade Redpath W 1995 Trauma energetics: a study of held-energy
Paperbacks, Atlanta systems. Barberry Press, Lexington
Johnson W 1999 The Liberation of Sensations. Rolf Lines Rolf I 1977 Rolfing: the integration of human structures.
27(1): 6-7 Harper and Rowe, New York
Kendall 0, Kendall F, Wadsworth G 1971 Muscle testing and Rossiter R, MacDonald S 1999 Overcoming repetitive motion
function. Williams and Wilkins, Baltimore, p 19 injuries the Rossiter way. New Harbinger Publications,
Latey P 2002 Modern Pilates: a step-by-step at home guide to Oakland
a stronger body. Allen and Unwin Spiegel R 1994 Bodies, health and consciousness: a guide to
Leigh W S 1987 AZen approach to Bodytherapy. T he Institute living successfully in your body through Rolfing and yoga.
of Zen Studies, Honolulu SRG Publishing, San Carlos
Levine P 1997 Waking the Tiger: healing trauma. North Atlantic Sultan J 1986 Towards a structural logic. In Flury H (ed)
Books, Berkeley Notes on Structural Integration 1: 12
STRUCT URAL
BODYWORK IN THE
CONTEXT OF OTHER
COMPLEMENTARY
THERAPIES
There has been an unprecedented growth in new visible systems, often giving their clients something to
complementary (or alternative) therapies. The frenzied 'take'.
pace of this growth has been quite bewildering, and the
cross-fertilization between old and new stock is pro Psychological-emotional practitioners
ducing some strange and exotic hybrids. Each new sys deal with the inner life and its outward behavioural
tem is providing a different map, a different view of the aspects, the psychological and emotional aspects of our
human organism; each is focusing on different details, experience; they listen and talk to their clients in order
and different levels of detail within the whole person. to resolve and balance internal conflicts, or to broaden
Like the three blind men and their elephant, each sys self-knowledge.
tem is focusing on different aspects of the whole phe
Box 3.1 includes only those approaches that have an
nomenon, often taking these aspects to be the whole. So
'alternative' flavour: that are non-mainstream. Hence,
how can we begin to find order in this wild profusion,
conventional Western medical approaches are not
and what is the place of structural bodywork in all this?
included, but neither are the psychological-emotional
ones that have developed within academic contexts,
THREE CORE COMPLEMENTARY such as Freudian psychotherapy, or the cognitive and
PRACTICES behaviourist approaches to psychotherapy.
The model is clearly an oversimplification. It could
One perspective for understanding the scope of mod well be argued that certain approaches should be cat
ern complementary practice is to look at three core egorized differently. Some of the more comprehensive
practices, which are the three broad spheres of special systems like Chinese medicine or Shiatsu do include
ization and training - the somatic, the constitutional and both somatic and constitutional elements, while other
the psychological-emotional (see Box 3.1). systems such as Hellerwork or Postural Integration
include both somatic and psychological-emotional com
Somatic practitioners ponents. Many practitioners calling themselves 'holistic'
work with the living body in all its structural and func would claim that their work encompasses several or
tional aspects. They use either their hands or their all of these core practices; however in fact it is quite rare
voices to communicate with the somatic intelligence of to find what we might term 'true renaissance persons',
their clients, attempting to evoke a higher level of that is, practitioners who are equally skilled in more
functionality. than one of these core practices. By and large this model
does resonate with how the public views complemen
Constitutional practitioners tary approaches, and it is reflected in the curricular
deal with the deeper levels of our physical organization: structure of most complementary health colleges where
the systemic, biochemical, metabolic or energetic students tend to emerge as bodyworkers, naturopaths
aspects; they attempt to create balance within these less or counsellors.
Box 3.1 Three core complementary practices
naturopathy Bodywork - Hands-on approaches

homeopathy structural bodywork
Chinese medicine Rolfing
Ayurvedic medicine Hellerwork
energetic (oriental) Postural integration
Shiatsu Zen T herapy
®
accupressure Osho Rebalancing
Jin Shin Jyutsu Rosen method
Reiki functional approaches

Alexander technique
energetic (non-oriental)
Feldenkrais method
T herapeutic Touch
Trager approach
Touch for Health (Kinesiology)
Ortho-bionomy
Polarity T herapy
Aston-Patterning Uudith Aston)
Reflexology
Continuum (Emile Conrad)
Bowen Technique
Body-Mind Centering (Bonnie
Zero Balancing
Bainbridge-Cohen)
t
Rosen Method
Rubenfeld Synergy Method
CONSTITUTIONAL PRACTICES Watsu

Osteopathy/Chiropractic
THREE CORE
t Cranial osteopathy (W illiam Sutherland)
visceral manipulation Uean-Pierre Barral)
listening touch systems
COMPLEMENTARY � SOMATIC cranialsacral approaches
PRACTICES PRACTICES myofascial release Uohn Barnes)
Somato-Emotional Release
Uohn Upledger)
Body Harmony
PSYCHOLOGICAUEMOTIONAL massage
PRACTICES European massage
Swedish
Hoffa
bindeswebbemassage
Reichian line contemporary Western massage
Reichian therapy Esalen
BioEnergetics neuromuscular (trigger points etc.)

deep tissue
Hakomi
sports
Eriksonian line
manual lymphatic drainage
NLP
ethnic massage
Transpersonal psychology
Lomi Lomi
holotrophic breathwork
T hai massage
rebirthing
Chinese Tui Na
Humanistic psychology
Maslow Movement arts
Rogers Western
Perls Gymnastik
Experiental psychology sensory integration
Focusing dance approaches
Gestalt Pilates
Eastern
psychodrama
Hatha yoga
Voice Dialogue
QiGong
Process oriented psychology
T'ai Chi Ch'uan
martial arts
STRUCTURAL BODYWORK IN OT HER COMPLEMENTARY T HERAPIES
ANOTHER PERSPECTIVE ON For these practices a more extensive training is required

C OMP LEMENTARY PRACTICE - than for relaxation approaches and, therefore, assess
M A ITL AND'S T H REE PA R A D IGM S OF ment procedures tend to be more detailed and refined.
PRACTI CE Maitland cites chiropractic, deep-tissue therapies and
neuromuscular re-education as examples of these
It has already been suggested that some kinds of practice approaches. Holistic or integrative practices, he says,
are inherently broader in scope than others. Chinese 'are devoted to enhancing the natural tendency of the
medicine, for instance, comprises a vast constitutional whole person to seek higher and higher orders of func
system encompassing acupuncture, herbal and moxa tioning and well-being'. He sees Rolfing, homeopathy
treatments and different kinds of massage. It is inherently and acupuncture as being integrative practices in this
a bigger, more complete system than say foot reflexology sense.
or Swedish massage. Maitland (1992, 1993) offers a per Maitland points to a hierarchical relationship between
spective that is very useful in clarifying the nature of dif the approaches; namely that a relaxation approach can
ferent complementary practices. He suggests that all not produce a corrective outcome except perhaps acci
complementary approaches can be categorized into three dentally. Similarly, a corrective approach cannot have
fundamental paradigms of practice: relaxation, corrective an integrative outcome except accidentally, although it
or holistic (see Fig. 3.1). Although in his paper he limits can achieve all the benefits of a relaxation approach. A
the discussion to massage and bodywork practices, he holistic approach can achieve everything that can
does suggest that a similar analysis could equally be be achieved through both relaxation and corrective
applied to any other kind of complementary practice. approaches, while at the same time it works to harmon
Relaxation approaches are intended to encourage the ize a whole system. Maitland sees corrective approaches
relaxation response and alleviate pain, and include as a by-product of the Cartesian tradition: the reduc
practices such as relaxation massage and biofeedback. tionist perspective that understands the body as com
Corrective approaches are centred upon the treatment posed of parts, of being a 'soft machine' rather than an
of the symptoms of structural or functional dysfunctions. integrated, unified whole.
Third paradigm: integrative, holistic systems
Second paradigm: corrective
First paradigm: relaxation
Figure 3.1 Maitland's three paradigms of practice.

In a later paper (Cottingham and Maitland 1997), the This analysis offers a perspective into the scope of
authors suggest that these three approaches may be complementary practices to see whether their intent is
used sequentially (and even concurrently) in the treat to relax, to correct or to balance, and whether they are
ment of somatic dysfunctions by alleviating symptoms, complete practices or just collections of techniques
restoring balance and alignment, and promoting effi without a unifying rationale.
cient postural and movement patterns.
REFERE N CE S
Cottingham J , Maitland J 1997 A three-paradigm treatment Maitland J 1992 Rolfing: A third paradigm approach to body
model using soft tissue mobilization and guided movement structure. Rolf Lines 20(2): 47-49
awareness techniques for a patient with chronic low back Maitland J 1993 Das Boot. Rolf Lines 21(2): 1-7
pain: a case study. Journal of Orthopaedic and Sports
Physical Therapy 26: 3
WHAT IS
STRUCTURAL
BODYWORK?
DEFINITI O N • is a strategic, systematic process

• is an individualized approach
• proceeds through the cumulative effects of small
Structural bodywork
changes
• is a lengthening process
is a 'hands-on' somatic practice that attempts to enhance
• works within the fascial network.
posture and flexibility, and to encourage more ef f icient
movement patterns by inducing relatively long-lasting
changes to the body's structure and educating clients A holistic approach
into embodying these changes functionally.
The New Oxford Dictionary of English defines holism as
This definition of structural bodywork emphasizes a philosophy 'characterized by understanding the parts
that the main aim of this approach is shared with all of something to be intimately interconnected and explic
other somatic modalities: to improve the quality of our able only by reference to the whole'. Of holistic medi
client's functionality. But it also highlights its defining cine it states, 'Medicine characterized by the treatment of
difference: that it works by effecting structural change the whole person, taking into account mental and social
at a tissue level. The soft-tissue changes of structural factors, rather than just the symptoms of a disease'.
bodywork are intrinsically different to those of mas So what does it mean to say that structural bodywork
sage, being fascial rather than tonic, and are longer is a holistic approach? It certainly does not mean that it
lasting. This definition also includes those structural addresses the whole person. All approaches that claim
bodywork approaches that have a more psychological to be holistic are really only relatively so; the wholeness
flavour. The educational aspects that are a necessary of an individual is simply too vast to comprehend. How
component of these approaches can take many forms, ever, if we take a systems view of the whole person, if
including proprioceptive, movement-oriented and work we accept that a person encompasses many layered and
directed at a psychological and emotional level. This interpenetrating systems (the human being as a 'system
definition accepts that some structural changes cannot of systems'), then we can address and perhaps even
be accepted by the body without an accompanying begin to understand a whole system within the whoLe per
emotional or psychological shift. son. Structural bodywork considers the entire fascial
network by looking at the relationships between its
parts and how it relates to its 'neighbouring' systems:
THE MAIN CHARACTERISTICS OF
the skeletal-articular, neuromuscular and central ner
STRUCTURAL B ODYW ORK
vous system (with its somatic and autonomic aspects),
as well as the emergent emotional and psychological
Structural bodywork:
aspects of our being. We can therefore say that structural
• is a holistic approach bodyworkers aspire to be holistic in working with the
• balances the structure rather than fixes somatic structural aspects of the client, and that success depends
dysfunctions largely on how holistic in scope their work becomes.
Balancing rather than fixing mechanical thing composed of parts, will ultimately fail
to recognize the ubiquitous presence of compensatory,
Unlike corrective or remedial approaches, structural
adaptive strain patterns throughout the body. Simple
bodywork is not primarily symptom driven and does
joint mobilization without any understanding of how
not necessarily or immediately seek to address where
these patterns reinforce structural dysfunctions can
clients are hurting; it looks beyond the immediate symp
only produce temporary change.
toms to find an underlying pattern that may have given
rise to that symptom or cluster of symptoms. It looks Being a holistic approach, structural bodywork holds
for deeper causes. Very often the place that first regis as a core assumption that balancing the structural sys
ters pain is really the 'weakest link' in a complex web of tem as a whole will reduce the overall level of biome
imbalances, or the place that has become overworked chanical stress within it. The system then becomes more
because other parts are not participating enough and robust and resilient, and there will be less likelihood
sharing the functional burden. Ida Rolf often used to of painful conditions recurring. Ida Rolf herself saw
say 'Where you think it is, it ain't', suggesting that the this process in thermodynamic terms in that we are
cause of somatic distress is often not obvious, and rarely attempting to increase the order, decrease the 'entropy'
at the point of pain. in the structural system (Feitis 1978). In fact her descrip
Suppose a client is suffering from wryneck. It is quite tion of order within the human body has strong res
natural to want to alleviate the discomfort. If the dis onances with chaos theory and the emerging science of
comfort is the result of recent injury, such as a minor complexity (Lewin 1993).
strain or just the recent effect of a bad sleeping position, The primary aim of structural bodyworkers is to
then symptomatic treatment is entirely appropriate. If balance the structure of their clients, not to fix their
the condition is acute then a structural approach is out aches and pains. Yet it is usual to find that these aches
of the question in the short term since we cannot ask and pains do spontaneously disappear, sometimes so
the sensory-motor intelligence to integrate structural gradually and non-dramatically as to pass unnoticed
changes at the same time as it is organizing the body to by the clients themselves! In fact many clients have to
avoid pain. If they have the remedial skills, structural be reminded that their first impulse for seeking treat
bodyworkers will often focus on relieving the discom ment was to deal with their pain. If the client's problems
fort of their client's acute conditions, with the intention are severe or recurrent then it is usual to find that, after
of addressing the broader structural issues later on, the process of structural balancing, painful episodes
once the acute problem has settled. become less frequent and, when they do occur, the
However, this wryneck may equally be the end result recovery time is speedier.
of a complex web of interrelated causes, the 'last straw',
as it were, so that applying a heat-pack, giving some light
massage or performing some joint mobilization is likely A strategic, systematic process
-------------------- ----- -------- - - ---
to be just a partial solution. It may alleviate the discom

Structural bodywork is strategic and systematic. Changes
fort in the short term and speed the healing of tissues
throughout the myofascial network system cannot be
locally, but it will not address the underlying network
made all at once. The work therefore proceeds stepwise
of causes and a repetition of the problem is likely. Any
by a series of approximations towards a more harmo
experienced somatic therapist will at some time have
nious condition of structural balance. This implies that
played the game of 'chase the pain' or 'chase the symp
a series of sessions are required, with enough time
toms' - the saga of fixing one locus of pain only to have
between to allow the organism to assimilate the changes.
it appear elsewhere. It is highly likely that the under
The process is strategic because the sequencing of the
lying web of causes needs to be investigated in this case.
structural interventions is critical. Certain structural out
We have already mentioned the important distinc
comes can only be achieved if prior ones are achieved
tion between corrective-fixing approaches and holistic
and sessions often contain interventions designed to
integrative approaches. Maitland (1992) takes as an
allow for change at a later stage. As an example, it would
example of the fixing approach the use of an isolated
be pointless trying to address the 'head forward syn
strategy such as joint mobilization. He states that an
drome' by merely working with the neck, because the
approach:
organization of the chest, spine, and tilt of the pelvis
whose therapeutic goal is joint mobility and whose the would all need to be addressed, and these in turn are
oretical commitment is to conceptualizing the body as a influenced by the connections between the pelvis and
WHAT IS STRUCTURAL BODYWORK?
Any structural change in the body will require a period of

relearning, of integration. Definite changes that have
occurred in the tissues and the sensory-motor intelli
gence will need to adapt to a body that feels different,
that has new degrees of freedom. New patterns of mus
cular recruitment will need to be established, or old
patterns modified. This must take its time. The dra
matic changes so often seen in the before and after
photos of Rolfing clients are achieved gradually. The
strategic pacing of structural bodywork sessions hon
ours the integration process and accepts that gains are
cumulative and assimilated gradually.
Structural bodywork is a systems approach that has
much in common with ecology. We can view the body
as a vast ecosystem containing various semi-autonomous
Figure 4.1 Progress in the Rolfing series (drawings based on systems that have definite interrelationships with each
photos of one of Ida Rolf's clients) (Rolf 1977). other. Ecologists recognize that any large-scale inter
vention in an ecosystem will invariably have unfore
seen consequences, which are often bad. We see this in
the legs, and so on (see Fig. 4.1). The head forward syn the catastrophic side effects of large-scale damming,
drome is best understood as a whole body pattern in strip mining, deforestation, and irrigation. This has
which the forward head is the most obvious feature. parallels in a complex system such as the human body;
Some general guidelines for sequencing structural work here too, large-scale interventions tend to have unfore
will be examined in Chapter 14. seen consequences - also often bad. It is recognized that
large-scale structural interventions, such as the surgical
An individualized approach lengthening or shortening of any part of the muscu
loskeletal system, are very difficult to assimilate. The
Each person's structure is unique. Certainly there are results of drastic orthopaedic surgery can require long
some structural patterns and themes that are widespread, periods of rehabilitation before functionality returns.
and some important generalizations can be made about Structural bodywork therefore allows time between
these common patterns, but effective structural body interventions to allow the whole system to readjust at
work must be tailored to the client's structural idiosyn all levels.
crasies. Interventions must be specific and selected with
care, and the approach can never be entirely protocol
driven. Non-individualized approaches are common in Structural bodywork as a lengthening process
many gyms, yoga and exercise classes in which every
In all Rolfing work, we are involved in a lengthening
one gets the same treatment, regardless of their struc
process. If there were a law against lengthening a body,
ture or condition. The same tendency exists in formulistic
Rolfing would be out. I'm not kidding, completely.
massage approaches in which practitioners apply an
Rolfing involves lengthening. That's the only way you
unvarying sequence of strokes to their clients. While
can straighten a body.
non-individualized approaches can be entirely appropri
Ida Rolf (Feitis 1978)
ate for maintenance purposes, they can only go so far
in addressing the individual's idiosyncratic needs. The One of the main strategies used by structural body
individualized approach also happens to be much workers is to free up and lengthen tissue that has either
more interesting for the practitioner, with each client adaptively shortened or lost some of its resilience, that
presenting a unique challenge. is, lost some of its ability to lengthen effectively. Figure
4.2 is a simplified model of a joint or articulation. It
shows tissues spanning each side of the joint - tissues
The cumulative effects of small changes
that, broadly, could be called agonist and antagonist
Bodies are conservative; they take time to change. (without, at this stage, being too specific as to whether
Ida Rolf (Feitis 1978) it is muscular, fascial or ligamentous).
Agonist Agonist - Antagonist

tissue tissue tissue agonist antagonist
tissue tissue
:-Ideal
: alignment
(a) (b) (c)

Figure 4.2 (a) Bones are held out of alignment by shortened tissue on one side and lengthened tissue on the other; (b) an ideal,
balanced arrangement around a joint. Optimal connective tissue density allows easy lateral movement in both directions; (c) increased
fibrosity in all soft tissue around the joint. The bones are aligned but with compromised ease of movement and increased compression
on the joint. (Based on original drawings by Dr Hans Flury.)
Figure 4.2a presents the typical short-long imbalance These scenarios require different lengthening strat
around an articulation in which the agonist tissues egies: those of balancing and decompression. Balancing
have adaptively shortened and the antagonist tissues involves establishing or re-establishing a balanced rela
have adaptively lengthened from their optimal work tionship between the agonist and antagonist tissues,
ing lengths. This maintains a misaligned relationship by lengthening only those tissues that have adaptively
between the skeletal elements. It is apparent that in order shortened (see Fig. 4.2a). Decompression works by mobil
to create a more efficient alignment of the bones, the izing all the compromised tissue - agonist and antagonist
antagonist musculature must work harder to overcome alike (see Fig. 4.2c).
the elastic resistance of the shortened agonist tissue. An obvious question arises at this point: what can we
Figures 4.2b and 4.2c present a balanced relationship do about tissue that has adaptively lengthened and is
between the agonist-antagonist tissues. However this already too long? It will be suggested later in the book
'balance' may be of different kinds. Figure 4.2b demon that lengthened tissue can usually be left to look after
strates an optimal balance that allows maximum ease of itself. As the shortened tissue lengthens there will be less
movement around the joint, with a healthy resilience in neurological inhibition of its lengthened antagonists,
the connective tissues. This is the ideal. Note that there which will naturally strengthen and shorten with the
can also be sub-optimal balance, one involving a gener exercise involved in everyday movements.
alized shortening around the joint. Figure 4.2c repre
sents the case in which the agonist and antagonist
Working within the fascial network
tissues alike have become more fibrotic and have lost
their optimal resilience. This is usually the end result of Ida Rolf was one of the first to emphasize the impor
a generalized tightening of the musculature around tance of the fascial network as an anatomical system. She
a joint, sometimes referred to as a 'holding pattern' - a called it 'the organ of structure' since its most obvious
habitual, relatively continuous pattern of high tonus function is to provide the structural support for the
in all of the musculature around a joint. All groups human body. As a system, it had received little atten
respond by becoming too tight and by working harder tion from the medical profession, even though it has
than necessary, and in the longer term stimulating the some remarkable properties, and more of its functions
investing fascia into becoming more dense and fibrotic. are being discovered all the time. It is in fact the most
Movement in either direction then becomes limited extensive system in the human body, being more exten
by the inelasticity of the opposing tissue. This will sive than even the nervous or circulatory systems (in
inevitably result in higher energy expenditure for all fact it forms the supportive superstructure of both these
rotatory movements around that joint and an increased systems). It ranges in scope from coarse macrostruc
burden of compression on the joint surfaces. tures such as the iliotibial tract to the diaphanous
WHAT IS STRUCTURAL BODYWORK?
wrapping of individual muscle cells. It is connected Fascia responds to the mechanical stresses borne by the
and continuous from the grossest to the finest levels. body through a process of adaptive shortening, length
In the words of Ida Rolf (1977): ening, thickening and tightening. It constantly adapts
to our habitual postures and to repeated patterns of
In the myofascial system as whole, each muscle, each
usage. Structural bodywork attempts to free up this com
visceral organ, is encased in its own fascial wrapping.
promised tissue so that a higher level of functionality
These wrappings in turn form part of a ubiquitous web
can emerge.
that supports as well as enwraps, connects as well as
Fascia is much more than just a containment system
separates, all functional units of the body. Finally, these
of the body; movement scientists are now beginning to
elastic, sturdy sheets also form a superficial wrapping
recognize the crucial role played by the fascial network
serving as container and restraining support for the
in creating efficient movement patterns. Our bodies are
whole body - this is the so-called superficial fascia, lying
able to harness the elastic recoil properties of fascia to
just under the skin.
create economical, efficient rhythmic movement. Kinetic
Oschman (2000) has broadened this vision even further energy is stored as potential energy in the stretched
by showing that fascial continuity extends even to a sub fascia, which can immediately be released, or 'recycled',
cellular level and that the continuum of what he calls in further movement. This inherent rhythmicity in our
'the living matrix' actually crosses cell boundaries and structure will be explored in Chapter 10.
links up with the cytoskeleton, the micro-filamentous
superstructure within individual cells.
REFERENCES
Feitis R 1978 Ida Rolf talks about Rolfing and physical reality. Oschman J 2000 Energy medicine: the scientific basis. Churchill
The Rolf Institute, Boulder Livingstone, Edinburgh, p 66
Lewin R 1993 Complexity: science at the edge of chaos. Rolf I 1977 Rolfing: the integration of human structures.
Phoenix, London Harper and Rowe, New York
Maitland J 1992 Rolfing: a third paradigm approach to body
structure. Rolf Lines 20(2): 47-49
STRUCTURAL
BODYWORK: SOME
FREQUENTLY ASKED
QUESTIONS
W H Y DO PEOPLE COME FOR structural imbalances that are often sensed as a lack of
STRUC T URAL BODYWOR K ? energy. Sometimes it is for purely cosmetic consider
ations; clients wish to look straight, or do not like their
Ida Rolf characterized two broad groups of people who shoulders rounding forward.
came to her for work: those who were hurting and those Cosmetic considerations cannot be dismissed as mere
who were seeking a way to facilitate change in their lives. vanity or just the need to conform to the current body
In her words: aesthetic. Most humans are acutely attuned to reading
the body language of others, which is achieved mostly
There are two types of people who come to a Rolfer. One at a subconscious level by appraising their posture, facial
has what I so elegantly call a bellyache, and wants you expressions and how they move. Acknowledging that
to get that bellyache out. The other's ache is an overly certain postural configurations indicate certain feeling
absorbing recognition of the fact that he is unhappy. He states, such as depression, lack of confidence, anxiety or
is unwell, uneasy. He wants to know why, he wants to bravado, they often wish to deal with the deeper causes
move on, he wants to know more. of the signals that their bodies are sending to the world.
Ida Rolf (Feitis 1978) Many clients see structural bodywork as a way of
changing their outlook, their being. In the mid-twentieth
And when clients speak to me of their aspirations when
century, psychologists began to notice that psychologi
beginning this kind work, the most common reasons
cal disorders were often reflected in a disorganized
they give are that they wish:
somatic self (Feldenkrais 1949). Freud's protege, Wilhelm
• to relieve their aches and pains
Reich introduced the concept of 'character armouring',
• to deal with what they perceive as their postural

describing how strategies of muscular tension can be
problems used for the suppression of feelings. He suggested that
• to overcome movement restrictions and a lack of

there was now a cogent alternative to the 'talking cure'
flexibility in dealing with psychological issues, which was to work
• to work with somatized emotional problems

directly through the agency of the body. Feldenkrais
• more rarely, to achieve some kind of cosmetic result.

pointed out that, until this point, there was a strict taboo
against working with the body in a psychotherapeutic
Clients often arrive having worked with many differ context and that all touch between client and therapist
ent kinds of practitioner and will often speak of their pain was frowned upon. More recently however, somatic, or
'history' - a sequence of stressful or traumatic episodes 'body-centred', psychotherapeutic systems have begun
that has gradually brought them to their present unbal to suggest that therapists can help clients organize their
anced state. Sometimes their main concern is their over psychological and emotional life by helping them to
all comfort level; they may have aches and pains that organize their physical presence, to live more embodied
they relate to poor posture, and certainly the biome lives. This has resulted in a clear trend towards a blend
chanical imbalances of poor posture can lead to discom ing of the roles of the somatic therapist and the psy
fort. Sometimes it is a functional inefficiency arising from chotherapist. There seem to be two historical strands at
STRUCTURAL BODYWORK: SOME FREQUENTLY ASKED QUESTIONS
work here: a Reichian strand, which came from a 'head over many years, and networking with other practi
based' psychological tradition trying to become more tioners. This wisdom is more a body of folklore than a
somatic in its orientation, and a bodywork approach system of validated knowledge and can be likened per
trying to become more psychological in its orientation, haps to the Materia Medica of homeopathy, which is a
as exemplified in the work of Heller, Painter and others. huge repository of anecdotal evidence that is an extremely
Whether there is a true middle ground here remains a useful resource, athough not necessarily organized along
moot point. scientific lines. This folklore is obviously pre-scientific,
It is interesting to note that many traditions regard often in agreement in its generalities but almost
postural 'correctness' as having a spiritual dimension. inevitably at odds in its specifics. And as in the history
Our language contains many words that have a strange of all practical knowledge, there is a point at which it
ambiguity in that they express parallel physical and must move beyond the collection and classification of
emotional meanings. 'Attitude' can mean one's posture data into the next stage - of clarifying its theory, testing
or bearing, or it can mean one's perspective or sentiment. it, and becoming a true applied science (Flury 1988).
'Flexibility' can mean suppleness or elasticity, but it can Since the days of Ida Rolf there has also been an
also mean a willingness to compromise or accommodate, immense amount of research into the biochemistry and
that is, a behavioural flexibility. 'Upright' can mean erect, biomechanics of connective tissues, while in the field of
but in the Christian tradition, it means principled and sports medicine there has been some useful research
honourable. And in various religious traditions, such as into the techniques and efficacy of stretching. The
yoga, Zen and Jesuit monasticism, the correction of pos results of this research will be examined in Chapter 9.
ture is seen as a necessary part of spiritual develop
ment. There seems to be a universal acknowledgment
that if you change your posture, you change how you
HOW IS S TRUCTURAL BODYWO R K
feel, and for many people this is the real reason they
DI F FERENT FROM MASS AGE?
seek structural bodywork.
Massage therapy can provide excellent benefits to

clients: a measurable reduction in tonus levels, improved
IS THE R E ANY RESEARCH INTO
local circulation, reduction of stress, improved immuno
THE BENEFITS O F S TRUCTURAL
logical response, quicker healing of injury, reduction of
BODYWORK?
oedema, and so on. These results, though highly desir
able, are usually relatively short term and require fre
There has been a considerable amount of research in the
quent follow-up treatments. The techniques of structural
fields of massage and osteopathy, but little in other
bodywork can give much the same kind of results as
alternative modalities. For Rolfing, however, there has
massage, but result in longer lasting changes to the over
been a small but significant body of research that has
all structural organization of the body that can indeed
established, among other things, that it can decrease
be lifelong if clients are able to integrate them fully into
pelvic tilt, improve agonist-antagonist coordination,
their movement repertoire.
decrease vagal tone (a measure of autonomic activation),
and reduce anxiety (Cottingham 1985). It is preliminary
research that shows only gross correlations; it does not
show which elements of the Rolfing process are most CAN S TRUCTU R AL BODYWORK DEAL
potent, nor does it exclude the possibility that other W ITH S KELETAL ASYMMETRIES LIKE
somatic therapies can produce similar results (we know S COLIOSIS?
for instance that almost any form of benign touch can
have beneficial effects on the immune system). Structural bodywork is a very effective way of dealing
However, there has been an immense amount of with the structural imbalances of scoliosis. As can be seen
qualitative or 'action research' in the area of structural in Figure 5.1, a combination of myofascial and osteo
bodywork, with much individual enquiry, exploration pathic approaches can produce remarkable changes in
and daily problem solving conducted by the practitioners the relatively young (Dalton 1998). We know, however,
themselves. There is a real wisdom that can emerge that bony deformations tend to consolidate in time, and
from the shared, collective clinical experience of thou that the potential for completely reversing these changes
sands of practitioners working with thousands of clients in adults is limited. Wolff's Law tells us that bones do
BACKGROUND AND HISTORY OF STRU CTURAL BODYWORK
IS STRUCTURAL BOD YWORK REALLY

ABOUT IMPROVING POSTURE?
Kisner (1985) defines posture as Ja position or attitude of

the body; the relative arrangement of body parts for a
specific activity, or a characteristic manner of bearing
one's body'. This is the static conception of posture which
many of us have, as if there were only one way of stand
ing, one way of sitting, and so on. Such definitions tend to
hide the extraordinary and dynamic neuromuscular
process of moving and being within the field of gravity,
all the unconscious proprioception and response of the
anti-gravity musculature. A seemingly static posture is
as surely a function as walking, throwing or jumping. For
this reason, Feldenkrais disliked the word JpostureJ, con
sidering its Latin roots suggest a certain fixedness, like a
Jpost'. He coined the word 'acture', preferring its connec
tion with the roots of the word Jaction'. Posture is not a
static condition, but rather a state of dynamic equilibrium
in which the nervous system coordinates the myofascial
and skeletal systems to maintain a continuity of stance or
Figure 5.1 Improvement in scoliosis after thirty months orientation within the field of gravity.
of myofascial and osteopathic work. Client of Erik Dalton One of the questions most frequently asked of struc
(Dalton 1998). tural bodyworkers is 'Why is keeping a good posture
so difficult?' From our earliest days we are being given
postural advice, ranging from crude imperatives like
adapt to the stresses applied to them and can change
JSit up straight', 'Chest out, stomach in', JStop slouch
shape even in adulthood; bony tuberosities, crests and
ing', JTuck your tail under ', JPull those shoulders back,
condyles can enlarge and densify from the effects of
soldier!' and so on, to quite refined suggestions from
stressful exercise. In the opinion of one Advanced Rolfer:
the Alexander approach: 'Let my neck be free in order
When scoliosis is in an advanced stage, some vertebrae that my head may go forward and up . . . ' Why then is
can actually degrade to a cone shape that can no longer it so difficult to follow these suggestions? Why is it that
be modified. In spite of this, we can work to release com we can follow them when we remember to, but that
pensations and let the body be more at ease. as soon as we forget we revert to the more ancient pat
(Mazzali Fulgenzi 2000) tern? Ida Rolf suggests that in order to understand this
problem we need to draw a vital distinction between
One can speculate that if the process of structural body the concepts of posture and structure, and explained it
work does balance the tensions within the myofascial like this:
network and remove the major stresses then, in the
longer term, perhaps even skeletal form may be remod It's rare to find a person with structural integrity, a
elled. However bony changes do not occur quickly, so it body stacked properly with respect to gravity, free to
is unlikely that this question will be answered in the move ... Mind, I'm not talking about posture. I'm talk
near future. This being said, there is much anecdotal ing about structure. Posture is holding your structure
evidence to suggest that the segmental asymmetry of as well as you can. When the structure is properly bal
scoliosis can be markedly reduced, even in adults, and anced, good posture is natural. A man slouches not
the stresses that arise from asymmetrical muscle usage because he has a bad habit but because his structure
can be greatly eased by balancing the fascial network. doesn't make it easy for him not to slouch. Structure
JEven if Rolling sometimes induces only limited decrease implies the relationship of parts and it implies gravity.
in rotations (mainly in adults), easing the compensa In school they never make you feel you are living in
tions makes the client more comfortable' (Mazzali a gravitational field. We know about gravity in archi
Fulgenzi 2000). tecture. We know that buildings show strain to the
STRUC TURAL BODYWORK: SOME FREQUENTLY ASKED QUESTIONS
degree that they deviate from an optimal relation to constantly at work balancing our structure against
gravitational pulls. In buildings we recognize the ori the effects of gravity and other external forces. So it is
gins of these strains but in bodies we don't. correct to say that one important aim of structural
(Gustaitis 1975) bodywork is to help clients achieve better posture, and
the approach is through freeing up the structural
In this context, 'structure' refers to the integrated restrictions that make it difficult to maintain efficient
cooperation of the major structural elements of our alignment. However, posture is just one function that
physical reality, the skeletal and the fascial systems - structural bodywork addresses; a whole spectrum of
our personal architecture. Our posture then is a func functional patterns can be effectively enhanced by this
tional pattern in which our neuromuscular system is approach.
REFERENCES
Cottingham J T 1985 Healing through touch: a history and Flury H 1988 The third finger. In Flury H (ed) Notes on
a review of the physiological evidence. Rolf Institute, Structural Integration 1: 2-5
Boulder Gustaitis R 1975 Rolfing after Rolf. New Realities
Dalton E 1998 Myoskeletal alignment techniques: deep tissue Kisner C 1985 Therapeutic exercise: foundations and tech
routines for today's manual therapist. Manual and video niques. F A Davis, Philadelphia, p 418
tape set, http://www.erikdalton.com Mazzali Fulgenzi M 2000 Scoliosis: what to do? Rolf Lines
Feitis R 1978 Ida Rolf talks about Rolfing and physical reality. 28(4): 5-13
The Rolf Institute, Boulder
Feldenkrais M 1949 Body and mature behaviour: a study
of anxiety, sex, gravitation and learning . International
Universities Press, New York
OUR SOMATIC
ORGANIZATION
6. Human maps 37
7. The techniques of structural bodywork 43
8. Structure and function 48
9. The connective tissue network 58
10. The oscillatory properties of the fascial network 80
11. The muscular system 83

HUMAN MAPS
Maps are essential gear for pilgrimages. It is not easy to error of mistaking the territory for the whole known
use them without being led astray. universe. On the road to understanding in any field, if
Don Hanlon Johnson (1994) there is a tendency, calculated or otherwise, to exclude
anything from our enquiry, then it automatically limits
Maps are beguiling, empowering, practical, convenient, or stalls any progress in thinking. Therefore, it is vital
and profoundly incomplete. They guide us through that, as complementary health practitioners, we know
domains of great complexity without the need for local our maps and the assumptions underlying them, which
knowledge. They summarize certain facets of reality so often remain unacknowledged. We need to realize
without distracting the mind with incidental details. that the view of the human being taken within our dis
They are also a tacit admission that we rely heavily on cipline is limited; it is necessarily incomplete. Failure to
conceptual props to help us deal with reality in all its understand this may (and so often does) lead us to
glorious intricacy. Intrinsic to maps are assumptions believe that our system can do more than it can. But if we
about which aspects of reality we wish to deal with and take the time to reflect upon and understand our maps,
which aspects we wish, in a sense, to disregard. This is we become less fixated on our own systems and more
true of all types of maps, including standard territorial accepting of the potential validity of others. It gives the
maps, maps used in all conceptualized systems, maps
freedom to explore and respect other systems, and to
used within all complementary health approaches, and realize that complementary therapies are, as the name
maps used in structural bodywork. In this section we ought to imply, complementary, not only to conventional
will look at maps generally in the world of somatic
medicine, but to other complementary therapies as well.
therapies and identify those maps that are specific to the
This understanding leads to the realization that, as
conduct of structural bodywork.
individual practitioners, we cannot do everything and
We have already seen in Chapter 3 how each comple that it is vital that we develop a sound referral network
mentary modality offers a different view of the human
in our practices, and are willing to pass on clients who
being, focusing on different details and different levels
we feel would achieve more within another modality.
of detail within the whole. Every modality has its own
unique selection of maps, models, views and schemas
of the human territory. And they are always merely a A SCIE N TIFIC MAP OF HUMA N S
selection from that vastness that is the human being. So
at the heart of all modalities, whether ancient or mod Figure 6.1 i s a structural map o f a human that summar
ern, medical or complementary, is a systematic process izes much of the domain of biological science, encom
of elimination (though not necessarily a conscious one), passing the vast territory of anatomy, physiology and
in which we decide which aspects of the whole human biochemistry (Tortora and Grabowski 1993). It shows an
it is important to look at and investigate, and which to elegant and hierarchical layering of systems within sys
ignore. This makes all therapists specialists. tems, with the emergence of different orders of function at
So, as the quotation from Johnson implies, maps each level. This view is the culmination of the analytical
have their dangers; and not just the common error of and reductionist approach to understanding humankind
'mistaking the map for the territory', but the graver that started with Descartes and developed throughout
OUR SOMATIC ORGANIZATION
Organismic level Integumentary

Skeletal
I
Muscular
II
Nervous
System level Endocrine
I Cardiovascular
I
Heart
Lymphatic
II
Lungs
Respiratory
Organ level Brain
Digestive
Skin
Urinary
Muscle Pancreas
Reproductive,
Tissue level
..
Nervous
Connective
Biceps brachii
Eye,
etc. I
II Epithelial etc.
-� Adipocyte
Parietal
Cellular level
Muscle cells
Leukocytes
Nuclei Neuroglia
Organelle level Mitochondria Osteocytes

Ribosomes Chondrocytes
Lysosomes Goblet cells,
Centrioles, etc.
Chemical level etc.
Figure 6.1 A scientific map of a human showing different levels of structural organization (after Tortora and Grabowski 1993).
the scientific revolution. It sees an organism as the other constitutional maps that are in much currency in
integrated collaboration of organ systems, such as the the world of complementary therapies, such as the
skeletal, digestive, circulatory and respiratory systems. Chinese and Japanese meridian systems, or the
Each organ system is seen as consisting of two or more Ayurvedic dosha system.
organs that work together towards some systemic end. This map also has nothing to say about how the
Each organ is seen as composed of a combination of the organism experiences the world, nothing to say about
four basic types of tissue - muscular, nervous, connec emergent properties like self-sensing and awareness. Yet
tive or epithelial. Each tissue is characterized by specific these are the very functions that stand at the heart of
kinds of cells supported with specific kinds of extracel true somatic approaches. So, as useful as this map is for
lular matrix. Each cell is seen as including a complex structural bodyworkers, it must be supplemented with
arrangement of organelles, and each organelle is seen as other dimensions: emergent functions like propriocep
an orderly arrangement of biochemicals. tive awareness and feeling, and all of the behavioural,
The above figure is an extremely useful map for sum psychological, emotional and energetic aspects of our
marizing the domain of Western biological science being. For a more complete map of the domain of struc
as each of its levels represents vast amounts of special tural bodywork, another point of view is required - the
ized knowledge and enquiry. However, this map also somatic viewpoint.
covers much of the ground of Western complementary
approaches, which have staked their claim on the same T HE S OMATIC VIEWP OINT
territory. Later on we will examine which particular
aspects of the scientific map have been considered rele The adjective somatic has come to have a rich meaning
vant to the structural bodywork worldview. This map in the world of complementary therapies, and is used
does not try to be all-inclusive; it consists of those aspects for defining broad categories of practice, as in somatic
of man that biological science has chosen to examine therapies, somatic approaches, and somatic psychother
according to its own methodologies. But just what does it apy. Indeed it is now used to identify the whole field of
omit? It does not extend below the chemical level, down somatic exploration and enquiry, which is known as
to the subatomic level of organization of matter (it 50matics. The word 'somatic' is derived from the ancient
would probably be argued that subatomic phenomena Greek word for body, soma, and has come to have two
are not relevant at the organismic level of organization). distinct though related meanings. There is the long
Nor does it extend upwards into the emergent properties established usage within biological science referring to
of the whole organism by representing its behavioural, the physical or corporeal body; the New Oxford Dictionary,
psychological, emotional, social and species characteris for instance, says: 'somatic, adj., of or relating to the
tics. This map does not relate in any obvious way to body, especially as distinct from the mind'.
HUMAN MAPS
In this sense it is used in such phrases as: psycho an exploration of the quality of their own inner senso
somatic disease, somatic cells (as distinct from germ rium and feeling experience. They challenge them to
cells), the somatic nervous system, and so on. It is this track the changes taking place and to sense the differ
broad meaning that has been adopted in naming one ences that emerge from the work. So, if we look back
of the three core complementary practices (see Box 3.1, once again at the three core complementary practices
p. 22); all of these somatic practices deal with the palpable (Box 3.1, p. 22) we find that many of the modalities
human body in this general sense. defined there as somatic are so in the biological sense,
More recently however, the term somatic has acquired but not in the sense described by Hanna. Some modali
a more specific meaning within the world of comple ties, like Feldenkrais, Continuum and Rolfing are firmly
mentary therapies. Thomas Hanna (1980), one of the grounded within the somatic viewpoint, while others,
founding thinkers in the new field of Somatics, has such as routine, mechanical massage approaches (except
sought to differentiate the terms body and soma. He in a more minor way), are not. Similarly, psychological
defines soma as 'the living body in its wholeness' or emotional approaches like Hakomi are grounded within
'the body as experienced from within', whilst the body the somatic perspective and others, like the behaviourist
is the externally referenced perception of the same phe or cognitive approaches, are not.
nomena. We see the body of others but sense the soma This is not to say, however, that the somatic point
of ourselves. Other thinkers have emphasized this cat of view is intrinsic to complementary systems alone.
egorical distinction. Nicoll (1952) states: All therapeutic approaches depend upon both perspec
tives; it is a question of degree. Even within an extreme
We can all see another person's body directly. We see the biomedical approach, in which objective tests and the
lips moving, the eyes opening and shutting, the lines of careful examination of signs and symptoms are the chief
the mouth and face changing, and the body expressing path to diagnosis, practitioners still need the informa
itself as a whole in action. The person himself is invisible. tion that comes from a simple question like: 'How do
you feel?' Conversely, somatic approaches cannot avoid
He goes on to say that the internal and external perspec
a third person perspective; after all, as somatic practi
tives are irreducible to each other, categorically different.
tioners we can never have our clients' experience for
In discussing this distinction and its relationship with
them. We can only infer the nature of their experience
the emerging field of Somatics, Hanna writes:
by observation, by reading the external signs, and then
Somatics is the field which studies the soma: namely the extrapolating from our own experience. Again, it is
body as perceivedfrom within by first-person perception. stressed that somatic approaches differ from other
When a human being is observed from the outside - i.e., approaches merely in the importance they place upon
from a third-person viewpoint - the phenomenon of a aligning their clients with their inner experience, by
human body is perceived. But, when this same body is helping them to experience their experience. Structural
observedfrom thefirst-person viewpoint of his own pro bodywork is just one of many somatic practices that
prioceptive senses, a categorically different phenom make this attempt.
enon is perceived: the human soma. So why is the somatic perspective so significant to the
(Hanna 1995) domain of structural bodywork? Structural bodywork

ers have long noticed that their work is simply more
The third-person perspective is the basis of the scien effective when they engage the client's attention in
tific observation of all phenomena, including the human sensing the changes that are taking place in them, open
body. It is the body perceived and studied as an external ing them to the richness of their own sensorial life. And
object - as it is so elegantly summarized in Figure 6.l. they notice that their work is less effective when they
This perspective does not take into account the subjec treat their clients as passive receivers of their work, as
tive experience of the particular body being looked at. clay to be moulded into shape, almost without the client's
However, the somatic perspective, the first-person perspec participation. Our sensory-motor intelligence is such
tive, takes the subject'S inner experience as being para that if a new pattern is deeply sensed as more efficient
mount; that is, how that body experiences itself through or pleasurable, it is much more likely to be accepted
proprioceptive self-sensing and feeling. Practitioners and integrated into our movement repertoire. Clients'
using somatic approaches have, as a primary aim, the sensitivity in listening to their body and sensing
enrichment of the subjective experience of their clients. changes is to a certain extent predictive of how success
They attempt to engage the attention of their clients in ful a structural bodywork approach will be with them.
A U NIQUE STARTING P OIN T Part of the skill of the structural bodyworker, then, is
to find ways to awaken clients to a fuller experience of
W hen people come to a somatic practitioner for the first themselves through a greater perception of the quality
time it is a pivotal moment. They are at a unique start of their movement, their alignment and the sensations
ing point - the first day in the rest of their somatic life. of their own tissues. It may not be possible to sense the
They bring with them a unique constitution, a unique reorganization occurring at the level of their connective
history, their unique sensitivities and sensibilities. There tissues, but they can experience the results of it in the
is a vast spectrum in the levels of their preparedness for overt signs, such as easier gait, reduced bodily stress
somatic work, many different levels of sensory-motor and an extended range of movement, and in having a
intelligence, and a huge variance in the use and abuse sense of the aesthetic in their movement - that it is well
their bodies have received in their life so far. Thus, it is executed, inherently graceful, organic or efficient. And
highly unlikely that a single proprietary approach will we, as structural bodyworkers, can also help the client
suit them exactly. learn to delve into and differentiate, through sensation,
Some people have spent their lives with an extreme the different states of their tissues: whether densely
outward orientation of their perception; they have never stuck or healthily resilient, vaguely sensed or full of
really taken the time to listen in to their body and have vitality, tense or relaxed, turgid or soft. Hence it is vital
never allowed their attention to 'come home', to rest that the somatic viewpoint be integrated into the maps
and settle inside. This may include people who may of structural bodywork. It is also vital that we, as somatic
have played a lot of sport, danced, or who are quite ath therapists, should ourselves have at least started the
letic and seem to revel in their physicality. Many who journey along the road of somatic awakening. How else
have taken these paths are externally driven, believing can we talk about it?
in gain through pain, and although extremely fit and
healthy may actually have bodies that are quite insen T HE MAPS FOR STRU C T U R AL
sitive. The subtlety of yoga or Alexander Technique B ODYWORK
may be beyond them, but the inherent directness of a
structural manipulative approach, however, may be a The maps for structural bodywork have been inherited
more suitable way to put them more in touch with their partly from the biomedical model, partly from yoga and
bodies. osteopathy, and partly from dance and movement sci
We live in a culture that encourages the outward flow ence. And, encouragingly, maps from other cultures are
of our attention; it is the culture of 'the ten second sound entering the mix - particularly Eastern energetic con
bite'. Only a few practices such as meditation, tai chi, chi cepts. Some forms of structural bodywork have incorpo
kung, yoga and true somatic therapies attempt to reverse rated certain psychotherapeutic models into their map
the flow in order to encourage an internally directed collection, while most have taken on board the overrid
attention. Hanna observes that often our attention is so ing somatic perspective. Structural bodywork accepts
externally diverted that it is only pain that can awaken the scientific map as outlined in Figure 6.1, but brings a
us to our somatic dysfunction, and that sometimes even more unifying perspective to bear upon it. For instance,
the early mild signals of pain may not reach the thresh it sees the connective tissue network less as a tissue type,
old of our awareness and so may pass unnoticed. He
more as an overriding organizer of the human form.
has even given this tendency the status of a syndrome, Labelling connective tissue merely as one of several tis
calling it sensory motor amnesia (Hanna 1988). This means sue types does not give a sense of the intelligent whole
that while we can expect some clients to have a deep ness and the essential unity of the network.
sensitivity to their process, others have only a fairly
gross level of self-sensing. It is important to keep this
LE VELS WIT HIN O UR SOMATIC
fact in mind. As somatic practitioners we can observe
ORGA NIZATI O N
the immediate and short-term changes occurring in our
clients and can imagine that this is relatively perma
All multicellular organisms that move must possess at
nent. We may observe the visible signs: their walking is
least:
more fluid or there is a healthy resilience to the tissue,
but it so often happens that some clients find it difficult • a system of executive control
to sense these changes, even when you point it out • a locomotory system
to them. • a morphology or architecture.
HUMAN MAPS
From the vastness of the human being, these are the architecture refers to the properties and the disposition
systems we directly contact and seek to change through of the structural materials from which a body is com
the structural bodywork process, with the intention of posed: bone, cartilage, ligaments, tendons, bursae, syn
influencing the emergent processes of complex behav ovial sheaths, retinaculae, interosseous membranes,
iour and the somatic awareness that arises from the fascial sheaths and fascial hydrostatic bags, plus all the
integrated life processes of the whole organism. The 'semi-liquid material' that is enclosed within these
terminology of biology acknowledges the tight integra bags. This is the unanimated body; a body with its
tion of these systems with each other: with the term somatic nervous system turned off. This architecture is
neuromuscular relating the systems of executive control animated by the contractile properties of muscle fibres
and locomotory, and the terms musculoskeletal and under nervous system control, which together com
myojascial reflecting the inseparable connection of the prise the neuromuscular system.
locomotory system with the architecture of the body. At the highest (or functional) level is the executive
These closely integrated systems are, however, quite control that emanates from the central nervous system.
hierarchical in their internal structural organization as This system is itself hierarchical in its organization, with
they consist of layered and nested systems, with each whole-body functions initiated at the higher centres of
layer having its own functions, intelligence, sphere of coordination and control within the sensorimotor cor
influence and semi-autonomy. The higher elements tex, cerebellum and basal ganglia; other functions coor
control the lower elements, whilst the lower elements dinated from further down the spinal cord, at the level
have a constraining influence upon the higher levels of of the brain stem, and the lowest level (reflex activity)
the hierarchy, providing real-time limits in what they mediated purely at the spinal cord.
are able to realize. Let us look now at these three systems and show
At the lowest (or structural) level is the morphology how they relate to those aspects of the scientific map that
or architecture of the body (and from here on in we are most important for structural bodywork. Figure 6.2
will stay with the word 'architecture', in keeping with shows the emergent behaviours that are of central inter
Dr Rolf's predilection for architectural analogies). The est to structural bodyworkers and also other conceptual
( Soma
)
Higher-order functions,e.g. awareness,
feeling and proprioceptive self-sensing
¢J 1.. __ T
. .....
Other maps that are often
( Body
) brought to bear on the process
of structural work
• Ethical models
• Psychological and emotional
theories and typologies
• Perceptual models
• Treatment protocols
• Biomechanics, kinesiology
'" Organismic level I--_J Movement art and science
E •
J!! • Postural/structural models etc.
l
'"
>-
'"
u . --------------------.---------------------------------.--.------------------------------------------
� Executive control locomotory system Architecture
J
�.. System level • • Central nervous system • Neuromuscular system • Skeletal system
• Fascial network
�
�
<=). - --------------------- ---------------------------------------------------------------------- --------
• Visceral complex
'I • Brain The musculature • Fascia
[
� •
• Somatic nervous system

I
J '
Spinal cord Tendons
:5 Organ level • •
'i Peripheral nerves • ligaments

E • IndiVidual bones
�c: .----------------------------------------------------------------------------------------------------
.2' • Nervous tissue • Nervous tissue • Connective tissue
Ci Tissue level
• Muscle tissue
Figure 6.2 A map summarizing the domain of structural bodywork and the perspectives often brought to bear on the process.
maps that are often brought to bear on the process of relationship, aspects of movement science, structural
structural bodywork, such as psychological theories, models and so on.
ethical constructs, prescriptions around the therapeutic
REFEREN CES
Hanna T 1988 Somatics - reawakening the mind's control Johnson D 1994 Body, spirit and democracy. North Atlantic
of movement, flexibility, and health. Addison-Wesley, Books, Berkeley, p 200
Reading, Massachusetts Nicoll M 1952 Living time. Eureka Editions, The
Hanna T 1995 What is somatics. In: Johnson D (ed) Bone, Netherlands, p 3
breath and gesture: practices in embodiment. North Atlantic Tortora G, Grabowski S 1993 Principles of anatomy and phys
Books, Berkeley, p 341 iology. HarperCollins College Publishers, New York
THE TECHNIQUES OF
STRUCTURAL
BODYWORK
Ultimately, all somatic approaches aim at giving our have the widest applicability, particularly if they have
clients greater somatic awareness, more freedom of an overriding holistic orientation.
movement, more options for movement, greater effi Some of the better-known approaches work purely at
ciency of movement, more pleasure in movement, less the highest level of somatic organization, that is, the
discomfort and less mechanical wear and tear. If we level of whole-body neuromuscular organization. They
look at the broad gamut of somatic approaches in Box work both locally and globally to influence global neuro
3.1 (p. 22), we note that the approaches vary consider muscular patterns, and include approaches like:
ably in how they attempt to reach these ends. Each
• the Alexander technique
system has its own characteristic goals, assessment
• the Trager® approach
strategies, procedures, protocols and maps, plus a 'tool
• the original complete Proprioceptive Neuromuscular
box' of techniques that are specific to it. Alexander
Facilitation (PNF) system (the contract-relax stretching
teachers would no more consider using soft-tissue
protocol that is often called PNF is actually only a
mobilization techniques than chiropractors would
fraction of the system)
consider using subtle manual suggestion to draw out
• the Feldenkrais method
the improved functionality that may arise from their
• the Continuum® approach
manipulations.
• Hatha yoga
All techniques used by therapists are quite specific
• the martial arts
as to which level of our somatic organization they
• Rolfing Movement Integration.
address. For instance, the techniques of myofascial and
osseous release directly address the architecture, while These aim to enhance our somatic awareness, improve
the subtly informative hands of an Alexander teacher the efficiency of functions, give more movement
directly address our sensory-motor intelligence, the options, induce less stress on the body and promote
functional level of our organization. Sometimes, even greater coordination - in short, to promote an inte
entire approaches are dedicated to addressing only one grated functionality. The techniques these systems
level of their clients' organization, for example the employ are largely educational and use either verbal or
Alexander technique and connective tissue massage manual cuing, or direct imitation ('Do it like this'), in
(Bindegwebbsmassage). This may be entirely appropri order to communicate new movement possibilities to
ate if that is exactly the work that a client requires; how their clients. These systems often have an unacknow
ever, working at one level is likely to be somewhat ledged 'trickle down' rationale, which is the assump
limiting, arbitrary and artificial, since important tion that if you can change the outward behaviour then
aspects of the client's needs are likely to be overlooked. the benefits will eventually be felt at the lower levels,
Inevitably, a singular technique can address only a nar particularly in the gradual adaptation of the soft tissues
row aspect of the somatic organization. Approaches to the new patterns of movement.
that employ a combination of techniques can address Another class of techniques operates at an intermedi
more. However it is approaches that can address the ate level of neuromuscular coordination, even at the
wider spectrum of our somatic organization that will level of spinal reflexes. For the techniques in this
class, the intention is to influence relatively local tonus facet joints. Where once the effects of such manipula
patterns, usually around a specific joint or articulation, tions (such as a reduction of spasm) were thought to be
with less emphasis on whole body functioning. This due to the mechanical freeing or stretching of the facet
work may be intended to allow greater lengthening of joint capsule, it is now thought to be due to the resetting
muscles or stimulate them to fire more consistently of the tonus levels in the immediate muscular environ
through a range. They include such neuromuscular ment, a decrease in 'gamma bias'. Schleip (2003) sug
techniques as: gests that the measurable increase in fascial resilience
following direct technique myofascial release is due in
• the muscle energy technique
part to a local resetting of tonus levels, via a number of
• the PNF contract-relax techniques and eccentric
local feedback loops in the surrounding tissues. In fact,
resistance techniques
more advanced dissection techniques are showing that
• the CRAC (contract-relax-antagonist--contract)
the fascia, tendons, ligaments and joint capsules are
approach
very densely innervated, having perhaps the highest
• trigger point therapy
number of proprioceptors of any organ or system. This
• the strain--counterstrain approach
class of techniques often work on the unacknowledged
• the positional release approach.
assumption of the 'filter up' effect; that if you release
These techniques work locally to affect the proprio restricted tissues then the intelligent body will auto
ceptive regulation of local muscular tonus. Used alone, matically respond to these changes and begin to move
these techniques belong to Maitland's corrective or fix more efficiently. The degree of this 'filter up' effect,
ing paradigm and their results are not necessarily inte however, seems to depend largely upon the sensory
grated into stable whole-body movement patterns. motor intelligence of the client.
Other techniques focus on effecting mechanical These soft-tissue techniques are mirrored to a certain
changes at the tissue level of our somatic organization, extent in the releasing techniques of physiotherapy and
our architecture. They work locally to release local soft the more direct approach of orthopaedic medicine.
tissue restrictions. These techniques include: These mainstream disciplines achieve similar outcomes
using techniques such as:
• deep tissue massage
• passive stretching • traction
• myofascial release • cross-friction massage
• soft-tissue mobilization (Bindegwebbsmassage) • taping
• joint mobilization • the surgical shortening, lengthening or repositioning
• osseous release (including both indirect techniques of muscles, ligaments or bones

and high velocity low amplitude thrusts). • various kinds of fasciectomy for addressing com
pression, tunnel or compartment syndromes (for
(It should be noted in passing that traditional massage instance releasing the carpal tunnel or the anterolat
techniques are not included here, since their main inten eral compartment of the lower leg)
tion is to produce a short-term relaxation response and • the use of mechanical aids that force or redirect struc
not a structural change). tural adaptation (shoe orthotics, Harrington rods,
The intention of these techniques is to increase the splinting, body casts, leg braces, corrective shoes and
range and quality of movement around articulations by so on)
releasing mechanical restrictions, for instance, by eas • the strengthening of ligaments by inducing fibrosis
ing restrictions in the periarticular tissues around facet (by prolotherapy or cross-friction massage)
joints, by giving more resilience to the fascial sheaths or • the shrinking of connective tissue using microwaves.
by gently challenging ligamentous limitations. There is
a growing body of evidence to suggest, however, that Figure 7.1 illustrates in an approximate way the corre
many techniques that aim at changes at the tissue level spondence between the somatic levels of our organiza
are in fact facilitated neurologically by a resetting of tion and the techniques and approaches typically used
local proprioceptive output from the surrounding con to address them. What is not illustrated by this diagram,
nective tissues, which results in releases that were once however, is the fact that although structural bodywork
thought to be purely mechanical. This has been demon approaches focus on effecting structural changes at the
strated, for instance, with the high velocity release of level of our architecture, they also attempt to evoke
THE TECHNIQUE S OF STRUCTURAL BODYWORK
Somatic level Body systems Typical functions Typical techniques Typical approaches
Executive control Cortex Orchestration of whole

Functional
• •
• Cerebellum body response • Spoken guidance Feldenkrais

Sensory-motor
domain
• Basal ganglia • Tactile guidance Alexander
intelligence • Initiation of novel • Demonstration and
Aston-Patterning
• Alpha motor system movement imitation Continuum etc.
• Immediate solutions to
movement problems Movement arts
(see Box 3.1)
• Brain stem • Integration of
kinaesthetic information
• Gamma motor system

• Startle reflex
• Tonic neck reflexes
• Postural reflexes such
as the Landau response
PNF
• Spinal cord Simpler reflexes Neuromuscular
such as: techniques such as:
• stretch reflexes • Muscle energy technique
• reciprocal inhibition • Contract/relax stretching
• post isometric response
Locomotory • The musculature • Coordinated firing of

system motor units
Neuromuscular PNF
• Motor units techniques
• Sarcomere contractility
The architecture • Myofascial system • Visco-elastic and visco- • Cross frictions • Structural bodywork
plastiC properties • Traction • Rolfing
• Soft-tissue techniques • Hellerwork Structural
• Myofascial release • Postural integration etc. domain
• Skeletal system • Compressive resistance • Osseous release
• Ostoepathy
• Chiropractic
• The viscera • Semi-liquid hydraulic • Visceral manipulation

properties
Figure 7.1 The correspondence of techniques and the levels within our somatic organization.
fresh functional patterns, employing many of the tech techniques invariably focus on only one level of our
niques used by the more educational approaches such somatic hierarchy, then it is clear that many
as Alexander and Feldenkrais. This will be clearer as we approaches, by themselves, cannot offer a full solution
explore the nature of structure and function in the next to our clients' needs. There may, by happenstance, be a
chapter. close correlation between what a client needs and what
a practitioner can offer, but the more complete somatic
therapist will be able to work at a number of different
THE IMPOR TANCE OF ADDRESSING levels within the client's somatic organization. Ulti
ALL LEVEL S OF OUR SOMATIC mately, the minimal requirement of a structural body
ORGA NIZATION worker is to have a range of skills that include some
in each of the three groups of techniques: soft-tissue
So if we consider these two facts: that clients' starting releases, neuromuscular releases and integrative tech
places will be extraordinarily varied, and somatic niques, and knowing when to use them. Without this
46 .
range of skills, bodyworkers will need to select their

Soft-tissue release
clients carefully, appraising who will respond to their Employing such techniques as myofascial
release, joint mobilization, passive
work and who needs referring on to another kind of
stretching, osseous release, etc.
practitioner. -J
THE NEED FOR AN IN TEGRATED

U
Neuromuscular release
Employing such techniques as contract-relax
APPROACH stretching, muscle energy technique,
strain-<:ounterstrain, trigger-point work,
PNF techniques, etc.
Many somatic practitioners have emphasized the need
for an integrated approach using several levels of
technique, believing that structural and functional U
Integrative work
approaches are appropriate at different phases of treat Employing the kinds of educational and
proprioceptive techniques employed within
ment. For instance, Cantu and Grodin (1 992) state:
Feldenkrais, Rolling Movement Integration,
Alexander Technique, Trager, etc.
the sequencing of treatment includes beginning superfi
cially with a manual approach, and working gradually Figure 7_2 A simplified three-level protocol for structural
into deeper tissues. Once the deeper tissues are accessed bodywork.
and affected, elongation of the structures becomes facili

tated. When optimal length and mobility are estab
As was stated in the introduction, this protocol will not
lished, neuromuscular re-education is emphasized to
make you a structural bodyworker as it lacks the over
prevent recurrence, as well as postural integration. The
riding holistic rationale that is necessary for real struc
progression from a light manual approach (mechanical),
tural integration. However, it will allow you to make
and then to an emphasis on movement and posture
some initial explorations in gently reorganizing struc
(movement approach) is the key to complete treatment.
ture, and can give results which, although not a com
Cottingham and Maitland (1 997) recommend a treat- plete structural rebalancing, can alleviate some of your
ment model for use within a physiotherapeutic context, clients' structural problems in the short to medium term.
based on Maitland's three-paradigm schema (see The complete structural bodyworker requires skills
Chapter 3 and Fig. 3.1, p. 23). Here the authors suggest a in at least three levels in order to produce real and last
treatment protocol that works at three levels: within the ing structural change, and best results can be achieved
relaxation paradigm - essentially pain modulation pro by progressing through the three levels of somatic
cedures; within the corrective paradigm - manual tech organization. First, at the tissue level, there is generally
niques and exercises to correct faulty biomechanical a lengthening or softening process that brings more
alignment, and within the integrative paradigm - guided length and resilience to shortened tissue. This is rarely
movement to improve postural and movement patterns. sufficient for lasting change. Sometimes clients with a
They emphasize that although this work can be per high degree of sensory-motor intelligence can integrate
formed sequentially, in actual fact there can be a huge this kind of work directly into their overall somatic
overlap in the application of these different levels of organization, but for most clients at least some integrat
approach, and work within the three levels often pro ing work is essential. Neuromuscular techniques can
ceeds concurrently. then be used to assist the released muscles in 'knowing'
that they can lengthen. This class of techniques is aimed
at modifying responses at a relatively low level of neuro
A T HREE-LEVEL MODEL - FROM logical organization and not a whole body response -
RELE A SE TO IN TEGR ATION essentially changing the mapping on the sensory-motor
cortex. Finally, this local pattern needs to be integrated
In the practical section of this book it will be recom into the whole body functions of standing, sitting, walk
mended that therapists who wish to explore the struc ing, reaching and all complex movement patterns. This
tural bodywork approach can begin their exploration requires proprioceptive education, somatic awareness,
by employing a simplified three-level protocol (see integration and coordination.
Fig. 7.2) that closely parallels the Cantu-Grodin and This protocol assumes that for most clients both struc
Cottingham-Maitland protocols mentioned above. tural and functional work will be necessary, the relative
THE TECHNIQUE S OF STRUCTURAL BODYWORK
amount of each depending greatly on individual needs. with it. So in the next section we will look more closely
It also suggests that if structural work is required, it at the concepts of structure and function, which stand
should either precede functional work or run in parallel at the heart of the structural bodywork approach.
REFERE N CE S
Cantu R, Grodin A 1992 Myofascial manipulation: theory low back pain: a case study. Journal of Orthopaedic and
and clinical application. Aspen Publishers, Gaithersburg, Sports Physical Therapy 26: 3
pp 20, 25-57 Schleip R 2003 Fascial plasticity: a new neurobiological
Cottingham J, Maitland J 1997 A three-paradigm treatment explanation. Journal of Bodywork and Movement Therapies
model using soft-tissue mobilization and guided move 7(1): 1
ment - awareness techniques for a patient with chronic
STRUCTURE AND
FUNCTION
There is no real difference between structure and func her writings in which she acknowledges his insights
tion; they are two sides of the same coin. If structure into the neuromuscular patterns of anxiety. And from
does not tell us something about function, it means we the earliest years of her exploration, Dr Rolf employed
have not looked correctly. various movement techniques to support the struc
Dr A. T. Still (the founder of Osteopathy)(1899) tural aspect of Rolfing - 'tracking', 'Rolf yoga' and
re-patterning exercises. Later on she promoted Judith
There are many apocryphal tales surrounding the great
Aston's movement work, and then Rolfing Movement
somatic pioneers, Ida Rolf and Moshe Feldenkrais. One
Integration. She knew that soft-tissue manipulation by
is that in the early days of their association in England
itself was not enough to guarantee an improvement in
they agreed to divide the somatic world into two
functionality.
empires (rather like politicians who had just carved up
And neither did Feldenkrais hold to an extreme func
Europe after World War II); Ida Rolf developing the
tional view. He was Rolfed by Ida herself. And in a
process of structural integration, and Moshe Feldenkrais
touching (but still guarded!) testimonial for her book,
the process of functional integration. Time passed and
Rolfing (Rolf 1977), he wrote,'when Ida Rolf integrates
they each separately fashioned their own unique sys
structure, as nobody else can, she improves function
tems; however, they managed to preserve a running
ing. Rolfing was a revealing and unforgettable experi
dispute that lasted the rest of their lives, each asserting
ence for me.' We also know that some of her students
that their process was the superior.
worked very hard on the steely psoas that Feldenkrais
Many years passed, and on the occasion of Ida Rolf's
had developed from his years of Judo, and that he was
eightieth birthday, a huge party was organized to which
even known to use these structural release techniques
all the luminaries of the Rolfing world were invited.
on his own clients (for, like all the great somatic innov
Included, of course, was Rolf's old friend and sparring
ators, he was a skilled borrower).
partner, Moshe Feldenkrais. When all the formalities
were over, these two old antagonists got together and,
ignoring everyone else, spent the rest of the evening S TRUCTURAL AND FUNCTIONAL
continuing their favourite dispute about the role of APPROACHES - A PRACTICAL
structure and function, with the course of their argu POLARITY?
ment going something like this: 'Function determines
structure!' (Feldenkrais),'No, no, you old fool, structure Structure refers to our physical form or, in biological
determines function!' (Rolf) and so on for the rest of terms, our morphology; function refers to the behav
the evening. ioural patterns effected by structures. The Macquarie
We know that both were inclined to exaggerate a Dictionary (1989) for instance defines function as 'the
point to provoke critical thinking in those about them kind of action or activity proper to a person, thing, or
(and perhaps also out of sheer cussedness!), and that institution', and structure as'Biol[ogical] mode of organ
neither seriously held the extremes of these viewpoints. isation; construction and arrangement of tissues, parts,
Rolf's respect for the genius of Feldenkrais is evident in or organs'.
STRUCTURE AND FUNCTION
Rolf's works offer many examples of how structural

change brings forth functional change: sometimes the
dramatic and visible shift in postural organization
evident in the before and after photos of Rolfing (see
Fig. 1.4, p. 11); and sometimes more subtle and less vis
ible changes such as the shift in muscle usage from
sleeve to core (in her terminology), which can be experi
enced as a feeling of effortlessness in movement and a
sense of lift in posture.
When we look at the historical development of the field
of Somatics, it certainly appears that the newly emerging
modalities naturally aligned themselves towards the
opposite ends of the structural-functional spectrum. At
the functional end we have approaches such as the
Alexander Technique and the Feldenkrais method, in
Figure 8.1 Moshe Feldenkrais.
which the stated intention of the approach is to evoke func
tional change through learning; and at the structural end we
have Rolfing, osteopathy and chiropractic in which the
Feldenkrais (Fig. 8.1) believed that our structure is intention is to evoke functional change through structural
moulded by the interaction of our genetic inheritance change. It is important here to restate the major contention
with the sum result of all the movements that the body of this book: that all modalities can and do assist clients,
has enacted throughout its life. The central rationale of but the most successful strategies will appropriately
his approach is that, as human beings, we are largely address every level of their somatic organization, and this
unaware of our movement patterns (our functions). usually means both structural and functional work in dif
The ways that we have found to solve the movement ferent degrees, depending on the individual.
problems presented by life are not necessarily the most
sound or efficient. His method involves, first, guiding
our attention to our movement patterns so that we THE BIRTH O F S TRUC TURE AND
discover how we move, then offering new movement FUN C TIO N
options that may be more efficient or more pleasurable,

and then helping us integrate these new options into Since structural bodyworkers are working primarily in
our larger movement repertoire. To him, change in the structural realm, it would be useful to clarify the
function is about learning: he believed that the pro meaning of 'structure' and 'function' from an anatom
found functional changes that arise from this work ical and developmental perspective.
ultimately modify our structure. In human embryogenetic development, shortly after
Rolf, on the other hand, believed that structural conception, the fertilized egg develops into a blasto
changes are the key to functional improvement. She sphere: a hollow sphere of cells. These cells are undiffer
believed that structural reorganization of the body would entiated and seemingly identical in every respect; they
allow it to intelligently renegotiate its relationship with do not yet exhibit the huge range of different cell struc
gravity, so that new ways of standing, moving and being tures and functions that are found in the mature organ
would spontaneously emerge: ism. After about a week the process of differentiation
begins (see Fig. 8.2). The cells swirl, migrate and begin
You can change human beings. You can change their to differentiate. They organize themselves into two
structure, and in changing their structure you are able primitive germ layers, which are the ectoderm and
to change their function. Structure determines function endoderm. Then, in between these layers emerges a third
to a very great degree and to a degree which we can util layer, the mesoderm. There follows an amazing devel
ize. The basic law of Rolfing is that you add structure to opmental cascade in which each of these three layers
the body. In so doing you are demanding a change in undergoes an extraordinary sequence of growth, fold
function. This is the basic reason why Rolfing works as ing and invagination, which ultimately develops into a
it does. major cluster of related organ systems within the body
Ida Rolf (Feitis 1978) (see Box 8.1). The ectoderm will transform into the skin
A
� Notochordal process
__ Ectoderm
Mesoderm
As structural bodyworkers our main focus will be on
those systems that arise from the middle layer, the meso
derm. These systems are:
\ - -
III '-'----
\ Endoderm
1. the connective tissue network (particularly the skel
B
...o:r-" ,IIF<--.i"'....---
.. Neural crest etal and fascial systems), and
2. the muscular system (particularly the skeletal
muscles).
+--- - Growing
mesoderm
These are the tissues that we will actively engage and
seek to change. The ectodermic systems, too, will be
important because we work through the skin (with its
vast collection of nerve endings) and will necessarily
c �---- Dorsal mesodermal structures
�-� (vertebral arch and spinal muscles)
engage the central nervous system, but these systems
are perhaps more the central concern of somatic therap
"""",,"",,",'r--- Dorsal cavity
ists with a functional emphasis (like Feldenkrais and
_-+t-+\--- Neural tube
(brain and spinal cord) Alexander Technique practitioners) who work more
with sensory-motor coordination and integration.
--'\-+-1+--- Ventral cavity
From a structural perspective it could be argued that
1I--+1-H-- Endodermal tube
(alimentary canal)
the endodermic system (the visceral complex) is of lesser
/.".'---- Developing epidermis (skin)
importance to the structural bodyworker. It may be an
extraordinarily complex and intelligent system, but
"-"------ Ventral mesodermal structures
(ribs, abdominal muscles, pelvis) from the point of view of gravity it is just bags of jelly
Figure 8.2 The growth of the mesoderm.
(in the same way that a computer, despite its complex
functionality, could equally be used as a doorstop or an
anchor!). The visceral complex can be considered as a
Box 8.1 'semi-liquid' aspect of our material reality and we move
as if our core space were a large balloon packed with
ECTODERM
smaller, jelly-filled balloons. Some animals need to
tissues of the central nervous system tighten their abdomen during running to prevent this
epidermis of skin semi-liquid mass from 'sloshing around' too much.
hair However, the visceral complex has its own soft connect
eyes, ears and other senses
ive tissue network, with suspensory ligaments and the
fascial wrappings of organs, and in the opinion of many
MESODERM
osteopaths and structural bodyworkers the condition
skeletal and cardiac muscle of the viscera can have both a mechanical and a reflexive
most smooth muscle influence on our posture and movements. When grosser
cartilage, bone myofascial interventions fail to produce the expected
other connective tissues
result then visceral work is often the next step.
blood vessels and blood cells
dermis of skin
THE BODY'S ARCHI TEC TURE

ENDODERM
the respiratory tract Ponder this question for a moment: 'If it were possible
the digestive tract
to remove all the cells from the human body, what
the digestive organs
would be left?' Our anatomical training might lead us
to answer something like: 'Not very much' or 'Just a
pool of liquid - gastric fluids, lymph, synovial fluid and
and nervous system, the mesoderm into the connective the like'. But in fact a great deal would be left, for
tissues and muscles, and the endoderm into the internal instance, most of the skeletal material, bone and cartil
organs or viscera. Schultz and Feitis (1996) give a more age; most of the connective tissue network, ligaments,
detailed account of this extraordinary process. joint capsules, bursae, fasciae and tendons, as well as a
lot of fluid - in fact all the extra-cellular materials in the prepared from the boiled down collagen of the skin, liga
body. When we come upon animals that have died in ments and bones of animals. In our bones, collagen fibres
the wild, what we find are the skin, tendons, ligaments combine with bone salts to forge the most rigid of our
and the bones. And although eventually all will be connective tissues. In connective tissue proper, collagen
returned to dust, it is the watery, cellular materials that fibres and ground substance (the all-pervasive extracel
disintegrate first, leaving behind the more durable, lular lubricating gel) combine with other kinds of fibre
structural parts. (elastin and reticulin) to create a vast array of connective
It is sobering to realize that a large part of our mate tissues, each suited precisely to their local conditions.
rial reality is non-cellular. Our structure is composed of These structural materials have some extraordinary
real structural materials in the same way that bridges properties; collagen fibres have a tensile strength greater
and buildings are composed of steel, glass, concrete, than steel, yet form tissues of great elasticity and pli
plastics and carbon fibres. And like these familiar struc ability. They give the iliotibial tract the resilience of tyre
tural materials from our engineering world, our bodily rubber, and yet shape the delicate reticular tracery of the
structural materials have physical properties such as spleen. Think of the strength and durability of leather
tensile and compressive strength, elasticity, plasticity, (the preserved dermis of the cow) or the density of bone,
electrical conductivity, and so on. The behaviour of our which can resist compressive forces in the order of 2 000
bodily structural materials can best be understood pounds per square inch (approaching 14 OOOkPa). Our
within that branch of physics called mechanics and be
- somatic bricks and mortar are real structural materials
seen as responding to Newtonian forces. So in a sense, with some remarkable properties. As a unified whole
structural bodyworkers are the engineers of the human they are the yin (or passive aspect) of the mesodermic
body (though of course not only engineers) in that we system. The contractility of muscle cells is the yang.
roll up our sleeves and tinker with its structure to help
it work more efficiently.
The yin and yang of our structural reality
However, our bodily building materials differ from
architectural building materials in one major (and extra The body's structural materials and their resident ser
ordinary) respect, which is that they are self-adapting. vant cells are one major outflux of the mesoderm; the
They can transform themselves in response to the forces muscle cells are the other. These two subsystems have
applied to them. Interpenetrated by living cells, these very different properties: the connective tissues are
materials have a unique relationship with the rich tap essentially non-cellular and metabolically passive,
estry of life processes that surround them. They live at a whilst the muscle cells are cellular, metabolically active,
slower pace and have a less vigorous metabolic life than and actively contractile. These form the passive and
their resident cells, but are actively serviced by them. active elements of our structure and so can be described
There is a specialized group of cells whose job is to sup as the yin and yang of our structural reality, being our
port and maintain these structural materials by debrid structural connective tissue materials and the actively
ing damaged or redundant tissue and manufacturing contractile elements that provide the motive power to
new materials according to the greater needs of the move them. But what we normally call'muscle' is more
organism as a whole. Would that our own architects and properly seen as an inseparable fusion of muscle cells
engineers could devise buildings that could intelligently and their fascial environment: contractile units sus
and unobtrusively modify their internal structure to pended in an ocean of fascia, which is the most abun
meet the demands we place on them! dant connective tissue in the body. In fact, muscle tissue
is 50-60 per cent fascia.
Our somatic bricks and mortar
What are the building materials of our bodies? What are A MAP FOR S TRUC TURAL BO DYWO RK
our somatic bricks and mortar? The most pervasive
structural material is collagen fibre, comprising as much We can now summarize the components of the three
as 40% of the body's protein. Later we will look at this embryogenetic organ systems from a structural body
remarkable substance in more detail, but suffice to say work perspective. Figure 8.3 relates to the earlier one
that in different forms and configurations, collagen (Fig. 7.1, p. 45) and shows a layering of processes with
unifies our whole structure; it is literally the glue that increasing complexity, intelligence (or information pro
holds us together. In fact old-fashioned wood glue was cessing capability) and other emergent properties. Like
Figure 8.3 Elements of the

(Cortex
�)
Ectodermic systems Functional domain
embryogenetic systems that relate to
Sensory-motor intelligence
(Cerebellum )
�__
________
structural bodywork.
_ __-"
C !§i gang li� @£!ia motor....:

___
sy st
'- _ ___�_..,;J)
Gamma motor system
(Simple reflexes ,)
Mesodermic systems (�uscle celis ) Sarcomere contractility
(Visco-elastic and visco-plastic propertie)

j
(Bone=-oJ Compressive resistance

Endodermic systems ()liscera ) (Semi-liquidhydraulic properties .) Structural domain
all maps it does not describe the whole territory, but it

does present, in a hierarchical form, all the elements
essential to structural work.
Some models for understanding human structure

The mesodermic subsystems work together along with
other systems to form a completely functional, organic
whole. What forces are at play? What are the structural
dynamics of a system such as the human body? Many
Figure 8.4 A robotic model - the body as a collection of
structural and functional models have been offered,
skeletal levers like this.
some from biological science, some from the somatic
pioneers and, interestingly, some remarkable insights
cannot be taken too far. Like buildings we do need to be
have emerged from architectural science.
balanced within the field of gravity, and compressional
A robotic model forces from gravity do indeed act longitudinally
The mechanistic model, found in older kinesiological through our upright skeleton. But in truth a human
texts, portrays the human being as a system of skeletal being does not stand in the same way that a gothic
levers impelled by muscular pulleys, making it a 'soft cathedral stands: there are no level surfaces within the
machine' (Maitland 1992). It paints a robotic picture that body to build up from, and our bones do not, in fact,
leaves huge areas of our functionality unexplained. even touch one another (Flury 1989).
This is not to say that the bones do not act as levers, but The 'blocks in a sack' model
simply that this is an extremely limited and partial
Rolf also offered a 'blocks in a sack' model that por
description, ignoring for instance the oscillatory behav
trayed the body as an organization of blocks enclosed
iour of the all-encompassing fascial network (Fig. 8.4).
within an elastic envelope (see Fig. 8.6). This model
A building block model emphasizes the structural importance of the superficial
As mentioned earlier, Ida Rolf was very fond of using and deep fascial network, and seems to anticipate the
architectural analogies in her discussion of human tensegrity model from the world of modern architec
structure and used various models to highlight different ture. The tensegrity model has proved extremely useful
aspects of our structural dynamics. One was a building in the description of living structures from the cellular
block model that saw structural segments, such as the level to a macroscopic level.
thorax, pelvis and limbs, stacked in vertical alignment
somewhat architecturally. This thinking is very evident
Tensegrity systems - ·Continuous tension and
in her'Little Boy Logo' (see Fig. 8.5). This model is use
local compression'
ful in visualizing the kinds of segmental displacements
that can occur in an unbalanced structure (what she Buckminster Fuller, the architect and inventor of the geo
called a 'random body'). However, such an analogy desic dome, coined the term tensegrity (from 'tensional
Figure 8.7 A tent as a tensegrity structure
etc.) as they employ a clever combination of two kinds

of material element - those that are strong when com
pressed, and those that are strong when stretched. All
materials in fact have both compressive and tensile prop
erties. However some traditional building elements such
as posts, poles, struts and columns are employed to
capitalize on their compressive strength, which means
that they can effectively resist crushing forces that are
applied to them. Other elements, such as cables or
sheets, are utilized for their tensile strength and can
effectively resist forces that would stretch or lengthen
them. Tensegrity structures combine these two kinds of
Figure 8.5 'Little Boy Logo' - the body as a stack of blocks or structural element and mutually balance their tensile
segments (Rolf 1977). and compressive qualities in such a way that the com
pressive elements do not actually touch one another.
Some aspects of the human structure can perhaps be
best understood as tensegrity systems.
One remarkable property of a tensegrity system is
that if an external force disturbs its internal equilib
rium, it will yield but will do so in a way that distrib
utes the stresses and loads evenly throughout the whole
system, with all the elements sharing the workload.
What a design advantage this would be for an organ
ism: to have a system that inherently avoids loading
some parts too much.
The tent tensegrity structure

A tent is a tensegrity structure, as shown in Figure 8.7.
Figure 8.6 'Blocks in a sack' model (reproduced with the kind Here the poles are the compressional elements and the
permission of Alan Demmerle). fabric the tensional element. If we look at the disassem
bled tent we have poles with many degrees of freedom,
and the tent fabric that by itself lies in a random, chaotic
integrity') to describe a principle for designing light heap. But when they are arranged together, with tension
weight integrated structures that deliver great stability strategically placed through the fabric, and compression
with minimal material. Tensegrity structures are differ through the poles, they form a whole with a real struc
ent in principle from the traditional columnar struc tural integrity. The tension in the fabric acts to space and
tures that employ a'ground up' stacking of compressive position the poles appropriately. The poles preserve an
elements (bricks, stone, concrete, steel posts and struts, appropriate span and tension in the fabric.
Figure 8.8 A balloon (or hydrostatic bag) as a tensegrity

structure.
Figure 8.9 A simple tensegrity structure. This octahedral
Fluid mechanics tensegrity structure can be constructed from three sticks and three
A balloon is also a tensegrity structure, although at first elastic bands. The sticks do not rely on the contact in the centre.
glance it might not seem so. Not only solids have com
pressive qualities; the whole field of hydraulics is based
on the principle that fluids and gases can resist com behaviour of our bodies. Later, it will be shown that
pressive forces. So there is another class of structure economical rhythmic movement such as walking must
that conforms to the tensegrity principle, that is, the harmonize with the body's inherent undulatory prop
balloon or hydrostatic bag (see Fig. 8.8). erties at a structural level and that part of our job as
A balloon is compressed air surrounded by rubber. bodyworkers is to assist our clients to discover the
The tensioned skin of the balloon is compressing the air rhythmic harmony inherent in their own structure. This
inside and, conversely, the skin is being placed under rhythmic aspect of our biological inherency will be
tension by the expansive tendency of the pressurized examined in more detail in Chapter 10.
gas within. This tension is communicated evenly
throughout its whole surface area so that the balloon is The human body as a tensegrity structure
a balanced combination of compressive and tensional Our human structure can be understood as conforming
elements - a tensegrity structure. Having such a struc to the tensegrity design. Our bones (like the tent poles)
ture, a balloon is self-balancing. Externally applied forces are the compressional elements; the fascial sheaths,
will deform the structure redistributing the force evenly tendons and ligaments (like the tent fabric) are the
throughout. Once the force is removed, however, the tensional elements. The fascia serves to maintain the
balloon will return to its former shape. We will see later appropriate spatial relationships between the skeletal
that tensegrity structures of both the tent and balloon elements. If we could turn off the tonus of the muscle
design can be found within the human structure. fibres entirely we would be left with a true tensegrity
structure, that is, bones organized into a skeleton by the
A tensegrity model spanning fascia.
You can get a practical understanding of the tensegrity Imagine that by some miraculous intervention we
principle by constructing the model in Figure 8.9 from could dissolve away all materials from the human body
elastic bands and dowels or tongue depressors. You will except the fascia; what would remain would be a per
find that the whole has a real structural integrity and is fect representation of the human form, with spaces to
resilient enough to regain its shape after you gently represent all the muscles, bones, organs and cavities of
deform it. In fact, it regains its shape with a bouncy rhyth the body. However, this fascial spectre could not last a
micity. This is the oscillatory dance of potential and moment because the relentless force of gravity would
kinetic energies that is inherent in the tensegrity design. instantly act, and like a tent without pole it would
The behaviour of the human body is beginning to be slump to the floor in a random heap. (Here we are using
more fully explored within scientific kinesiology. It is the word fascia in its broadest sense, to mean all of
increasingly apparent that the elasticity of connective the binding connective tissues: myofascia, aponeuroses
tissue within a tensegrity arrangement goes a long way and tendons, ligaments, synovial capsules, and even
towards explaining the rhythmic, elastic, undulatory the periosteum of bones.)
STRUCTUREAND FUNCTION
55
If we could repeat the experiment, but this time dis

solving away everything except the bones, then what
would momentarily remain would be a skeleton, fol
lowed by the clattering of a disarticulated and jumbled
heap of bones because there was nothing to bind them
together or maintain their normal spatial configuration.
But if, in a third experiment, we could dissolve away
all the materials except the fascia and the bones, then
what would remain would still retain a recognizably
human form as it would still remain an integrated and
coherent whole, despite the fact that it would be col
lapsed and unresponsive. Like the fabric of the tent, it is
the fascia, ligaments and other connective tissues that
maintain the appropriate relationship between the
bones by maintaining an appropriate spacing and span. Figure 8.10 An anaesthetized spaceman. showing his real
It is fascia that creates the unified skeleton. It takes the inte structure.
grated properties of the fascial and skeletal systems

to create a true tensegrity structure, but like all such In order for the structural body to perform even the
structures it would be relatively inert, relatively static. most rudimentary act of standing upright, another elem
It would be internally stable but would respond only to ent needs to be added as a means of intelligently vary
externally applied forces, particularly gravity, and ing the pattern of tension throughout the fascial network.
would be unable to initiate movement from within This is performed by the coordinated contraction of
itself. With its neuromuscular system turned off, it muscle cells, organized into motor units, and under the
would be a body with structural integrity but which control of the central nervous system. The neuromuscu
could not move of its own accord. lar system supplies the orchestrated pattern of tensions
Hans Flury (1997) has been one of the foremost to the fascia, which then communicates them through
thinkers in helping to clarify the meaning of structure in tendons and aponeuroses to the bones and hydraulic
the field of structural bodywork. Of structure he says: bags, thus allowing the whole structural body to balance
harmoniously within gravity. The muscle cells supply
Structure is the spatial arrangement of all the parts of
the motive power, and the central nervous system sup
the body, determined primarily by the fascial net, as it
plies the control.
manifests in the absence of any muscle activity in the
It is important to note that not all the contractile force
body and with no outside forces acting on the body. This
of the musculature is conducted directly through to the
spatial arrangement can be called the' structural body.'
skeleton; some is utilized to tighten fascia (the iliotibial
It is evident that we can never see the structural body
tract for instance) and some is used to maintain the
directly because there always exists muscle activity in the
form of key hydrostatic bags (the other type of tenseg
body, and outside forces are always acting on the body.
rity structure in the body). Our tissues are about 75%
Even with this definition of structure, we could see water, which is most evident in a relaxed state. Think
the structural body directly by removing all muscular of a relaxed cat (in full parasympathetic mode!), for
tension and removing all outside forces, including the instance, which can almost be poured from your hands.
influence of gravity, although that would be under the Our bodies contain many balloons, or fascial bags,
rather extreme set of conditions of someone floating in filled with semi-liquid contents: our muscles within
outer space under general anaesthetic! (see Fig. 8.10). their myofascial sheaths, the viscera within their peri
This is not in fact a fanciful suggestion: a human body toneal 'bag', the heart in its fibrous pericardium, and
under such conditions would necessarily'give in' to all the lungs within their pleural containment. Indeed, our
its internal structural tensions and would assume a entire organism as a whole is contained within the
form that accurately represents that body's true struc embrace of the superficial and deep fasciae.
ture. Would the body tend to flex as a whole, or extend The structural integrity of a hydrostatic bag comes
as a whole? This would surely show which internal from the interaction between the compressive tendency
forces within the structure would need to be balanced by of the surrounding sheath and the tendency for the
muscular tension when in gravity and in full function. fluid contents to resist compression. If we take for
instance the abdominal cavity; the viscera are contained • an environmental context dominated by the constant
within a fascial bag, the peritoneum. The muscles sur pull of gravity.
rounding this bag are the breathing diaphragm, the
pelvic floor and the abdominal muscles. A coordinated The above can be stated as a simple formula:
contraction of these muscles (i.e. the valsalva man
Functional body Structural body + neuromuscular
oeuvre) will both reshape and firm up the peritoneal bag
=
coordination (within the context of gravity and other

in a way that can actually give structural support to the
forces)
thorax above, and stiffen the spine. So we can look at
the human body as an integrated combination of two So what does this formula mean for the structural
kinds of tensegrity design: the tent and the hydraulic bodyworker? This way of looking at bodies can clarify
bag or balloon. and define the central concerns of our work. It tells us
where we work and why. Since the intention of struc
tural bodyworkers is to evoke functional change through
THE UNITY O F THE S TRUCTURAL structural change, the practical focus of the work is to
AND F U N C T I ONAL BOD IES evoke change in the structural body. The structural
body consists of a skeletal-fascial complex. Since in the
So far we have explored the internal dynamics of the short term we cannot change the shape of bones, it is
body, but we know that bodies also exist within a larger the fascial net that we work with. This means that the
environmental context. On earth, the most significant fascial net becomes the main focus of our work. In the
environmental influence is gravity. Other external forces words of Ida Rolf' A bone is where it is by way of how
may impinge on the body from time to time, but grav it is carried by the soft-tissue. So a Rolfer's job is with
ity is the ever-present force to which the functional body the soft-tissue. The bones are the landmarks, but our job
must constantly adapt. is with the soft-tissue' (Feitis 1978).
The structural body responds to two sets of forces: Working to influence the fascial net is the defining
those generated from within itself and those received characteristic of the structural bodyworker; working to
from without. Muscular forces act from within the struc influence tonus patterns (the coordinated firing pat
ture, constantly harmonizing it with the pull of gravity terns of the musculature) is the defining characteristic
and other external mechanical forces that may impinge of the functional bodyworker.
upon it, for instance impacts from other bodies or forces
of acceleration. A change of shape caused by a change of the fascial net
Our structural body can be understood largely in terms is a structural change. It is plastic in nature. A change
of the two kinds of tensegrity structure: the skeletal of the tonus pattern also changes the shape of the body,
fascial complex and fascial hydraulic bags - fascial bal but this is elastic in nature.
loons with either hard or soft fillings (Flury 1991). Our (Flury 1997)
functional body can be understood as our structural body
animated by neuromuscular dynamics. So, when we look
at a human being in motion, are we seeing a structure
S U M M ARY
or function? In fact we are seeing both. Any action, even
the simple act of standing upright, will require:
This chapter began with the structure versus function
• the structural body, being a tensegrity system that debate of Rolf and Feldenkrais and clarified the mean
consists of the coordinated interaction of the struc ing of these terms to help define more clearly the respect
tural properties of the materials from which we are ive domains of the structural and functional somatic
built - the compressive strength of bone; the tensile therapist.
strength of the fascial web; and the hydraulic behav Function is ultimately initiated and ruled by the cen
iour of the semi-liquid contents of the fascial bags tral nervous system but, as was stressed in Chapter 7,
• the functional body, which consists of a structural there are many levels to our somatic organization. And
body that is animated by a coordinated pattern of although the higher organizing functions of cortical
neuromuscular activity, including the maintenance processes are at the top, the movement patterns they ini
of pressure in the visceral hydraulic bags through tiate are necessarily conditioned by what the structure
muscular tonus will allow in real time. Our sensory-motor intelligence
STRUC TURE AND FUNCTION
is constantly making choices about what is economical Ultimately, the structural and functional viewpoints
in our movement, what is pleasurable (or at least what can be reconciled if we realize that structure and func
does not cause pain), and will usually (although not tion can both be viewed as processes within different
always) take the path of least resistance. And the path time frames. In the words of the great biologist and sys
of least resistance is largely defined by our structure. tems theorist, Ludwig von Bertalanffy (1952):
Our structure has a major influence on what is econom
The antithesis between structure and function, morph
ical in movement and will therefore condition and
ology and physiology, is based upon a static conception
temper greatly how we move. Our structure will be a
of the organism. In a machine there is afixed arrangement
constant, underlying, unconscious determinant of our
that can be set in motion but can also be at rest. In a sim
movement patterns, thereby making certain patterns
ilar way the pre-established structure of, say, the heart is
statistically more likely to occur and others less likely.
distinguished from its function, namely rhythmical con
Nevertheless, the body will not always take the path
traction. Actually, this separation between pre-established
of least resistance, and the body will not always
structure, and processes occurring in that structure,
respond to the input of the structural bodyworker; some
does not apply to living organisms. For the organism is
times the body has its own deep reasons for remaining
the expression of an everlasting orderly process, though,
unbalanced and inefficient. Godard (2000) uses the
on the other hand, this process is sustained by underly
poignant term libidinal efficiency to point to the fact that
ing structures and organized forms. What is described
sometimes a body will choose discomfort or postural
in morphology as organic forms and structures is in
inefficiency as a means of supplying a deep emotional
reality a momentary cross-section through a spatio
need that overrules the need for physical comfort. Even
temporal pattern. What are called structures are slow
with the best structural bodywork available, a body
patterns of long duration, functions are quick processes
will not allow itself to shift from its old patterns or
of short duration. If we say that a function such as the
become more aligned unless it really wants to. For this
contraction of a muscle is performed by a structure, it
reason it was mentioned earlier that, if a client is not
means that a quick and short wave process is super
responding to seemingly sensible structural changes,
imposed on a long-lasting and slowly running wave.
then it may be necessary to refer on that client to another
kind of practitioner. The work of structural bodyworkers is defined, but
Later we will look in more detail at the reciprocal not limited, by working with restrictions within the
pattern of influence between what we call our structure fascial net: an aspect of our reality that von Bertalanffy
and our functions. We will look at the processes at work would have called a 'slow pattern of long duration'. We
that will consolidate our movement patterns into long will see later how we can assess practically where we
lasting structural changes at a tissue level, and how need to work within this net, and will look at specific
these structural changes then serve to predispose us approaches to creating real and lasting change within it.
towards the movement patterns that gave rise to them Now we have defined the territory of the structural
in the first place. We will also look at the place of the bodyworker, we can look in greater detail at the make
structural bodyworker in interrupting this cycle (see up of the structural body - the myofascial network and
Figs 1.2 and 1.3, pp. 8 and 9). the composition and the properties of fascia.
RE FEREN CES
Feitis R (ed) 1978 Ida Rolf talks: about Rolfing and physical Godard H 2000 Notes from Bodywisdom Conference,
reality. The Rolf Institute, Boulder Coromandel, New Zealand
Flury H 1989 Theoretical aspects and implications of the Maitland J 1992 Rolfing: a third paradigm approach to body
internal! external system . Notes on Structural Integration structure . Rolf Lines 20(2): 47--49
1: 15-35 Rolf I 1977 Rolfing: the integration of human structures .
Flury H (ed) 1991 Normal function. Notes on Structural Harper and Rowe, New York
Integration 1: 6-21 Schultz R, Feitis R 1996 The endless web: fascial anatomy and
Flury H 1997 Grounding structural concepts in physical physical reality. North Atlantic Books, Berkeley
reality. Unpublished paper Still A 1899 Philosophy of osteopathy. Kirksville, Missouri
Gallaudet B B 1931 A description of the planes of fascia of the von Bertalanffy L 1952 Problems of life. Harper and Row,
human body. Columbia University Press, New York, p 1 New York
THE CONNECTIVE
TISSUE NETWORK
THE LAY E RING O F TIS SUES toughens and helps waterproof the skin. These cells are
produced continuously from an underlying basal layer
If we consider the layering of the body's tissues, mov and gradually migrate to the surface, displaced by new
ing from superficial to deep, we find: the skin, the cells from beneath. They gradually dry out and die as
superficial fascia, the deep fascia and, beneath these they approach the surface, becoming the tough protective
layers, the myofascial network, proliferating inwards outer layer of skin, eventually to be sloughed off at the
throughout the musculature towards the core (Fig. 9.1). surface through everyday wear and tear. The dermis is
composed mostly of connective tissue but accommodates
many nerve endings, blood vessels and other specialized
The skin
structures such as hair follicles and sweat glands.
Our outermost layer, the skin, consists of two sub-layers:
a thinner outer layer, the epidermis, and the thicker and
The superficial fascia
more fibrous inner layer, the dermis. The epidermis is a
complex layer in itself, consisting mostly of epithelial Beneath the skin is the superficial fascia, which is also
cells with a high content of keratin, which is a protein that known as the subcutaneous layer. It is a continuous
Semimembranosus Semitendinosus
Adductor magnus .5);�+---- Biceps (long head)
Sciatic nerve
Gracilis--_--l--I...o!':!1.1
Biceps (short head)
Adductor longus -----+:1I-::;;;fr--'---=--_
-++---- Epimysium of biceps
Sartorius r--=;;;ob---- Femur
��"I----\----
- -- Periosteum of femur
Vastus intermedialis --- --t':f;��.� --r--- Iliotibial tract
Vastus medialis ---��..:..;: .J.....t�,--r----=- Vastus lateralis
Epimysium of ---t
vastus medialis +--=-;---f---- Quadriceps tendon
Deep fascia
(fascia lata)
Superficial fascia
Skin
Patella -----+----
Figure 9. 1 The layering of tissues.

THE CONNECTIVE TISSUE NETWORK
layer of loose connective tissue that lies between the trabeculae connecting the layers become taut. This fact
skin and the deep fascia, and which follows the surface allows us, as structural bodyworkers, to palpate deeper
contours of the body. It is webbed by a fine network of structures by compressing the superficial fascia and
the most superficial nerves, blood vessels and lymph sliding it over them.
ducts, and is the place where layers of subcutaneous fat
of varying thickness tend to collect. Although it is the
The deep fascia
next and deeper layers, the deep fascia and the myofas
cia, that are of most concern to structural bodyworkers, Beneath the superficial fascia runs the deep fascia, which
the superficial fascia does have structural significance. is a continuous membrane of dense, irregular con
In certain places, particularly over the trunk, it is more nective tissue that flows over the surface of muscles,
durable than the deep fascia, and although it is not as over superficial bony surfaces (such as the sternum, the
densely fibrous as the deep fascia it does have enough anterior surface of the tibia, the iliac crests, the clavicles
collagen mass to provide resistance to movement. and so on), and over superficial tendons (such as those
There are considerable differences between individuals of the ankle and wrist). It also branches from the sur
in the density of this layer, and such differences may be face occasionally and runs deep to form the sturdier
congenital. These are not just differences in the amount intermuscular septa that separate major functional
of fat, but also in fibrosity - seemingly in the amount of muscle groups from each other. In the thigh, for
collagen fibre within the matrix itself. For some, this instance, it separates the hamstring group from the
layer is very thick and tough, somewhat like a thick, adductor and quadriceps groups. In a dissected body
tight wetsuit and this will tend to limit all movement. the deep fascia appears almost as a slick, white second
Traditionally, Rolfing addresses this layer quite early in skin or bodystocking, covering the entire surface -
the 10-series as a first approximation in freeing up the bones, muscles and tendons alike - and punctured
structure, before turning attention to the layers of the occasionally by openings or hiatuses through which
deep fascia and myofascia underneath. Rolf (1973) blood vessels, lymph ducts and nerves enter and leave
states: 'Actual manipulative work with fascia calls to the superficial fascia. In a freshly dissected body the
mind the lowly onion. Layer lies within layer. Deeper deep fascia is often transparent but tends to whiten as it
layers can be affected only as the more superficial ones dries out; this is the glistening, silvery and extremely
lose the rigidity that is the signature of imbalance.' tough membrane that you find in some cuts of meat.
Elsewhere, Ida Rolf, in her homely language, calls the Sometimes it is delicate, thin and almost invisible;
work of freeing up the outermost layers 'Taking out sometimes it is especially thickened in areas that require
the pins'. tensile strength, for example in specialized bands such
The superficial fascia varies considerably throughout as the iliotibial tract, the band of Richter or the retinac
the body and takes on specialized roles in different ulae of the ankles and wrists. Occasionally, superficial
areas. In some places, like the palm of the hand, it is muscles insert into the deep fascia and influence move
very thin, with a total absence of fat beneath the creases. ment by tightening whole fascial planes. Such muscles
Here, the close association of the skin with the deep include the tensor fasciae latae, the most superficial
fascia allows little movement or slippage between the fibres of the gluteus maximus, the palmaris longus and
layers and makes the palm an excellent surface for grip the platysma.
ping objects. In some areas, such as the breasts, the scalp In his classic treatise on fascial dissection, Gallaudet
and the soles of the feet, fat is packaged into small (1931) describes this layer as:
connective-tissue compartments. In the soles of the feet
a sheet of connective tissue varying in thickness and
this creates a shock-absorbing pad. This same packaging
density according to locality. This covers and invests all
of fat is evident in the dimpling of hips and thighs
the so-called higher structures; i.e., muscles and ten
commonly known as cellulite. It is also this layer that
dons, bursae, vessels, lymph nodes, nerves, viscera, liga
tends to sag in old age as it becomes loosened from the
ments, joints, and even cartilage and bones, these last
underlying layer.
by close adhesion to perichondrium and periosteum
This layer is easily palpable and, to a greater or lesser
between the attachment of muscles.
degree depending on its fibrosity, may be slid over
the underlying layer, the deep fascia. The superficial He describes the deep fascia's close adherence to the
fascia adheres to the deep fascia but will allow a limited superficial fascia above, and to the myofascia beneath,
kind of sliding over it, probably only until the fibrous by tiny connecting fibrous trabeculae. The trabeculae
OUR SO MATIC ORGANIZATION
prevent the complete slippage between and separation
�
of the layers, so that nowhere in the human body can
you lift the skin and superficial fascia away from the
underlying tissue, as you can, for instance, with a young
puppy. Gallaudet also notes that the deep fascia tends +
---------
to split into separate laminae when it meets a 'higher'

structure such as a muscle, reuniting on the other side.
This is clearly illustrated in some of the better anatom
ical atlases: for instance in the beautiful sternoclei
domastoid dissection in the Sobotta atlas (Ferner and
Staubesand 1982). Gallaudet makes the interesting
point that after the deep fascia has been completely
reflected (i.e. peeled) from a cadaver, the epimysium (the
outermost myofascial layer of individual muscles, to
be described later) remains intact. Therefore the deep
fascia is distinct from (though adhering closely to) the
underlying myofascial network, which will now be
described.
Figure 9.2 Orange analogy from Ida Rolf (Rolf 1977)

The myofascial network (reproduced with the kind permission of Alan Demmerle).
Biological entities at all levels tend to have specialized
reveal the surface outline of each individual muscle as
boundaries, or interfaces, that both connect them with
well as its internal fascial structure.
and separate them from their surrounding environ
So, while the myofascia wraps and separates the
ment, and these are usually membranes of some sort.
major functional groups of muscles, related forms of
For muscles, this membrane is the myofascia, which
fascia form the structural layer of all serous membranes
both separates muscles from and connects them to their
that line the major cavities of the trunk, wrapping and
surrounding musculature. The myofascia packages
suspending the viscera. Ida Rolf described fascia as 'the
individual muscles but also forms the internal subdiv
organ of support and structure' (1977), and now seems
isions within them. All of the muscles of the body are
more justified than ever in elevating this network to the
individually packaged within their myofascial bags,
level of an organ. Even Gallaudet (1931) suggests that it
and all of these bags are connected together as one
is more accurately designated as a system.
piece; then, as a whole group, they are enclosed entirely
Since Rolf's early investigations, the fascia has been
within the embrace of the deep fascia. Hence the myofas
found to have many functions other than the purely
cia meets the deep fascia only at their common, most
mechanical one of giving form, tensile strength and
superficial surfaces. To borrow an analogy from Ida Rolf,
elasticity to tissue. It also assists in the transport of
if the skin of an orange represents our skin, the super
metabolites, playing host to a variety of cells, and has
ficial and the deep fascia, then the muscles are the indi
immunological and other protective functions. It has
vidual orange segments and the myofascia is the fibrous
also been found to have a major biomechanical function
membrane that wraps individual orange segments -
in dampening mechanical shocks to the system and in
separating them from each other but also from the skin
generating rhythmic movement. These properties will
of the orange (Fig. 9.2).
be examined in more depth in Chapter 10.
In Chapter 8 we played with one of the common
thought experiments, often used to help visualize the
The inn er structure of the musculature
fascial network, in which we imagine a body in which
all has been dissolved except the fascia. In this scenario Muscles have an extraordinarily complex internal struc
the deep fascia would reveal the overall human shape: ture that follows a design principle quite widespread in
the head, the limbs, the trunk and even smaller surface nature and known as fractal patterning. This is the recur
details like the facial details, toes and external genitalia, sive self-duplication of a basic pattern at finer and finer
but also the septa that enclose the major intermuscular levels of organization. It is found not only in the organ
compartments. The myofascia, on the other hand, would ization of muscles and nerve trunks, but also in networks
that periodically branch or cluster into smaller units of the

same intrinsic structure, such as blood vessels, periph
eral nerves and bronchioles. In the myofascia this design
manifests as 'bags inside bags inside bags'. Alter (1996)
illustrates clearly how this recursive patterning con
tinues further down through the contractile and fascial
elements, which are the two major sub-components of
muscle tissue. The contractile elements start from the
myofibril (the basic muscle cell) and fractally divide
inwardly through the successively finer elements of the
sarcomeres and the myofilaments, and then down to the
individual, filamentous macromolecules of the contrac
tile proteins. The fascial elements similarly reduce down
from the mature collagen fibre, through the fibril, subfib
ril, microfibril and the basic tropocollagen molecule.
There are three main levels of muscle organization
(see Fig. 9.3). Each muscle is fully enclosed in a tough
outer sheath called the epimysium. This layer covers the
entire belly of the muscle and extends to enclose the
outer layers of the muscle tendons, or aponeuroses.
Internally, each muscle is composed of long, cylindrical
or gently fusiform subcomponents called fascicles, each
of which is individually wrapped in its own fascial bag
called the perimysium. Each of these fascicles is a pack
age containing 100-150 muscle fibres, and each muscle
fibre is wrapped in its own sheath, the endomysium. At
each of these three levels within the musculature, the
body's 'plumbing' can be found, with nerves and blood
vessels traversing these fascial routes (which is a con
sistent pattern throughout the body). Large vessels are
found at the epimysial level and capillaries at the
endomysial level. Areolar tissue and intramuscular fat
may also be deposited along these routes.
But this subdivision continues further. Muscle fibres
Figure 9.3 The three myofascial levels within the musculature.
are composed of muscle cells, the ultimate contractile
unit, and each is individually wrapped in a cell mem
brane, the sarcolemma, and organized in series along
the length of the fibre.
Quadriceps
It has been estimated that fascia forms 50-60 per _____ . /compartment
"
cent of the mass of muscle tissue. Superficial . a,,,
..a-_ .
,
It is important to pause and ponder this fact: that fascia ' _ Epimysium of
--...... 1lL..:.--
..",
is the abundant, unifying and all-encompassing environ vastuslateralis
ment of all muscle cells. This fact alone makes the inher Periosteum
of femur
ent elasticity of muscles comprehensible and it is
important for bodyworkers to realize this. 'Working with Lateral
Adductor . intermuscular
fascia' has become a fashionable catchphrase in body -,
' septum
compartment
work circles, and sometimes practitioners talk as if they
are working on something other than the musculature;
however, they are inseparable aspects of the same system. . � Hamstring
compartment
Figure 9.4 is a cross-section of the mid-thigh. It illus
trates the recursive packaging arrangement of fascial Figure 9.4 Cross section of mid-thigh.
bags. Beneath the skin and superficial fascia is the deep after the fact (Feitis 1978). Structural bodyworkers from
fascia, which in this locality is called the fascia lata (or Ida Rolf's time until now have been working with a
milky fascia in reference to its white colour). It envelops particular vision of how muscles operate. This ideal
the thigh like a second skin and contains within it the four ized conception of the musculature is:
major myofascial compartments of the thigh: the quadri
ceps, the hamstrings, the adductor group and the perios that in a perfectly functioning body, all muscles are sep
teum of the femur itself (which is also a fascial bag arate entities, each individually wrapped in their own
enclosing the entire bone). There are also some lesser fascial bag, free to glide over neighbouring muscles like
bags that enclose the sartorius and various neurovascu silk stockings.
lar 'plumbing' routes (every good architect knows that
Against this idealized picture of perfect function is
you try to keep all the plumbing together). Within the juxtaposed a picture of dysfunction in which these
quadriceps group, the vasti and the rectus femoris are all independent muscles became 'glued' to each other
individually ensheathed within their own epimysial through injury or abuse, similar to the adhesions
sleeve. Similarly, within the hamstring compartment the known to surgery. According to Rolf:
hamstrings semimembranosus, semitendinosus and the
two heads of the biceps femoris area are each individu following inflammatory illnesses or traumatic injury,
ally wrapped in their own epimysium. layers adhere one to another - they seem to be 'glued'
This is a little different from the picture of the muscu together. They no longer slide but cause adjacent struc
lature that is often portrayed in most anatomical atlases. tures to tug on each other, thus contributing to general
These texts generally portray muscles as being independ weariness and tension.
ent, distinct and individual entities. In fact, the muscula
ture is entirely embedded within a fascial context, and Later, she adds:
most of the so-called 'individual muscles' are seen as sep 'Gluing' is an interesting phenomenon. In practically
arate only through meticulous dissection and teasing all bodies, on one muscle or another, small lumps or
away of the epimysium. As bodyworkers we tend to thickened non-resilient bands can be felt deep in the tis
visualize the 'insides' as they are represented in anatom sue ... They apparently form when the fascial envelope
ical texts and atlases. Since most bodyworkers have never of one of the muscles attaches itself to a neighboring
performed a dissection, we rely on the representations of fascial surface
anatomical artists who tend to simplify their diagrams to (Rolf 1977)
highlight the traditionally accepted or named muscles,
and this means stripping away the deep fascia and the This representation of the musculature has entered
superficial epimysium to show the 'important stuff' the consciousness of most bodyworkers; it is power
beneath. It was mentioned at the start of Chapter 6 that fully suggested by simplified anatomical drawings and
our 'maps' are always a simplification, and anatomical is perpetuated in the teaching of many schools of struc
illustrations are a prime example; although, of course, tural bodywork. This representation of the musculature
this kind of simplification can easily be reasonably justi seems also to have formed the basis for the practical
fied on educational grounds. Nevertheless, simplification hands-on aspects of structural bodywork in that we use
can lead to error. We have inherited and internalized the elbow to break down the adhering layers between
images of the musculature as if all the muscles in the muscles and restore the ideal arrangement. A great deal
body were separate entities that could glide freely over of effective structural bodywork has been performed as
each other and do their work independently while not if this is how muscles work and how they become dys
affecting their neighbouring muscles. It is much more dif functional - a potent 'as if' among many in this field.
ficult to visualize and understand the complex dynamics Yet there is surprisingly little evidence to support this
of a system in which all the muscles are bound together view; it has not been confirmed by cadaveric studies,
in shared bags, such that if one muscle shortens it will and for obvious ethical reasons cannot be easily
inevitably drag upon and deform its neighbours. explored in live humans (although it can and has been
explored with animals).
The traditional structural bodywork representation
of the musculature - a potent 'as if' 'Put it where it belongs and ask for movement'
Ida Rolf freely admitted that many of her explanations as Ida Rolf gave an enormously powerful practical rule for
to how her techniques actually work were rationalizations structural interventions: 'Put it where it belongs and
ask for movement' is one of the so-called 'Rolf laws'. Subscapularis

Was she suggesting here that soft tissue can actually be
Potential space
moved around, relocated with respect to adjacent tis
sues? It is certainly a compelling suggestion, and in a
Scapula
real pragmatic sense it is an extraordinarily useful rule
/
of thumb - another potent 'as if'. If you follow this rule
Head of t-+------ Serratus
you normally obtain a predictable improvement in h"m,ru, anterior
functionality, and it is a very practical rule that has been
used creatively to augment many different kinds of
'
movement. However, it seems to be based on a picture Sliding direction
of muscle tissue that sees each muscle as separated of scapula over
from other surrounding muscles and free to glide over thorax
them. This rationale is difficult to maintain if the mus Figure 9.5 Potential space beneath the scapulae.
cles are bound together in fascial compartments. So
what is a more realistic picture of the musculature? If the lung from the inner wall of the thorax and allows
fascial adhesions can develop, just where do they some gliding movement of the surfaces during respira
occur? Obviously not in places where there is a natural tion, but it does not allow them to separate. Occasionally,
fascial fusion already. Where are the potential spaces of this potential space can fill with air or bodily fluids, dis
the myofascial network? astrously, as in the case of pneumothorax or collapsed
lung.
When there is such a close approximation of internal
Potential spaces, ectopic bursae and adhesions
- - - surfaces, there is the potential for them to become stuck
What is a potential space in the body? It is a space to each other, which is a phenomenon known as adhe
defined by two surfaces that are in intimate contact yet sion. In medical parlance, adhesion has been defined as
not bonded, a space that can be opened, like the space 'the union of two surfaces that are normally separate,
between the pages of a closed book. Physics tells us that also any fibrous bands that connect them' (O'Toole
potential spaces can be very difficult to open as the sur 1997). This is a well-understood result of abdominal
faces are firmly held together by surrounding pressures, surgery. But adhesions can also occur whenever there
and nature abhors a vacuum. This is easily illustrated is a traumatic interference with any organ boundary,
by trying to separate two sheets of moistened glass. whether through surgery, disease, excessive friction or
Until the seal is broken the two surfaces cannot be sep impact injury. The normal inflammatory processes of
arated, although they can slide over each other. Within granulation and fibrous infiltration can fuse together
the human body, potential spaces tend to be separated surfaces that should be separated by a potential space.
by a fine layer of an extracellular fluid such as ground So where are the true potential spaces within the mus
substance, synovial fluid or a specialized surfactant, as culoskeletal system? What are the layers that, ideally,
in the lung. should glide over each other? Can the deep tissue tech
An obvious potential space is the scapulo-thoracic niques employed by structural bodyworkers actually
articulation, which is the space between the deep sur free up such adhesions? Or are the measurable improve
face of the subscapularis and the superficial surface of ments achieved through soft-tissue mobilization more
the serratus anterior. This is a space that allows the neces likely the result of bringing increased resilience to the
sary sliding of the concave scapula over the convexity fascia, rather than a breaking down of hypothesized
of the rib-cage in shoulder-girdle movements such as adhesions?
pushing, punching or reaching (see Fig. 9.5) and, as a Surprisingly little has been written about potential
potential space, it could conceivably be injected with spaces within the myofascial system (Prof C dos
fluid or with air. There are potential spaces between the Remedios, personal communication 2002). We know of
visceral organs within the peritoneal bag, again kept large bursal areas, between the scapulae and thorax for
separate by a film of fluid. The pleural cavity is another instance, as well as ectopic (or floating) bursae, such as
example where there is potential space between the vis those over the greater trochanters. If we take the quadri
ceral pleura of the lung and the parietal pleura that ceps compartment in the thigh as an example, the four
lines the inside of the thoracic cavity. This potential 'named' muscles are entirely enclosed within the fascial
space likewise has a small amount of fluid separating bag defined by four fascial boundaries: the fascia lata,
the two intermuscular septa and the periosteum of the weight of the body (Heller 1990). This network is even
femur (see Fig. 9.4). Therefore, if the quadriceps shorten more extensive than the already prodigiously branch
they will inevitably drag upon other structures that are ing vascular and nerve networks. Various imaging
bound to the common septa. If there is any suggestion techniques have demonstrated the extraordinary dens
of independent or sliding movement between muscles, ity and fineness of the branching networks of our vas
in this instance it must be between muscles within cular and nervous systems, which seem to proliferate
this bag: that is, between the individual quadriceps. exponentially towards their extremities (see Fig. 9.6).
Cadaveric studies have shown that areolar and adipose Connective tissues, however, penetrate even further
tissue can be deposited between the fascicles. We can into more 'nooks and crannies' of the body than either
speculate that this will allow some sliding movement of these two systems and, in fact, form the supportive
between adjacent fascicles in the same way that we can superstructures of both of them: nerve trunks and
slide the areolar tissue of the superficial fascia over the blood vessels have their own supporting connective tis
deep fascia in a limited way. Some authors have sug sues. Connective tissues are the matrix in which all else
gested that there may be a fluid separation of the fas is embedded.
cicles (St George 2001). Dissection of freshly killed
animals does tend to suggest that there is a lot of fluid
The biomedical view of conn ective tissue
between muscles and they can be easily separated
(C Rossi, personal communication 2002). Connective tissues are usually classified as one of four
Anatomist and RoHer, Gil Hedley, through many dis fundamental tissue types. The Tortora and Grabowski
sections of cadavers (which were mostly elderly speci map (Fig. 6.1, p. 38) represents the view in which the
mens), has made some interesting remarks about the four types of tissue are characterized by the unique
daily turnover of collagen threads and the build-up of functions of their cells:
connective tissue. From his dissections he notes that, by
• connective tissue has cells that secrete the structural
and large, over time, structures will tend to adhere to
materials of the body
each other, and although some can be teased apart with
• muscle tissue has cells that are contractile
gentle finger pressure, some require a scalpel. 'There
• nervous tissue has cells that are irritable
are certain tissue textures that yield readily to your
• epithelial tissue has cells that line and secrete vital
hand or finger. Cotton candy, gossamer threads that are
biochemicals.
very thin like spider webs. If you touch them they dis
appear', but in other areas 'You end up having this However, there is something more elementary about
big solid muck that has cemented the one to the other' connective tissue; it is the environment in which all the
(Hedley 1999). He suggests that with lengthy periods of other tissues are created and maintained and, unlike
immobilization these fibres will accumulate, become the other three types, connective tissues are substan
dense and complex, and attract fat deposits. He notes, tially non-cellular, consisting mostly of secreted extra
however, that even in cadavers movement will dissolve cellular materials. None of the other three tissue types
the threads. could exist apart from this matrix. Muscle tissue, for
So a picture is emerging in which there is a conti instance, is a composite of contractile cells and their
nuous turnover of collagen threads - threads that will enveloping myofascial meshwork. It is impossible for
disperse with movement, or solidify with immobility. these contractile cells to generate movement without
Movement is the key. the unifying presence of their myofascial environment:
the epimysial, perimysial and endomysial layers. This
fascial framework harnesses the contractile force of
TH E C ON N E C TI VE T I S S U E S all the active muscle cells and gives direction to their
combined force, transmitting it to the tendons and
The fascial network belongs to the family of tissues in beyond. Nervous tissue similarly does not exist inde
the body called the connective tissues, of which there is pendently of its supporting connective tissues. Nerves
an extraordinarily diverse range of forms throughout are enwreathed and supported by connective tissue
the body. As a class, these tissues form the most perva membranes: for example, the meninges of the brain and
sive network within the human body: wrapping, sep spinal cord and the fascia of peripheral nerves, which
arating, interpenetrating, connecting, supporting all have a three-level fascial structure that closely resembles
anatomical structures, and forming about 60% of the that of muscle and consists of the epineurium, perineurium
,65
Figure 9.6 The nerve and vascular networks.
and endoneurium (see Fig. 9.7). Epithelial tissues, such Connective tissues display an extraordinary continu
as the mucous membranes, similarly could not main ity between all the various structural levels of the body.
tain their integrity without the adhesive support of the At the grossest level they maintain the form of the entire
basement membrane (basal lamina). This is the under organism, containing all within the superficial and deep
lying layer of connective tissue that binds them into fascial layers; they provide the structural support for
continuous sheets or into the globular form of glands. all individual organs, in many cases individually sub
This layer also provides nutrients to epithelial mem partitioning the organs into finer and finer functional
branes, which are avascular and can only receive nutri divisions; they form the superstructure for the other
ents that diffuse through the basement membrane. So three tissue types; they are the basic cellular glue at
there is a sense in which connective tissues are the most the cellular level of our organization, and, as Oschman
fundamental tissue type. (2000) has shown, they can even connect into the micro
Nearly all connective tissues arise from mesoderm, filamentous superstructure of individual cells.
the middle germ layer that forms between the ectoderm
and endoderm in the developing embryo (see Fig.
8.1, p. 49). Developmentally, all structures are guided Connective tissues as composite materials
in growth by connective tissue templates. Bones grow As outlined in Chapter 8, all connective tissues consist
either within a cartilage template or within a fascial primarily of an extracellular matrix, permeated with a
matrix; connective tissues form the scaffolding on scattering of isolated cells that rarely contact one another.
which muscle fibres form (Schultz and Feitis 1996). The extracellular matrix itself is a highly variable com
The reason that nerves and blood vessels are so often posite material that nevertheless always contains at least
found following along fascial planes is that their
growth was originally guided along the plane of a • some fibrous elements
primitive fascial template. • a form of the amorphous ground substance'.
I
Reinforced concrete, for instance, combines the tensile

strength of steel with the compressive strength of the
surrounding concrete to produce a composite that has
the combined properties of the original materials, being
strong both in compression and tension. Fibreglass con
sists of glass fibre embedded within a resinous filler.
These materials are almost a case of technology imitat
ing life, since bodies have been making these experi
ments from time immemorial and have succeeded in
creating some remarkable and unique composite mater
ials. Connective tissues have close parallels with some
of the composite materials used in industry (5 Evanko,
personal communication 2002).
The fibrous elements in connective tissue are of
three basic kinds: collagen fibres, elastin fibres and
reticulin.
1. Collagen will be looked at in greater detail later but,

briefly, it is the most abundant fibre within the con
nective tissue network, forming more than a third
of the total protein in the body. It has great tensile
strength and is very flexible, even though individual
collagen fibres have little inherent elasticity.
2. Elastin, as its name implies, is an elastic fibre, able
to lengthen up to one-and-a-half times its unstressed
length. It is present in tissues that must resume their
shape after stretching.
3. Reticulin is a chemically modified form of collagen
that has strands of a much smaller diameter and
length than collagen fibres. It is a lighter material that
forms the delicate reticular superstructure of the
visceral organs.
Ground substance is the ubiquitous, transparent,
gooey lubricant of the body that pervades the fibrous
elements in the connective tissue matrix and keeps
it hydrated. Juhan (1987) distinguishes ground sub
stance from other intercellular fluids that are derived
Figure 9.7 The three-level organization of nerve trunks. from blood plasma. Ground substance is derived from
fibroblastic cells and becomes 'the retort in which all
extracellular activities occur'. It is a gel or colloidal sub
Although these are the basic ingredients, there may be stance that contains various water-soluble carbohydrate
additional elements. Bone, for instance, contains other protein complexes and can have a wide range of
extracellular materials such as crystalline deposits of viscosities. It consists of about 75 per cent water and
bone salts, tricalcium phosphate and calcium carbonate the rest is made up of macromolecules - mostly gly
in particular. cosaminoglycans (GAGs), proteoglycans and glycopro
We are familiar with composite materials in industry. teins. This class of substance tends to be electrostatically
Our technologists are continually combining materials attracted to collagen and to have an immense capacity
of diverse properties in order to create new materials to attract and bind water. The GAG content of connec
that have at least the amalgamated properties of their tive tissues tends to decrease with age, which is the rea
elements, and perhaps other ones besides. Examples son that the tissues of the elderly can become dehydrated
are reinforced concrete, fibrous cement and fibreglass. and lose their extensibility.
·,67
GAGs are essentially complex carbohydrate poly between collagen fibres, preventing microadhesions
mers, usually with an attached protein group. They and thereby maintaining the resilience of the tissue.
may be unsulphated (hyaluronic acid being the main Ground substances also have a key role in the nutrition
example) or sulphated (chondroitin, dermatan, heparan, of cells in transporting dissolved nutrients and meta
heparin, and keratan sulphates). Hyaluronic acid is a bolic by-products while providing a barrier to micro
slippery cellular glue that has a lubricating role, par organisms. It is also no longer believed to be an inert
ticularly in the synovial fluid of joints. The sulphated mechanical barrier, but to have an active role in assist
GAGs are jelly-like substances that have the remark ing the passage of certain compounds while resisting
able property of actively attracting water molecules the movement of pathogens, similar to the way in
and binding them in specific arrays around themselves; which water filtration systems allow the free passage of
they are hydrophilic. They help maintain fluid balance certain sized particles but not others.
within connective tissues, keeping them 'juicy' and
providing a lubricating role in the potential spaces of
the body, thereby minimizing friction by allowing the Types of conn ective tissue
free gliding of layers. Histologists have classified the connective tissues in
Proteoglycans are complex macromolecules consist various ways. This fact is hardly surprising when one
ing of GAGs linked to a core protein. Like GAGs they considers the huge range of functions these tissues per
are intensely hydrophilic. They exert an enormous form and the great diversity of local variation in the
swelling pressure, which in a fully hydrated form as a specific needs that they fulfil. Figure 9.8 shows the
component of cartilage tissue can resist massive com place of connective tissues in the map of Tortora and
pressive forces. Glycoproteins are also carbohydrate Grabowski (1993). These authors sub-classify connect
protein complexes that have diverse functions, including ive tissues as follows:
a role as a basic cellular glue, examples being laminin
and fibronectin. 1. Embryonic connective tissue
In the connective tissue composites, ground sub A. Mesenchyme
stance acts as the spacer (like the plastic resin of fibre B. Mucous connective tissue
glass) by holding the fibres apart and preventing them II. Mature connective tissue
from 'matting down', compacting and becoming glued A. Loose connective tissue
together. It thus maintains a 'critical interfibre distance' 1. Areolar connective tissue
Figure 9.8 The place of connective tissues within

Organismic level the Grabowski-Tortora map.
System level
Organ level I
II Tissue level The four tissue types
Cellular level Muscle tissue A classification of

connective tissue types
Nervous tissue
Organelle level Loose connective tissue
Connective tissue • areolar
Chemical level • adipose
Epithelial tissue
• reticular
Dense connective tissue

• dense regular
• dense irregular
• elastic
Cartilage
• hyaline
• fibrocartilage
• elastic
Osseous connective tissue

• bone
Vascular connective tissue

• blood
, -�
2. Adipose tissue spaces around joints and in, and between, muscles
3. Reticular connective tissue (think of the marbled cuts at the butcher shop).
B. Dense connective tissue
1. Dense regular connective tissue Reticular connective tissue
2. Dense irregular connective tissue Composed chiefly of reticulin fibres, this forms the
3. Elastic connective tissue superstructure (or stroma) of organs such as the liver,
C. Cartilage pancreas and lymph nodes.
1. Hyaline cartilage It was mentioned earlier that loose forms of connect
2. Fibrocartilage ive tissue can be of significance to the structural body
3. Elastic cartilage worker, particularly if there is an increase in density in
D. Bone (osseous) tissue the superficial fascia; however, it is probably through
E. Blood (vascular tissue) affecting the dense connective tissues that we can
achieve most effect.
As structural bodyworkers it is the loose and dense
forms of mature connective tissue that are of most Dense connective tissue
interest to us; they are most relevant to our work, Dense connective tissue is marked by a greater density
being most accessible to change through mechanical of fibres within the matrix and fewer cells than the
intervention. loose forms. The fibres themselves are thicker and in
closer contact with adjacent fibres. Geometrically they
Loose connective tissue
form either parallel or latticed arrays, and may exist in
Under the microscope, loose connective tissues are dis laminated layers with an oblique arrangement of fibres
tinguished by having a sparser distribution of fibres at each layer.
and a larger proportion of cells than the others types.
The fibres form a loosely woven and randomly oriented Dense regular connective tissue
three-dimensional network that is maintained in sus This forms key structures such as tendons, aponeuroses
pension by the jelly-like ground substance. and ligaments. The collagen fibres are aligned in ordered
arrays, either parallel or close to parallel. This allows
the tissue to resist tensile pulls through the long axis of
Areolar connective tissue the fibres. Sometimes there is a wave-like crimp to the
This contains all three kinds of connective tissue fibre: array that allows a small degree of lengthening.
collagen, elastin and reticulin. It is widespread in the
body, forming the superficial fascial layer beneath the Dense irregular connective tissue
skin, and mucous and serous membranes elsewhere. It This forms most of the tensile sheets within the body:
plays a key role in the function of our musculature, the fasciae, joint capsules, the periosteum of bones, the
where, in combination with the fascia, it lines muscle perichondrium of cartilage, heart valves and the heart's
walls, allowing some independent movement between investing pericardium, as well as organ capsules such
adjacent muscles. as those of the kidneys. The fibres are mostly collagen
and tend to be randomly oriented to resist tensile pulls
Adipose tissue from various directions. Such latticed arrays contain
This is widespread throughout the body and forms an cross-linkages, or fibres that criss-cross other fibres,
important part of the superficial fascia. Adipose cells fusing at their intersections (possibly through covalent
store globules of fat that can pad and insulate the skin bonding) and knitting them together to form a meshed
and also serve as a site for food storage. It is also a kind or latticework structure (Fig. 9.9).
of general-purpose packaging material for internal
organs and similar in function to the polystyrene 'mac Elastic connective tissue
aroni' in which we package loose articles for postage to This forms the key structures of the body in which an
stop them rattling around. There is for instance a 'fat elastic recoil is of prime importance: the ligamentum
pack' that surrounds and supports the kidneys and flavum of the spine, the nuchal ligament, the elastic
glues them to the back of the abdominal cavity. There walls of arteries, vocal chords and the bronchioles. The
are also fat pads behind the eyes, hence the 'sunken tissue is composed mostly of branching elastin fibres
eyes' of people who lose weight quickly. Fat also fills in that give these tissues their characteristic yellow colour.
• provide storage sites for metabolic food in the form

of fat
• have a protective and immunological function, by
harbouring protective cells such as phagocytes, leuko
cytes, mast cells and fibroblasts
• have a key function in tissue repair after injury or
inflammation
• provide vital information to the central nervous
system about the forces acting through them (all
connective tissues excepting cartilage are richly sup
plied with nerve endings)
• form the gross wrapping and containment environ
ment at all levels
• assist in cushioning compressive forces within the
structure and in resisting tensile forces
• provide a means of recycling the kinetic energy present
in the moving structural body by generating oscilla
tory movement patterns.
Figure 9.9 Dense connective tissue (Grays Anatomy 1973).
Structures composed of conn ective tissue
Having true elasticity, these fibres allow the tissue to
All anatomical entities contain connective tissue; how
regain its original form after being deformed.
ever, there are some structures that are composed
almost exclusively of it. Their mechanical properties are
Functions of connective tissue determined entirely by different combinations of the
basic elements, particularly the proportions and types
So far we have spoken mostly about the structural
of fibres and ground substance. The structures that con
importance of connective tissues. They have been found,
sist almost entirely of connective tissue are:
however, to have a vast range of functions other than
simply providing structural support to the body. It was • bones, including cartilage and its fibrous coating, the
noted earlier that connective tissues are evident at periosteum
every level of our structural organization, in fact at all • ligaments, which approximate bone to bone
of the structural levels outlined in Fig. 6.1 (p. 38), so it • tendons and aponeuroses which link muscle to bone
can be expected that they should have different emer or, in a few cases, muscle to fascia
gent functions at each level, from the microscopic to the • fascia, the universal wrapping substance of the body
macroscopic. At a cellular level they have metabolic, • interosseous membranes which couple contiguous
immunological, reconstructive and nutritional functions; bones
at the organ level they supply the structural framework • bursal sacs: flattened, fluid-filled fascial bags that
that gives stable yet pliant form to organs, and may serve to reduce friction in key positions in the body
both package and insulate them. At the organismic • synovial capsules that encapsulate and hermetically
level they have important gross biomechanical func seal synovial joints
tions and also provide vital proprioceptive information • retinaculae, which reinforce key areas that overlay
to the central nervous system. tendons.
Connective tissues:
Although this list suggests that these structural elem
• provide pathways for fluid nutrients and waste ents exist as separate entities, dissection often does not
metabolites to pass to and from the blood stream, reveal such sharp distinctions. They are all intercon
and are thus the main supply route to the more avas nected. As Hedley (1999) notes, there is a certain arbi
cular regions of the body trariness in the naming of any key connective tissue
• serve to quarantine infected tissue by providing a structures. If we take ligaments, for instance, there are
semi-permeable barrier to pathogens, thereby delay so many specialized thickenings in the connective tis
ing the spread of infection sue that we could easily justify having more 'named'
OUR SOMAT IC ORGANIZAT ION
"
"-
'-
"
-�
I
I
I
Figure 9. 1 1 Ligament (Grays Anatomy 1973).
Figure 9. 1 0 Tendon.
laminated straps of mostly collagen fibres organized in
a slightly less than parallel arrangement. They are less
ligaments than we have already. We need to keep this in
regular in their fibrous configuration than tendons.
mind when discussing the following structures, since
Their fibres may spiral or layer themselves into oblique
they are sometimes a matter of definition.
arrangements as in Fig. 9 . 1 1 .
Tendons
Fascia
Tendons are the convergence of all the myofascial struc The word fascia is derived from the Latin word jascis
tures within the body of a muscle; a gathering together meaning 'bundle'. This name is descriptive of the
of all the fascial strands of the epimysium, perimysium bundled appearance of the collagen fibre bundles under
and endomysium towards the ends of the muscle. They magnification. Structural bodyworkers think of influ
are extraordinarily tough and pliable cords but have lit encing two kinds of fascia: the deep fascia or bodystock
tle inherent elasticity so as to more efficiently conduct the ing, and the myofascial network, particularly the more
force of contraction through to the adjoining bone. Too easily reached and worked aspects of the epimysium. In
much elasticity would make the timing and coordin the epimysium the collagen fibres tend to encircle the
ation of movements very difficult, and yet they are pli belly of the muscle but become more parallel with the
able enough to go around comers almost at right angles - axis as they reach the tendinous ends. This concentric
beneath the ankle retinaculae for instance. They have arrangement around the muscle belly demonstrates just
a parallel alignment of collagen fibres with a crimped one aspect of the body's ability to recycle the elastic
pattern that, magnified, resembles bundles of undulat energy of fascia. As a muscle contracts the diameter of
ing ribbons. This crimp allows a minor degree of elasti the belly increases, thereby tensing the concentric fascial
city under tension since the fibres are able to straighten grain. On the muscle's relaxation this stretched fascia
to a limited extent (see Fig. 9 . 1 0 ) . squeezes the belly back into shape and assists the
Some tendons, such as the wrist flexors, are enclosed muscle to return to its resting length. It may be surmized
within synovial sheaths that serve to minimize friction that this 'pumping' action also promotes circulation
as the tendon slides within; others such as the calcaneal throughout the muscle tissue (Fig. 9.12).
tendon are continuous with surrounding areolar tissue, The collagen fibres of the major fascial sheaths, how
and this has a similar action of minimizing friction. ever, tend to be oriented in various directions, reflecting
the need to resist tensional vectors from many direc
Ligaments tions. Despite the fact that collagen fibre itself is rela
Ligaments provide stability to joints and oblige them to tively inextensible, the composite, fascia, has a high
work through a limited range of motion and to resist degree of flexibility and extensibility; the reasons for
forces from many directions. They consist of layered or this will be discussed later.
Mitochondrion
Goigi apparatus
Figure 9. 1 3 Fibroblast.
The main types of cells found within connective

tissue are:
• factory cells - fibroblasts, osteoblasts and chondro-

( a)
blasts
• adipocytes or fat cells
• macrophages
• mast cells, which secrete hormones such as hista
mine, seratonin and heparin
• plasma cells, which are part of the immune system
and secrete antibodies
• leukocytes, which are also known as white blood
cells.
Fibroblast cells
Fibroblasts (Fig. 9.13) are the most common cell within
connective tissue. They are spindle-shaped and manu
facture and express all the complex substances used in
building connective tissues, that is, the macromolecules
that make up both the fibrous and ground substance
elements. Related cells, osteoblasts, are specific to the
building and maintenance of bone, while chondroblasts
build the fibrous component of cartilage. Juhan (1987)
comments on the exceptional functionality of fibroblasts,
noting that they are unique in being the only cells in the
(b) body 'which retain throughout our lives the unique
Figure 9. 1 2 Fascia (Ron Thomson). property of being able to migrate to any point in the
body, adjust their internal chemistry in response to local
conditions, and begin manufacturing specific forms of
The histology of connective tissue structural tissue that are appropriate to that area'.
Although we have stressed the relative scarcity of cells
within the connective tissue matrix, the cells that do Fat cells
reside within the extracellular matrix are vital for its Fat cells are the next most common cell in connective
continued functioning. A variety of cells are hosted: tissue. They are specialized in storing triglycerides, a
some that are stationary and glued to fibres, and some major energy reserve of the body. They are globular in
that have a wandering brief. shape and contain a sac that may be more or less filled
O U R S O M AT I C O R G A N I ZAT I O N
with liquid fat. The nucleus and other organelles tend polymerize with other tropocollagen molecules to form
to be squeezed around the cells' periphery. collagen fibrils, which then aggregate to form individ
ual collagen fibres - a whole of great tensile strength.
M acrophages Vitamin C is essential in this process, and the collagen
Macrophages (or 'big eaters') are the reserve foot sol formation will be depressed if there is a significant defi
diers of the body, awaiting a call to action. They are ciency. Vitamin C deficiency diseases such as scurvy are
generally embedded within the matrix, attached to marked by disorders of connective tissue metabolism
fibres, but may become mobilized in response to injury, and can result in weak bones, loosened teeth, fragile
infection or inflammation. Their job is to clear the sys capillaries and the compromised healing of wounds.
tem of damaged tissue, such as frayed, fragmented or Collagen has some remarkable properties. It has a
redundant collagen fibres, but they also scavenge for tensile strength greater than steel; this means that its
organic foreign elements such as bacteria, splinters and individual fibres are very inelastic. They are however
other foreign objects that end up in the body. They thus remarkably flexible and will bend easily, even though
play a major part in the regeneration of damaged tissue. they do not stretch. So how can we then explain the
They attack these materials by engulfing and digesting great elasticity found in collagen-based structures, such
them in a process known as phagocytosis. as fascia, and the lesser elasticity found in ligaments
and tendons? This is due more to the particular geo
Mast cells metric arrangement of the fibres in the fabric of the tis
Mast cells comprise about one tenth of the cell popula sue. In tendons the fibres are arranged in parallel arrays
tion of connective tissue and are found mostly in loose with a built in crimp (see Fig. 9.10). This allows some
connective tissue. These cells secrete important hor lengthening through a straightening out of the crimp.
mones such as histamine, serotonin and heparin, which In fascia however it is the latticed arrangement of the
are all released during local inflammation. Histamine is fibres that allows extensibility.
of particular interest to manual therapists since it is Consider the timber lattice in Figure 9.14. Such lattices
released in response to localized pressure into tissue are popular building items and are commonly used for
and has the function of dilating the local capillaries, privacy screening. The diagram demonstrates how a
increasing the throughput of blood in the area and
flushing metabolites away. This vasodilation process
gives rise to the characteristic skin redness that follows
deep tissue work. It is important in promoting the heal
ing of damaged tissue and in easing localized ischaemic
conditions.
About collagen
Collagen fibres are found in nearly all connective tis
sues but are particularly abundant in cartilage, liga
ments, tendons, fasciae and bone. As of 1988, eleven
( a)
different collagens have been discovered, each genet
ically distinct (Miller 1988). According to Juhan (1987):
Collagen is the longest molecule that has ever been isol

ated; if one were as thick as a pencil, it would be a yard
long. If ever a molecule was designed to make netting
and cable, this is it.
Collagen is manufactured within fibroblasts. Here, col
lagen precursor molecules, procollagen, are synthe
sized within the endoplasmic reticulum of fibroblastic
cells from available amino acids. These intertwine into
a triple helix configuration, forming tropocollagen, a (b)
three-ply rope of great strength. These molecules are Figure 9. 1 4 A timber lattice demonstrates how inextensible
then expressed into the intercellular space where they elements can combine to form a structure that can be deformed.
structural arrangement composed totally of inextensible well-known 'snagged cardigan' diagram (Fig. 9.17) from
elements can be deformed, in this case by the coupled Ida Rolf's book (Rolf 1973).
action of lengthening and narrowing. In this instance,
the original shape is not elastically recoverable; it will
not return to its original shape unless pushed. But if we
take the plastic version of the same latticework struc Changes within the connective tissue network typically
ture, often used in gardens for supporting vines, we see occur with the aging process, most commonly as an
how the fused joints give elasticity to the whole arrange overall loss of fluidity and extensibility. Muscles become
ment, and it will return to its original shape after being less extensible as muscle fibres begin to be replaced
deformed (Fig. 9.15). Figure 9.16 is an electron micro with fat and collagen. As the collagen content of
graph of collagen fibres. Note its similarity in structure muscles increases the collagen itself becomes more crys
with the lattices and how the micro-adhesions (known talline and less flexible; there is an increased 'matting
technically as cross-links) fuse the criss-crossed fibres down' of fibres and more cross-linkages are formed.
into a latticed arrangement. One can also visualize the There is a gradual loss of the GAGs within the ground
spaces between the fibres filled with the gelatinous substance, which impairs the tissue's ability to retain
ground substance and can see that as the tissue is water and leads to a dehydration of the tissues. This
deformed it will tend to squeeze the ground substance occurs throughout the connective tissue network, with
around, turning it into a hydraulic 'dampener', and fascial sheaths, spinal ligaments and arterial walls all
thereby delaying the immediacy of a stretch. Yet another tending to become less extensible with age.
useful analogy is the silk stocking. Silk is a polymer With aging, there is also an increase in mineralization
ized, macromolecular protein like collagen, and like of the tissues. Metal salts, particularly of calcium, tend
collagen has a tensile strength greater than steel; yet to be deposited between the collagen fibres of liga
consider the spring and 'give' of a silk stocking. Its ments, tendons and fascial sheaths, in a manner similar
elasticity is due to the woven arrangement of the silk to that in which bone is formed. This process is usually
fibres rather than to any inherent elasticity in individ
ual silk fibres. This same principle is expressed in the
( a)
(b) Figure 9. 1 6 An electron micrograph of collagen (from

Figure 9. 1 5 A plastic lattice that does recover its shape after W M Copernhaver, R P Bunge, M B Bunge 1995, Bailey's textbook of
deformation. histology, Lippincott, Williams & Wilkins, Baltimore).
OUR SOMAT I C ORGAN IZATION
of fascia and look at some of its mechanical characteris

tics to see why it is so plastic.
F O C US S I N G O N FAS C I A - T H E D OM A I N
O F T H E S TRU C T U RA L B O DY WO R K E R
Fascia is a specialized tissue in the whole family of con

nective tissues. Fascial sheaths are continuous and
interweave all structures from the dermis to the perios
teum. They not only invest and interpenetrate all
muscle tissue, but also blend seamlessly with tendons,
ligaments and the periosteum of bones. Fascia is the
universal wrapping substance of the body. Fascial
sheaths are completely continuous and one can reach
any part of the body by tracing a path through it. Juhan
(1987) calls fascia the metamembrane of the body: the
'binding, containing, and shape-giving connective tis
sue of the body'; he compares it to the function of cellu
lose in the plant world, which in that realm is the
all-pervasive substance of form. However, of all the
Figure 9. 1 7 The snagged cardigan analogy demonstrating
connective tissues, fascia is the most plastic and open to
how strain patterns communicate throughout the whole system
mechanical change, and is therefore of great interest to
(Rolf 1977).
structural bodyworkers.
Like all connective tissues, fascia consists of cells (rel
attributed to the decreased movement and inadequate atively few), ground substance and fibres. It forms
circulation common in older age groups, leading to a membranes of varying densities. Its fabric is composed
low-level ischaemic condition in the tissues, which of interlinking collagen, reticulin and elastin fibres, sep
gives rise to areas of reduced biological energy. This arated from each other by ground substance. Depending
reduced circulation contributes to an increasingly on the structural requirements of the fascia in any area
acidic metabolic environment; metabolites like lactic of the body, the fibres can be arranged in parallel to
and carbonic acids in particular remain too long in the achieve great tensile strength in one direction or organ
tissues, encouraging both fibrosis and the precipitation ized more into a latticed arrangement to resist stresses
of minerals. Tendons and ligaments stiffen and try to from several directions.
become bone; bone spurs form. Elastin also tends to We have known for some time that the joint capsules
thicken, fray and attract calcium deposits. The calcifica are densely innervated and contain specialized
tion of spinal ligaments accounts in part for the increased mechanoreceptors that respond to deforming forces
spinal rigidity found among many seniors; such restric within the joint. Recent microscopy has shown that
tion along our vital axis can be devastating, limiting fascia too is highly innervated; it contains myelinated
both movement and respiration. and non-myelinated axons, autonomic nerve fibres,
Many authors have suggested that such degeneration sensory nerve endings and even isolated smooth mus
is not inevitable, or at least not so early in life (Hanna cle cells (Schleip 2003). In fact, fascia is one of the most
1988). It all points to the need to keep moving. Certainly highly innervated systems within the body and it pro
the descent into rigidity is accelerated when people stop vides a vital source of the kinaesthetic feedback
moving, believing this to be an inevitable part of aging. required by the CNS in regulating bodily movement.
The old adage of 'Use it or lose it' certainly applies. Fascia has some unique mechanical characteristics,
At the end of Chapter 8 it was concluded that the dis particularly in its short and medium term response to
tinguishing feature of structural bodyworkers is that deforming stresses, and in its extraordinary ability to
they attempt to influence the overall structural organ intelligently modify its own structure in the longer
ization of the body by inducing changes within the term to accommodate more efficiently the forces that
fascial network. We will now examine the microstructure pass through it. It is self-adapting and self-organizing.
:., 75
Fascia responds to stress - an extension of bricks: removing them from one part of the house, lodg
Wolff's Law ing them elsewhere, discarding some bricks and intro
ducing some new ones. This seems uneconomical to the
Fascia shares many features, functional as well as histo
extreme, so why does the body need to keep its mater
logical, with its connective tissue sister, bone. Neither
ials in constant flux? What is the biological advantage?
are inert, and in both there is a continuous turnover of
Ida Rolf (1977) suggested:
their basic materials. Both respond very intelligently to
the stresses that act through them and can actually Connective tissues, particularly the fasciae, are in a
modify their own structural properties to more effi never-ending state of reorganization. The continuous
ciently deal with these stresses. Discussing this intelli metabolic interchange made possible through the intim
gent plasticity of fascia, Oschrnan (1989) notes that: ate relation of fascia with water metabolism allows
structural reorganization.
These changes are of two sorts. First, an overloaded
structure may have been gradually reinforced by the Oschrnan (1989) proposed:
laying down of extra collagen fibers . .. Alternately, some Each part of the body, from the smallest to the largest
structures may not have been used at their normal capa has an average life span rangingfrom minutes to years;
city; and their fabric becomes, therefore, slowly reduced but all structures are always being recreated. This end
by the removal of some collagen fibers. less cycle of renewal provides a biochemical basis for
Within the fascial matrix, macrophages are constantly plasticity; it enables the body to change its shape in
debriding damaged or redundant collagen fibres while response to the ways it is being used.
fibroblasts are laying down new collagen fibrils where and he later added the suggestion that metabolic regen
extra support or tensile strength is needed. As new col eration permitted the rapid adaptation of an organism's
lagen fibrils mature they tend to align themselves along structure in response to changes in movement patterns.
the lines of mechanical stress that pass through the tis (Oschrnan 2000).
sue stresses which arise chiefly from the action of the
muscles themselves. They may perhaps be guided by
Some views on the plasticity of fascia
the piezoelectric induced fields that surround collagen
under stress. Some authors have extended the parame Ida Rolf was quite explicit about what she believed to
ters of Wolff's law to include fascia (Cantu and Grodin be the physiological basis of the great plasticity of the
1992). Wolff's law is an early observation about the fascial network:
response of bone to mechanical stress, and states: While fascia is characteristically a tissue of collagen
The form of the bone being given, the bone elements fibers, these fibers must be visualized as embedded in
(collagen) place or displace themselves in the direction ground substance. For the most part, the latter is an
of the functional pressure and increase or decrease their amorphous semifluid gel. The collagen fibers are
mass to reflect the amount offunctional pressure. demonstrably slow to change and are a definite chemical
(Wolff 1892) entity. Therefore, the speed so clearly apparent in fascial
change must be a property of its complex ground sub
The structure of the entire connective tissue network is
stance. .. The observable speed of the changes that are
in constant flux, so that fascia, like the 'shrink-wrap'
induced supports this hypothesis in the light of what we
plastiC sheeting used in the packaging industry, is con
know about the action of colloids and the physical laws
stantly remoulding itself to conform to our average
governing them. The application of pressure is, in fact,
shape and our everyday patterns of usage.
the addition of energy to the tissue colloid. (It is well
known in physics that the addition of energy can turn
The metabolic flux of fascia colloid gel into sol).
(Rolf 1977)
The opposing forces of synthesis and dissolution,
anabolism and catabolism, are an unceasing aspect of This is the so-called 'sol-gel hypothesis' of fascial
our internal chemistry while we live. Drawing upon plasticity.
isotopic evidence, Chopra (1991) notes that, 'Every Authors since Rolf have used the term thixotropy to
year, fully 98 percent of the total number of atoms describe the tendency of gels to undergo a phase tran
in your body are replaced.' Imagine a house in which sition, from gel to sol or sol to gel, by the addition or sub
a bricklayer is permanently employed in switching traction of energy, particularly heat energy (Juhan 1987).
OUR SOMATIC ORGAN I ZATI ON
This is the same kind of phenomenon as the thinning of Some authors have suggested that the viscoelastic
oil paint through the mechanical action of stirring. The behaviour may be due to the gradual failure of inter
techniques of structural bodywork usually involve and intra-molecular bonds between collagen molecule
the application of deep slow pressure into the tissues fibres and cross-linking fibres when stressed (Cantu
and, according to the sol-gel hypothesis, the mechani and Grodin 1992). Other investigators have empha
cal energy derived from pressure is converted to heat sized the behaviour of composite materials:
energy within the tissues, which induces the phase
shift. Oschman (2000) discusses more recent evidence Viscoelastic materials, connective tissues, exhibit time
that suggests that sol-gel transitions can result in dependent material properties and 'creep' behaviour. . . .
increased hydration of tissues, leaving a ground sub The slower the force is applied, i.e. when enough time is
stance that is 'more porous, a better medium for the allowed for the liquid component to flow, the more the
diffusion of nutrients, oxygen, waste products of whole tissue behaves like a liquid. The faster the force is
metabolism, and the enzymes and building-blocks applied, and the less time allowed for viscous damping,
involved in the "metabolic regeneration" process'. He the more the load is taken up more directly by the inex
suggests that in the sol-gel phase transition, fibres that tensible collagen fibers and the more the tissue behaves
may have become shortened or kinked can be freed like an inextensible steel cable.
to their original length, thereby increasing the extensi (Evanko 2000)
bility of the tissue. He further notes how this same
process can release toxins that may have been trapped Schleip suggests that the sol-gel hypothesis is insuf
in tissues for years, which is a proposition that has long ficient to explain the immediate response of tissues to
been advanced by bodyworkers (and often leads to manually applied pressure (Schleip 1996, 2003). He
the parting advice after a particularly deep session: suggests that the available research shows that the kind
'Keep the fluids up'). That there is a dramatic change to of mechanical force applied during structural body
tissues from this approach is beyond dispute; the actual work is not sufficient to induce the tissue changes that
physical laws and mechanisms at work, however, are so obviously occur: 'stronger forces or longer duration
disputed. would be required for a permanent viscoelastic defor
There has been considerable research into the bio mation of fascia'. He does, however, see factors such as
mechanics of connective tissue (Alexander 1975, 1988; thixotropy as contributing to longer-term adaptations
Cantu and Grodin 1992; Alter 1996). Connective tissues in the connective tissues. His experiments in Rolfing
display viscoelastic properties; that is, they have the patients under anaesthesia convinced him that the
dual properties of viscosity and elasticity. Viscosity nervous system must be active during the process if
refers to the degree of stickiness in a semi-fluid sub changes are to occur. Schleip suggests that other factors
stance; its ability to flow. Chewing gum, for instance, may be at work in allowing such an immediate response
can be lengthened and will remain lengthened. in the tissue. Factors such as autonomic response, fluid
Elasticity, on the other hand, refers to the degree to mechanics and hormonal responses have been mooted.
which a substance can resume its original length after His review of the research demonstrates convincingly
deformation or stretching, like a rubber band. But how that connective tissue is quite densely innervated and
can a substance have both properties? It is all about tim has large numbers of mechanoreceptors. He suggests
ing. For fasciae, a quick stretch and release means that that the short-term plasticity of fascia in deep-tissue
there will be a true elastic response and the tissue will work stems from the deep stimulation of the fascial
return to its original length. If, however, the tissue is mechanoreceptors, which then operates through two
lengthened and held long, then it will return to a differ major pathways in the central and the autonomic ner
ent resting length, the degree of which depends on the vous systems. He suggests that autonomic responses
length of time it was held in the lengthened position. can influence fascial smooth muscle cells and the local
This is a phenomenon known as 'creep'. Research into fluid dynamics, and by influencing the hypothalamic
sports stretching has come to similar conclusions (Alter tuning, which all lead to a 'softening' response in the
1996) suggesting that, for a stretch to effectively modify soft tissues.
the tissue, it must be held in a lengthened position for Explanations are so often a rationalization after the
a while. Whether viscoelasticity can account for the fact, and despite the different possible explanations, all
immediate response of soft tissues to deep work who have used the more direct form of myofascial
remains a moot point. release recognize that the 'melting pressure' - a slow,
continuously applied load - is extremely effective in bone, the fascial web responds to stress by thickening
producing a softening response in the tissue. or becoming denser, by laying down new collagen
fibres in a direction determined by the stresses that pass
through it. (We noted earlier that cells are constantly at
Connective tissue - a perspective of
work recycling the materials of the connective tissue
structural bodywork
network.) Paradoxically the fascial network can also
Many anatomists within the structural bodywork trad thicken in places where there is insufficient movement,
ition, starting with Ida Rolf herself, have framed a per but in such cases the collagen fibres tend to 'mat down',
spective on connective tissue that is rather different to to fix themselves in a chaotic or 'haystacked' fashion
the biomedical viewpoint. Fascia is rarely shown in and attract fat deposits because there is not the move
standard anatomy books. Often it is carefully dissected ment required to align the fibres intelligently. It is as if
away to show the muscles beneath as if somehow it gets the structural intelligence of the body is saying 'OK,
in the way. There is not the acknowledgement that the you obviously don't wish to move this area, so let's
totality of the connective tissue network can be viewed make it easier for you not to move it!' This is the kind of
as a unitary structure, that is, more at the level of an 'fibro-fatty intrusion' or contracture that is often seen
organ or a system within our overall structural organ by physiotherapists when their clients have suffered
ization. Older surgical techniques tended to ignore its prolonged periods of joint immobility. This is why
complexity and integrity and would crudely sew all the modern orthopaedic medicine now tries to avoid total
layers together instead of reconnecting them individu immobilisation after injury or surgery. The newer
ally, though this is now changing. protocol seems to be something like 'Whatever you can
A number of authors within the somatic tradition have do without pain, you must do'. So appropriate move
visualized the connective tissue network as one contin ment, rather than complete rest, is usually the preferred
uous and interconnected fabric with a huge diversity of protocol. Where once a patient undergoing a knee
forms. All of these forms are seen as different configu reconstruction would awaken after surgery with a leg
rations of the same basic elements that have adapted in plaster, they now awaken with their leg already in a
specifically to local conditions within the body (Rolf flexion machine, undergoing gentle flexion and exten
1977, Juhan 1987, Heller and Henkin 1991, Bajelis 1994). sion movements, which allows the repair of the connect
Thus tendons, ligaments, aponeuroses, interosseous ive tissues to be 'informed' by the actual movements
membranes, synovial capsules, bursae, fasciae, and that the limb will need to undergo later.
even bones, are all variations of the one substance, with An appreciation of the synergistic relationship
collagen being the all-pervasive unifying element. between form and movement, structure and function,
Drucker refers to the entire connective tissue network is crucial to the structural bodywork perspective.
as 'the one fascia'. As an example of this view, one can Movement is seen as necessary for physical health at all
visualize ligaments and fascia both as metamorphoses levels: for healthy circulation and metabolic efficiency,
of the same kinds of material, with both structures teth the maintenance of adequate hydration in connective
ering bone to bone, but with different spans and a dif tissue, the maintenance of joint health and the appro
ferent density and organization of collagen fibres, and priate span of connective tissues. This is why structural
with fascia having muscle cells embedded within its bodyworkers need to see how their clients move and
matrix. how they stand, and then take special note of areas of
the body where there is little movement or more poten
tial for movement. Then, through a skilful use of both
Implications for bodywork
-- - - - - - - - - - - - structural and functional work they aim to elicit easier,
The tensile structure of the myofascial network is very fuller, more coordinated movement patterns.
dependent upon usage. In this structural view, fascia is
always slowly and imperceptibly adapting to the
Congenital differences in tissue density
mechanical, metabolic and environmental stresses that
act on it. It is always shaping itself according to our Busy manual therapists soon realize that there is a wide
habitual postures and average movement patterns. variability in the qualities and textures of the soft tissues
If our postures and movements become limited and of their clients. At one extreme there are those clients,
fixed, our fascial network will stabilize to that average often of a meso- or ectomorphic body type, whose tis
form, and help maintain the habitual pattern. Like sue seems too hard and who, despite the fact that their
muscles are hypertoned, may actually be quite weak. Is the tissue dense or just tense?
It is as if the very density of the tissue is inhibiting free Hard-tissued clients (those with a constitutional ten
movement. At the other extreme we have those with a dency towards dense connective tissue) need to be
soft quality to their soft tissues, as if their 'glue' is too distinguished from those for whom there is a general
weak. Such clients often have lax ligaments and a ten exaggeration in muscular tonus, the habitually tense, or
dency to hyperextend at their joints. They may also have those we might call 'highly strung' or overwrought. It
hypermobile segments in their spine, which makes it is as if their tonus 'thermostat' is tuned too high. There
easy for them to fall into slumped postures. They tend to seems to be a regulation problem within the autonomic
have ecto- or endomorphic body characteristics. And of nervous system such that it has become more attuned
course there is a spectrum of tissue densities in between to sympathetic activation than to parasympathetic. Of
these two extremes. course, in time this continual low-level tonus must trans
This soft-bodied tendency has long been recognized late into an increase in the fibrosity of the soft tissues
within the world of structural bodywork and yoga and will lead to their having a denser feel. This can
(Rolf 1977, Flury 1989) where it is often seen as dys make it difficult at times to distinguish these two
functional. For instance, there are congenital problems armoured types, which is complicated again by the
with collagen metabolism that can leave people open to possibility of both tendencies being present in the same
dislocations and general collapse. Alter (1996) cites evi individual. However, it is important to know the source
dence to suggest that there are measurable differences of the hard-tissue tendency as they each require a dif
in ligamentous laxity between racial groups, but the ferent emphasis in their work. For those with a consti
anecdotal evidence of many structural bodyworkers is tutional tendency to dense connective tissue, a systemic
that the difference between individuals is greater than approach might be called for (some genetic conditions,
between racial groups. mineral deficiency states and connective tissue diseases
Tissue density is most definitely a factor that will can predispose to this condition). For the habitually
influence how we work with our clients. The conven tense, some sort of relaxation education is often indi
tional wisdom in structural bodywork circles is that it is cated, although often they do not respond well to the
more difficult to achieve changes with hard-tissued conventional relaxation education approaches such as
types, but that once achieved the changes tend to be yoga Nidra, and progressive relaxation. A movement
fairly stable. Soft-tissued types on the other hand are approach such as Trager work can be an excellent way
easier to balance but tend to revert to old patterns more of working with such clients as it trains them to move
easily, and perhaps are more in need of an educational in a softer and easier fashion so as to use less energy in
approach. rhythmic movement.
RE F EREN C E S
Alexander R M 1975 Biomechanics. Chapman and Hall, Ferner H, Staubesand J (eds) 1982 Sobotta Atlas of Human
London Anatomy. Urban & Schwarzenberg, Munich, I, p 265
Alexander R M 1988 Elastic mechanisms in animal move Flury H 1989 Theoretical aspects and implications of the
ment. Cambridge University Press, Cambridge internal/external system. Notes on Structural Integration
Alter M J 1996 Science of flexibility. Human Kinetics, 1 : 15-35
Champaign, Illinois, p 40 Gallaudet B B 1931 A description of the planes of fascia of the
Bajelis D 1994 Hellerwork: the ultimate in myofascial release. human body. Columbia University Press, New York, p 1
International Journal of Alternative and Complementary Hanna T 1988 Somatics: reawakening the mind's control
Medicine 12(1): 33-38 of movement, flexibility, and health. Addison-Wesley,
Cantu R, Grodin A 1992 Myofascial manipulation: theory and Reading, Massachusetts
clinical application. Aspen, Gaithersburg, pp 20, 25-57 Hedley G 1999 Integral anatomy, Part 11. Rolf Lines 27(1): 8-12
Chopra D 1991 Perfect health: the complete mind body guide. Heller J 1990 Fascia. Transcript of lecture. In Drucker D (ed.)
Three Rivers Press, New York Fascial anatomy. Workbook for student Hellerworkers.
Drucker D (n.d.) Fascial anatomy. Workbook for Hellerwork (not published)
students. (not published) Heller J, Henkin W 1991 Bodywise. Wingbow Press, Berkeley
Feitis R (ed) 1978 Ida Rolf talks: about Rolfing and physical Juhan D 1987 Job's body: a handbook for bodywork. Station
reality. The Rolf Institute, Boulder, pp 34, 198, 206 Hill Press, New York, pp 64, 66, 70
Miller E 1988 Collagen types: structure, distribution and func St George F 2001 Myofascial technique. Australian Physio
tions. In: Collagen (ed) Nimni. CRC Press. Vol I Biochemistry therapy Association News. March, 15-17
Oschman J 1989 How does the body maintain its shape? Schleip R 1996 Adventures in the jungle of the neurofascial
Rolf Lines 18(1): 8-12 net. Rolf Lines 24(2): 38-42
Oschman J 2000 Energy medicine: the scientific basis. Schleip R 2003 Fascial plasticity: a new neurobiological explan
Churchill Livingstone, Edinburgh, p 159 ation. Journal of Bodywork and Movement Therapies
O'Toole M (ed) 1997 Miller-Keane encyclopedia and diction 7(1): 1
ary of medicine, nursing, and allied health. 6th edn, Schultz R, Feitis R 1996 The endless web: fascial anatomy and
W B Saunders physical reality. North Atlantic Books, Berkeley
Rolf 1 1973 Structural integration: a contribution to the under Tortora G, Grabowski S 1993 Principles of anatomy and physi
standing of stress. Confinia Psychiatrica 16: 76 ology. HarperCollins College Publishers, New York
Rolf I 1977 Rolfing: the integration of human structures. Wolff J 1892 Das Gesetz der Transformation der Knocken.
Harper and Rowe, New York, pp 39, 41, 129 A Hirschwald, Berlin
THE OSCILLATORY
PROPERTIES OF THE
FASCIAL NE TWORK
When we look in awe at the grace of a gazelle in flight, movement is seen less as the coordinated action of
the poise of a hovering eagle, the stupendous leap of a opposed muscles and more in terms of the dynamics of
cat, or the accomplished performance of an athlete or the elastic and oscillatory properties of the myofascial
dancer, we are witnessing an extraordinary efficiency of network as a whole. In this view of rhythmic movement,
movement. When we see the poise of many traditional muscular action works primarily to maintain oscillatory
peoples, perhaps carrying heavy loads on their heads, patterns with an occasional and timely input of energy
we are seeing perfection in movement. Or when we see each movement cycle (Gracovetsky 1988, Novacheck
the focussed mastery of a skilled martial artist totally 1998).
committing herself to the execution of a technique, Work in the field of vertebrate biomechanics has
again we see the kind of efficiency in which there is no demonstrated how animals utilize the springiness of
unnecessary muscular action, where neither too much their tendons and ligaments in locomotory behaviour
nor too little energy is spent; nothing detracts from the such as hopping, walking and running, and how they
coordinated action of the whole. have found some very efficient ways of recycling some
Many who work in the somatic field have this appre of the energy of movement through their connective tis
ciation of the aesthetic in movement and wish this sues (Alexander 1975, 1988). More recent work, however,
inherent grace and efficiency for themselves and for is even challenging the basic kinesiological assumption
their clients. Structural bodyworkers have long noticed that muscles need to shorten against resistance in order
that as their work unfolds - as they free up the soft-tissue to propel the organism forward. Once the animal is in
restrictions in their clients and assist them in bringing rhythmic motion and has established a forward momen
more awareness to the quality of their movement - tum, then some muscles work purely isometrically, that
their movements become more fluid and generous. is, they work to maintain a constant length against resist
There can be more presence, poise, rhythm and delicacy ance as if they are trying to turn their tendons (and by
of balance in the client's movement, which of course implication their myofascia) into springs - by holding
means less stress on their body. Encouraging this kind the ends of the 'spring' rigid, as it were (Pennisi 1997).
of efficiency and harmony in movement is one of the It was mentioned in Chapter 8 that the human body
chief aims of any somatic work. can be partially understood as a tensegrity structure and
that one of the essential features of tensegrity structures
is that they are able to absorb external forces, distributing
FASCIA AS T H E AN TAGONIS T them throughout the whole system, and thus avoiding
an excessive loading on any one part. These forces are
Biomechanical research is beginning to paint a picture absorbed and dampened by the stretch and elastic recoil
of human movement that is rather different to the some of the tensile elements of the structure, and communi
what robotic model of early kinesiology. The early model cated throughout the whole. In fact a tensegrity structure
sees movement purely in terms of the coordinated action will bounce or oscillate in a dance of exchanging kinetic
of antagonistic or synergistic muscle groups. Now fascia and potential energies. In the human body fascia is the
itself is seen as an antagonist to muscular action, and tensile element, and it is becoming increasingly apparent
THE OSCILLATORY PROPERTIES O F THE FASCIAL NE TWORK
that the inherent rhythmicity of much of our movement resistance of these fibres, which on relaxation will
arises from the mechanical properties of the totality of squeeze the muscle belly back in and assist the muscle
the fascial network. A clever body would surely find a in returning to its resting length. However, it is the
way to harness the rhythmicity inherent in our struc oscillatory tendency of the fascial system as a whole
ture to find more economy in movement. From an evo that most concerns somatic therapists (Fig. 10.1).
lutionary perspective it makes sense that animals should Physics tells us that all complex elastic structures
have discovered the efficiency of energy expenditure have their own resonant frequencies, whether they are
that arises from sensing and capitalizing on the pendular, structures such as bridges and buildings, guitar strings
oscillatory behaviour of their own bodies. or even human bodies. Engineers need to know the res
Many of our most important activities are essentially onant frequencies of the bridges and tall buildings they
rhythmic - breathing, walking and running. They have design. This information is vital since it is quite possible
a repetitive, cyclical, periodic quality. There is an emer for such structures to be shaken apart during high
ging perspective around such movement that sees the winds of specific velocities; they can literally resonate
sensory-motor intelligence utilizing the elastic recoil of the to their own destruction. The human body, however,
connective tissues by recycling it into the next movement is much more complex than a bridge or building, and
cycle. In breathing for instance, muscles of inspiration unlike these mechanical constructions has the remark
actively work to expand the thoracic cavity, creating a able ability of being able to vary the pattern of its internal
pressure gradient that induces air to be pushed into tensions, meaning that its resonant frequencies can also
the lungs. The expansion of the thoracic cavity is resisted be varied by the states of tension in the various body
by the elasticity of all the fasciae of the thorax, so part segments. If we recall the anaesthetized spaceman in
of the kinetic energy supplied by the muscles of inspir Chapter 8 (Fig. 8.9, p. 54), where we had a pure struc
ation is stored as potential energy in the stretched fas tural body with no muscular activity whatsoever, we
cia. As the muscles of inspiration release, the elastic can easily visualize that a body in this condition could
recoil of the fascia can then be recycled, restoring the be induced to undulate in various ways. For example
thorax to its resting state, and in the process inducing flexion-extension, lateral flexion (left and right) and
the expiration of air. This is an example of how the body transverse undulation around the long axis of the body
can intelligently harness this stored elastic energy of the would be possible, and the actual frequency of these
connective tissues. The same principle can be seen in the undulations would be quite specific to the mass and pro
design of fusiform muscles themselves. The collagen portions of the body, as well as to the tensile structure of
fibres in the epimysium of muscles tend to encircle the the fasciae of that body. This would change of course in
muscle belly, running perpendicular to the long axis of gravity and in full function; however, it may be surmized
the muscle. Again, as a muscle actively contracts and that being able to tune in to the inherent resonant qual
shortens, it swells in the middle, against the elastic ities of one's body would greatly assist in movement
(a)
I (b) (c) (d)
Figure 10.1 The oscillatory properties of elastic structures that have close parallels within the human structural body:
(a) a spring in tension; (b) a torsional pendulum; (c) a spring in compression; and (d) a pendulum.
efficiency, and there is now evidence that supports absorb the energy of the hip's lateral translation and
this view. then recycle the stored elastic energy to assist the return
Some observers have been amazed at the ability of of the hips to the midline.
porters throughout the world to carry considerable loads What the author did not mention is that these women
on their heads with little apparent effort. Studies of are obliged to be economical in movement as a matter of
Kenyan women have shown that they routinely carry survival. Carrying heavy loads for long distances is part
up to 70% of their own body weight on their heads, yet of their everyday existence and their bodies would
they are not particularly fit by ordinary standards of soon break down if they did not discover the most effi
physical fitness. In his review of the research in this cient way to do this work. They have the capacity to
area, Samuel (2001) concludes that this ability arises not 'listen' to their bodies and sense which movements do,
through muscular strength but through the women's and do not, cause strain. This 'listening' is perhaps a
sensitive use of the inherent periodicity of walking, the skill that we have largely forgotten in the West, a skill
pendular motion of their hips. that we as somatic therapists can awaken in our clients.
Treadmill experiments measuring oxygen uptake However, the undulatory movement of the hips in
show that these women can carry up to a fifth of their walking is more complex than this simple 'inverted pen
body weight before their breathing even becomes dulum' model would suggest. Gracovetsky has shown
affected, such is their efficiency under load! They were that the spine, coupled with the pelvis, has a complex
found to be more efficient porters than extremely fit, motion that has elements of flexion-extension, side
trained soldiers. It was speculated that their extraordin flexion-extension and rotation, which all combine into a
ary efficiency arose from the pendular motion of their complex motion that actually forms the basis of effi
hips and the seemingly effortless transfer of weight cient gait. Even the motion of the legs is partly driven
from foot to foot during each gait cycle. The aspect of by this complex motion of the spine (Gracovetsky
the women's timing that differed from soldiers', how 1988). In the assessment section of Chapter 14 it will be
ever, was too subtle for the observers to notice. Samuel suggested that one way of assessing gait is to analyze
suggests that gait works on similar principles to the it into the above three components; this can prove an
pendulum clock, which requires a minimal input of invaluable means of seeing where structural or func
energy in each cycle to maintain the momentum of the tional work is required in our clients.
pendulum. The efficiency of the gait of these women Part of the work of somatic therapists, therefore, must
is seen as arising from their use of their hips as an be in helping people listen more carefully to the inher
'inverted pendulum'. Only at the beginning of each gait ent rhythmicity of their structure. In the practical sec
cycle is an input of muscular energy required. The author tion of this book we will look at the three main elements
makes no specific reference to the spring-like qualities of of pelvic undulation in walking, how they combine into
tendons and fascia; however, it may be surmized that in a complex movement, and how this can be enhanced by
this instance the iliotibial tracts could act as springs to appropriate bodywork.
REFERENCES
Alexander R M 1975 Biomechanics. Chapman and Hall, Pennisi E 1997 A new view on how leg muscles operate on the
London run. Science 275: 1067-1070,21 February
Alexander R M 1988 Elastic mechanisms in animal move Samuel E 2001 Walk like a pendulum. New Scientist
ment. Cambridge University Press, Cambridge 169(2272): 38
Gracovetsky S 1988 The Spinal Engine. Springer, Vienna
Novacheck T 1998 The biomechanics of running: review
paper. Gait and Posture 7. Elsevier Science
THE MUSCULAR
SYSTEM
In Chapter 8 it was stated that the connective tissues What happens when a muscle changes length?
and muscle cells were two major outflows of the meso
-------------------------------------
Through repetitive usage, muscles may adaptively

derm during embryogenetic development and they
lengthen or shorten from a baseline resting length, and
were called the yin and yang, or the passive and active,
whenever there is such a change in length it is a change
aspects of the mesodermic system. These outflows, the
more in the fascia than in the contractile cells. Remember
muscle fibres with their fascial environment, form an
that muscle tissue is 50-60% fascia. Essentially it is the
inseparable unity, the musculature, which under the
fascia that has lengthened or shortened. Nevertheless,
control and coordination of the central nervous system
when muscles do adaptively shorten, over time some
provides the orchestrated pattern of tensions that
muscle cells that were organized in series will be lost.
enables the structural body as a whole to move within
This is not irreversible however; it is now apparent that
the gravity field. In this chapter we will take a brief look
if a muscle lengthens from its average resting length, then
at the kinds of muscular dysfunction that can arise
muscle cells can be generated to 'fill the gap' (Alter 1996).
through direct trauma, underuse and overuse - all of
This suggests that there is a greater potential for struc
which will in time contribute to creating and maintain
tural change in the musculature than was once thought
ing structural imbalances.
to be the case.
Structural bodywork training traditionally requires a
detailed working knowledge of the action of muscles;
however when it comes to the practical application of
this approach, there is less emphasis on the muscula MUSCLE SUBCLASSIFICATION
ture than in other ways of working with posture. It has
already been stated that it is an artificial distinction to Muscles can be subclassified in a number of different
talk of the fasciae and musculature as if they were ways. Two that are important in the field of structural
independent of each other, yet, when strategizing their bodywork are the tonic-phasic and genetic flexor
work, structural bodyworkers often think almost in extensor classifications. We will look at tonic-phasic clas
dressmaking terms of which areas of the body need to sification now, and in the section on Janda in Chapter
be 'opened up'. So that although a general knowledge 13. In that chapter we will also look at the genetic
of the action of the underlying muscles is essential and flexor-extensor distinction in the section on Schleip's
remains in the background awareness of structural postural model.
bodyworkers, it is often secondary to a more global
sense of which areas need more 'length' or resilience.
Phasic and tonic musculature
And in practical terms, the techniques of structural
bodywork are aimed less at isolating particular muscles There are two broad functional categories of muscle
than in working on the overlying superficial and deep types: phasic and tonic. Essentially this classification
fasciae, as well as the most superficial aspects of the depends upon the overall predominance of either 'fast
myofascia. twitch' or 'slow-twitch' muscle fibres within the muscle.
All skeletal musculature contains both kinds of fibre muscles responding by shortening, but phasic muscles
and there will be varying proportions of each; one type, becoming inhibited neurologically and thence weaken
however, will predominate. This leads to a full spec ing. This behaviour will have structural outcomes in
trum of functional muscle types. And just as muscles the longer term. In Chapter 13 we will look at a number
are able to adapt to different working lengths through of postural syndromes proposed by Janda that can arise
usage, so also are they able to change their tonic-phasic from the differential behaviour of postural and phasic
tendency. In other words, the balance of fast-twitch and antagonist groups (Chaitow 1996).
slow-twitch fibres can be modified through usage to a
certain extent. Various approaches to classifying indi
vidual muscles within the tonic-phasic distinction have THIN GS THAT CAN GO WRON G
been proposed, leading to a number of different 'lists' WITHIN THE MUSCULATURE
of tonic and phasic muscles (Schleip 1995).
In Chapter 1 it was suggested that the soft tissues of the
Tonic muscles body will gradually conform to the average patterns of
Tonic muscles (sometimes called postural muscles) are daily usage and that these structural changes will then
those that have predominantly a postural, a maintain reinforce the neuromuscular habits that led to them in
ing, or a stabilizing function, while phasic muscles are the first place, regardless of whether those habits are
more active in making big, powerful or 'willed' move ultimately healthy or unhealthy (see Figs 1.2 and 1.3,
ments. Tonic muscles have a predominance of slow pp 8 and 9). We will now look in more detail at some of
twitch fibres, work anaerobically, and can usually work the physiological mechanisms by which the process of
for longer periods at low intensity without tiring. Think structural adaptation may occur, and particularly the
of your jaw for instance, which can remain closed all body's response to overuse, underuse and the results of
day against the pull of gravity by the action of the mas direct insult or trauma to the soft tissues.
seter and temporalis muscles, both tonic muscles, and
yet they do not seem to tire from this sustained work.
Overuse
Tonic muscles work at a subconscious level, beneath
our everyday awareness, and are continuously making There is a great deal of current interest in overuse syn
minute adjustments to our posture, even when we are dromes, since in recent times there has been a spate of
stationary. They maintain our upright stance within insurance claims for overuse injuries, resulting in pay
gravity and stabilize distal parts of the body. outs that have imposed a heavy burden on industry.
The heavier burden perhaps has been upon the sufferers
Phasic muscles themselves who, despite their considerable discomfort,
Phasic muscles on the other hand have a predominance have sometimes been accused of malingering. Overuse
of fast-twitch fibres, work aerobically and tend to tire syndromes have variously been called repetitive strain
after explosive use. Unlike the tonic muscles, which are injury (RSI) and cumulative stress disorder; however they
constantly working to maintain our posture beneath might more accurately be described as a 'cumulative and
the level of our conscious awareness, phasic muscles constant tension complex' (Damany and Bellis 2000).
are 'doers'. In other words, they operate at a more con These syndromes have been reported as affecting
scious level and respond whenever we decide to per smaller muscle groups, in the wrist, arm, neck and
form a movement. Of course, the tonic muscles are shoulder, and have been attributed to repetitive muscle
obliged to cooperate with these 'willed' movements use over extended periods of time, often involving a large
athough, as Godard (2000) suggests, subconscious emo degree of distal stabilization. A number of factors have
tional attitudes can be expressed through the tonic mus been blamed, including repetitive work with poor
culature and may even oppose or 'sabotage' willed ergonomic support, or certain sports that have a large
movements. In some postural imbalances phasic mus repetitive component. However, many structural body
cles are obliged to do the work of tonic muscles, and workers would broaden the scope of this perspective
vice versa. Performing work that they are not designed significantly and affirm that virtually any function per
for can lead to fatigue and inflammation, and also con formed repetitively under adverse biomechanical condi
tribute to the onset of overuse syndromes (Key 1993). tions will in time lead to some kind of cumulative stress
Research has suggested that postural and phasic dysfunction. Even 'harmless' functions such as carrying
muscles respond differently to stress, with postural a bag over one shoulder, standing with hyperextended
THE MUSCULAR SYSTEM
knees, jogging on hard surfaces, sitting in low soft fur squeezed sponge will always hold less water than an
niture, playing computer games, gardening in a flexed open and expanded one.
position, practising on a musical instrument, carrying a In time this energy crisis leads to a dysfunction of the
baby on one hip, lounging in front of the TV, or simply motor end-plates in certain muscle fibres, such that they
the heightened muscular tension that accompanies do not respond to efferent nervous impulses but
habitual anxiety, can all lead to the same kind of dys instead maintain a state of constant contraction. These
function through the gradual modification of the soft fibres can be palpated within the body of the muscle as
tissues. From this perspective, even postural syndromes taut bands. Trigger points normally occur at the sites of
such as the head forward syndrome can be seen as a motor end-plates, and when pressed give rise to a char
form of repetitive strain dysfunction. acteristic distribution of referred myofascial pain.
In Chapter 9 we outlined how increased mechanical Trigger points can precipitate further satellite trigger
demands on soft tissues can lead to an increase in fibros points in nearby muscles, starting a chain reaction of
ity within that tissue, and how this can then contribute effects by reflexively inhibiting the action of related
to structural dysfunction. Another possible pathway to muscles. This all occurs subconsciously; many clients
structural imbalance is through the formation of trigger do not know they have trigger points until you press
points within the musculature. them! These points are therefore constraining the clients'
Simons and Travell have carried out some extraordin movements without their even being aware of it.
arily detailed and definitive work on the study of trig Many somatic therapists, both mainstream and com
ger points - how they arise and how they can be treated. plementary, have been turning their attention to repeti
They define a trigger point as 'a hyperirritable spot in tive strain disorders and trying to find ways of dealing
skeletal muscle that is associated with a hypersensitive with them. These disorders are often attributed to the
palpable nodule in a taut band' (Simons and TraveIl 1999). changes in work habits that came with the computer
These points are said to arise from the overuse of cer revolution, especially in the use of keyboards designed
tain muscles, either through repetitive movements with with little regard to sensible ergonomics.
incomplete relaxation between cycles; through pro RSI is seen as a cumulative disorder that arises from
longed contraction, say in stabilizing a distal part, or in the complex interaction of many factors. It develops
the unnecessary co-contraction of antagonistic muscles gradually, perhaps over many years, and may go unno
(what Feldenkrais has called 'parasitic' muscular tension). ticed until there is a rapid onset of symptoms triggered
Simons and Travell propose an energy crisis hypothe by some relatively minor stressful episode that often
sis, which suggests that when muscles work under such seems out of all proportion to the discomfort caused
unfavourable conditions they effectively cheat them (Damany and Bellis 2000).
selves of oxygen and metabolic fuel. They do this by These authors suggest two common 'trauma paths'
compromising the efficiency of their own circulation, that can lead to RSI: through muscular inflammation
while at the same time retarding the timely removal of and through nerve entrapment. Muscular inflammation
the by-products of their own cellular respiration: car they see as arising as in Simons and Travell's model, that
bonic and lactic acids, for instance. These and other is, through localized ischaemia, congestion, irritation
by-products can act as irritants that maintain the elevated and so on. Nerve entrapment is seen as arising from
tonus within the muscle and, in a vicious cycle, work to myofascial constriction along the pathways of periph
further compromize circulation. Muscles are being asked eral nerve trunks. Such indirect pressure on nerves can
to do more and more with less and less - hence the lead to paraesthesia, numbness or pain, which again
'energy crisis'. will force the sensory-motor intelligence of the body to
We know that the musculature acts as an indirect cir avoid movements that stress such tethered nerves. It is
culatory pump that mechanically squeezes venous interesting that both Simons and Travell and Damany
blood towards the heart. For this to occur harmo and Bellis recommend myofascial release techniques as
niously the muscle must actually pump, that is, it must an important aspect of treatment.
contract and fully relax in a cyclic manner in order to
maintain this throughput of fluids. If muscles are work
Underuse
ing for too long or too continuously then they
will mechanically restrict the arterial and venous flows Prolonged immobilization of tissues will encourage a
within their own tissues, creating a localized ischaemia. chaotic build up of collagen fibres, which may then
This can be illustrated by the simple analogy that a attract fat deposits and increase the possibility of
mineralization within the tissues. Such 'haystacking' is If the trauma is considerable, then at the same time as
particularly evident in the periarticular connective tis the inflammatory response is proceeding, the sensory
sues around joints. Immobilization can be deliberate, motor intelligence of the body will do its best to
for instance in the therapeutic use of splints or plaster immobilize the injured part by a coordinated muscular
casts to immobilize broken bones. However, it is appar splinting around the injury. This is a protective spasm,
ent that many people simply immobilize themselves: they usually accompanied by pain. Like any of the short-term
slow down and move less and less, and this is not only measures taken by the body, if it persists too long it will
among the aged. This process can start quite early in leave a lasting influence on movement, and lessons
life, particularly for those in sedentary work. This kind learned in pain tend to be learned very deeply. A
of immobility can also arise from muscular holding pat by-product of the formation of scar tissue is the increased
terns that create a general heightening of tonus levels. possibility of adhesions between adjacent structures. If
This leads to a widespread pattern of low-level co-con nerve trunks happen to be in the vicinity of the injury
traction that can give a 'rigid' appearance to clients and they may become enmeshed within the local process of
constrain all movement. At the end of Chapter 9, two fibrous infiltration, resulting in a tethering of the nerve,
'armoured types' were mentioned: those with a congeni which normally should slide through the tissue like
tal tendency to dense connective tissues, and those with string through a ball of wool. Additionally, other struc
a generalized elevation in muscular tonus. In either tures may become tethered in this process, potential
case, whole areas of the body may be missing the move spaces within the musculature for instance.
ment required for basic tissue health, and this underuse
in some areas will inevitably lead to overuse in others
AN O VERV I EW O F THE PRO C ESSES
that are obliged to take on a heavier share of the work.
THAT C AN LEAD TO STRU C TURAL
DYSFUNC TION
Trauma
Figure 11.1 is an expansion of Figure 1.2 (p. 9). It is an
Trauma to any part of the body will set in motion a mas
attempt to bring together in diagrammatic form some
sive and complex healing response. The response in the
of the different physiological mechanisms that have been
soft tissues, such as the fascial and myofascial tissues,
proposed as giving rise to structural dysfunctions. The
nerves and the viscera, is very similar to that in skeletal
diagram is not meant to be definitive in any way but
tissue. There is an inflammatory response consisting of
summarizes proposals from various sources, all of which
a mobilization of the cells of repair, the synthesis of col
are mentioned in this book. Although Figure 11.1 is
lagen fibres by fibroblasts, the formation of a connect
presented in a linear or flow-chart format, the web of
ive tissue scaffolding for the construction of new tissue,
causation is almost certainly far more complex and
and a period of fibrous reorganization that may result
interrelated than this 'simple' diagram would suggest.
in scar tissue being formed. Scar tissue tends to be
Central to this diagram is a 'black box' consisting
debrided of redundant collagen as healing progresses,
of what throughout this book has been referred to as
but depending on the severity of the trauma some may
the sensory-motor intelligence. This refers collectively to
remain as keloid tissue which, like the biblical new
those aspects of the central nervous system that:
cloth used to repair the old cloak, will tend to tug on all
the surrounding tissue during movement. Ida Rolf's • integrate proprioceptive information
image of the 'snagged cardigan' illustrates how a local • store movement 'programs'
ized restriction can have effects throughout the whole • orchestrate whole body patterns of movement (via
body, far from the actual site of restriction, and can efferent outflows)
influence all movement (see Fig. 9.17, p. 74). • initiate novel movements
The kinds of trauma suffered by tissues can vary con • find real-time solutions to immediate movement
siderably in its intensity. It is not only 'one off' injuries problems.
that lead to this healing response. It is common for This black box can be conceptualized as the repository
clients to suffer repeated microtrauma, low-level strain, of all our learned movement behaviours. It receives
which may not lead to significant pain at the time, afferent information from sensory and proprioceptive
however the cumulative effects of such repeated micro receptors, and constantly modifies the efferent sym
trauma can produce marked structural changes in the phony of its movement 'programs' in response to this
longer term. incoming information. This kind of real-time modification
THE MUSCULAR SYSTEM
J Muscular dysfunction
J [Tissue trauma/microtraum
�
)
I I
l I l I
j l
l
1--
J [ l
Overuse Underuse Inflammatory
Protective spasm
(repetitive strain, cumulative (through immobilization, reduced response
1 I
stress, muscle spasm, spasticity, etc.) efferent flow, etc.)
l l 1 j
I
·l
I l I Scar formation
Nerve tethering
l and adhesions
.[ 1 J J
Stress-induced 'Haystacking,
I
Localized
fibrosis and fibro-fatty
ischaemia
rReflexive inhibition
J
(Wolff's Law) intrusion
l J Lof nearby muscles
I
Cycle of
l J [ }-
ischaemia
Energy crisis Contracture
(Simons
and Travell)
I ,
J
Formation of
l trigger-points
[ ]
�
and 'taut bands' Predisposing factors
STRUCTURAL
Learned poor postural habits
BODY
Soft-tissue Learned repetitive or asymmetrical usage
constraints Adaptation to previous injury
Cranial rhythm imbalance (Upledger/Sultan)
Posterior/anterior pelvis (Flury)
[
Congenital asymmetries
Hard/soft tissue density
1
SENSORY-MOTOR
: Diseases that affect structure
IL
INTELLIGENC
Reflexive
Movement I e.g. asthma, hormonal imbalances, fibromyalgia ,
J
inhibition of
connective tissue diseases, etc.
other muscles
constraints I
Through Poor ergonomics
[
repetition Stress, sleep deprivation, nutritional deficiencies
Autonomic disturbances - especially high tonus
J
Reinforcement of aberrant
'Sensory motor amnesia' (Hanna)
neuromuscular habits
'Character armouring' (Reich, Keleman)
Shortened tonics
inhibit their phasic
antagonists
- Psychogenic factors (Sarno)
Flexor/extensor dominance (Feldenkrais, Schleip)
l
J
Gradual alteration in
average muscle function
r r jl � 1
J J
nnecessary co-contraction Differential behaviour of Gradual shift in proportion Of
Adaptive shortening and
generalized shortening tonic and phasic fast-twitch and slow-twitch
lengthening of muscles
around an articulation musculature (Janda) ,
fibres in some muscle groups
[ 1
1 rl
J
Trigger points
Alteration of Biomechanical
in ligaments
J
joint mechanics misalignment
and periosteum
Il 1 r
}--
Larger scale adaptive patterns of stress Secondary problems
Postural
J l
are communicated throughout the whole • compression of viscera
syndromes
of the soft-tissue network (Rolf) • restricted respiration
• nerve entrapment/tethering
• inefficient movement
• low energy, etc.
Figure 11.1 An overview of the physiological mechanisms regarded as contributing to structural dysfunction.
to movement programs can be a short-term response to socialization process, particularly the imitation of parents
the immediate environment of our organism or, if there and peers; the results of ill-advised postural advice
is sufficient rehearsal and repetition, the modification ('Shoulders back, chest out, stomach in'), and learned
can become ingrained as a learned pattern by the process patterns of repetitive or asymmetrical usage. These fac
we usually refer to as sensory-motor learning. The tors also include broad cultural influences; for instance,
sensory information comes from the external environ most people in the world squat, while in the West
ment and the proprioceptive information flows from we use chairs. Many 'traditional' peoples are actually
the internal environment of the structural body, espe taught to move with more fluency than Westerners; in
cially from the mechanoreceptors within the myofascial many parts of Africa children are actively taught effi
network. Figure 11.1 shows that movement constraints cient rhythmic movement through games, and so on.
can arise from: pre-existing learned patterns; tenden There is also a 'trauma history' for each individual. Ida
cies; 'complexes' and states of the organism; the short Rolf spoke often of childhood diseases and accidents,
term results of muscular spasm and reflexive inhibition, and the effect that these could have on the development
and from soft-tissue constraints. of posture and movement patterns. All such develop
The structural body is shown as another 'black box': mental episodes require an adaptive response in the
one source of input for the sensory-motor intelligence. short term, and often the resulting adaptations are
Soft-tissue constraints are just one of several sources of never fully relinquished (Feitis 1978, Rolf 1977, Schultz
afferent information to which the sensory-motor intelli and Feitis 1996).
gence must respond. It is bound to take into consider
ation these genuine mechanical constraints as it organizes Congenital factors
movement. These include such things as: a constitutional tendency
The heart of Figure 11.1, like Figure 1.2, suggests that towards the extremes of soft-tissue density, that is, too
structural dysfunctions essentially arise from restricted hard or too soft; skeletal asymmetries such as a leg
movement. Through repetition, restricted movement length discrepancy or hemipelvis; the tendency towards
patterns become learned. These learned patterns will in heightened or depressed autonomic activity, and the
time lead to compensatory adaptations throughout the predisposition to diseases that can affect structure. The
whole of the soft-tissue network, and these adaptations latter include asthma, fibromyalgia and connective tis
will tend to maintain those learned patterns. Habit sue disease. Perhaps there may also be inherited features
becomes fixed in the tissues, and then fixed tissues of form, for instance a tendency to an anterior or poster
reciprocate by supporting the habit. ior tilt of the pelvis, which can often be seen strongly
Soft-tissue constraints stem from two basic sources: expressed within some families.
from the results of dysfunctional muscular usage and
from tissue trauma. Muscular dysfunction can arise Immediate environmental stressors
through the gradual process of fibrotic contracture, These include such factors as sleep deprivation, emo
induced by over- or under-use of musculature, or from tional stress and nutritional deficiencies. Prolonged
the scar tissue and adhesions that arise from direct periods of stress can lead to a shift in autonomic tone
trauma. All these constraints become superimposed on towards extremes of either sympathetic or parasympa
the core of learned movement patterns. thetic activity, which can have a major effect on tonus
The diagram suggests that there are a number of pre throughout the entire musculature.
disposing factors that may exist in the background of
any individual that will hasten the onset of structural Behavioural, emotional and psychological patterns
dysfunction; they include historical and congenital fac These have been proposed by some authors as being
tors, current environmental stressors, and perhaps certain factors that may affect structure in the longer term.
emotional, behavioural or psychological tendencies or com The whole somatic psychotherapeutic movement start
plexes. These factors will make the arising of structural ing from Reich has proposed that the musculature
imbalances much more likely without necessarily being can 'hold' and express certain emotional tendencies
sufficient or prime causes in themselves. (Keleman 1985).
Coming from a more Freudian perspective, Sarno
Historical factors (1998) proposes that repressed emotion can lead to
These include aspects of individual history, such as muscular pain and a host of other psychosomatic dis
the postural and movement habits learned within the orders. He suggests that the physiological mechanism
THE MUSCULAR SYSTEM
same kind of response in the body. He suggests the

Repressed unconscious emotions (Rage)
autonomic nervous system can be induced to provoke
very specific areas of ischaemia, which then give rise to
mild oxygen deprivation and to expressed physical
symptoms. If this is indeed a valid mechanism then it
Abnormal autonomic activity
must be assumed that there must be structural conse
quences in the longer term.
In Chapter 6 we discussed Hanna's concept of 'sen
Reduction in local circulation of blood (ischaemia)
sory motor amnesia', in which whole aspects of our
soma may be 'anaesthetized' to proprioceptive infor
mation; even to mild pain signals. If this proprioceptive
information is not being fully received by the central
Mild oxygen deprivation nervous system then we can expect aberrant patterns to
increase, since the corrective power of pain is not even
being received.
A number of different authors in the somatic field have
Muscle pain
Nerve pain and/or numbness, tingling, weakness
speculated about the tendency of some clients to have an
Tendon pain exaggerated flexor or extensor tone. In Chapter 13 vari
ous structural-postural models will be discussed that
Figure 11.2 Sarno's proposed pathophysiology for tension
use this as an explanatory concept. One model developed
myositis syndrome (TMS).
successively by Feldenkrais, Hanna and Schleip suggests
that such a neurological imbalance will have significant
structural outcomes in the longer term.
by which the subconscious mind can affect the body in
this way is through the limbic system's influence on the
autonomic nervous and immune systems (see Fig. 11.2). SUMM A RY
Sarno cites some research evidence that support some
aspects of this proposed mechanism. It is known that In Section 2 we have explored many of the background
the autonomic nervous system has the ability to adjust concepts and maps used within the structural body
the amount of blood flowing through any part of the work tradition, especially the mutual influence of struc
body by control of the smooth muscle of arteries and ture and function, and the adaptive, mediating role
veins - the process known as vasodilation. During played by the connective tissue network. We have
sympathetic activation, for instance, the blood is par looked at some of the mechanisms by which functional
tially shunted away from the visceral space to the sur patterns give rise to structural patterns, and how struc
face layers of the body, where the musculature is in tural patterns feed back into the functional patterns that
more immediate need; similarly during parasympa gave rise to them. In Section 3 we will look more specif
thetic activation, blood can be directed more towards ically at the kinds of structural dysfunctions that can
the core space, to aid in digestion. Sarno takes the bold arise and at ways that a structural bodywork approach
step of saying that repressed emotions can evoke the addresses them.
REFERENCES
Alter M J 1996 Science of flexibility. Human Kinetics, Feitis R (ed) 1978 Ida Rolf talks: about Rolfing and physical
Champaign, p 40 reality. The Rolf Institute, Boulder
Chaitow L 1996 Muscle energy techniques. Churchill Godard H 2000 Notes from Bodywisdom Conference.
Livingstone, New York, pp 15-46 Coromandel, New Zealand
Damany S, Bellis J 2000 It's not carpal tunnel syndrome: RSI Keleman S 1985 Emotional anatomy: the structure of experi
theory and therapy for computer professionals. Simax, ence. Center Press, Berkeley
Philadelphia, p 3 Key S 1993 Body in action. Bantam Books, Sydney, pp 104-115
Rolf I 1977 Rolfing: the integration of human structures. Schultz R, Feitis R 1996 The endless web: fascial anatomy and
Harper and Rowe, New York physical reality. North Atlantic Books, Berkeley
Sarno J 1998 The Mindbody prescription: healing the body, Simons D, Travell J 1999 Myofascial pain and dysfunction: the
healing the pain. Warner Books, New York trigger point manual. Vollo Upper half of body. Lippincott,
Schleip R 1995 Tonic/ Phasic muscles. Online. Available: Williams & Wilkins, Baltimore
http:// www.somatics.de
PRACTICAL
MANUAL
12. A catalogue of some common postural dysfunctions 93
13. Some useful models for working with structure 117
14. Practicum: assessment, technique and strategy in structural bodywork 130
15. A first approximation to balancing structure 147
16. Working in the sagittal plane 153

156
The front l i ne
The back line 167
M ovement work for sagittal undulation 180
17. Working in the frontal plane 184

The lateral line 187
The medial leg line 197
M ovement work for frontal undulation 199
18. Working in the transverse plane 204

M ovement work for transverse undulation 205
19. Working with the shoulder girdles 209

Ele vated 209
Depressed 214
Protracted 216
Retracted 217
20. Working with the external rotation of the leg 218

A CATALOGUE OF
SOM.
POSTURAL
DYSFUNCTIONS
Structural bodyworkers are vitally interested in their or as the various rotations and counter-rotations of seg
clients' posture and how they move in the world, but ments around this midline. However, the body can also
recognizing such patterns is one thing, discovering how be viewed as having many structural levels (Flury
efficiently these patterns are regulated is another. So it 1987), and underlying this gross segmental description
may be useful here to recall Rolf's distinction between of structure are skeletal configurations. So, in this sec
posture and structure: tion we will examine the most common postural dys
functions that form the 'bread and butter ' of structural
Posture is holding your structure as well as you can.
bodywork, and we will define them in terms of skeletal
When the structure is properly balanced, good posture
organization, even though it is largely the soft tissues
is natural. A man slouches not because he has a bad
that determine the patterns and the soft tissues that we
habit but because his structure doesn't make it easy for
seek to reorganize when working with our clients.
him not to slouch.
It has been a theme repeated throughout this book that
functional patterns will over time consolidate into T H E A RT H R O KI N EM AT I C P E R S P E C T I V E
structural patterns. Our moving and postural habits create O F M O V EM E N T A N D P O S T U R E
the structural body. The structural body then becomes
an underlying, unconscious influence on all our postural When we look at the extraordinary complexity of a
and movement patterns - a relatively constant back body in motion, one crucial aspect of what we are
ground constraint that our sensory-motor intelligence observing is the movement of bones relative to other
must continually allow for in organizing movement. In bones. And Similarly, when we analyze someone's sta
this section we will examine the more common kinds of tionary posture (which is a function as surely as any gross
postural dysfunction that structural bodywork attempts movement), we are observing the static spatial relation
to address, realizing that beneath these overt postural ships between contiguous bones. This arthrokinematic
patterns there are hidden structural patterns that sus perspective is a fundamental aspect of scientific kinesi
tain them. ology. It views movement as the movement of contigu
Ida Rolf used a 'block model' as a simplified means ous bones away from the 'home' of anatomical position
of demonstrating the relationship between the major to the degree that the ligamentous and myofascial envir
elements of the human structure such as the head, chest, onment of each joint will permit. It defines movement
pelvis, and upper leg (see Figs 8.4 and 8.5, pp 52 and 53). in terms of angles and velocities, using its specialized
This is a useful, though limited, means of viewing the terminology of 'flexion', 'extension', 'abduction', and
body and visualizing its gross postural dynamics, and has so on. Similarly, when it describes static positions, or
the practical advantage of giving an approximate idea postures, it does so again by describing the skeletal con
of where the individual segments need to be 'taken' in figuratlon relative to anatomical position. Even though
order to normalize the structure. Postural dysfunctions, no-one ever habitually stands in anatomical position,
according to this model, are seen as the horizontal dis this convention remains a precise and convenient means
placement of bodily segments from the vertical midline, for describing movements and postures. It is an essential
P RACT I CA L M A N UA L
tool in the tool-bag of the structural bodyworker, allow posture. It is common for clients to suck in their
ing them to define gross patterns and to communicate abdomen in a vain attempt to meet the Western aes
with other somatic professionals. thetic ideal of the flat belly, or to retract their shoulders
The skeletal definition of posture allows us to make because they do not like to feel them rounding forward.
judgements such as: the head is too far forward (or the Regardless whether a posture is balanced or dys
neck too protracted), or there is potential for this shoul functional, it is the spatial relationships between the
der girdle to settle more comfortably down on the bones that define it and alert us to potential structural
thorax, or that this pelvis would be more balanced if there problems. All of this emphasizes the fact that the lan
were more posterior tilt. It helps us recognize that there guage of anatomy and kinesiology is very useful for
is more potential for hip extension in a client's gait. W hen recognizing the basic postural patterns of our clients,
we make such judgements we are essentially describing but that this is never sufficient for a more complete
skeletal relationships. Recognizing these patterns is a understanding of their structural organization. So, in
vital first step in understanding the structure of our our evaluation of our clients we examine their posture,
clients, although ultimately such descriptions say very making a preliminary assessment based on the organi
little about the structural dynamics and tonus patterns zation of the skeleton; then we see what is revealed by
required of a real body; nor is this anatornical language the quality of their movement and refine these impres
particularly useful for describing subtle or rhythmic sions as we use touch in working with them.
movement, for which a more metaphorical vocabulary It was suggested in Chapter 8 that it is the fascia that
may be needed - for instance the evocative language of creates the unified skeleton because it spans the bones
dance. and defines the range of possible spatial relationships
Many aspects of our clients' functionality will be between them. Although it is the fasciae that maintain
missed if we focus on their skeletal organization alone. the postural arrangement, and the fasciae that we seek
However, when making an initial assessment of our to change in structural bodywork, when we come to
clients, the first step is to look for segmental displace describe postural dysfunctions and syndromes it is eas
ments (which are ultimately defined by their skeletal ier to follow the conventions of anatomy and to define
configuration) without necessarily focussing on whether them skeletally. In the following section we will describe
perceived misalignments are postural (i.e. functional) the most commonly presented postural-structural dys
or structural. functions by their skeletal configuration. We will also
Poor postural-structural organization can arise in make some reference to the tonic patterns required to
many ways, and some of the physiological mechanisms maintain such configurations, as well as the typical pat
have been discussed already in Chapter 11. However, terns of fascial shortness that arise from them.
even a seemingly balanced or 'aligned' posture may
mask an underlying structural imbalance, with a 'bal
anced' posture sometimes being maintained only with TH E S KE L E TA L S Y S T E M
great effort. This could either be through a widespread
pattern of unnecessarily elevated muscular tonus, or The skeleton is the densest aspect of the connective tis
perhaps through an over reliance on the powerful sleeve sue continuum, the densest form of 'the one fascia'.
muscles when deeper tonic muscles could do the work Bones are a bone-salt-collagen composite, consisting
more efficiently. For instance, the apparently aligned approximately of 7 5% bone-salts and 25% collagen and
posture of a student of yoga or dance may conceal a ground substance. They are surrotmded by their own
subtle holding pattern: an effort to find 'form' that may fascial 'bag', the periosteum, which serves to connect
mask some underlying structural dysfunction, and the skeleton to its tendinous muscle attachments and
which reveals itself only when they relax a little. One making the skeleton entirely continuous with the
also finds clients who appear classically aligned in fascial network.
standing (see Fig. 2.2, p. 16) yet maintain a widespread If we look at the body as a tensegrity system then
pattern of elevated tonus, of unnecessary co-contracture, bones are the lightweight compressive beams. They are
which compresses their structure generally and may strong in compression, torque and shear, but are also
only become apparent from the quality of their move slightly flexible through their long axis. The long bones
ments. Most clients, when having their posture/ are marvellously constructed of an outer shell of dense or
structure evaluated tend to 'hold to form' rather than compact bone that encloses a network of canals and trab
allowing themselves to drop into a habitual, comfortable eculae: the cancellous bone (Fig. 12.1). The trabeculae
A CATA L O G U E OF S O M E C O M M O N P O S T U R A L DYS F U N C T I O N S
Cancellous bone - note the lines of

mechanical stress
Periosteum -----1\
Compact bone ---It
Medullary cavity ---1Ir-,
Figure 12.1 Compact and cancellous bone.
are arranged precisely along the lines of mechanical

stress as predicted by Wolff's law. In the skeletal system
Figure 12.2 The bilateral symmetry of our structural
the bones articulate but do not touch; they are kept
organization (after da Vinci).
apart either by a resilient and shock-absorbing cartilage
and a film of synovial fluid, or else by fibrous matter.
mentioned in Chapter 9, Wolff's law operates through

S T RU C T U RA L OVE RVI EW O F THE out the entire connective tissue network, and if any
HU M A N D E S I G N aspect of our structure can adapt, then it will adapt, and
probably in an asymmetrical fashion.
Like all vertebrates, the grand structural plan of the If we divide the body through the mid-sagittal plane
human body is based on bilateral symmetry around the we observe individual (i.e. non-paired) bones only
mid-sagittal plane (Fig. 12.2). However, the bilateral along this plane. These bones include the frontal, occipi
symmetry of the human body is of a particular kind; it tal and mandible bones of the skull; the hyoid; the
is not the perfect mathematical symmetry of a snowflake. individual and the fused vertebrae of the spinal column,
Most of the musculoskeletal units that are recognized and the sternum. All other bones are paired, somewhat
in anatomy exist in pairs, and although in general each is symmetrically, on either side of the mid-sagittal plane,
close to being a mirror image of the other, the reflection including the parietal and temporal bones of the skull,
is never perfect. Biological entities tend not to have the the clavicles, the scapulae, the ribs, the innominates
symmetry of crystals. All elements of the musculoskeletal and all the bones of the limbs (Fig. 12.3).
system are subject to a wide range of developmental There are left-right differences even at birth, and these
pressures, many of which are asymmetrical in nature. differences may diverge even further during develop
There is a strong tendency in humans to develop lat ment. For instance, the ribs are shaped partly by the
eralized functionality; that is, left- or right-handedness, underlying viscera; the liver on the right and the aorta
'leggedness' and 'eyedness', and often even different on the left cause deviations in the shape of the ribs. The
sensitivities to the left or right side of the perceptual field. ribs will also respond to the torsional forces within
Because of this tendency, perfectly symmetrical func a scoliotic structure and will, in time, flatten in some
tion and symmetrical growth are highly unlikely in any areas, become more rounded or angular in others,
aspect of the connective tissue network. As was close up in some areas and spread apart in others. The
P RACTICAL M A N UAL
--,-\----- Cranium
r------ Clavicle
-MII!'PI--- Scapula
��::;:r\--H---- Sternum
1--4\--- Humerus
-\------ Radius
W\\---- Ulna
1+-----+-,\\-1\--- Pelvis
flflI�---- Carpals
\\-\-\>,---- Metacarpals
f----- Phalanges
Itt---- Tibia
111/------ Fibula
�----- Tarsal bones
II-M\----- Metatarsal bones

f------ Phalanges
Figure 12.3 The axial skeleton - anterior and posterior aspects.
innominates vary in shape and can be of variable as paired muscles on either side of the midline,with the
lengths, a condition known as hemipelvis, and legs are diaphragm, sphincters and some facial muscles being
commonly of unequal length. Laughlin in his review of the only exceptions. Muscles are even more immediately
the radiological research into leg length discrepancy responsive to usage patterns than the skeleton. And
(LLD) reports that half the subjects surveyed had a again, because of our lateralized functionality and asym
length discrepancy of 5mm or more (Laughlin 1998). metrical usage, it is very common to have muscle pairs
This 'near-bilateral symmetry' is found also within that differ in mass, length and other adaptive character
the muscular system. Most somatic musculature exists istics, such as degree of fibrosity. This is obvious for the
A CATA LO G U E O F S O M E C O M M O N PO S T U R A L DYS F U N CT I O N S
superficial and more easi ly palpated muscles, but ultra

sound investigations have confirmed this now for deeper
musc les such as the psoas and multifidus (Richardson
1998) - the psoas being the least symmetrica l of al l
musc le pairs.
Within our core space, the thoracic and abdominal
cavities,there is even less symmetry. The lungs have two
lobes on the left side and three on the right. The liver is
to the right and stomach is normally to the left. The heart
is usually left of centre. The alimentary canal, being a
long tube, has to be folded to remain within its confining
peritonea l bag and cannot be symmetrically arranged.
The pattern of visceral connective tissue, the supportive
mesentery and suspensory ligaments of organs, are not
symmetrical and this, it has been argued, is another rea-
son why absolute bilateral symmetry is impossible.
Segmental standard rotation
F lury (1991) observes that there is an a lmost universal

pattern of rotatory asymmetry in the human body, which
is independent of handedness. In this pattern, the vari
ous bodily segments are rotated relative to each other
around the longitudinal axis of the body (see Fig. 1 2.4).
Figure 12.4 Segmental standard rotation. (With the kind
For the axial components: the head is rotated right, the
permission of Dr Hans Flury.)
thoracic segment left and the pelvic segment right. For
the appendicular components: the left leg as a whole is
externally rotated to the left,while the right leg is more Asymmetrical usage, injury and other factors will tend
conflicted, having the right femur internal ly rotated to push the body further away from this baseline towards
compared to the left, while the right lower leg and foot asymmetry, and these are the adaptations that can be
are more externally rotated re lative to the femur above. addressed fruitfu l ly by the structural bodyworker. Judith
Variations from this pattern, he states, are rare, and Aston, student of Ida Rolf and developer of the Aston
a lthough there may be reversals in some aspects, in Patterning movement system, affirms from her exten
Flury's clinica l experience he has not found a sing le sive clinical experience that if the outer structure is made
instance in which there has been the complete reversa l too symmetrica l it can give rise to somatic conf lict: 'If the
of this pattern. He suggests that asymmetrica l tensions body has asymmetry on the inside and you hold sym
within the mesentery may be a factor. He also suggests metrical ly, you create what I call "micro-whip lashes/'
that this rotational pattern may be related to a common shear patterns which over time create scar tissue'
pattern of skeletal asymmetry, described as ilial torsion, (Pare 2002).
in which the right ilium tends to rotate forward and out
relative to the left ilium.
The axial-appendicular design
F lury does not draw any practical conc lusions from
this finding; however, it does seem to have important The basic pattern of structura l organization for all
imp lications for the structura l bodyworker. The near mamma ls is a central axis defined by the axial skeleton
universality of this pattern does suggest that any attempt and two appendicular systems -the superior and infer
to 'correct' it may be futile as there may be genuine ior girdles and their associated appendages. In humans
limits to how much bodywork can achieve in bringing these are the shoulder and pelvic girdles with their
a body towards greater symmetry. Here,the advice 'Don't attached limbs. In the human being the axial system
fix what ain't broke' may be salutary. So perhaps the pat consists of: the sku ll, a vertebral co lumn of seven cervical
tern of segmental standard rotation is best seen as a base vertebrae, twe lve thoracics with their attached ribs and
line: as the best one can achieve in creating symmetry. sternum, five lumbar, the five fused sacral vertebrae
P RACT I C A L M A N UAL
and the four fused segments of the coccyx. The sacrum We will not examine intersegmental or intrasegmental
belongs to the axial skeleton but is ligamentously bound dysfunctions either of the limbs or of the pelvis,with their
to the two innominates, forming the relatively stable conditions such as inflare, outflare and other torsional
unit of the pelvic bowl. Appended to the axial skeleton patterns that are traditionally the domain of osteopaths
are the shoulder and pelvic girdles, from which issue and chiropractors, although these are definitely amenable
the upper and lower limbs. to change through soft-tissue work ( Maitland 2001).
P O S T U R A L- S T R U C T U R A L
A XI A L O V E R V I E W
DYS F U N C T I O N S D E F I N E D
S K E L E TA LLY
From a structural bodywork perspective, the main struc
tural themes associated with the axial skeleton relate to:
In the following analysis we will look at postural
structural dysfunctions that: • the form of the spinal curves
• the placement of the head on top of the spine
• relate specifically to the organization of the axial
• the relationship between the rib cage and the thoracic
skeleton
spine.
• arise from dysfunctional relationships between the
girdles and the axial skeleton In the sagittal plane we are interested in the overall
• arise from the relationship between the girdles and pattern of curvature of the spine ( Fig. 12.5), that is, the
their attached limbs.
A fuller analysis of dysfunctional patterns would also
look in detail at dysfunctional relationships within limb
complexes themselves.
What does it mean to say that a postural -structural
pattern is dysfunctional? It means at the very least that
the pattern is not an optimal arrangement in a bio
mechanical sense; it is not the most efficient possible. It
means that gravity will in time tend to exaggerate the
pattern and that, ofitself, will give rise to undue stress to
soft tissues, ultimately causing tissue damage and degen
erative changes. Practical constraints will not allow us to
examine all the postural-structural dysfunctions that
structural bodyworkers typically deal with. Instead we
will limit ourselves to the most common ones that arise in
practice that can be addressed through soft-tissue work
alone. Resolving these patterns will be an excellent 'first
approximation'in normalizing the structure of our clients.
We will examine in most detail:
• dysfunctional patterns within the axial skeleton
• dysfunctional relationships between the pelvic girdle
and the axial skeleton
• dysfunctional relationships between the shoulder
girdle and the axial skeleton
• dysfunctional whole body patterns such as excessive
shift of the pelvic segment
and, of the whole possible range of dysfunctional limb
patterns, we will only consider
• the pattern of externally rotated legs (which is one of
the most common gross structural dysfunctions
of the lower limbs). Figure 12.5 The axial skeleton, sagittal view.
A CATA L O G U E O F S O M E C O M M O N PO S T U RA L DYS F U N C T I O N S
relationships between the primary and secondary is concerned with bringing the head under control and
curves, while in the frontal plane it is scoliotic curva bringing extensor tone into balance with flexor tone
ture with its inevitable rotatory compensations. We will ( Fiorentino 1981). The cervical lordosis develops in
look at the biomechanical importance of the curves of response to the child's drive to orient its head (and its
the spine in more detail later, but briefly, the spinal full complement of teleceptors) out into the sensorial
curves serve many important functions, which may world. At about two months the tonic neck reflex
be compromised if they are either too curved or not emerges. This is an activation of the neck extensors to
curved enough. allow visual tracking (of the mother in particular) and
Being the bearer of our main orienting sense recep the ability to orient the eyes and mouth to the horizon
tors, it is critical that the head be placed efficiently on tal. An increase in extensor tone gradually progresses
top. Misalignment of the head and neck can have a dis inferiorly until it includes all the spinal extensors; this
proportionately large influence on our moving effi eventually allows upright sitting, supported standing
ciency. Conversely,any small refinement in the alignment and finally unsupported standing. The lumbar lordosis
of the head and neck will be keenly sensed by the client develops in response to the child's persistent efforts to
as an improvement.In the traditional Rolfing lO-series, stand upright. The curve develops as the child activates
the neck, like the back, is generally addressed each ses the lumbar extensors to bring the trunk more erect,
sion, although it is not until the seventh session that against the resistance of the hip flexors that are still
there is a serious intent to 'get the head on top' as the shortened from their term of full flexion in the womb
whole spine and thorax needs to be prepared before the (see Fig. 12.7).
head can be stabilized around a new, more balanced
home position. Sagittal organization of the spine
In the thoracic region, the rib cage plays a large part In the sagittal plane, certain deviations of the spinal
in determining the movement possibilities of the thor curves from a normal range can be problematic. The
acic spine. For any movement through the thoracic curves may be too exaggerated or (and this is not often
spine, the attached ribs will necessarily participate and acknowledged), too flat. W hat 'too curved' or 'too f lat'
constrain the kind of movement possible in the thoracic actually means for any individual is difficult to determine
segments. It is important to see how our clients main
tain elevation through the front of the ribcage when
there is no bony support from below; often there is a
tendency either to overcompensate and struggle 'to keep
the chest up' or to allow the ribs to collapse down the
front. It is a problem that has arisen from our bipedal
existence and how a client approaches this problem
often becomes a major theme in their ongoing struc
tural work.
The spinal curves
At birth there is only one primary spinal curve in the

sagittal plane since the foetus has usually developed in
a fully flexed position within the uterus. However, seg
mental rotations around the midline may be evident
even at this stage as it is not uncommon for the foetus to
be non-symmetrically flexed within the uterus, with the
shoulders rotated relative to the pelvis and with the
head turned to one side ( Schultz and Feitis 1996). Such
rotations may predispose individuals to scoliotic pat
terns later on ( Fig. 12.6).
The secondary spinal curves are developmental. At
birth, reflexive flexor tone predominates over extensor Figure 12.6 Rotations in utero and their longer term effects.
tone, and much of the early development of movement (Schultz and Feitis 1 996.)(With the kind permission of R Schulz.)
P RACT I C AL M A N UA L
.... - .
6.�
�
(a)
Q �==>,
ES ••
IP ,
�.....
.. . .
t>C:=
(b) (c)
(d)
Figure 12.7 The development of the secondary spinal curves showing the gradual lengthening of the iliopsoas and shortening of the
hip extensors. Abbreviations: ES, erector spinae; F, weak flexors; HE, hip extensors; Ip, iliopsoas. (From Cailliet R 1 981 Low back pain
syndrome. F A Davis Company, Philadelphia).
exactly; it depends on many factors including body

mass, bodily proportions, and distribution of fat, and
it can vary throughout life depending on usage.
However, the more exaggerated or extreme forms are
easily recognized, and structural bodyworkers consist
ently find that when they resolve these extreme forms
and the spinal segments become re-aligned,then clients
feel better, function more efficiently, and usually find
that many of their postural discomforts will resolve of r;?/
Shear
themselves.
We should have stayed in the trees Anterior longitudinal

ligament
Conventional scientific wisdom for many years has
suggested that humans are essentially quadrupeds that
have not yet fully adapted to bipedal existence. There is
a widely held view regarding the sagittal curvature of
the spine that 'the flatter the better'; this is just another
aspect of the 'somatic Platonism'mentioned in Chapter 2.
Figure 12.8 The l umbo·sacral angle.
In this view, the lurnbo-sacral junction is seen as inher
ently unstable, with the toboggan of LS resting on the disc and the supporting anterior longitudinal ligament
slippery slope of 51. The greater the lurnbo-sacral angle, ( Cailliet 1981) (see Fig, 12.8), The practical implication
the more unstable the LS-51 junction becomes, and the normally drawn from this view is that we need to
grea ter, the tendency for shearing forces to stress the decrease the lumbo-sacral angle, reducing the spinal
A CATA L O G U E O F S O M E C O M M O N PO S T U R A L DYS F U N C T I O N S
the impact of heel-strike in walking or running

( Alexander 1975, 1988). It is suggested that very straight
spines are less able to absorb these ' ground forces' and
are more likely to incur a thinning of the discs in the
longer term. It is known for instance that marathon
runners can lose several centimetres in height during a
race; the constant pounding of heel-strike on a hard
surface sends waves of compression through the legs,
pelvis and spine that will extrude water from the discs.
In fact we all tend to lose height during the day and are
normally tallest (and our discs juiciest) in the morning
when we rise. We always recover our height in the short
term; however, it may be reasonably conjectured that a
lifetime of inefficient shock-absorption will cause
undue wear and tear on the spinal discs. Feldenkrais,
who prior to his period of somatic invention was an
engineer and physicist, makes the interesting point that
Force that is not converted into movement does not

simply disappear, but is dissipated into damage done
to joints, muscles and other sections of the body
(Rolf 1977)
Ida Rolt too, realized the importance of disc health:

Figure 12.9 Tuck the tail under - appropriate advice?
Discs constitute one-fourth to one-fifth of the spinal
structure. Therefore, establishing or maintaining a good
fluid balance in the discs is important in maintaining
curvature as much as possible; and the advice usually
healthy spinal performance
given is to 'tuck the tail under '. Actually, this effort of
(Rolf 1977)
tucking the tail under, which is a lumbar flexion, usu
ally realized through a contraction of the abdominal and Many elderly clients with a flat back are more likely to
gluteal muscles, does have an immediate effect of redu have a rigid, even fused, lumbar spine, thinning discs
cing the lumbar lordosis. It will be argued strongly, how and secondary problems like sciatica that arise from such
ever,that this advice is usually misplaced. Any postural compression.
advice that involves asking someone to maintain a con In addition, if we look structurally at a straight back,
tinual holding pattern is doomed to failure; in any case, we note that it is at a mechanical disadvantage when
the experience of many structural bodyworkers sug compared with a lordotic back in its ability to support
gests that having too flat a spine can be equally prob the cantilevered rib cage; in crude terms, it is much
lematic. Giving advice such as ' Tuck your tail under ' is harder to keep you chest up if you have a flat back. A
always dubious anyway because we are asking people lumbar lordosis does tend to bring the lumbar spine
to wilfully assume a posture that cannot be assumed closer to the midline of the body. Having a flat back
naturally, that is, unconsciously ( Fig. 12.9). This advice means that the thoracic erectors (working synergistic
seems doubly inappropriate in that for about half our ally with the scalenes) have to work harder to prevent
clients this advice will tend to exaggerate their pattern, the chest collapsing down the front. This fact goes a
and has the potential to disorganize them even further. long way to explaining why flat-backed clients so often
An alternative view is that problems arise from the report muscle pain between the shoulder blades; it is
extremes of curvature - too much or not enough. Among because the thoracic erectors are overworked and strained
the spine's many functions is the gross biomechanical in their effort to keep both the head and the chest up.
function of shock absorption. Mechanically a curved In Chapter 13 we will examine a postural model that
spine acts as a spring that can absorb and dissipate the has arisen from the Rolfing community, which is
constant waves of compressive forces passing upwards known as the internal-external model. Briefly, this model
through the skeleton in standing postures or through looks at the sagittal organization of the pelvis and spine
PRACTICAL M A N UAL
and suggests that the sagittal tilt of the pelvis can be too crude form of somatic Platonism is extremely wide
extreme in either an anterior or posterior direction. spread, and was never ever confined to Ida Rolf alone.
Here, pelvic tilt is defined as the movement of the super Even massage therapists would benefit from some
ior aspects of the pelvis away from a neutral or 'home' rudimentary ideas about structural variation, since a
position around an axis that passes through both acet knowledge of their clients' tendencies can help them
abula. An anterior tilt means that the anterior superior position them more comfortably on the table. Internal
iliac spine ( A S I S) has moved to the anterior and infer (lordotic) clients for instance are often more comfortable
ior, a posterior tilt means that the posterior superior in a prone position with a pillow under their abdomen,
iliac spine (P SI S) has moved to the posterior and infer and clients with an exaggerated 'head forward' posture
ior. Pelvic tilt is synergistically related to certain pat cannot be comfortable with the face-hole of the conven
terns of spinal curvature, having most effect on the tional massage table.
form of the lumbar lordosis. Figure 12. 10 is a simplified If spines are deemed to have too much curvature, we
model showing the two basic patterns of tilt of the can do the soft-tissue work that will tend, indirectly, to
pelvic segment: the anterior tilt of the interI).al arrange reduce that; and likewise if they are too straight we can
ment and the posterior tilt of the external. do the soft-tissue work that will encourage more curva
Additionally there are shift patterns of the pelvis, in ture. Inducing more curvature to a spine is more prob
which the pelvic segment as a whole translates in an lematic than reducing it, and in general the changes are
anterior or posterior direction over the feet. Tilt patterns less dramatic visually than when we try to reduce cur
combined with shift patterns will result in characteristic vature; however, the work is rarely wasted and will
patterns of soft-tissue contracture. The internal-external always remove some of the strain from the system,
model suggests that it is the extremes of these patterns giving a sense of lift and giving more 'spring' to the
that need to be addressed when we try to promote a structure. Figure 12. 11 shows drawings from before
more balanced structure. This view means that as after Rolfing photos demonstrating how in these cases
somatic therapists we need to know our client's struc lumbar lordosis may be diminished or augmented by
tural tendencies, whether towards an anterior or poste this work.
rior tilt in pelvic organization. Figure 12. 12 demonstrates the synergistic relation
There are many practical reasons why therapists ships between the primary and secondary curves - the
need to know if their clients' spines are too curved or general tendency for them to increase or decrease together.
too straight, and this kind of information should be
known not just by structural bodyworkers but by per
sonaltrainers, yoga teachers, Pilates teachers and physio
therapists. The 'tuck the tail under' advice seems to
be almost universal and unquestioned; indeed this
Figure 12.10 The patterns of anterior and posterior pelvic tilt.

Note how the centre of gravity of the pelvic segment is superior
to the axis of the acetabula, meaning that gravity will tend to
exaggerate these patterns unless opposed by muscular action.
(With the kind permission of Dr Hans Flury.) Figure 12. 1 1 Reducing curvature, augmenting curvature.
A CATA L O G U E OF S O M E C O M M O N PO S T U RA L DYS F U N C T I O N S
However, this i s hardly a comprehensive selection of we are intending to influence spinal curvature then
profiles; spinal curvature can be very idiosyncratic, and working with the superficial fascia alone may not be
it is common to find spinal organizations that do not fit sufficient to bring about the intended change; some
these profiles at all. This diagram does suggest, how way of influencing the deeper ligamentous structure of
ever, that the spine is an integrated system, that there the spine needs to be found. In the practical section of
are mutual influences between the primary and sec this book (Chapter 16) some indirect stretches will be
ondary curves. If we bring a more holistic perspective shown which are powerful means of influencing the
to bear, it would suggest that it makes no sense to try to spinal curves at a ligamentous level. These stretches
reorganize the contour of one curve without allowing will then support the more superficial fascial work.
for the reorganization of the others. Hence the conven
tional wisdom among structural bodyworkers that the Frontal organization of the spine
lumbar and cervical lordoses need to be treated together. In the frontal plane scoliotic patterns may be apparent
Figure 12.13 illustrates the complex system of liga as lateral deviations of the spine from the midline,
mentous support for the spine in the sagittal plane; the inevitably associated with rotatory patterns in the trans
lateral ligaments connecting the transverse processes verse plane that will always be accompanied with alter
are not shown. Looking at this diagram it becomes ations to the symmetry of the rib cage. Scoliosis is a
apparent that ligaments, including the one-segment liga structural dysfunction that has received much attention
ments, will probably have a larger structural influence from physical medicine. There are clearly many factors
in maintaining spinal curvature than the investing fas that contribute to scoliosis, many different reasons why
ciae of the spinal musculature, owing to the fact that a spine will adapt in this rather ingenious way. Some of
they are denser and can more powerfully bind adjacent the factors include: neurological developmental prob
vertebrae together. In practical terms it means that if lems, proprioceptive insufficiency, postural reflex prob
lems at a spinal cord level, and degraded collagen
metabolism (Larson 2000). Idiopathic (i.e. of unknown
-- A cause) scoliosis is often of adolescent onset, particularly
in young women, and has been attributed to a mis
match between the growth of the skeleton and the
tardier growth of the supporting soft tissues. POSSibly
the most common form of scoliosis seen by structural
bodyworkers, however, is that induced by a leg length
Pedicle Lamina (cut)
Anterior Supraspinous
longitudinal ligament
ligament
Interspinous
Vertebral
ligament
body
Capsular
ligament
Intervertebral Ligamentum
disc
flavum
Nucleus
Spinous
process
Figure 12.12 Different forms of the spinal curvature in the sagittal

I
Posterior longitudinal Inferior articular
ligament process
plane. A, B and C show different degrees of spinal curvature
associated with different degrees of lumbo-sacral angle. (After Cailliet R Figure 12.13 The ligamentous structure of the spine. (After
1 981 Low back pain syndrome. F A Davis Company, Philadelphia). Gorman.)
PRAC T I C A L M A N UA L
discrepancy (LLD). In this case a scoliosis can be seen as

the body's ingenious solution to solving the problem of
LLD. It was mentioned in Chapter 5 that structural
bodywork is very effective in reorganizing fascia; bones
however adapt over a much longer time span. If a scol
iotic pattern is maintained too long during early life
then the vertebral bodies may become wedge-shaped
and asymmetrical. For many, however, the vertebral
bodies maintain their shape and the scoliotic curves are
taken up in the asymmetrical deformation of the discs
themselves; for the latter group there is more possibility
of lasting change through soft-tissue work.
The head
Evolutionary biologists point to the major evolutionary Figure 12.14 The pOise o f the head. (From M Gelb 1 981 Body
trend known as encephalization, which is the tendency learning: an introduction to the Alexander technique. Henry Holt,
for the brain, the sense receptors and the mouth to clus NY, p.46.)
ter towards one end of the organism. In humans the head

is the bearer of most of our major exteroceptors: the ears,
eyes, olfactory receptors, taste buds, and also the vestibu some of the top sports-people of his day and expressed
lar apparatus. In the human structure the neck too has a the opinion that although top athletes have extremely
crucial role in this regard; its job is to orient the head to well organized necks, the best organized necks he ever
optimize its sensorial contact with the environment, worked with belonged to top business people and mili
allowing the head to scan more efficiently for sensory tary officers, and he offered the suggestion that the abil
impressions. Additionally there is a concentration of pro ity to make quick decisions, as it were, on the run, requires
prioceptors in the sub-occipital muscles, some of the a delicate poise of the head (see Fig. 12. 14). Many authors
most densely innervated muscles of the body. Our have pointed to the extraordinarily poised head posture
sense of balance, in fact our whole orientation in space, seen in less Westernized cultures: Nubian tribesmen,
depends largely upon the coordinated proprioceptive Australian aborigines, the Balinese, and in traditional
input from the eyes, the sub-occipital muscles and the representations of the Buddha. We instantly ascribe to a
vestibular apparatus. balanced head posture expressions of nobility, contain
Many somatic pioneers have stressed the importance ment, poise, balance and mastery (Von Durkheim 1977,
of the balance of the head, and the role of the neck in Gelb 1981).
organizing our overall movement patterns. Alexander The positioning of the skull on top of the spinal col
spoke of primary control, the notion that it is the neck umn is critical in achieving postural balance. This is
that chiefly organizes our movements. Human beings problematic, however, since even with the most bal
have an intricate orienting response that operates when anced upright posture the skull itself is inherently
we negotiate any complex terrain, whether in the bush, unbalanced its centre of gravity being anterior to the
-
playing a team sport or traversing a busy supermarket. fulcrum of the atlanto-occipital (AO) junction (Fig. 12. 15).
This deeply habitual orienting sequence is: the eyes Therefore, the cervical extensors are inevitably obliged
glance and fixate, the sub-occipitals orient the head in to work all the time, whenever we are upright. It is
that general direction, the larger neck muscles join in, a first class lever (the fulcrum lying between the effort
and then the trunk orients itself in the desired direction. and the resistance) and is a hangover from our
This orienting response forms very early in our devel quadrupedal past. The reason why your head drops
opment and is vital for efficient interaction with the forward to your chest when you 'nod off' is that the cer
environment. The neck must be delicately poised if it is vical extensors simply turn off, and gravity asserts
to support this orienting sequence in an efficient way. itself. So, in normal upright stance, the tonic extensor
It has been reported that Feldenkrais, too, believed in muscles of the neck are bound to work non-stop all day;
the critical importance of the neck in organizing our however, as true tonic muscles they are well adapted to
movement (Wildman 1993). Feldenkrais worked with do this. If the head is not carried too far forward, these
A CATA LO G U E O F S O M E C O M M O N POST U RA L DYS F U N C T I O N S
r---"-<:----+>r- Centre of gravity

of head
�_"r------,'-+- Fulcrum at the

occipital condyles
__-.,.,'-- Force counter

-
balancing
weight - posterior
neck muscles
Figure 12.15 Balance of the atlanta-occipital joint. (After Gorman.)
muscles, being tonic or slow-twitch, are easily capable head moves forward, the workload of the cervical exten
of working continuously throughout the day without sors is doubled; hence the ropy, fibrotic feel of these
tiring. It is only when the centre of gravity of the head muscles so often found in our clients and their common
is habitually held too far forward that these muscles complaints of muscle pain between the scapulae.
exhibit signs of strain. The 'head forward syndrome' is Forward head syndrome is accompanied by a chain
very common in our culture, with nearly all of our of compensatory adaptations. It is probably more accur
work requiring us to look forward and down. ate to see this syndrome as a whole body pattern in
which the forward head is the most conspicuous aspect.
The head forward syndrome This pattern typically includes a depressed rib cage
Whether cutting vegetables, typing at a desk or work and shoulder girdles that protract and elevate, with
ing over a bench, the head tends to be drawn forward scapulae that rotate and abduct giving the typical 'up
and to look down. There is a recognized reflexive rela and over ' appearance of the shoulder girdle.
tionship between the oculo-motor muscles, the suboc One major consequence of the head forward position
cipital muscles and our trunk flexors and extensors; is that the AO junction becomes compromized in a
when we look down it facilitates the action of the flex number of ways. Tonic neck reflexes operate to keep
ors and when we look up it facilitates our extensors. our face vertical and our eyes oriented towards the
Therefore, having our work tasks always below eye-level horizon. There is a habitual relationship between our
will always tend to encourage both head and trunk eyes and the angle of our face: the sensed 'home pos
flexion. It has been estimated that for every 2.5 cm the ition' of the eyes within the orbits. To change this would
P RAC T I C A L M A N UAL
require different tonus patterns in the oculo-motor mus direction of ' up', 'down' and where the horizon is. As
cles of the eyes, a completely different proprioceptive mentioned earlier, somatic pioneers such as Alexander
feel, which we will try to avoid if at all possible. Hence, and Feldenkrais have emphasized the critical import
as the head translates forward, neck reflexes operate to ance of this region in organizing our overall movement
keep the face relatively vertical. This can only be patterns, and subsequent research has confirmed their
achieved through cervical flexion and capital extension, intuitions (Garlick 1982). So, if the AO junction is com
and this action closes the AO joint posteriorly (see Fig. promized in this way we may expect it to adversely affect
12.16). If this pattern becomes habitual many neural how we move around and function in the world. You just
and vascular structures that congregate in the AO area need to put on a restrictive neck brace for a while to
may be compromised. Additionally, the delicate sub realize how much we rely on neck mobility to organize
occipital muscles themselves are placed under strain. our movements from moment to moment. Figure 12.17
We now know that the sub-occipital muscles, although shows further examples of the head forward syndrome.
minimal movers and initiators, have an important pro
Importance of the sub-occipital muscles
prioceptive function. Neurologically they are very much
related to the functioning of the oculo-motor muscles The sub-occipital muscles (Fig. 12. 18) are minimal
and to the proprioceptors of the inner ear, thereby movers of the head; they can initiate a little nod 'yes', or
helping us orient ourselves in the world, telling us the
Obliquus
capitis sup.
Transverse
Rectus capitis process of C 1
post. minor
Rectus capitis Vertebral artery

post. major
Obliquus capitis info

Figure 12.16 The posterior closure of the atlanto-occipital
joint as the head shifts forward. Figure 12.18 The sub-occipital muscles. (After Gorman.)
Figure 12. 1 7 Examples of the head forward syndrome.

A CATA L O G U E O F S O M E C O M M O N POST U RA L DYS F U N CT I O N S
a little 'no' and the little circle that combines both these Secondary aspects of the head forward syndrome
movements. Like all of the deepest spinal muscles they The head forward tendency will be exacerbated if there
have a vital proprioceptive role, acting as movement is a tendency for the chest to collapse down the front
sensors for the head (Abrahams 1982). They are densely (into what will be described later as an expiration fix pat
innervated, densely populated with motor units, and tern). The ribs will tend to angle down more in the front,
have many mechanoreceptors that provide informa and this means that the thoracic outlet may be compro
tion about the angle of the head. This input, when coord mised. If to this is added some shoulder girdle depression,
inated with related input from the oculo-motor this may result in the compression of the neurovascular
muscles and the vestibular apparatus, provides vital bundles that run beneath the clavicle producing a con
information to the central nervous system concerning dition known as thoracic outlet syndrome. The brachial
where the head is in space and how it relates to the hori plexus is the neurological telephone exchange for the
zon (Berthoz 2000). Experiments in which the sub arms, and consists of an interconnected complex of the
occipitals are disabled with local anaesthetic show that cervical nerves emerging from C5 to Tl. The plexus
subjects will have a staggering gait, as if drunk. If the exits between the anterior and mid scalene muscles
injection is one-sided then the subject will have an irre before diving beneath the clavicle and entering the arm.
sistible sensation of listing to that side (Abrahams Like most nerve bundles it shares a pathway with other
1982). plumbing, in this case the brachial artery. Localized
The sub-occipitals are small muscles and definitely compression can exert pressure on the nerve and vas
not prime movers and, like the deeper, smaller spinal cular bundles, and can arise from tight, overworked
muscles, they can easily be inhibited by the larger over scalenes; elevated tonus in the upper trapezius and other
lying musculature. In the forward head posture the neck muscles, or from excessive shoulder girdle depres
more superficial musculature will of necessity be called sion in which the pectoralis minor is often involved. This
upon to stabilize the head. To work with their inherent pattern is often connected with repetitive strain syndromes
delicacy the sub-occipitals must not be overwhelmed in which myofascial impingement on the brachial plexus
by the sheer power of these more superficial neck can give rise to numbness, pain or 'pins and needles'
muscles. So a vital aspect of structural bodywork is sensations in the arm and hand and reduced circulation
what Ida Rolf called 'getting the head on top', that is, at the extremity.
bringing the head into a more posterior position with Often the collapse of the chest will lead to breathing
out strain, and giving the deeper muscles more free restrictions and a compression of the abdominal con
dom to act. She emphasized the critical importance of tents. This overall pattern has long been recognized by
activating the deeper muscles of the neck to achieve somatic therapists, with Janda, for instance, calling it
poise: the 'upper crossed syndrome' (Chaitow 1996), and it has
been explored in some of the earliest literature about
When the head functions incompetently, movement of posture (Todd 1937). For people with a 'straight back'
the head is initiated and largely executed by the superfi tendency this often results in the so-called Dowager's
cial muscles that attach to the shoulder girdle. Thus in hump, a fibro-fatty pad that builds around the spinous
the random individual, the head or neck turns with lit processes of C7 and Tl . It seems to be the body's
tle or no participation of the deep-lying intrinsics attempt at bracing those segments of the spine to pre
(Rolf 1977) vent a further translation of the head forward. It is more
common in women, but can appear in either sex, par
Ida Rolf also emphasized the importance of working ticularly among those with a flattened thoracic spine.
around the jaw and the important relationship between
the jaw and the base of the skull. The jaw is often slung
Thoracic spine
asymmetrically, particularly for clients with scoliosis.
Interestingly the whole face including the line of the The rib attachments in the thoracic spine makes this part
nose tends to conform to the general winding curvature of the spine the least flexible, so that any attempt to reor
of scoliosis. This can lead to the habit of one-sided ganize the thoracic curvature here will require parallel
chewing. As structural bodywork reduces the curva work with the structure of the rib cage. If the thoracic
ture of scoliosis it is often necessary to deal with the spine is 'too flat', it will produce an unfavourable angle
myofascial asymmetries around the jaw to assist it to sit of action for the neck extensors, which are consequently
more symmetrically. overworked and liable to form trigger points and fibrotic
PRAC T I C A L M A N UA L
adaptations between the shoulder blades. The thoracic forces coming up through the skeleton (Alexander
erectors have a mechanical advantage when they pull 1975, 1988). So the common practice of attempting to
around a curve, and become stressed if this curve is reduce this lordosis uncritically is often shortsighted.
absent. However, if the thoracic spine is too curved, or The flattened lumbar spine is typically associated
kyphotic, then it will feed into patterns such as the expi with a posterior tilting pelvis, shortened hip extensors
ration fixed chest or a shortened ventral aspect of the (particularly the hamstrings), obliques, and the lower
trunk, so there will inevitably be a corresponding short rectus abdominus, as well as a tendency towards flac
ness on the anterior chest wall. But as is often the case cid gluteals and external rotation of the femurs (what
with the spine, the chief contributors to the spine's form later we will call the 'external' pattern). At a ligament
are the long spinal ligaments rather than the fascia. The ous level, it is the anterior longitudinal ligament in the
thoracic aspect of the anterior longitudinal ligament is lumbar spine that has shortened (though it is more
obviously not amenable to the application of direct likely the case that it has never lengthened). Because of
techniques so, although direct myofascial work to the the widespread use of chairs in Western societies, there
ventral aspect of the trunk will assist in ameliorating a is a common tendency to slump in sitting, and even to
kyphotic pattern, it is probably only through 'counter develop lumbar kyphosis in the seated posture. This
curve' stretching that this deep, strong ligament can be can be deleterious for those whose lumbar lordosis is
significantly affected. In Chapter 16 several stretches diminished anyway, and especially deleterious for soft
will be shown that can influence this ligament in the tissued types whose lax ligaments will tend to even
thoracic area. greater laxity through slumped sitting. Biomechani
cally there is less shock absorption in the flat lumbar
spine and therefore a greater tendency towards com
The lumbar spine
pression problems in later life. In the elderly one often
There is a widespread misconception among the general sees this typical pattern of collapse where there is an
public (and even among some somatic professionals) extreme posterior tilt of the pelvis, which combined
that a lumbar lordosis is not a good thing. Add with a growing thoracic kyphosis leads to a compressed
itionally, the lordosis is often confused with a sway back, abdomen and the habit of sitting on the coccyx or even
which is probably best described as an anterior shift of the sacrum instead of the 'sit bones'. It is also common for
the entire pelvic segment and can be accompanied with flat-backed clients to develop non-specific knee pain, and
either an excessive or a diminished lumbar lordosis. it might be conjectured that this is another consequence
Hence, many new clients will insist that they have too of inefficient absorption of compressive ground forces.
much lordosis when in fact they have very little. The
view of many structural bodyworkers, however, is that
The rib cage
having either an excessive or diminished lordosis can
be equally problematic. The common term 'rib cage' is actually a misnomer since
Excessive lordosis is normally associated with an there is little of the rigidity that 'cage' might suggest;
anterior tilting pelvis, shortened hip flexors and lumbar the ribs are usually quite springy and compressible and
erectors, and internally rotated femurs. At a ligament have synovial connections with the thoracic vertebrae
ous level there is a shortening of the posterior longitu and discs, but also at the cartilaginous connections
dinal and interspinous ligaments of the lumbar spine, around the sternum.
and often a tension in the ilio-femoral ligament that The ribs can be visualized as a series of cantilevered
severely limits hip extension. An exaggerated lordosis rings of bone connected to the spine at the back, to the
tends also to be linked with an exaggerated kyphosis sternum at the front, to adjacent ribs by the intercostal
and a cervical lordosis. On the basis of a meticulous fasciae, and unified internally by the endothoracic
mathematical modelling of the spine, Gracovetsky (1988) fascia. The ribs are 'hinged' at their synovial attachments
suggests that a lumbar lordosis is absolutely necessary at the spine and have quite a complex movement dur
for lifting and, in general, for the transmission of power ing respiration that involves rising and falling in a
through the skeleton in trunk flexion and extension. Other 'bucket-handle' fashion, but also twisting as they rise
investigators have emphasized the shock-absorption and fall. During respiration the rib cage expands in all
potential for the lumbar lordosis because it can act as a directions, including backwards and downwards, but
spring, somewhat like the old-fashioned car suspen is stabilized by the quadratus lumborum against the
sion, and can dampen the shock of compressive ground pull of the diaphragmatic crura.
A CATA LO G U E O F S O M E C O M M O N PO S T U RA L DYS F U N CT I O N S
I f we consider the structural environment o f the rib

cage as a whole we note that the skeletal support is
entirely posterior; the anterior aspect, the space between
the xyphoid process and the pubic bone, is spanned by
soft tissue alone. This does suggest a potential design
problem - since there is no skeletal support down the
front, just how do we prevent the front of the chest from
dropping towards the pubis, compromising breathing
and pressing on the contents of the abdominal cavity?
This is actually one of the most common postural dys
functions of all. There are two main ways of preventing
this collapse:
• by tightening the erector spinae, which in synergy
with the scalenes can lift the chest from above (no
doubt assisted by other accessory breathing muscles)
• through a valsalva manoeuvre - a general increase in
Inspiration fix
the tonus of the abdominal muscles, which turns the
visceral core into a hydraulic balloon that can sup
port the rib cage from below (what has more recently
been termed core support), or
• through a balanced combination of both of the above.
It has been suggested already that the erector spinae

scalene solution is less favourable for those with dimin
ished spinal curvature, so it is quite common for 'flat
back' clients to mobilize the scapular retractors as well
in an attempt to lift the chest, which leads to the
military-squared shoulders seen in so many of them.
Rolfers talk of two extremes of rib adaptation: inspir
ation fix and expiration fix. Since we rarely use our whole
lung capacity for most activities in daily life our breath
can habitually hover around the point of maximum
capacity or minimum capacity, or anywhere between,
and this will in time modify the fascial and ligamentous Expiration fix
structure of the chest. Those who tend towards maxi Figure 12. 19 Inspiration and expiration fixation of the chest.
mum capacity are called 'inspiration fixed' and have
the 'pumped chest' look of bodybuilders; those towards
minimum capacity are called 'expiration fixed' (see Fig.
12.19). According to many in the field of somatic psy
chology, there are definite emotional tendencies associ
ated with these patterns of chest organization, and the
brea thing patterns tha t go with them (Keleman 1 985).
These patterns also tend to reflect the solutions
people have found to counter the collapsed chest. Inspir
ation fix is often associated with the above-mentioned
pattern of an elevated tonus in the thoracic erectors, Diaphragm --\-+--/
scalenes and shoulder girdle retractors. Expiration fix
can be the result of several factors: the tendency just to Crural
collapse and 'let go' into our fascial and ligamentous

slings, or as a result of a constant low level of elevated
tonus in the trunk flexors, which is what Feldenkrais Figure 12.20 Expiration fix and the shortened diaphragm.
P RAC T I C A L M A N UA L
called 'the body pattern of anxiety' (see Schleip in Sterno-clavic ular joint
Chapter 13). Both of these tendencies may also be exac
erbated if there is insufficient tonus in the deep abdom
inals, the transversus in particular. In either case, the
costal arch and xyphoid process will not only drop
closer to the pubis but will also angle inwards towards
the crural attachments of the lumbar spine. One might
expect that the internal fascial connections from front to
back, the diaphragm and visceral connective tissue,
will adaptively shorten in time and serve to maintain
the collapsed chest pattern (see Fig. 12.20). So, in order
to fully address this pattern some means of lengthening
the internal fascia is also required. Some stretching
approaches will be covered in Chapter 16.
Shoulder girdle
Figure 12.21 The shoulder girdle.
The shoulder girdle is the clavicle-scapula complex
from which the arms are suspended (see Fig. 12.21). Its
function is bringing the hands into contact with as chest. Elevated and protracted shoulders are particu
much of the immediate tactile environment as possible. larly implicated in 'the body pattern of anxiety', while
It is connected to the axial skeleton chiefly by soft tis retracted (or military squared) shoulders are statistic
sues, since the only ligamentous connection to the axial ally related to what we later call the external posture,
skeleton is at the sterno-clavicular joint. Because of the involving a flat back and a posteriorly tilted pelvis. Less
extensive musculature connecting the axial skeleton to frequent is the depressed shoulder girdle, which tends
the shoulder girdle and other muscles crossing the to be found mostly among those we have called the
gleno-humeral joint, the mutual influence of the neck soft-tissued types. The elevated-protracted pattern is
and shoulder girdle can be quite marked. So work on produced by the synergistic operation of the shoulder
the neck and shoulder girdle go hand in hand. girdle elevators and the pectoralis minor, and is usually
Embryologically, the shoulder girdle is related to the an aspect of the forward head syndrome.
pelvic girdle since the limb buds appear about the same The shoulder girdle will inevitably adapt to a scoli
time; however, functionally it does not have the stabil otic pattern of the spine and tend to sit approximately
ity or weight bearing function of the pelvic girdle, but is perpendicular to the upper thoracic spine, leading to
adapted more to positioning the hands in as wide a the common postural pattern of one shoulder sitting
sphere as possible. And in one of the typical comprom higher than the other (Fig. 12.23). Even if the scoliotic
ises in our somatic organization, mobility is gained at client has cleverly managed to maintain horizontal
the expense of stability. The shoulder girdle is designed shoulders there will be a left-right asymmetry in the
to allow free movement via the sterno-clavicular and rhomboids and trapezius.
acromio-clavicular joints, and the scapulo-thoracic articu
lation. As a unit the shoulder girdle should ideally rest
The pelvic girdle
snugly on top of the superior, conical apex of the rib
cage, yet we continually find the girdle shifted from The pelvic girdle is the central exchange for the
this natural 'home' position and displaced in a number mechanical forces in the body. It mediates the trunk
of ways. above and the lower limbs below, transmitting com
Through habitual usage, the shoulder girdle may be pressive vectors down through the lurnbo-sacral junc
displaced in elevation, depression, retraction, protrac tion, the sacroiliac joints, the pelvic arches and into the
tion, or more likely in some combination of these direc legs via the acetabula. Compressive ground forces travel
tions (see Fig. 12.22). And since the girdle rests on the upwards by the same route. The pelvic girdle serves as
top of the rib cage it will naturally conform to the shape the attachment for a great many very powerful muscles
of the upper ribs, whether lifted above the 'pumped' and therefore responds to tensional vectors from many
chest or dropping forward and down onto the collapsed directions; and it must also withstand the wedging action
A CATA LO G U E O F S O M E C O M M O N P O S T U RA L DYS F U N CT I O N S
Depressed Elevated
Retracted Protracted
Figure 12.22 Some typical displacements of the shoulder girdle.
of the visceral mass above. During gait there is a shear

ing moment through the pubic symphysis and sacro
iliac joints as weight shifts from one side to the other. In
all, there are a great many vectors to deal with. How
ever, the pelvic girdle is able to harmonize these forces
because of its extraordinary structural design. The
innominates and sacrum are stitched together and uni
fied by an intricate network of ligaments that either
reinforce the points of articulation or else act like pliable
cables by uniting the bony superstructure of the pelvis
from the inside and creating a tensegrity structure of
great strength (see Fig. 12.24). All the ligaments work
together to make for a strong yet yielding structure that
can safely transmit all the distorting mechanical forces
that pass through it.
The pelvic segment can habitually be shifted anteri
orly or posteriorly in standing such that the weight of
the upper body falls in front of or behind the hip joint,
requiring different muscles to stabilize the pelvis in
Figure 12.23 The relationship between the shoulder girdle and standing. Flury notes that the different combinations of
thoracic spine in the scoliotic client. (Dalton 1 998.) pelvic tilt and shift tend to set up fairly predictable
· PRACTICAL M A N UAL
112
Iliolumbar ligament
Lumbosacral
ligament
5th lumbar
vertebra
Anterior
longitudinal
ligament
Ventral
sacro-iliac
ligament
Greater sciatic
foramen
Sacrospinous
ligament
(c.f. coccygeus)
Ventral sacro
coccygeal
ligament
Anterior superior Lesser sciatic

iliac spine foramen
Sacrotuberous
ligament
Pectineal
Anterior inferior iliac spine
��_;;i�!- ligament
Iliopectineal eminence
Iliolumbar ligament
Short posterior
sacroiliac
ligaments
Sacrotuberous �n----,k��iir-:-'i
ligament
Long posterior
sacroiliac
ligaments
Superficial fibres of
posterior sacrococcygeal ll7J'(�??::;�';;;;;'::
ligament
Sacrotuberous
ligament: 4..---l.......,.---'
.. k---\:\
helical margin
Falciform process -----...,r"':;jjj
Figure 12.24 The ligamentous structure of the pelvis. (After Gorman.)

A CATA LO G U E O F S O M E C O M M O N PO S T U R A L DYS F U N C T I O N S
patterns o f fascial strain and contracture that may need • promote muscular imbalances that will perpetuate
to be addressed through soft-tissue work (Flury 1989). trigger points in the affected muscles, especially in
The myofascial adaptations related to these patterns the quadratus lumborum
will be examined in more detail in Chapters 13 and 14. • cause back pain (which is frequently relieved by a
There may also be asymmetries in the frontal plane, compensating heel-lift).
side-shifted patterns, in which left-right imbalances of
the hip abductors and adductors arise. These side-shifts It was also noted that if an LLD is artificially induced
may be due to asymmetrical usage, or through a differ with a heel-lift, then normal subjects will begin to experi
ence in leg lengths. ence back pain within a few days, They also make the
interesting point that if children are given compensa
Leg length discrepancy (LLD) tory heel-lifts then leg lengths will equalize within 3-7
Radiological research has shown that: months (Simons and Travell 1999).
An LLD will inevitably result in pelvic obliquity, an
• 17% of people have a leg-length discrepancy of more
induced scoliosis and altered gait biomechanics that can
than 10 mm, and
cause stress around the lumbar-thoracic junction. LLD
• 35% of people have an LLD of between 5 and 10 mm
may also result in other postural patterns such as ilial
(Laughlin, 1998).
torsion or rotatory displacements around the midline. It
Hence more than 50% of the population have a true dis should not, however, be confused with a unilateral con
crepancy in leg length of 5 mm or more (see Fig. 12.25). tracture of the adductors, which can mimic its outward
Laughlin argues that, depending on other interacting appearance.
factors; an LLD of this seemingly small magnitude can If we look at the geometry of LLD in standing, the first
have serious ramifications in terms of postural balance obvious fact is that the different heights of the femoral
and its attendant pain, depending on usage factors. For heads will cause the tops of the ilia to stand at different
example, a 10 mm LLD is more significant if you teach heights, setting up the pelvic obliquity in the frontal
four aerobic classes a day than if you sit all day at a plane (see Fig. 12.26). A factor often missed by researchers
desk. In their review of the research into LLD, Simons in this area is that the width of the hips is a confound
and Travell (1999) note that this condition can: ing factor here. The larger the distance between the
Figure 12.25 Some examples of leg length discrepancy.

P RACT I CA L M A N UA L
Figure 12.26 The pelvic angle of obliquity.

Figure 12.27 How the angle o f obliquity is influenced b y hip
width (distance c < d, angle a > b).
femoral heads, the smaller the angle of the pelvic obli

quity caused by an identical LLD (see Fig. 12.27). In crude cervical spine - forming the common 'C' or 'S' curve
terms, the wider your hips the less the effect of an LLD. adaptations of scoliosis - or sometimes curves even more
This factor is not considered in most studies, which complex than this. These side-bendings are accompa
implicitly assume that a 10 mm difference will be the nied by rotatory compensations in which the anterior
same for all. aspects of the vertebral bodies tend to rotate towards
In all cases of LLD the sensory-motor intelligence of the side of the concavity at that level.
the body is obliged make some kind of adaptive response, If the sensory-motor intelligence of the body opts to
and there are essentially two main avenues open to it: minimize the effects of LLD by trying to level the pelvis,
it can achieve this by:
l. To accept the height difference at the acetabula by
adapting through the upper body • keeping the longer leg continuously flexed
2. To minimize the height difference at the acetabula by • externally rotating the longer leg (which will tend to
adapting through the hips and legs. pronate the foot, collapse the medial arch, bring the
calcaneus more valgus and thereby shorten the leg
Or, of course, it can try a little of both.
on that side: a 10 mm difference is achievable by prona
If the height difference at the acetabula is accepted
tion alone)
then inevitably the sacral base will tilt from the horizontal
• rotating the hip of the longer leg forward or back
in standing, setting up an induced scoliosis. With a
(usually forward), circling around the vertical axis of
sacral base tilting from horizontal in the frontal plane,
the shorter leg (which means that the longer leg is
the lumbar spine will list from vertical. An intelligent
then constantly maintained at a more acute angle
body is then obliged to bring the centre of mass of
to the ground in the sagittal plane and one hip will
the upper body back towards the midline, setting up a
be rotated forward)
Side-bending adaptation in the lumbar spine with
further compensating side-bends in the thoracic and or more likely some combination of the above.
A CATA LO G U E OF S O M E C O M M O N P O S T U R A L DYSF U N CT I O N S
The adaptations o f the rib cage and shoulder girdle

are not entirely predictable from the longer leg as
a 'C' curve adaptation will usually lead to a low shoul
der on the side of the longer leg (see Fig. 12.26),
while an '5' curve adaptation will often lead to a low
shoulder on the side of the shorter leg. Laughlin
( 1998) notes that, in his clinical experience, the com
plexity of scoliotic patterns seems to be largely asso
ciated with how adaptable people are in the upper
chest. Those with little ability to adapt here tend to
develop a simple 'C' curve scoliosis. Those with
cleverer bodies tend to develop the '5' or even more
complex curvatures.
There are two ways that the structural bodyworker
can address the LLD-induced scoliosis: to relieve the
system in the short- to medium-term by releasing the
shortened fasciae and allowing the system to lengthen
generally, or to suggest an orthotic, a simple heel-lift, to
partially compensate the shorter leg. In either case the
myofascial work is virtually identical.
Clients that have been given heel-lifts by podiatrists
often report annoying settling discomforts and even
emotional irritation; this is probably because the body is
being asked to make a lot of quick adjustments to a new
Figure 12.28 The externally rotated leg.
postural regime. The approach of structural bodywork
is first to perform general lengthening and balancing,
and then to prepare the client for the orthotic by making
through the myofascial approach), or there may be inter
the soft-tissue adjustments in advance of their wearing it.
segmental rotations such as tibial torsion or eversion of
The body is then prepared and can easily 'slot into' the
the feet (which are less readily addressed, being fixated
new postural arrangement.
at a ligamentous level).
In physiotherapy circles, this pattern is known as the
Ida Rolf spoke a great deal about the pattern of exter
short-leg syndrome. Key ( 1993) describes the common pat
nally rotated legs, the 'toes out' posture that is an aspect
tern in which the longer leg is slightly advanced in stand
of the 'first position' in ballet, and regarded it as a par
ing, leading to a flexion contracture, a reduced stride
ticularly stressful habit (see Fig. 12.28). In the internal
length in the shorter leg that alters gait pattern. There is
external model of structure (see Chapter 13), the external
an asymmetrical pattern of rotation around the longitu
rotation of the leg is more commonly found in the 'exter
dinal axis during walking that results in stress at the
nal' (flat-backed) form of organization. Myofascially it
lumbar-thoracic junction because the lumbars, hav
is the external rotators of the hip that will adaptively
ing very little rotation in themselves, will conduct the
shorten. The anterior adductor mass will present for
rotatory aspect of gait directly to the lumbar-dorsal junc
ward and will be positioned to work more like hip flex
tion, thereby stressing it asymmetrically. The asymmet
ors. The gait pattern of this 'toe out' position leads to a
rical stresses around the hips can lead to mild sacroiliac
swaggering gait (try it), like an inverted pendulum.
disorders and back pain.
Because of the external rotation of the foot, the 'toe off'
phase of walking will bring more weight to bear on the
inner arch of the foot encouraging pronation and, in the
Legs
longer term, the stressing of the ligaments that support
Apart from length discrepancies between the lower the medial arch, ultimately encouraging the medial
limbs, legs can exhibit internal or external rotations that migration of the navicular and the tendency to big toe
may emanate from the hip (which are readily addressed adduction or bunion formation.
P RACT I C A L M A N UA L
REFERENCES
Abrahams V 1982 In Garlick D (ed) Proprioception, posture Gracovetsky S 1988 The spinal engine. Springer, Vienna
and emotion. Committee in Postgraduate Medical Education, Keleman S 1985 Emotional anatomy. Center Press, Berkeley
Kensington, NSW Key 1993 Body in action. Bantam Books, Moorebank,
Alexander R M 1975 Biomechanics. Chapman and Hall, pp 116-130
London Larson J 2000 Central nervous system processing in idio
Alexander R M 1988 Elastic mechanisms in animal move pathic scoliosis. Rolf Lines 28(4): 21-22
ment. Cambridge University Press, Cambridge Laughlin K 1998 Overcome neck and back pain. Simon and
Berthoz A 2000 The brain's sense of movement. Harvard Schuster, New York
University Press, Cambridge, Massachusetts Maitland J 2001 Spinal manipulation made simple: a manual
Chaitow L 1996 Muscle energy techniques. Churchill of soft tissue techniques. North Atlantic Books, Berkeley
Livingstone, New York Pare S 2002 An interview with Judith Aston, Part III. Rolf
Fiorentino M R 1981 A basis for sensorimotor development Lines 30(1): 8-11
normal and abnormal. Charles C Thomas, Illinois, Chapter 1 Richardson C 1998 Therapeutic exercise for spinal segmental
Flury H 1987 Structural levels at the pelvis. Notes on stabilization: in lower back pain. Churchill Livingstone
Structural Integration 1: 25--34 Rolf I 1977 Rolfing: the integration of human structures.
Flury H 1989 Theoretical aspects and implications of the Harper and Rowe, New York, pp 277, 184, 232
internal/ external system. Notes on Structural Integration Schultz R, Feitis R 1996 The endless web: fascial anatomy and
1: 15-35 physical reality. North Atlantic Books, Berkeley
Flury H 1991 The line, the midline, the postural curve, and Simons D, Travell J 1999 Myofascial pain and dysfunction:
problems of stance. Notes on Structural Integration 1: 22-35 the trigger point manual. Vol 1. Upper half of body.
Garlick D (ed) 1982 Proprioception, posture and emotion. Williams & Wilkin, Baltimore, pp 179-182
Committee in Postgraduate Medical Education, Kensington, Todd M 1937 The thinking body. Princeton Book Company,
NSW Princeton
Gelb M 1981 Body learning: an introduction to the Alexander Von Diirkheim K 1977 Hara: the vital centre of man. George
Technique. Henry Holt, New York Allen & Unwin, London
SOME USEFUL
MODELS FOR
WORKING WITH
STRUCTURE
Having catalogued some of the most common postural particularly at how pelvic tilt and shift can interact to
dysfunctions in the last chapter, we will now look at influence the curvature of the spine and how the mus
some different ways of visualizing and understanding cular dynamics of these different aspects of postural
whole body patterns. In this chapter we will examine a habitus can lead to fairly predictable patterns of strain
number of important models that can help us perceive within the fascial network. The model was originally
aspects of our clients' postural-structural organization: inspired by a relatively minor observation made by
John Upledger in his classic text on craniosacral therapy
• The internal-external model, which has evolved
(Upledger and Vredevoogd 1983). Upledger noticed a
within the Rolfing community as a means of differ
pronounced postural habitus that correlated with two
entiating different kinds of sagittal organization.
kinds of disturbance to the craniosacral rhythm - towards
• Janda's identification of the muscular patterns
the 'flexion' or 'extension' phase (at the sphenobasilar
involved in common postural dysfunctions, particu
junction). He observed two polar postural types: (1) the
larly the different responses of tonic and phasic mus
'flexion lesion' type, who are externally rotated at their
culature to stress.
extremities, have a broad cranium and a 'waddling
• Feldenkrais' contribution to our understanding of how
quality' to their gait; and (2) the 'extension lesion' type,
emotional complexes can have a postural outcome -
who have internally rotated extremities and a narrower
particularly through 'the body pattern of anxiety', a
cranial vault. Craniosacral therapists of the Upledger
pattern of exaggerated flexor tonus.
school call them flexion or extension types. This model,
• Hanna's extension of Feldenkrais' ideas to include a
however, has been considerably augmented and extended
postural pattern based upon exaggerated extensor
within the Rolfing community.
tonus.
Jan Sultan, a senior Rolfing instructor, became inter
• Schleip's extension of Hanna's typology to include a
ested in this correlation observed by Upledger and
collapsed pattern.
sought to clarify this typology within his own clinical
• Myer's anatomy train concept - a detailed map of the
practice (Sultan 1986). When palpating the cranial
longitudinal fascial lines of the body.
rhythm of his clients he found about a 90% correlation
between the pressure preference (towards the exten
sion or flexion phase of the rhythm) and the tendency
THE INTERNAL-EXTERNAL MODEL towards internal or external rotation of the femora. For
the most part, however, he discovered people were of
The internal-external model is a way of looking at struc mixed types, rather than being one of the 'pure' types
tural dysfunctions that are most evident in the sagittal in Upledger's schema. Sultan took the pure types as
plane. It looks at the broad tendency for the body's extremes on a spectrum calling them congruent types,
extremities to rotate internally or externally and how while those with mixed characteristics he called con
this tendency relates to other segmental displacements flicted. From his clinical observation of the two congru
in the body, for instance, the organization of the chest, ent types he arrived at the broad set of tendencies
pelvis, legs and the form of the spinal curves. It looks shown in Figure 13.1.
PRACTICAL MANUAL
External congruent Internal congruent
Vault broad, prominent frontalis, Head Long narrow vault, jaw delineated,
'retracted' mandible, 'flat' occiput prominent occiput
Primary and secondary curves Spine Spinal curves augmented

diminished
Inspiration fixed, wide chest, narrow Thorax Expiration fixed, wide back, narrow chest
back
Drawn posterior-medial (back) Shoulder girdle Drawn anterior-lateral (forward)
Ilia tilted posterior on axis through Pelvis Ilia rotated anterior on axis through
acetabula, narrow tuberosities, broad acetabula, wide tuberosities, narrow crest
across crest
In external rotation referenced to Femurs In internal rotation referenced to the sagittal

sagittal plane, 'valgus', X-legs plane, 'varus', O-Iegs
Short, anterior Calcaneus Long
Arches fixed high, often rigid Sub-talar foot Low to flat
Figure 13.1 Sultan's congruent types.
He also noticed a broad correlation with personality with their underlying type, that is, to try to resolve the
characteristics, externals tending to be more 'outgoing' conflicts within their structure. Then the work should be
and internals more 'reserved'. to ease any exaggerated segmental displacement in the
Sultan suggests that each type will tend to present now more congruent structure.
with characteristic patterns of fibrous density within Figure 13.2 shows some typical profiles of internals
the myofascial network: 'In each of the polar types and externals. Subjectively, we sense the difference
then, there is a predictable imprint on the myofascial expressed. Note the stolid groundedness of externals
web that is demanded by the habitual use of the struc and the springiness of internals.
ture'. This imprint consists of lines of increased fibros
ity within the myofascial network which arise from the
Flury's internal-external model
increased mechanical stress that follow these lines dur
ing everyday usage, and is determined by the different Hans Flury is a Swiss Rolfer and physician who has
biomechanics of each type. It can be thought of as a delved deeply into the biomechanics of the internal
three-dimensional pattern of increased collagen density external typology and has published extensively his
within the structural body. musings and findings. In his prolific writings he has
Although there are some people who clearly are con attempted to elucidate the biomechanics of structure,
gruent types, that is, they display all the listed charac exploring key functions such as standing, sitting, fold
teristics of the type, in practice most will have mixed ing and breathing from a structural point of view. He
tendencies, being incongruent, or in Sultan's terminol has also made an extensive semantic analysis of the
ogy 'conflicted'. All, however, will tend to show a pref meaning of key concepts such as 'structure', 'integra
erence towards one end of this structural spectrum tion' and 'normal' in an attempt to clarify their mean
(Sultan 1986). In practical terms, knowing the client's ing, and hence lead the way to a clearer discourse
tendency, whether towards the internal or external within the structural bodywork community. Also, he
organization, has major consequences in strategizing has contributed to our understanding of efficiency in
the subsequent bodywork. He suggests that the first aim movement with his theory of normal movement. Briefly,
should be to take the client towards more congruence his movement work is concerned with the initiation of
SOME USEFUL MODELS FOR WORKING WITH STRUCTURE
Figure 13.2 Typical internal and external profiles.
Internal profiles
External profiles
movement, whether through a relaxation of the antagon different structural types. It has been mentioned before
ists, or an increased tonus in the agonists, which is a that there is a widespread, unacknowledged assump
distinction that bears considerably on movement effi tion in the world of somatic therapy that there is only
ciency. One of his major achievements, however, has one best kind of posture and one best way of trying
been to describe the different muscular dynamics of to achieve it. Flury shows that there are qualitatively
PRACTICAL MANUAL
different kinds of organization of the pelvis and that to depending on the organization of the fascial net (see
treat them as if they are the same means risking taking Fig. 13.3). The greater the divergence between the zig
some clients further into an unbalanced pattern. zag line and 'the Line', the more the muscular energy
His approach is based on the strict application of is required to stabilize the segments or 'blocks' of the
Newtonian physics and especially the rotatory effect body, and therefore the less efficient the standing organ
of gravity on the various segments of the human body. ization (see Fig. 13.4). He sees structural improvement
The structural model is developed in great detail in his
Notes on Structural Integration (Flury 1986-1993). He
takes the primary structural unit to be the fascial net
and sees the integration of structure as balancing the
fascial net such that the musculature supplies the least
force necessary to counteract the bending and shifting
effects induced by gravity.
The expression 'fascial net' has been widely used in
the field of structural bodywork to give an impression
of the three-dimensional organization of the 'organ of
structure'. Flury states, however, that the more
appropriate metaphor is a system of:
balloons inside balloons, with the characteristic that
the balloon wall has a certain tension and the con
tents (the filling) a certain pressure. The tension of the
balloon wall (a passive tension) is modified by the active
tension from muscle tissue or fibers, something like the
basic frequency of a radio station that always remains
the same but is modulated in order to produce music.
(Flury, personal communication 2002)
This inherent passive tension in the fascia perhaps

explains why muscles immediately shorten if a tendon
snaps or becomes detached.
In Chapter 8 we touched upon Flury'S elucidation of Figure 13.3 Two sagittal profiles showing the average midline
structure. He states that we cannot see structure but can and 'the Line' (adapted from Flury).
only infer it. When we look at someone standing still,
we see a coordinated pattern of muscular tonus, super
imposed upon a three-dimensional tensile pattern
within the fascial web. Different tensile patterns within
the fascial network can lead to various degrees of effi
ciency in standing and in movement. A poorly balanced
fascial network will require a greater expenditure of
physical and nervous energy, whereas a more organized
fascial network will require less. Therefore he regards
structure, abstractly, as the pattern of passive tension
within the fascial network minus the effects of the
current tonus pattern of the musculature.
In this analysis of standing posture, the average mid
line of the body can be visualized as composed of the
centres of mass of each horizontal section of the body,
what Flury calls the 'zig-zag' line. It may be recalled Figure 13.4 'Various midlines and their relationship to the
that 'the Line', in Rolfing terminology, is a plumb line Line . . . The shaded area on the left and right of the line are equal
through the body's centre of gravity, and the average and indicate how much energy must be spent to hold up the
midline can be closer to or further from 'the Line' "body" against gravity' (Flury 1991).
as bringing the zig-zag line closer to 'the Line' in a way

that allows maximum muscular efficiency. For various
reasons there can never be an exact correspondence
between the zig-zag line and 'the Line'.
Whereas Sultan takes femoral rotation to be the key
factor in determining the structural type, Flury uses the
degree of tilt of the pelvic segment. Flury makes a crit
ical distinction between the structural 'pelvic segment'
and the anatomical pelvis, noting that the pelvic seg
ment has a rotatory axis higher than the axis connecting \
the acetabula (Flury 1989). He has extended some \
aspects of Sultan's model by focussing on the different \
kinds of organization of the pelvis. His postural \
structural typology is based upon four different organiza
tions of the pelvic segment in standing, four different
combinations of sagittal tilt and shift, and each having
a fairly predictable pattern of fascial elasticity or rigid
ity that determines the shape of the whole. These struc Figure 13.5 The basic internal and external pattern.The dense
tural patterns, however, may evolve differently in both lines show shortened tissue, the dotted lines show lengthened
the cranial and caudal directions, and they are overlaid tissue (with the kind permission of Dr Hans Flury).
by permanently changing functional patterns of active
tension. Some people may habitually have 'collapsed'
and given in to gravity while others may have actively
'overcompensated' and struggled against it, and each
of these tendencies in the longer term will leave a
definite imprint in the fascial net.
Tissue that has adaptively shortened is described by
Flury as being in 'primary shortness'. For instance, in
cases where the shoulder girdle is habitually protracted
the pectoral fascia is actually shorter in a geometric
sense. In contrast, in his terminology, he says tissue is in
'secondary shortness' when it has lengthened geometric
ally and adapted to continuous functional demands by
stretching and rigidifying, for instance the erector spinae
group over a strongly kyphotic back. In both cases the
tissue has become less resilient, less able to lengthen.
The practical aspect of this model is that by knowing
the areas of primary shortness in the fascial net we are
informed of where we need to work. It is the tissue that is
in primary shortness that needs to be lengthened or made Figure 13.6 Anterior and posterior shift patterns of the pelvis
more resilient. This then removes the functional burden (with the kind permission of Dr Hans Flury).
from the 'antagonist' tissue in secondary shortness.
through the acetabula). An anterior tilt means that the
The structural types ASIS has moved anterior and inferior, a posterior tilt
Adopting the basic terminology of Sultan, Flury calls means that the PSIS has moved posterior and inferior.
the pattern of an anterior tilting pelvis 'internal', while The other major variable Flury considers is pelvic shift,
that with a posterior tilt 'external' (see Fig. 13.5). Here the sagittal shift of the pelvic mass, either forward or
pelvic tilt is defined as the movement of the superior back of 'the Line' (Fig. 13.6). Of shift, Flury notes that
aspects of the pelvis away from a neutral or 'horne' pos this tendency can be more difficult to determine than
ition around an axis through the centre of gravity of the tilt, simply because most of us at times slip into an ante
pelvic segment (which is actually higher than the axis rior shift as a posture of relaxation. Flury calls this a
PRACTICAL MANUAL
'sleeve supported stance' because it is a stance in which • The anterior shift is quite pronounced.
we rest into the 'sling' or 'sleeve' of all the superficial • There is a tendency to 'rest' in the ligaments and fascial
anterior fasciae (the abdominal fasciae, the iliofemoral slings, resulting in secondary shortness in this tissue.
ligament, and the anterior aspect of the fascia lata). • The knees are always hyperextended.
Thus, when we combine the two aspects of pelvic tilt • The lower legs are shifted posteriorly in relation to
with the two aspects of pelvic shift we have four basic the thigh.
structural types, as shown in Figure 13.7. • The biggest curvature is in lumbar area, with the
The four types are characterized as follows: mid-back usually kyphotic.
Regular internal Since this stance is considered habitual (because it is

- anterior tilt, posterior shift quite economical in a way), postural education is
strongly indicated, with less work required in lengthen
• The hip joint is behind 'the Line'; the weight of the ing the areas of primary shortness.
upper body comes down in front of the hip joint, the The tissues that are in primary shortness are: the lower
thorax tilts back to maintain balance. lumbar erectors and thoracolumbar fascia, the chest, the
• A constant tonus in the hip extensors is required in hip flexors, the distal quadriceps and the tibialis anterior.
order to prevent further anterior tilting of the pelvic
segment - a 'tensional' dynamic. Symmetrical external
• The hip extensors are spared overwork by a slight - posterior tilt, posterior shift
flexion of knees, which may lead to hypertrophy of
• The posterior tilt is pronounced, with the upper body
the vasti group.
weight coming down behind the hip joints.
• The upper thorax often sags through the front,
• Shift is usually of secondary importance to tilt
there is often a strong kyphosis at back, thoracic inlet
and, when tired, such individuals can often allow an
slopes forward.
anterior shift into a 'sleeve supported stance'.
The tissues that are in primary shortness are: the • The upper body 'hangs' rather than 'bends' forward,
groin; the hip flexors, especially the psoas; the lumbar and there is a tendency for the thorax to sag through
erectors; the neck extensors, and the pectoral fascia. the front.
• The knees are flexed or extended but rarely hyperex
Locked knee internal tended.
- anterior tilt, anterior shift • The whole back tends to have a long C-curve kyphosis
• The anterior pelvic tilt is less obvious than in regular in secondary shortness - the 'clearest expression of
internals (however when they are brought back into symmetrical externals'.
a normal stance by shifting the pelvis back to the • There is sometimes a lumbar lordosis of small radius.
midline, the anterior tilt is usually enormous). • Lateral rotation of legs often brings the adductor
mass forward.
Sagittal tilt
Anterior Posterior The tissues that are in primary shortness are: the
Regular internal Symmetrical external hip extensors (hamstrings and gluteals) and the whole
q
ventral surface of trunk.
{
Posterior Regular external
- posterior tilt, anterior shift
• The shift element is considered more important and
Locked knee internal Regular external there is a slight tilt.
f f
• Support is 'compressional' (i.e. maintained less
through tissue tension and more through the more
Anterior
vertical stacking of the skeletal elements).
• The pelvis sits almost on top of the femora.
• The knees are extended.
Figure 13.7 The four structural types of the Flury • There is often a hyper erect spine, sometimes with
internal-external model (with the kind permission of Robert short lumbar lordosis.
Schleip). • There is a characteristic 'banana' profile.
The tissues that are in primary shortness are: ham JANDA'S A PPROACH - TH E
strings, gluteus maximus, posterior gluteals, deep hip BEH AVIOUR O F TH E TONIC AND
rotators and the lower part of abdominal wall. PH A SIC MUS CULATURE
Figure 13.8 shows the typical profile of Flury's
types. Whereas the internal-external model focuses on pat
terns of shortness within the myofascial network,
Janda's approach is more concerned with the aberrant
muscular patterns that can arise from and then main
tain postural syndromes, although he appears to be
describing patterns virtually identical to those in the
internal-external model. Janda's work is based on an
extensive amount of research that has established the
different responses of tonic (postural) and phasic mus
culature to stress (see Fig. 13.9). Under stress tonic
musculature will respond by shortening, while phasic
muscles respond by weakening and showing signs of
neurological inhibition (Chaitow 1996).
The tonic muscles that will shorten under stress
include: gastrocnemius, soleus, hamstrings, short
adductors of the thigh, hamstrings, iliopsoas, piri
Figure 13.8 Profiles of a regular internal, symmetrical external, formis, tensor fasciae latae, quadratus lumborum, the
locked knee internal and regular external showing areas of spinal erectors, latissimus dorsi, upper trapezius, stern
primary shortness. The bold lines show shortness resulting from ocleidomastoid, pectoralis major and the elbow flexors.
pelvic shift; the dotted lines show shortness resulting from pelvic Others could include the oblique abdominals, the lat
tilt (with the kind permission of Dr Hans Flury). eral hamstrings and the anterior and posterior tibialis.
Sterno-cleido
mastoid Levator :,'\------ Upper
-----nil, trapezius
scapulae
Pectoralis __ +---.
major
�n---+--- Latissimus
Oblique Sacrospinalis ---1---1+--111111 dorsi
abdominals
Flexors ]ffi�f-W_\--- Quadratus

Tensor
fascia lata Piriformis -+-I-------J,MW
Adductor ----+r-tH----+�'f!1fh
Rectus femoris ----+\-VIr� magnus
Semimembranosus --H-WI--I--f Bisceps femoris

Mf--- Semitendinosus
Gastrocnemius
-L/I-
__ Tibialis
posterior
w �
Figure 13.9 The tonic musculature (from Chaitow 1996).
PRACTICAL MANUAL
Erector
spinae Abdomainals
tight weak
Deep neck flexors Trapezius and
weak levator scapula
tight
Tight
Weak Iliopsoas
Gluteus
maximus
Tight
Weak
pectorals
Rhomboids
and serratus
anterior
Figure 13.11 The lower crossed syndrome (from Chaitow 1996).

Figure 13.10 The upper crossed syndrome
(from Chaitow 1996).
rhomboids. Typically the occipital area will hyperex
tend and the upper cervicals become compromised.
Janda suggests that the main task of the therapist is to
lengthen the shortened postural muscles, and empha The lower crossed syndrome
sizes that it is not necessary to strengthen the weakened
This pattern (Fig. 13.11) is essentially the same as an
antagonists. This is an important departure from the
extreme internal pattern in the internal-external model.
widely practiced 'stretch and strengthen' protocol. He
In this syndrome the muscles that typically become
suggests that as the shortened muscles lengthen they
tightened and shortened are: the hip flexors (especially
lose their inhibitory effect on their already lengthened
the psoas and rectus femoris), tensor fasciae latae,
antagonists; hence these antagonists will spontan
quadratus lumborum, and the erector spinae in the
eously become more easily recruited and will therefore
lumbar region. The muscles that weaken are: the
strengthen through normal usage and without any need
abdominals and gluteals.
for specific strengthening exercises.
He described a number of common whole-body
adaptations that have characteristic patterns of muscu
FELDENKRAIS - T HE ' BODY PATTERN
lar shortness and weakness as the upper and lower
OF ANXIETY' AND T HE WORK OF
'crossed' syndromes. Treatment is based on lengthening
HANNA
the shortened structures, followed by postural
re-education.
Feldenkrais coined the phrase 'the body. pattern of
anxiety' (Feldenkrais 1949). He was one of the first to
The upper crossed syndrome
-------- - - suggest that our emotional habits and tendencies can be
This pattern (Fig. 13.10) is very close to what we have intimately correlated to patterns of muscular organi
already referred to as the forward head syndrome. In zation. He suggested that negative emotions are
the upper crossed syndrome a number of muscular associated with a muscular response in the flexors of the
adaptations will occur, some tightening and shortening body, while emotional patterns such as 'interest', 'out
and others lengthening and weakening. The muscles goingness', 'assertiveness' and 'exploration' are associ
that tighten and shorten are: the pectorals (major and ated with a response in the extensors. Thomas Hanna,
minor), upper trapezius, levator scapulae and the ster one of Feldenkrais' proteges, developed these ideas fur
nocleidomastoid. Those that become weakened are: the ther and looked at known whole-body reflexes such as
lower and mid-trapezius, serratus anterior and the the 'startle' or 'withdrawal' response, and the Landau
Figure 13.13 Startle reflex in the human embryo (with the

kind permission of Robert Schleip).
• The knees flex.

• The pelvic floor tightens.
• The feet pronate and evert.
• The toes lift.
Schleip notes that in human embryos the startle
response is apparent at as early as twelve weeks.
A sharp sound will cause the foetus to flex even further
(see Fig. 13.13) (Schleip 1993). Hanna suggests that the
startle response may still be operating even when there
Figure 13.12 Startle reflex in man (with the kind
are relatively low-levels of stress; in this case the body's
permission of Robert Schleip).
response will be essentially the same as for more severe
reflex. He noted that elements of these responses could stress, although to a less obvious or dramatic extent.
become relatively fixed and consolidated into our Basically, flexor tone will tend to override extensor
everyday postural organization (Hanna 1988). tone, leaving people with a slightly flexed look that we
often recognize as a sign of stress. This tends to explain
the key areas of muscular soreness that arise from
The startle reflex
stress, the areas people like to have massaged after
This reflex is universal throughout the animal kingdom work: the occipital area and the back of the neck, the
and is a primitive reflex of survival. With a stimulus upper trapezius and levator scapulae, and the solar
such as a sudden loud noise there is an extremely rapid plexus area.
wave of muscular contraction, mostly in the flexors,
that starts at the head and works down to the feet (see The Landau response
Fig. 13.12). Some authors, however, suggest that the
The Landau response is regarded as a developmental
flexion phase of the response is preceded by a brief
milestone that appears between the 5th and 7th month
extensor response (Keleman 1985).
in babies. When the prone baby is lifted from beneath its
In response to a sudden threat, the following will
belly it will arch its trunk backwards, extending its neck,
happen in rapid succession:
trunk and hips by actively engaging its extensor mus
• The jaws contract, then the eyes and forehead. culature, especially the erector spinae (see Fig. 13.14).
• The neck flexes and capitally extends. It seems to be a genetically programmed function that
• The elevators of the shoulder girdle contract - lifting enables the child to orient more into the external world
the shoulders and drawing the head forward and and is a necessary prerequisite for functions that appear
closer to the trunk. later such as crawling, standing and walking. Fiorentino
• The arms abduct, the elbows flex and the hands (1981) suggests that in the early stages it is more about
pronate. orienting the mouth and eyes into the world.
• The abdominals contract - both inhibiting deep Hanna argues that for some people this muscular
breathing and flexing the hip. pattern becomes a chronic habit that then shapes their
PRACTICAL MANUAL
concepts of structural bodywork, particularly the more

mechanical views of structure. He emphasizes the role
of the central nervous system, suggesting that many
so-called myofascial restrictions actually disappear when
aspects of the nervous system are 'turned off'. He and
others have observed that under general anaesthesia
some myofascial restrictions seem to disappear, while
the soft tissues cease responding to the direct form of
myofascial manipulation used by structural bodywork
ers. He believes that the nervous system must be
engaged in the process for this work to be effective.
He is interested in the development of postural
Figure 13.14 The Landau response (from Fiorentino M R habits and how these can lead to structural adaptations
(1981) A basis for sensorimotor development: normal and in the longer term. Following the models of Sultan and
abnormal. Charles C Thomas, III.) Flury, Schleip proposes a 'third model' for the use of
structural bodyworkers, a model that was inspired by
the thinking of Feldenkrais and Hanna. Whereas Sultan
overall posture and movement patterns. He describes
perceived the cranial system as driving our structural
this as the 'Green Light Reflex' to indicate the psycho
tendencies, and Flury saw the fascial organization around
logical state of preparedness or readiness for active
the pelvic segment as central to structural organization,
interaction with the environment. He writes:
Schleip focuses on three major functional determinants
The Green Light reflex is assertive; its function is of postural patterns: the tendency towards an exagger
action. If somebody's posture is dominantly shaped by ated flexor or extensor tone in the musculature, and the
this reflex - or one could say by this attitude - it will tendency to postural collapse.
become a chronic feature and show in a shortening of As discussed previously, Hanna proposed two broad
the genetic extensor muscles. postural--emotional tendencies based upon a predom
(Hanna 1988) inance of one of two primary reflexes: the Landau
response and the startle reflex. He suggested that the
It seems likely that the extremes of these emotional
Landau response in the longer term could lead to a
tendencies will result in structural imbalances and inef
chronic shortening of the genetic extensor musculature,
ficiencies in the overall postural organization and, fur
while the startle reflex could lead to a chronic shorten
thermore, that these postural tendencies may serve to
ing of the genetic flexor musculature - patterns that
maintain the emotional tendencies that led to them in
Schleip calls the short extensor pattern and the short flexor
the first place. What can be termed a postural-emotional
pattern. However, he extends Hanna's typology by sug
complex can develop. Just as the internal--external model
gesting that the short flexor pattern can be divided into
and Janda's approach lead us to expect certain patterns
two subtypes, depending on whether the ventral side
of myofascial shortness, so does this model. The green
has shortened through an exaggerated flexor tonus, as
and red light responses lead to definite patterns of myo
in 'the body pattern of anxiety', or through a postural
fascial shortness. So, if our clients present with these
collapse through the front induced by a 'giving up' of
kinds of pattern, we can address them directly and
the trunk extensors (Schleip 1993, 1995).
thereby help them towards biomechanical integrity, and
The genetic extensors develop on the dorsal side of
indirectly perhaps towards more emotional balance.
the developing embryo, the flexors on the ventral side,
and due to the lateral migration and rotation of the limb
S C H LEI P'S EXTENSION OF HANNA'S buds during embryological development, there is a
TYPOLO G Y loose'cross-over ' at the hips. In crude terms, the flexors
are found on the front of the trunk and on the back of
Robert Schleip is a Rolfing instructor who, through his the legs, while the extensors are found on the back of
cross-training in the Feldenkrais work and his interest the trunk and on the front of the legs (see Fig. 13.15).
in neurology, brings his functional insights to bear In order to understand the different postural effects
upon many issues of structural bodywork. In his writ of the genetic flexors and extensors Schleip examines
ings he often challenges the long held maps and the characteristics of these two groups of muscles.
In differentiating the genetic extensors and flexors, he The short extensor pattern
notes that this distinction is not quite the same as the
A generalized increase in the tonus of the trunk exten
tonic-phasic distinction of the musculature that was
sors will favour an extension of the spine and an inspir
discussed in Chapter 11, although there are close paral
ation fixated pattern of the chest. An increase of tonus
lels. The genetic extensors have a high proportion of
of the dorsal musculature around the pelvis will tend to
slow-twitch fibres (type I, slow oxidative fibres) and are
open the innominates anteriorly into an outflare pat
innervated from the ventral part of the anterior horn of
tern, which involves narrowing the space between the
the spinal cord. They are located on the dorsal side of
ischial tuberosities and widening the space between
the trunk and arms, the ventral side of the legs and the
the ASIS. The spiral orientation of the leg extensors will
plantar side of the foot. The genetic flexors, on the other
tend to rotate the femora externally.
hand, have a high proportion of fast-twitch fibres (type
Other postural features that would tend to arise from
lIb, fast glycolytic) and are innervated from the dorsal
a generalized heightening of extensor tonus are:
part of the anterior horn of the spinal cord. They are
located on ventral side of the trunk and arms, the dor • a posterior pelvic tilt (due to increased activity of the
sal side of the legs and the dorsal side of the feet. hip extensors)
Schleip categorizes the genetic flexors and extensors • shoulder girdle retraction
as primary, secondary and associated, as can be seen in • a pronation of the feet
Table 13.1. • abducted and internally rotated arms
• abducted legs
• valgus knees.
In extreme examples of this pattern you may find

the rigidity of what Ida Rolf called the classical military
posture of shoulders back, chest out (see Fig. 13.16).
The short flexor pattern
A generalized increase in the tonus of the trunk flexors

will lead to trunk flexion. In other words, there will be
a kyphotic thoracic spine and the expiration fixated
(a) pattern of the chest manifested in the very common
Figure 13.15 The genetic extensors (a) and flexors (b) pattern of the collapsed or sunken chest. There will be
(with the kind permission of Robert Schleip). less of a tendency for the femora to rotate externally,
Table 13.1 Schleip's categories of genetic flexors and extensors
Genetic extensors Genetic flexors
Primary Erector spinae (including head and neck extensors) Rectus abdominis
Levatores costarum Infrahyoids
Secondary Sartorius Short foot muscles

Rectus femoris Oblique and transverse abdominals
Tensor fasciae latae Abdominal aspect of pectoralis major
Neck extensors Serratus anterior
Associated Extensor digitorum longus and brevis Tibialis posterior, flexor hallucis longus, flexor digitorum
Extensor hallucis longus longus (the three deep flexors of the lower leg)
Peroneals The long adductors and the obturator externus
Latissimus, teres major and subscapularis Internal intercostals and transversus thoracis
Deltoid Pectoralis minor and subclavious
Triceps, brachioradialis, supinator and all Sternocleidomastoid
wrist and hand extensors
PRACTICAL MANUAL
touch and maternal care. He suggests that a want of

emotional! tactile 'nourishment' might form the basis
for this slumped pattern.
There are obvious parallels between Schleip's model
and the internal-external model. The short extensor
pattern shares many of the features of the external pat
tern, and the short flexor pattern looks very much like
an internal pattern, the main difference being in how
the feet are organized. But since these typologies are
predicated on different driving forces, one can imagine
perhaps examples that cross this divide, for instance
someone with a genetic tendency towards an external
pelvis but dominated by flexor tone. Schleip even
suggests that the Landau and startle reflexes are not
mutually exclusive but can overlay each other, result
ing in a trunk tightened both front and back. It is not
unusual to find clients that are armoured through the
trunk in this way.
MYERS' ANATOMY TRAINS
Rolfer and somatic educator, Thomas Myers has over a

Figure 13.16 The short extensor pattern - the classic military number of years developed an extraordinarily vivid
posture (after Schleip). and useful metaphor for describing the chief, three
dimensional fascial-skeletal linkages throughout the
structural body. Following a line of enquiry that was
and shoulder blades will tend to be protracted. The
inspired by the holistic vision of many thinkers within
pelvis will tend towards an inflare pattern, that is, a
the somatic tradition, he has developed a series of'fascial
narrowing between the ASIS in front and a widening of
maps' that can assist greatly in assessing the deep struc
the ischial tuberosities.
ture of our clients, seeing where specific fascial restric
Other features could include:
tions to functional patterns exist, and in practical
• an anterior pelvic tilt (from hip flexor activity) terms, knowing where specific releases are required.
• a high arch in the feet He describes a number of longitudinal 'trains', or
• elevated shoulder girdles fascial continuities, throughout the structural body:
• adducted arms and legs the superficial back and front lines, the lateral lines,
• varus knees. spiral lines and arm lines, but also lines that run deeper
However, Schleip distinguishes two subtypes within within our core space (Myers 2001).
the short flexors category: a contracted and a collapsed Ida Rolf stressed that local restrictions in the fascial
type. For the contracted type the flexor muscles are network will have global repercussions throughout the
overactive and shortened, and this seems quite close to entire structural body and her 'snagged cardigan'
what Feldenkrais described as'the body pattern of anx image demonstrates in a simple way the directional
iety'. However, some have a shortening on the ventral spread of a strain pattern (see Fig. 9.17). Myers'
side to the trunk not so much through overactive flexors anatomy train maps (Fig. 13.17) can give much more
but through trunk extensors that have 'given in' to precise information about how such restrictions and
gravity and allowed the front to collapse. In both cases patterns of strain spread throughout the structural
there is a lengthening of musculature of the dorsal side body; so, in using these maps as a tool for visualizing
of the trunk resulting in a kyphotic back. Schleip sug our clients' structure, there is an implicit demand
gests that neurologically this pattern may be more that we take a more holistic perspective and move
closely related to what has been called 'postural col away from the 'fixing' mentality of a more remedial
lapse', a typical primate reaction to early deprivation of approach.
Figure 13.17 Myers' anatomy trains (Myers 2001).
REFERENCES
Chaitow L 1996 Muscle energy techniques. Churchill Flury H 1991 The line, the midline, the postural curve, and
Livingstone, New York problems of stance. Notes on Structural Integration 1: 22-35
Feldenkrais M 1949 Body and mature behaviour: a study Hanna T 1988 Somatics - Reawakening the mind's control
of anxiety, sex, gravitation and learning. International of movement, flexibility, and health . Addison-Wesley,
Universities Press, New York Reading, Massachusetts
Fiorentino M R 1981 A basis for sensorimotor development Keleman S 1985 Emotional anatomy. Center Press, Berkeley
normal and abnormal. Charles C Thomas, Illinois, Myers T 2001 Anatomy trains: myofascial meridians for manual
Chapter 1 and movement therapists. Churchill Livingstone, Edinburgh
Flury H (ed) Notes on structural integration. Zurich, Schleip R 1993 Primary reflexes and structural typology.
Switzerland, May 1986, March 1987 December 1988, Rolf Lines 21(3): 37-47
November 1989, August 1990, September 1991, December Schleip R 1995 The flexor-extensor typology: in a nutshell.
1993 [Obtainable through the Rolf Institute.] Rolf Lines 23(3): 10-11
Flury H 1989 Theoretical aspects and implications of the Upledger J, Vredevoogd J 1983 Craniosacral therapy.
internal/external system. Notes on Structural Integration Eastland Press, Seattle, pp 108-110
1: 15-35
130·
PRACTICUM:
A SSESSMENT,
TECHNIQUE A ND
STRATEGY IN STRUCTURAL
BODYWORK
In this section we will look at some practical aspects of unpleasant ones!), and occasionally, after doing every
structural bodywork: making a structural assessment thing that your experience tells you to do, you still do
of our clients, strategizing a structural session and not obtain the expected result.
series of sessions, and looking at some of the technical Working with such complexity requires a willingness
approaches to working with structure. to engage in a process of continuous assessment: always
checking on the outcomes of any particular structural
or functional intervention. A certain kind of humil
ity can result as we realize that structural bodyworkers
ASSESSMENT are facilitators rather than doers. Therefore, it is import
ant not to come to premature conclusions about what
An essential feature of structural bodywork is that it is clients need and never to force an issue, but instead
a process; it does not consist of isolated or stand-alone engage in a genuine ongoing dialogue with them.
sessions; it needs its time. It can take a while to get a There is no absolute distinction between assessment
clear idea of a person's structure, and what seems obvi and ongoing work; one is continually assessing the
ous from an initial visual assessment of the client may client, and asking them to assess themselves. They need
need to be modified as the work progresses. The human to sense the changes in their body, feel the results of an
being is an extraordinary 'system of systems' and we intervention, sense how it is integrated, how it 'ripples
need to adopt a holistic perspective if we are to under through' their system. Constant checking in this way
stand the structure at all. Taking a linear or 'fixing' also keeps clients challenged into listening to their
approach to understanding structure can be useful only bodies.
in the very short term. This means that even the best As therapists we have the advantage of an external
structural work has an exploratory, provisional flavour, perspective of our clients; we can see them from
as work with any complex system must have. Things behind, above and from the side; we can see how they
are rarely as predicable as one would wish, and it takes move in a way that they cannot. The clients, on the
time to understand the complex dynamics involved in other hand, have the advantage of the somatic perspec
standing and moving in gravity. This means being pre tive into their own situation - what it feels like to be in
pared to modify conclusions as new information comes their particular body. We can never experience that for
to light. Ida Rolf expressed this dilemma as 'working them. So both kinds of information need to come
in a quicksand'. Hence, this kind of bodywork does together and this is only possible through dialogue,
sometimes lead to surprises (though not necessarily though this need not necessarily be verbal.
A S S E S S M ENT, TEC HNI Q U E AND STRAT E G Y IN STRUCTURAL B O DYWOR K
E.ssential background information their preference is for a strict regimen or a playful and
exploratory one.
- -
In the initial sessions, it is important to get a sense of:

It is then necessary to examine how the client stands
• their hopes and expectations from this work and walks. This is very different from normal massage
• aspects of their daily routines of movement and practice in which the client, after the initial gather
work activities that may affect structure ing of information, is immediately invited to lay face
• any significant musculoskeletal injuries or surgery in down, bypassing the opportunity to see their stance or
the past movement.
• acute and chronic conditions that may affect the
ongoing work, and Standing assessment of posture
• their exercise regimen, if any.
For the visual assessment, the client should ideally be
It is necessary first to uncover what clients would disrobed to basic underwear, although a skilled eye can
like to achieve through somatic work and how they detect what is happening beneath clothing. This assess
'frame' it: do they believe they have a 'problem' or not? ment is often referred to as 'body-reading' and is a vital
Here it is important to realize that clients may have skill that is taught in structural integration training. It
all sorts of erroneous beliefs about their posture/ involves simply taking as much time as necessary to
structure and unrealistic expectations about what can 'take in' the details of a body, but also seeing the body
be achieved through somatic work. They may have as a whole. This is, of course, quite confronting to
embodied many old wives' tales about what is 'good clients and they may need to be introduced to the idea
posture'; they may have a confused terminology (con gently. It is also traditional in structural bodywork to
fusing lordosis and 'sway back' for instance), or believ take photos at this initial stage so that clients can see
ing that their 'hip' is their 'pelvis', or even not knowing themselves from a different perspective.
that they have scapulae. It is quite common to find that The first and most obvious problem at this stage is how
clients have a very incomplete somatic map, with mis to get beneath the client's automatic posing, 'holding to
placed perceptions of themselves, which can be seen in form', or trying to present as well as possible. Clients can
its extreme forms in conditions such as body dysmor be asked to stand 'naturally' without trying to correct
phism, and often it is only the direct knowledge that anything, but it can also be useful to ask them to slump
something hurts that brings them to a practitioner in into a too-relaxed posture, to 'let go' into what they feel
the first place. is a habitual posture; this can give essential information
In gathering aspects of their medical history it is about how this body responds to fatigue. You can also
important to know if the client has any conditions that ask them to move back and forth slowly between these
may affect the connective tissue network. Structural extremes; this is vital proprioceptive learning that can
bodywork has much the same list of contra-indications help them experience new postural options in a new way.
as massage, so without medical advice to the contrary, This visual assessment should take in the three planes
you would not normally work on clients with active of standing posture: from the front to see left-right
cancer, active inflammation or really acute problems. asymmetries; from behind to check on scoliotic patterns
You would also need to weigh up carefully whether to and how the scapulae are organized; from the sides to
work with women who are in the last trimester of preg check on segmental displacements in the sagittal plane,
nancy, although with experience (and the agreement of and from above to note any segmental rotations. The lat
the client's medical practitioner) it is possible to do ter can be done standing on a stool behind the client and
some relieving work around all the above conditions. looking down the full length of the body (see Fig. 14.1).
It is important to know of any musculoskeletal The degree of internal or external rotation of limbs can be
injuries, impact traumas, and any other physical trauma, assessed from in front. At this stage other important
including surgery, the client may have undergone. impressions can be taken in, for instance, noting whether
Trauma can cause internal adhesions or nerve tethering their basic body type is ecto-, meso- or endomorphic.
that can become inflamed if you work too deeply in the Chapter 12 detailed some of the more important
area. It is vital to know their employment and the pos postural-structural dysfunctions that interest structural
tures and movements required of it. You also want to bodyworkers, so in this section they will only be men
know about any movement regimen they may have: tioned briefly. When assessing the axial organization it
phYSical activities, yoga, sport, or stretching, and whether is important to look at the form of the spinal curvatures,
PRACTICAL MANUAL
For this it is helpful to palpate key areas of the body

very softly, using what Godard (2000) has called
'gamma touch' - a light, non-directive kind of touch.
Simultaneously palpate the abdominals and the lumbar
erectors. Trace the erectors the whole length of the spine,
noting the general tonus and any ropy areas. From
behind gently palpate the scalenes to see how hard they
are working. Simultaneously palpate the quadriceps
and the hamstrings to sense which have the higher tonus.
It should be realized that the very act of palpation can
induce an increase in tonus, particularly in the abdom
Figure 14.1 The view from above to assess segmental inal region, which is why an unobtrusive 'gamma touch'
rotations in the transverse plane. is essential.
If you have sports massage or physiotherapy train
ing it may be useful to supplement this information by
the tilt of the pelvic segment, the placement of the head
employing some of the standard tests for myofascial
on top, and rib cage adaptations. The relationship
shortness, such as the Ober test, the straight leg raise,
between the pelvic segment and the spinal curves
trunk flexion-extension, side flexion, and so on.
should be appraised both in the sagittal plane, noting if
A simple test for internal or external pelvic organiza
there is an obvious internal or external tendency in the
tion is valuable here. To do this, sit on a stool beside the
organization of the pelvis, and in the frontal plane to
client and gently align the major segments of the body,
see if there is any scoliotic tendency or obliquity in
bringing them as close to 'the Line' as possible in the
the pelvis, either through a unilateral contracture or
sagittal plane; then ask the clients to become taller by
an adaptation to a leg length discrepancy. With a fuller
reaching up through their crown. How they perform
training one might then go on to assess any intraseg
this will usually show where their segments actually
mental distortion of the pelvis, inflare, outflare, up- and
need to be taken in order for them to become taller in
down-slip and sacro-iliac torsions, though these are not
fact. Internals will usually flatten their lumbar region to
covered in this introductory book, and in any case such
become taller; externals will usually take the lumbar
patterns would probably not be dealt with until some
spine further into lordosis. It is not a foolproof test since
of the more basic structural issues have been resolved.
some clients who have good awareness of their body
When assessing the legs note:
have several options for lengthening up, while some
• any internal or external rotation of the femur clients with poor awareness will have no idea at all how
• the degree of 'toe out' to lengthen - and may do things like lifting the shoul
• whether the knees are valgus or varus, and ders to become taller! This information must be
• whether there is any tendency to pronation in the feet. coordinated with other visual cues about their pelvic
A simple test to determine any asymmetry in external organization; Flury has also proposed some more
rotation of the legs is to have clients lie supine on the detailed tests for this (Flury and Harder 1988).
table with feet together. Ask them to press the toes A more advanced kind of postural-structural analy
together then release. As the feet drop laterally note the sis would look closely at spiral patterns of shortness
degree of external rotation, and if one hip rotates out throughout the structure, but this is probably best
more than the other, remembering the segmental stand learned in a formal training situation.
ard rotation pattern and that some degree of asymmetry From all of the above assessments an abstract picture
is normal. of the total pattern of myofascial shortness within the
Then look at the shoulder girdle, its relationship with client's structure begins to emerge. Then, after working
the axial skeleton (especially the neck and thorax), and with the client for a while, other aspects of their somatic
then how it relates to the upper limbs. organization become clearer: whether they are hard- or
soft-tissued, what their overall level of 'body intelli
gence' might be, and their autonomic tone. Hard
Palpatory assessment
tissued types have a recognizable rigidity in 'feel', a lack
It is important to get a general sense of the level of mus of differentiation in movement, and when you press
cular tonus throughout the entire standing arrangement. into them on the table they have the tendency to roll 'as
A S S E S S M ENT, TEC HNI QU E AND STRAT E G Y IN STRUCTURAL B O DYWOR K
one piece'. With practice one can get a sense of whether cannot be done all at once. This means a certain choice
such restrictions are in the fasciae, the ligaments or the on your part and you need to ask yourself, what am I
nervous system. Soft-tissued types will have a discernible going to do today, and what will I do next? Sequencing
laxity in the ligaments and often a hypermobility of is important, so now some initial ideas will be offered
their spinal segments. Those with a generally elevated to help determine how you strategize a series of ses
tonus are often 'sympathetically tuned' (Cottingham sions as well as deciding on the content of any particu
1987) and this can manifest as an inability to relax, a lar session.
tendency towards constant internal vigilance and con
trol throughout the sessions, and an inability to fall into
S T R AT E G IZ IN G A S E R I E S OF S E S S I ON S
a light alpha state.
Most schools of structural bodywork will teach some

Assessment of gait variation on the classic ten-session 'recipe' of Ida Rolf.
For beginning structural bodyworkers, this does remove
It is important also to see how a client walks. This can
some of the need for a detailed evaluation of the clients'
give valuable information not only about the client's
posture and gait. In Rolfing training, the principles for
general level of moving intelligence but also which
strategizing structural interventions are also taught,
areas are moving easily and which are not - remember
alongside this relatively fixed beginners' protocol. What
ing that long-term functional patterns will inevitably be
follows here, however, is neither an exposition of the
reflected in fascial adaptations. So, if an area does not
Rolfing principles nor a procedural recipe, but rather
move much it is likely that there is a degree of fascial
some 'rules of thumb' that can be of assistance in guid
contracture that underlies that pattern.
ing the initial stages of structural bodywork, in work
When observing a client's gait it is important to have
ing towards what previously has been called 'a first
enough working space to allow them to walk without
approximation' in balancing structure.
too much interruption, even if it is just down a passage
Having already gathered some initial impressions
way. As they walk, notice the degree of movement in
about the client's structure you know which areas of
the following planes:
fascial shortness need addressing but not necessarily
• the lateral sway of the pelvis in the frontal plane the order in which to address them. Experience has
• a rocking of the pelvis in the sagittal plane shown that the rules of thumb given in Box 14.1 are very
• the counter-rotation of the shoulder and pelvic useful in guiding the progress of structural bodywork.
girdles in the transverse plane - a slight twisting
and untwisting through the longitudinal axis of Box 14.1 Some 'rules of thumb' for strategizing
the body. structural bodywork sessions
There are many other more subjective aspects to focus • Work superficially at first and later work to affect deeper
upon, including the degree of coordination, the general layers
sense of the connectedness of the movement, whether • Then work on front-back balance (in the sagittal plane)
the movement is organic and how it flows. • Then as the work progresses further, begin gradually to
work on left-right balance (in the frontal plane)
The perceptual skills needed for this kind of assess
• Then work on axial and limb de-rotations (in the
ment are usually developed in structural integration
transverse plane).
training; however, you can learn a great deal by just
being interested in movement and observing the gait
of people in the street. One then begins to acquire a These steps should not be taken as strictly sequential
'vocabulary' of movement, and to see what is average and mutually exclusive. They refer to the focus of the
and what is 'normal'. Without this baseline information work at any stage of the process. Any session will prob
it is very difficult to make reliable judgements. ably address the organization in all three planes but
The totality of the information gathered from the will tend to concentrate more on one of them. So it does
postural and gait analyses will begin to give a sense of not mean that when you work on sagittal balance you
the unique structure of a client and some preliminary cannot also work on frontal symmetry, simply that
ideas about which areas are in particular need of being as front-back balance progresses it facilitates the later
opened up or given more resilience. For most clients the work of left-right symmetry. Earlier sessions are often
work is bound to take a number of sessions; it simply aimed at generally lengthening and decompressing the
PRACTICAL MANUAL
system, with less of an intention of achieving balance of include some kind of larger-scale integrating movement
any kind. Then sessions will tend to address front-back work, even if only by helping clients to 'ground' them
balance rather than left-right balance, and the empha selves by tuning in to their standing posture or exploring
sis gradually reverses. Experience has shown that as new options in walking, or maybe just asking them to
both front-back and left-right work progresses, many walk with awareness.
of the rotational patterns apparent early on will tend to Sometimes it is useful for clients to have some specific
resolve and unwind of themselves, so it is natural to 'homeplay' to maintain areas that have been 'opened'.
deal with them later in the sequence of sessions. This could include traditional stretches, but very often
There is a real wisdom in Ida Rolf's original recipe, in clients have not been taught to 'feel' or 'breathe' into a
which the first three sessions concentrate on the most stretch; they can be too brutal with themselves and will
superficial layers only, aiming for a general decompres
sion of the system and an overall lengthening. It is
Decide on the emphasis
certainly safer in most cases to begin in this way since it
of the work, based
is not asking too much of an adaptive response from the on the series strategy
body in the early stages. The body then becomes more
prepared to receive deeper work, and practitioners have
time to familiarize themselves with their clients' struc Select structural
ture. How long this superficial work should last, or themes for the session,
i.e. areas to be worked
even whether it is necessary at all, will depend on many
factors. Clients who have a high level of sensory-motor
intelligence are more able to integrate greater changes
and can receive deeper work sooner. Clients who are
deemed to be 'rigid' or 'armoured' should definitely
receive only superficial work to begin with, even if it
seems they are crying out for a deeper kind of work. It Perform soft-tissue
is a common mistake to work too deeply, too soon with
such clients, and often they will report pain later, and
usually not in areas that have been worked; it is as if
suddenly they have a new range of movement in cer
tain areas of their body to which their sensory-motor
intelligence is unable to adapt, so strain is thrown else
where and 'settling pain' results. So if there is any
If necessary, perform
doubt, do less, then deepen the work by degrees. small-scale integration
work
Strateg;z;ng a session
Figure 14.2 is a more detailed schema of the three-level
model of structural intervention that was shown in
Figure 7.2 (p. 46). It outlines one possible sessional format
(among others) for any individual session, once the main
Perform larger-scale
theme or themes of the session have been decided. At the
integration work, such
start of each session it is important to know where you as walking .
are within the overall progress of the sessions you have
envisaged, for example whether you intend focussing
on front-back, left-right or rotational issues. Then decide
on which areas you wish to address. Then use the three
levels of interventions to guide the process: first, soft
J
tissue releases to a particular area, then neuromuscular
releases followed by some small-scale integration work. Finish
Towards the end of the session, include some broad
back and neck work, and at the end of a session always Figure 14.2 An outline for a possible session structure.
therefore tend to avoid stretching. It is preferable to application, involve a lower intensity and longer dur
teach them the self-applied contract-relax (C-R) style ation of contact, and are based on the premise that the
of stretching that will be described later in this chapter. body will respond with a subtle unwinding if 'listened
Virtually all traditional stretches can be creatively trans to' in this way. A form of this technique is taught within
formed into a safe C-R type of stretch. osteopathic circles; Greenman, for instance, demonstrates
many such techniques for releasing superficial tissue
(Greenman 1996), while Stanborough (2004) provides an
T EC H N I Q U E S O F I N T E RV EN T I O N
excellent detailed exposition of the more direct approach
IN S T R U C T U R A L B O DY WO R K
that derived from the Rolfing tradition.
The direct technique of MFR involves the manual
It was suggested in Chapter 7 that the complete structural
application of controlled mechanical stress into areas of
bodyworker requires at least three levels of technique:
restriction within the myofascial network, thereby chan
l. Soft-tissue releases ging the mechanical properties of the tissue and allow
2. Neuromuscular releases ing new possibilities of movement in the surrounding
3. Integrative techniques. structures and to the organism as a whole. There has
been no definitive research into the effects of this kind
In this practical section we will look at myofascial
of myofascial release. In Chapter 9 various theories about
release as the principal approach to soft-tissue release
how it works were proposed: Ida Rolf took thixotropy
used within structural bodywork, and C-R stretching
as the likely explanation, emphasizing the colloidal
as a highly effective neuromuscular release technique.
nature of the connective tissue complex; Schleip conjec
The scope of this book will not allow even a sketchy
tures that it is neurological feedback into the local tissue
exposition of the various integrative methods as it is
that produces the effect, while others believe that the
simply too vast a field. Instead a few key examples will
collagen fibres are realigned by the mechanical stress
be demonstrated to give a general idea of how to pro
applied to the tissue, which breaks cross-linkages and
ceed and the interested reader can look at the many
hydrogen bonds. That it does work is not disputed by
possible avenues to movement training in Appendix l.
anyone who has ever applied it or received it. It can eas
Additionally, some self-applied C-R stretches and some
ily be tested in a minor way by pre-testing for a range
passive stretches have been included for homeplay.
of motion (ROM) with any of the standard myofascial
length tests (the Ober test for instance), applying the
Myofascial release (MFR)
technique and then post-testing the range. One virtually
Myofascial release is an extraordinarily versatile tech always finds an immediate increase in ROM. The import
nique that can be used within a wide range of somatic ant thing is that it actually works (see Box 14.2).
and therapeutic contexts. It can be used within an inte
grative context to create a better balance within the
Box 14.2 The myofascial release technique
human structure, but it may also be effectively used
within a corrective or remedial context for treating con Having selected the area in which you wish to work, you
nective tissue fixations in the short to medium term. It decide which is the most appropriate tool - finger chisel,
is one way among many of bringing more resilience to knuckles, soft fist, forearm blade and so on. Then:
selected areas of tissue. There are several styles of MFR, • gently contact the surface (too rapid or deep an entry will
some soft and indirect, some firm and direct. The provoke a reflexive, protective response)
approach outlined in this book is a direct approach that • sink to an appropriate depth - more or less, depending on
originated in the Rolfing tradition. It has been charac your intent
terized by its use of very slowly applied, deep sliding • hook into the appropriate layer by changing the direction or
pressure into restricted tissue combined with an appro vector of application (usually away from you)
• using your weight and gravity alone, slide/drift very slowly
priate assisting movement from the client to enhance the
through the tissue, controlling the drift by changing the
practitioner's input of energy. This technique is to be
angle of application rather than changing the amount of
distinguished from the myofascial approach popular
effort you use
ized by John F. Barnes (PT), which is also called myofas
• ask the client to make small assisting movements that
cial release (Barnes 1990). In Box 3.1 (p. 22) the Barnes introduce a lengthening vector through the area of tissue
approach has been grouped with the listening-touch receiving the work.
systems. These systems use very little force in their
PRACTICAL MANUAL
, 136"
"-
From a somatic perspective the technique is also a stretch and return will not affect the tissue's resilience,
valuable means of bringing more sensation, vitality and the underlying properties of the material will remain
biological energy to an area. Proprioceptively it 'awak unchanged; a longer duration of stretch allows for plas
ens' the tissue in areas that may be only vaguely sensed, tic deformation to occur, and for any 'slow flow' effects
and as such is a valuable tool in cases of what Hanna has in the colloidal matrix. Hence watching the technique
termed sensory motor amnesia, and like the sensory performed is highly unexciting. Yet the experience of
awakening techniques of Feldenkrais, this technique the client is very different. Clients experience the tech
can help fill in the hazy areas in the client's internal nique as strong. There is strong sensory input, which is
body map. More than superficial massage techniques, not to say that this is experienced as painful. There is an
MFR greatly enhances local circulation. The redness in implicit sense of safety in the slow speed of the tech
the skin after this work is the result of the release of nique; the client is able to anticipate the progress of the
local histamines which dilate the superficial capillaries work at all times, which gives ample time for feedback,
and bring a greater volume of blood to the surface. It is for instance if there are some tender spots ahead that
likely that an identical histamine response is occurring need lighter work. The application can be quicker if you
deeper within the tissue. This makes it an ideal tech wish to use it as a warm-up, preparing the tissue for
nique for treating localized ischaemic conditions. deeper work. The sense of safety in the technique can be
It is possible to influence relatively deep layers gauged by the fact that most clients soon fall into a light
within the body using this form of MFR. There are ways alpha state during this work.
of achieving deep penetration quite naturally, into mus
cular septa for instance, or by introducing unusual vec
Varying the vector of application
tors of force one can indirectly reach into deeper layers.
In general, control of the strokes comes from altering
However, it is probable that this technique has most of
the body's position rather than using arm muscles to
its effect in the more superficial layers. Stretching tech
push through the tissue; the arm muscles are then
niques have the potential to reach deeper layers after
reserved for a stabilizing function and the energy of the
the more superficial layers have been opened with
stroke comes from the whole body, using the floor as a
a MFR approach, so the two techniques can work
fulcrum. Looking at the vector diagram in Figure 14.3 it is
synergistically.
evident that the force delivered through this technique
How the technique is applied in a particular situ
ation depends on many factors: the area of tissue being
worked, the client's tolerance to pressure, the mass of
the underlying muscle tissue, the general collagen dens
ity, the client's tonic status at that time in the session
(as the client relaxes more it is possible to go deeper
without evoking a protective response), and their gen
eral tonic habitus.
If the client is unable to relax then the approach will
be less effective as it becomes difficult to achieve an
adequate penetration into the correct layer; this simply
results in stretching the skin and superficial fascia
alone. Very occasionally one finds clients who are
deeply conditioned to hardening themselves. Any pres
sure into their tissue will provoke a resistance to entry,
completely unconsciously of course. For these clients it
may be necessary to try a completely different approach
that seduces them into muscular relaxation, such as the
Trager approach.
This technique is inherently slow. All the research on
the 'creep' and 'flow' behaviour of connective tissue
suggests that it is the duration of the intervention that is Figure 14.3 Vector diagram showing the direction of forces
the most important factor in producing change. The involved in the appl ication of the direct myofascial release
viscoelastic properties of fascia mean that a quick technique.
can be decomposed into its component vectors. Any to occur; clients can really experience what it is like to
force directed into the tissue will have a vertical or pene lengthen through a particular line.
trating component, and a transverse or sliding compon For areas that are not heavily muscled, any movement
ent; in this instance, 35 kg of pressure applied in a seems to help. However, when working over more
direction directly through the long axis of the humerus powerful muscle groups it is important not to work
(at this angle) will provide the equivalent of about 30 kg deeply into the tissue when the underlying muscles are
of penetrating force and 17 kg of sliding force. The actively shortening. To do so causes undue discomfort
steeper the angle of application, the deeper the penetra and does not allow useful penetration into the tissue
tion into the tissue and the slower the sliding progress being worked. So in general, try to organize an assisting
through the tissue. It has been stressed already that the movement so that underlying muscles are being pas
technique (after warm up) must be slow to have an sively lengthened by their antagonists. This is not always
optimal effect. One way of putting on the brakes if you possible or convenient so that at times it is acceptable to
are drifting too quickly through the tissue is to bring work without any assisting movement at all, or just the
your weight more directly above the point of application. use of breath. Sometimes the technique works entirely
This makes the vector of entry steeper and thus slows by anchoring tissue with the hands and having the
the progress of the stroke while providing more pene client make all the lengthening movement away from
tration into the tissue. This is much more effective than the anchor point. In this way it is possible to introduce
trying to modulate the pressure through the arm and tensile vectors into the tissue that can be produced in no
shoulder muscles alone. The bodyworker can become other way, through yoga or stretching for instance.
quite skilled in making subtle trunk movements to vary Chapters 16-20 pictorially depict techniques that can
the depth and direction of their work, rather than using be used. They are numbered from n to n08. Specific
a more muscular effort in the arms and shoulders. techniques from this point will be referenced by the
appropriate number.
Using gravity Technique T8 exemplifies working into tissue as it is
The suggestion to use your weight and gravity alone is being passively lengthened. The client flexes at the
an exaggeration. Of course some muscular effort is knee by engaging the hamstrings and allowing the
required because the shoulder girdle needs to be stabil quadriceps to be passively lengthened at the same time
ized as you lean into the client. But this work has its as you are working into them. Sometimes it is possible
martial arts aspect, and one could easily apply to it for the practitioner to supply the lengthening impulse,
the basic dictum of judo 'Minimum effort, maximum rather than the client, as in techniques T31, T78 and
effect'. This also implies that the practitioner needs a n05 for instance. In technique T31 the client is asked to
well-developed body awareness. Ida Rolf was known do nothing but allow the practitioner to passively extend
to reject applicants for her training if they were either the knee, such that the hamstrings are passively length
too cerebral or not very dexterous. The 'judo' of this ening. In this same example it is possible to utilize
work is to align your own skeleton such that you reciprocal inhibition if the client is simply unable to
require minimal muscular involvement to perform the release - if there is some parasitic co-contraction occur
technique. If you begin to use unnecessary muscular ring. Here you can ask the client to actively extend their
effort then, as in any manual work, you will tire and knee while you gently resist them, allowing them to
ultimately damage yourself. The client too will pick up overcome your resistance. In this way the hamstrings
your tremulous energy and will feel less safe, sensing will usually release.
that you are not in control. However, these assisting movements need not
always be gross. Sometimes micro-movements may be
A ssisting movements asked for, or sometimes clients may be asked to
Experience has shown that the MFR technique has a 'breathe into' an area. This can mean simply to exag
more lasting effect when the client is engaged in appro gerate the in-breath or out-breath to obtain expansive
priate assisting movements in the area being worked. or contractive movement through specific areas of the
Appropriate lines of stress are thereby placed through thoracic sleeve. It may also mean to visualize the out
the tissue, which is added to the therapist's application breath flowing to a particular area; in this case there
of force. Hence there is a compounding of the energy may not in fact be any movement except for a subtle
entering the tissue. Giving assisting movements is also an release of tonus in the area. This valuable practice ori
ideal opportunity for incidental proprioceptive learning ginated in yoga, and although superficially it seems like
PRACTICAL MANUAL
a 'new-age' energetic idea, it has proved in practice to

be consistently useful. On the out-breath there is a per
ceptible reduction in muscular tonus throughout the
entire body, so it makes sense to utilize this effect for
therapeutic purposes. Breathing into an area can also
reduce the discomfort of very deep work.
The use of visualization

Many bodyworkers and movement practitioners have
discovered the power of active visualization as a means
Figure 14.4 The forearm blade.
of achieving some movement quality or some thera
peutic benefits for their client. We have already men
tioned the practice of having a client 'breathe into' an tool that suits one may not suit another. Practitioners with
area. Some of the other 'classic' visualizations are: feeling a tendency to hyperextend at their joints, for instance,
the body lengthen as if pulled up by puppet strings or a should not use their thumbs and perhaps even the 'finger
'skyhook'; sensing the head as floating like a balloon; or chisel', except sparingly. It is tempting to overuse the fin
even the simple suggestion that you feel the spine length gers because of the rich sensory feedback we receive from
ening. There is an idiokinetic tradition in dance that them. However, it is possible to use the elbow in most
uses the power of this idea. This use of visualization has situations where the fingers are used. It can be used with
been used by teachers of dance, yoga, Pilates and Trager great delicacy and not merely as a blunt instrument.
practitioners, among others, for many years. There is
now some research that begins to confirm this intuition. Forearm blade
Godard and others have shown that the use of imagina The forearm blade (Fig. 14.4) is probably the most ver
tive directionality in movement can eliminate unproduct satile tool in the structural bodyworker 's toolbox. If
ive co-contraction of muscles (Godard et al). you palpate your own forearm right now you can trace
the ulna, just beneath the skin's surface, extending con
The tools of myofascial release tinuously from the olecranon to the stylOid process at
MFR is usually a manual technique; it is the hands and the wrist. The fact that the ulna is such a superficial
forearms that are most commonly used. The selection of bone allows it to be used purely as a blade, making
the appropriate tool depends partly on experience and broad contact with the tissue in order to 'iron it out'.
partly on common sense. Experience will show you Then the tip of the olecranon can be used for intense
what will work and where. It is important not to use a point loading in certain areas of tissue if necessary. It
gross tool in a delicate area and vice versa. The pressure can be used for all variations between these extremes
can be very slight in areas such as the face, scalp and (see Fig. 14.5). The angle of contact can be subtly varied
neck, and more forceful where there is a greater under even as you use it, turning it from a blade into a plough.
lying muscle mass such as the hamstrings and erector There is even more versatility to this tool, since either
spinae. As with all techniques, you need to individual side of the ulna you will find relatively dense soft tissue
ize them, make them your own, and adapt them to your that can be used for a more cushioned contact with the
own body and style of working. So the techniques pre client. This allows the practitioner to rotate the forearm
sented in the next sections are not meant to be definitive away from the ulna in order to utilize this padding,
in any way; they are merely a starting point. You will which can be important for sensitive areas such as the
need to experiment and discover what works for you. iliotibial tract where bone-to-bone contact could be
Once the basic principles of the technique are under uncomfortable (your ulna, their femur!).
stood you can create an infinite number of variations to
suit the precise needs of the moment. In the technical The finger chisel
and pictorial sections that follow, different myofascial The finger chisel (Fig. 14.6) is an effective tool when speci
lines will be described along with specific techniques ficity is required. There are wide individual differences
that address them; from now on, these techniques will in the relative lengths of our digits, so some experimen
be referenced by number: Tl, T2 ... TlOO, and so on. tation is required to find which disposition of fingers
There are great differences between practitioners in serves best for any practitioner. The chisel can be used
their shape, strength, tissue density and dexterity, and a singly, as in technique T78, doubled (see Fig. 14.7), or
Figure 14.5 Varying the angle of the forearm blade to shift

from broad contact to point loading.
Figure 14.6 The finger chisel.
Figure 14.8 The dorsum of the hand, various tools.
overlapped for mutual reinforcement, as in technique

T20. In general, the fingers work better if slightly flexed
(a natural tendency anyway). Hyperextension of the
interphalangeal (IP) joints should be avoided as it will
stress them in the longer term.
Dorsum of the hands

There are many ways of using the dorsal side of the
Figure 14.7 The finger chisel doubled. hands (Fig. 14.8), with client-practitioner contact
PRACTICAL MANUAL
Figure 14.10 Doubled thumbs.

Figure 14.9 The octopus hand.
coming through the knuckles (metacarpophalangeal

joints), the pads of the combined proximal phalanges or
middle phalanges. In the full fist the whole hand is
flexed, with metacarpals and phalanges at right angles.
If the metacarpals and carpals are aligned with the
bones of the forearm there is then a direct line of force
through the skeleton that requires little muscular effort
from the practitioner (see technique TlOS) and allows
the weight to be used more effectively. The same
arrangement can be modified to form a 'soft fist', in
which the palm is naturally more open and the fingers Figure 14.11 The heel of the palm.
can shape themselves to more comfortably conform
to the shape of the underlying tissue. In technique of deep work, for 'feathering off' into the surrounding
TS8 they are used in this more open and 'moulding' tissue. Traditionally it has been used when you are
fashion. mostly interested in influencing the superficial fascia.
For delicate areas such as the neck, pads can be formed Ida Rolf used a homely image for this kind of work,
from the combined middle or proximal phalanges (see calling it 'taking out the pins'.
technique T73). In other areas, the saddle-shaped space
between the second and third knuckles can be used to Doubled thumbs
slide along spines or crests, for instance along the anter This is a controversial tool (see Fig. 14.10). There is a
ior iliac crest and along the spine of the scapula (see syndrome colloquially known as 'physiotherapists
technique T83). Undoubtedly there are other parts of our thumb', which is an inflammation of the metacar
hands that could also be used. pophalangeal joint of the thumb caused by overuse in
the performance of Maitland-style joint mobilization.
The octopus hand Shiatsu practitioners may also suffer the same com
The octopus hand is an invaluable tool for palpation, plaint. As with the finger chisel, if you are .not loosely
for getting an overall sense of the tissue, for testing the ligamented this tool can be used effectively though
mobility between layers and for evaluating the current sparingly, especially when sensitivity is required.
tonicity and density of the tissue (see Fig. 14.9). As a Again the pointed elbow can be used in the same way.
technique it relies upon a strong compressive vector
into the underlying tissue and then a lateral shearing Heel of the palm
motion as if to separate the superficial layer from the The heel of the palm (Fig. 14.11) can be used in a bread
deep. It is suited to areas in which there is not a great kneading fashion in fleshier tissue (see technique T8).
depth of tissues, such as over the ribs and anterior leg,
but it can be used almost anywhere to soften or 'warm The use of lubricant
up' tissue for areas that will require deeper or more This is another controversial area. Ida Rolf herself
detailed work. It is also useful for spreading the effect allowed no use of lubricants at all, except perhaps
A SS E S S M ENT, TECHN I Q U E AND STRAT E G Y IN STRUCTURAL B O DYWOR K
water. The normal massage practice of applying oil and believed that part of their unwritten contract with
liberally to the client's body does not work for this the client was to achieve maximum benefit in the short
technique; the surface simply becomes too slippery est time, and often their work did hurt. However the
to allow significant penetration. Sorbolene and other philosophy has changed; Rolfers realized that painful
petroleum-based products are also unsuitable since the work was usually counter-productive and so evolved
lighter fractions tend to be quickly absorbed into the more subtle ways of working. Sensations in the area
skin, leaving the stickier residue coating the surface, receiving this deep MFR may range from a pleasant
which becomes gluey and makes any gliding on the warmth to a type of transient discomfort that body
surface impossible. The most workable solution is to workers usually call 'good pain'. How clients experience
use special lubricants created for myofascial release - this form of MFR depends on sundry factors such as
usually a combination of coconut oil and beeswax, previous injuries, muscular tension caused by chronic
which has the right combination of 'slip' and 'grip'. stress, or Simply a constitutional intolerance to pressure.
This lubricant however is never applied directly to the However, most clients love 'the Rolfing touch'. Any
client; it is smeared as a faint film on the actual tool that potential challenge or discomfort needs to be negoti
you will use, your forearm blade or fingertips for ated with the client, just as in other approaches such as
instance. Nevertheless, if the client's skin is especially trigger-point therapy, shiatsu, yoga and physiotherapy
dry then it can be useful to apply a miniscule amount of in which there is always that delicate balance between
massage oil to the client: a few drops spread on your 'enough or too much'.
palm and dispersed over a wide area of the client's
body. This may be particularly useful for clients with Self care
very loose superficial fascia where you feel that the These techniques can stress the hands and wrists if
MFR technique may just be stretching the skin or caus performed inappropriately. A lot of force is conducted
ing the sensation of 'Chinese burn'. through the bones of the forearm, wrist and hand,
which can lead to compaction of the joints, and
Perception of pain therefore, in the longer term, a propensity to arthritic
'Pain is an opinion'. This saying is attributed to the changes. The fist tools require sustained flexion in the
famous Gestalt psychologist Fritz Perls after receiving hands, and some like the 'finger chisel' involve a
work from Ida Rolf. It is interesting in that it suggests co-contraction of the wrist-fingers extensors and flexors
that strong sensations can be reframed in our experi to stabilize the wrists. Depending on many factors, this
ence to become less threatening. In any case, people are can in time lead to repetitive strain injuries, for example
usually prepared to accept short-lived discomfort if they compression of the wrist joint and inflammation of the
believe it will help them. The MFR technique is inher wrist-finger flexor tendons. This does not mean you
ently direct and much more robust than traditional should not use the fingers in this way, but rather that
massage strokes, yet even at its strongest it causes less you should guard against their overuse. It is therefore
discomfort than some of the techniques of approaches important to find alternative ways of doing the same
such as deep tissue massage, myotherapy, some shiatsu thing but with a more robust instrument: particularly
and Chinese massage techniques, trigger-point treat the elbow, which with practice can be used with great
ment and some forms of joint mobilization, all of which delicacy. Sometimes, through overuse, the entire fore
can at times be excruciating and have been known to arm may become hypertonic and somewhat ischaemic.
bruise the skin. Appropriately applied, MFR should Practitioners can avoid such stress by taking appro
never bruise. priate care of their hands, first by learning �o use the
Even now, Rolfing has the lingering reputation of minimum necessary muscular effort while working,
being a painful process. It was once considered to be a and secondly by regularly stretching both the flexors
tough and painful, though highly effective approach to and extensors of the finger and hand. Sometimes an
postural problems, and this perception remains. alternating hot water /ice water soak can be used to
Although developed from the 1930s it was brought to deal with local ischaemia. And of course having the
the world in the 1960s - the era of 'the screaming ther technique applied to oneself is extremely beneficial.
apies'. This was a time when psychologists considered it
necessary to provoke a deep catharsis in their clients to The table
allow them to discharge their emotional pain. Possibly Traditionally a low table is used for structural work,
the early Rolfers got caught up in this historical trend which is half as wide again as the standard massage
PRACTICAL MANUAL
table and approximately knee height. This allows the passive stretching technique and new forms can always
practitioner's weight to be easily brought to bear upon be created once the principles are understood.
the client. It also allows the practitioner to be seated for
The C-R sequence
some work, such as that around the neck. The extra width
of the table allows flexed side lying whilst preventing Having established which area of your client requires
the overhanging of body parts. Massage tables can be stretching, you first test for range of motion (ROM), not
used, but if they are too high then exerting any down ing when the lengthening tissue begins to 'put on the
ward pressure becomes difficult and the pressure then brakes'. This is the so-called first bind limit of the move
comes from muscular strength rather than using your ment. The first bind is that place in the ROM where the
body weight to fullest advantage. A hydraulic table is lengthening tissues begin to oppose their lengthening;
excellent as it can be set at the exact height required. it is found long before the absolute physiological limit
The best designs go low enough for the client to sit easily and is discovered when making a passive ROM test for
for seated work. Many bodyworkers see the hydraulic any particular movement. It is a 'stickiness' in the move
table as an investment in their own back. ment which could be pushed through if you chose.
Then, starting from that position, use your own body to
Cl ient care
apply a counterforce to block the return path of that
When preparing to apply the MFR technique in any movement. Ask the client to use their own muscular
instance, it is important to apply the necessary force energy to press into you, essentially making an isomet
without the client having to accommodate too much to ric contraction of the muscles to be lengthened, then
the forces being applied to them; we need to under after relaxing that effort you move to the newly facili
stand in a practical way the simple physics involved in tated limit. This process is repeated until a specified
pushing into another body. In seated work (see tech limit is reached.
nique T90 for instance), it can easily be seen that any
lateral pressure will tend to unbalance the client, caus Box 14.3 A general protocol for assisted C-R
ing them to tense their lateral abdominals to resist the stretching
push. This may or may not be appropriate for them at For any particular movement restriction:
the time. So, when leaning into a client one can sense
• Find the first 'bind' or barrier to that movement.
the vector of pressure and then vary it so they do not
• Block the free return of that movement.
have to brace too hard to maintain their position.
• Ask the client to attempt to press back into you (Le. away
from the limit) while you use your own counterforce to
Contract-Relax (C-R) stretching stabilize them in a static position (you are asking for an
isometric contraction).
The C-R stretching approach co-evolved within • Remind the client to use no more than 20% of their
osteopathy and physiotherapy. It is one of a group of possible effort (* possibly more for very fibrotic tissue and
related neuromuscular techniques that work by reset less for more delicate musculature such as in the neck).
ting the average resting length of muscles. It has a great • Hold steadily for 7-1 2 seconds and ask the client to release
advantage over traditional passive stretching in that it (* possible use of breath).
is specifically designed to getting under the 'radar' of • Move to the newly facilitated l imit (* one variation is to use
the client's antagonist muscles (C RAC) , another is to
the stretch reflex. It beguiles the body into allowing tissue
sensitively assist them to the new l imit).
to be lengthened beyond what is habitual. The receiver
• Repeat until there are no further gains (usually three or
then waits a while in the lengthened position to allow the
four repetitions).
plastic deformation of the fascia to occur. This technique
• Remain at this new limit for a while, perhaps asking the
also has the proprioceptive advantage of enabling client to 'breathe to the area' to allow further lengthening -
clients to focus upon and localize the stretch with pin it is now that the fascia has a chance to 'creep' or lengthen.
point accuracy, which yoga teachers know can be a dif
* this denotes a point for possible variations in the technique
ficult task. This is because the muscles to be stretched
are activated immediately prior to stretching. Like MFR,
C-R stretching requires its own time and works partly Clients usually experience the technique as safe
by directing a controlled stress into the connective tissues. because they are being asked to apply force away from
Virtually all traditional stretches have a C-R counter their limitation or point of discomfort, and not into it.
part; it can be improvized from any existing traditional Variations of the technique are useful in a wide range of
contexts, from the gentlest mobilization of painful tis is perhaps optimal; however, some self-applied tech
sue to the vigorous challenging of dense or fibrotic tissue. niques will only allow a concentric contraction, although
Two forms will be shown in the practical section: a this still allows a subsequent lengthening (see Box 14.3).
practitioner applied form in which you assist your The 20% maximum contraction rule means the
clients within a sessional framework, and a self-applied stretch is taken gently. To invite a client to make an 'all
version which can be taught to clients for them to use as out' effort is to provoke a co-contraction of the muscu
a resource in their daily homeplay. lature on a major scale, which usually results in very
C-R stretching works at a relatively low level of neuro undifferentiated muscle action that cannot be useful.
logical organization, even at the level of spinal reflexes. It is quite obvious when someone works too hard and
Because of this its effects really need to become inte mobilizes far too much unnecessary or 'parasitic'
grated into a broader movement repertoire if the results co-contraction that this is not the kind of setting in
are to be more than just transitory. Clients with a good which clients are able to 'listen' more carefully to their
sensory-motor intelligence may be able to integrate the bodies - there is too much 'background noise' or neuro
changes directly; others will need a movement integra logical static distracting them.
tion approach to maximize the benefits of the tech How important is it to have an isometric contraction?
nique. At the heart of this technique's efficacy is the fact Optimal results can be achieved using such contraction.
that muscles are able to lengthen more fully after an iso Laughlin (1998) stresses the need to be absolutely
metric exertion, which is a phenomenon known as post immoveable in resisting movement, so that in moving
isometric relaxation (PIR). One variation of the technique, to the next bind there will be a true increase in muscle
Contract, Relax, Antagonist Contract (CRAC), makes use length. With you and your client as a coupled system
of the client's own antagonists to take them to the new it is important that the initial contraction be truly iso
barrier - to the next 'bind'. This variation relies on the metric, that it does not become concentric because you
muscular reflex known as reciprocal inhibition in which 'give' too much slack. This is an important aspect of
an active agonist muscle will neurologically inhibit its technique, again a martial arts aspect, organizing your
antagonist, thereby allowing it to be passively length body to most efficiently resist the impulse from your
ened. Chaitow (1996) gives an excellent detailed expos client. However, as said previously, the technique also
ition of the many variations of this approach. seems to work if the contraction is concentric. Hence
Different variants of this technique co-evolved within some of the self-applied stretches can still be useful if a
the osteopathic and the manual medicine traditions. Fred concentric contraction is used (see technique T72 for
Mitchell Sm. was the osteopath who first called the instance).
technique muscle energy technique, on the basis that it is
the muscles' own energy that is utilized to allow the Use of the breath
lengthening to take place. PNF or proprioceptive neuro Often, it helps to harness the client's breath in the
muscular facilitation is actually a highly evolved system process. One method is to ask the client to take a deep
of therapeutic exercises that was developed at Kabat breath at the beginning of the isometric contraction,
Kaiser Institute in the 1940s. It includes exercises such and then release the pressure and the breath at the same
as maintaining resistance through a range of motion, time. Another is to have them release the isometric con
enhancing postural and righting reflexes, and stretching traction first, then take a breath that is released while
and exercises to increase muscular endurance (Knott and moving to the next bind. We have already mentioned
Voss 1968). It was discovered that the isometric contrac that research has shown that the average tonus of the
tion of a muscle facilitated its lengthening, and this body decreases on the out-breath. Therefore, it is
technique above all has been absorbed into the full spec always useful when you wish your client to relax.
trum of manual therapeutic approaches. Many massage
therapists are taught one of the isometric techniques, Developing your verbal 'patter'
called 'PNF' as if this were the entire PNF system. It is important to develop your own 'patter ' when using
The 'contraction' of the C-R technique is an isometric C-R stretching. It becomes a standard which your clients
contraction, which strictly speaking is not a contraction in begin to understand and can then apply when you use
the geometrical sense as the muscle does not actually the technique in novel contexts. If the client knows how
shorten, it just tries to. Yet, experience has shown that to respond when you use C-R stretching for their ham
even a strict isometric contraction is not absolutely neces strings, they can very quickly respond appropriately if
sary for this technique to work. An isometric contraction you are working on their neck since the steps are virtually
PRACT ICAL MANUAL
1 44'
such as yoga, Pilates or gym work should be encouraged;

Box 1 4.4 The golden rules of assisted C-R
stretching
however in such class situations it is often impossible
for the leaders to give individual attention to everyone.
• Avoid the 'arm wrestle' syndrome - some clients will Consequently leaders usually 'teach to the middle', to
unconsciously believe that this is a contest of strength, you
the average person in the group. Often, therefore, the
against them!
exercises and stretches that people receive may not
• Try to organ ize yourself to be immoveable - if the clients
be particularly appropriate for them. For this kind of
sense that you are unbalanced, or that your energy is
structural work it is vital that the homeplay should
tremulous, or that they could push you over if they press
too hard, they will not be confident in pushing into you.
concentrate on areas that need to be opened or patterns
• You can use the vector of your own counter pressure to
that need to be more deeply felt.
give subtle cues to your client precisely where you wish In general, clients do not respond well to home exer
them to direct their force. cise regimens. On the other hand, they will usually agree
• You can subtly hint to your client that you are about to to find ten minutes a day in which to have 'a sensorial
release the counter pressure (and therefore it is safe for bath': a time just for themselves in which they can try
them to release also), either through the verbal 'patter' you their stretches and re-patterning exercises in a playful
establish with them, or by yourself slightly easing off your way. It can be suggested that they try a new activity for
pressure before saying ' Release'.
a week in order that it can be learned enough to become
part of their repertoire, and then it becomes their resource
identical. It will also allow them to learn self-applied that can be called upon whenever they need it. In this
techniques more easily. (See the list below and Box 14.4.) daily session they should be encouraged to feel what is
particularly needed that day and to find sensory enjoy
ment in it. One has only to look at children and cats to
A sample 'patter
realize that even stretching can be luxuriated!
'In a moment I will ask you to ... (press into my shoul
Passive stretching If someone stretches forcefully or
der, bring your head back to the midline, flex your
bounces into stretches they are literally encouraging
ankle, etc) . . . and I want you to use no more than 20%
'infighting' within the nervous system! The stretch
of your strength (effort, oomph, etc).'
reflex works to prevent tissue from being lengthened to
'I want you to increase the effort gradually and then hold
the point of damage; it is the automatic braking system
it steadily for 6 or 7 seconds, until I say "release".'
of the musculature. So to use our will (our cortical con
'Press into me now and maintain that pressure . . . (I, 2,
trol) to overrule the wisdom of this lower level response
3 . . . 7).'
is to encourage strain and a struggle between levels,
'And release [here you can cue your client that you are
because the spinal cord is trying to shorten the muscle
about to release your counter pressure by slightly
while the mind is trying to lengthen it. Clients need to
easing off as you say 'And release'].
be educated into 'gentling' the tissue long. Traditional
'Take a deep breath and on the out-breath we will go a
yoga wisely uses the breath to get 'under the radar ' of
little further ... OK, release.'
the stretch reflex. However clients often do not have the
luxury of this subtle form of movement education. The
The partnership of myofascial release and C-R stretching
self-applied C-R style of stretching can be taught fairly
As a combination of techniques, MFR and C-R stretch
quickly; since the assisted form of this stretching is used
ing complement each other very well. C-R stretching is
within sessions, clients can easily transfer this learning to
very useful after an area has been 'opened up' using
a self-applied form.
MFR. The stretching is effective for the overall elonga
tion of an area; however it may not address any Self-applied C-R stretching C-R stretching given as
microadhesions between muscle layers or fasciculi; the homeplay should be taught very carefully. Stretch
different force vectors at play during the application of coaches and yoga teachers know how easy it is for the
the MFR techniques may reduce these microadhesions body to 'cheat' a stretch. Sometimes even with the best
and anchor tissue in ways that stretching cannot. intention of stretching any area, the body will subtly
find a way of avoiding the stretch - that is what the
Homeplay stretch reflex is there for! So it is important to empha
Clients can be given stretching and re-patterning exer size aspects of 'form', showing the way to organize the
cises as homeplay. Their participation in group-work body before even beginning the stretch. Laughlin has
A S S E S S M E NT, T E C H N I Q U E A N D STRAT E G Y I N STRUCTURA L B O DYWOR K
developed an extraordinarily comprehensive collection a vague, pleasant and relaxed, but nonetheless disor
of assisted and self-applied C-R stretches that can fulfil ganized, state. Driving in such a state can be highly
most stretching requirements (Laughlin 1998, 1999). dangerous so some grounding work at the end of a ses
Occasionally the C-R stretching technique will give sion is absolutely necessary.
rise to a short-lived phenomenon of muscle weakness, Here it can be useful to use Alexander or Feldenkrais
usually experienced immediately after a particularly style hands-on work to suggest new postural or move
challenging stretch. The muscle has been working out ment possibilities, to track and encourage a new range of
side its customary range and needs a few moments to movement, or to explore a new pattern of coordination.
recover. Simple movement is all that is necessary for At the very minimum clients should be encouraged to
functionality to return and the new range to be inte walk around and try to feel any changes that might have
grated. This illustrates an important point though, that occurred and to explore new options for movement
any technique that actually lengthens tissue changes with them. This is also an ideal time to ask the client to
the body's structure and therefore needs to be integrated. use some of the visualizations that have been mentioned
After a powerful stretch one always feels a little dis or to give time for new sensory impressions to sink in.
organized. This is obvious for instance if you stretch the Clients often 'feel strange' when shown new postural
hip flexors on one side only and then walk; a lopsided or movement options because a different propriocep
gait cannot be avoided. In his overview of the research tive experience can sometimes feel rather alien. For
into stretching, Tsatsouline (1998) suggests that pre instance, the client with military squared shoulders
performance stretching has been shown consistently not who felt 'like a gorilla' when at last he was able to accept
to enhance performance, despite athletes often believing his shoulders in a more neutral position. Similarly,
otherwise. Baseball pitchers who stretch as part of their when clients with an anterior shift in the pelvis are
warm-up routine believe that it improves their pitch brought back to 'the Line', they often feel unbalanced,
ing, yet their throwing velocities are then actually and it seems strange although not necessarily unpleasant.
slightly less. This highlights the importance of integra Clients need time to get over the strangeness of new
tion; a serious stretch changes your structure. You options. Relearning, integration is always needed when
cannot simply stretch and immediately function as ancient, deeply learned patterns are challenged.
effectively as before; therefore, any serious challenge to
our structure, whether through stretching or MFR, will
The integration walk
need to be integrated.
A good general suggestion is to ask clients to take an
'integration walk' after the session. Immediately after
Integration work - embodiment
wards is best, but definitely before bedtime; uninte
Ideally integration work should be woven into the fab grated work has been known to affect sleeping patterns
ric of the whole session, but it is especially important at and emotional balance. Generally a ten-minute walk is
the end. Clients often fall into a light alpha state during ample, provided it is done with the attention directed
the early stages of this work. Often there are signs (bor inwardly to the sensations of walking. Clients can be
borygmus, muscular twitching, deep sighing breaths, asked to observe and enjoy their walking as if they
and so on) that the autonomic nervous system is shift were watching themselves on TV. The Feldenkrais
ing towards the parasympathetic. Clients do need to be approach suggests that this kind of attention to our sen
brought back into the real world gently, to re-adjust to sorial life is the most potent means of allowing our
gravity and to allow the changes to ripple through the sensory-motor intelligence to adjust to the differences
whole system. Traditional massage often does not take induced by somatic work, and to integrate new
this into account and sends its clients into the world in patterns.
R E F ER E N C E S
Barnes J 1990 Myofascial release: the search for excellence. Cottingham J 1987 Healing through touch. Rolf Institute,
Rehabilitation Services Inc., Paoli, Pennsylvania Boulder, pp 147-162
Chaitow L 1996 Muscle energy techniques. Churchill Flury H 1987 Structural levels at the pelvis. In H Flury (ed . )
Livingstone, New York Notes o n Structural Integration, 1 : 25-34
PRACTICAL MANUAL
Flury H, Harder W 1 988 The tilt of the pelvis. In H Flury (ed) Laughlin K 1998 Overcome neck and back pain. Simon and
Notes on Structural Integration 1: 6-15 Schuster, New York
Godard H et al Neurophysiological study of the emo Laughlin K 1999 Stretching and flexibility. Simon and
tion. Unpublished study. Online. Available: http : // Schuster, Sydney
www.somatics.de Stanborough M 2004 Direct release myofascial teclmique.
Godard H 2000 Notes from Bodywisdom conference. Churchill Livingstone, Edinburgh
Coromandel, New Zealand Tsatsouline P 1998 Beyond stretching: Russian flexibility
Greenman P 1996 Principles of manual medicine. Lippincott, breakthroughs. Dragon Door Publications, St. Paul,
Williams & Wilkins, Baltimore Minnesota
Knott M, Voss D 1968 Proprioceptive neuromuscular facilita
tion: patterns and techniques. Harper and Rowe, New York
A FIRST
APPROXIMATION
TO BALANCING
STRUC TURE
In the next chapters we will look at the practical appli movement through them during gait; soft-tissue restric
cation of the techniques covered in Chapter 14 and how tions in standing organization will relate to restricted
they can be used to address the following five funda gait patterns, and therefore freeing up these soft-tissue
mental structural themes: restrictions is an excellent means of approaching more
efficient walking. Looking at how our clients walk is one
• working in the sagittal plane - balancing the front of the most effective methods of seeing where both struc
and the back tural and functional restrictions exist. Very occasionally
• working in the frontal plane - balancing left and the restriction may be purely functional, owing to the
right fact that there may simply be motor concepts that the
• working in the transverse plane - unwinding longi client has never fully learned. In this case, perhaps
tudinal rotations movement work alone may be called for; however,
• working with shoulder girdle displacements such restrictions must in time become reflected in the
• working with externally rotated legs. structural body, so that it is usual to find that some
relieving structural work may be called for, even if only
Addressing these themes alone is an ideal approach to minor.
achieving a 'first approximation' to balancing structure. For each of the above five structural themes we will
In Chapter 14 a two-pronged approach was sug examine the key 'lines' or fascial continuities that will
gested for making an initial assessment of our clients: become the focus of that work. Much of the myofascial
observing their standing organization and observing work will then consist of progressively releasing areas
their gait. For the assessment of standing organization, of shortness within those lines. In the sagittal organiza
in the frontal plane we looked at left-right symmetry, in tion we will look at the back line and the front line; in the
the sagittal plane the organization of the spine, ribs, frontal organization we will look at the lateral line and
pelvis and legs, and in the transverse plane rotations of the inner-leg line, and in the transverse organization we
the vertically stacked segments: legs, pelvic and thor will cover just a few releases to help differentiate the
acic segments and the head. In assessing gait patterns thoracic and pelvic segments. Myers, in his masterly
we looked for the following undulatory patterns that analysis of these longitudinal fascial continuities (Myers
are inherent in efficient walking: 2001), proposes what he calls the superficial front lines
and superficial back lines. The lines examined here are
• the lateral sway of the pelvis in the frontal plane similar to but not identical with those. He also expands
• a rocking of the pelvis in the sagittal plane upon what he calls spiral lines, which obviously relate
• the counter-rotation of the shoulder and pelvic girdles to our transverse organization; however, working with
in the transverse plane - a slight twisting and untwist spiral and oblique lines calls for a more advanced
ing around the longitudinal axis of the body. understanding of structure and cannot be explored in
detail in an introductory book such as this. More
There is an obvious correlation between the fascial in-depth information about the spiral lines may be found
continuities in these three planes and the potential for in Myers' Anatomy Trains (Myers 2001).
PRACTICAL MANUAL
O P ENING T HE G A I T
Detailed mathematical modelling of the human spine

suggests that efficient gait is driven by the action of the
spine rather than the legs (Gracovetsky 1988). Gracovet
sky notes that in many animals it is undulation through
the spine that supplies the entire energy of locomotion;
we see this still in fish and to a lesser extent in reptiles
and amphibians. He believes that this is still the case in
mammals, and one only has to look at the slow-motion
picture of a cheetah in full flight to see the extraordinary
power of locomotion that comes from the vigorous flex
ion and extension of the animal's spine. He suggests that
this 'spinal engine' forms the motive power for locomo
tion even in human beings; it is the complex motion of
frontal and sagittal undulation combined with the
counter-rotation of the spine about its own axis that
drives our gait. Gracovetsky (1988) gives a dramatic
account of a man born with no legs who is able to 'walk'
with a spinal motion that is only a slightly exaggerated
form of our own. The legs amplify the action of the spinal Figure 15.1 Sagittal undulation (after Gorman).
engine but are not essential for locomotion.

In order to clarify the three components of pelvic
undulation we can perhaps illustrate them with their ungrounded hip a natural adaptation. So the Marilyn
more exaggerated forms, which are caricatures of the Momoe walk is not necessarily a 'put on' but is a natu
movements. The frontal undulation is a side-to-side ral consequence of having wider hips!
translation of the pelviS that is also accompanied by a All three components of efficient gait demand differen
tendency for the hips to alternately lift and drop; it has tiated movement of the head and the thoracic and pelvic
been called the 'Marilyn Momoe' walk, but is also seen segments, which means that these vertically stacked
in competitive walking and so-called 'power walking'. segments of the body can move somewhat independ
The sagittal rocking of the pelvis and spine in walking ently of each other. For instance, the thoracic and pelvic
and dance is very evident in some traditional African segments can counter-rotate against each other to the
cultures, but is also seen in the relaxed rocking pelvis of degree that spiral fascial lines will permit, and in the
trained dancers. In Rolfing circles it is sometimes referred frontal plane these same segments can move laterally,
to as 'the psoas walk', however it could also be called in opposite directions. This kind of differentiated move
the 'Jar Jar Binks' walk in reference to the Star Wars char ment requires a free spine and for abdominal muscles
acter who walks in this way. The transverse undulation (particularly the obliques) to work in a subtle and com
of the pelvis is the counter-rotation of the shoulder and plex way, otherwise these segments simply move together
pelvic girdles around the longitudinal axis of the body, as an undifferentiated block. Differentiated motion
which is most apparent in an exaggerated form as the will be inhibited if there is a generalized tightening
'cat-walk' of trained models. Our gait contains all three of the abdominal muscles as this can form a muscular
components but in very different degrees; the mixture 'corset', suppressing natural gait. We will now look at
is often a reflection of our cultural milieu: for instance, these three undulations in more detail.
one sees more movement of the hips in the streets of Rio
de Janeiro than in London. Aspects of these component
Sagittal lines, sagittal undulation
undulations are intrinsic to our structure. As an example,
the typical female pelvis is wider proportionally than The sagittal undulation of the spine and pelvis is a fun
the male pelvis and therefore has a proportionally damental and distinguishing movement of mammals
greater distance between the femoral heads. During the (see Figs 15.1 & 15.2). It consists of a subtle wave-like
'swing' phase of gait, the swinging leg is therefore sus rippling, like a skipping rope gently wriggled from one
pended from a longer lever, making the dropping of the end. In humans in upright stance the pelvic segment
A FIRST APPROXIMATION TO BALANCING STRUCTURE
, 149
Figure 15.2 Sagittal undulation.
Figure 15.3 Lateral undulation throughout the world

of vertebrates.
rocks anterior-posterior through the axis that passes
through the acetabula, and this is coupled with a sinus
oidal wave that passes up the spine and is combined
with a periodic shortening and lengthening of the
entire spine. The same kind of motion can be seen very
clearly in the powerful locomotory movements of
dolphins and whales, and can be seen dramatically in
human beings performing the butterfly stroke in swim
ming. Mammals are capable of utilizing this sagittal
undulation in combination with the lateral undulation
that is more characteristic of fish and reptiles.
Lateral lines, lateral undulation
Lateral movement within the frontal plane is a distin Figure 15.4 The main trunk segments in frontal organization
guishing movement in all vertebrates (Fig. 15.3). It can showing lateral flexion and lateral undulation.
be expressed as simple side-flexion, or as a lateral

undulatory wave that progresses longitudinally through through the hip, bypassing the knees (because of the col
the length of the animal. In fish this wave becomes their lateral ligaments) before reaching the ankles and feet.
principal means of locomotion. Humans, as vertebrates, The hip joints are designed to abduct and adduct freely,
have the same potential for a 'wavy spine' through this and thus have the potential to translate laterally within
plane. If we look at the main structural segments in their the frontal plane (Fig. 15.5). In walking, this becomes
frontal aspect, we see the three main skeletal masses of the rhythmic swaying of the hips that accompanies the
the head, the thorax and the pelvis connected respect weight shift from one supporting leg to the other.
ively by the cervical and lumbar spines (Fig. 15.4). It
also shows the main ways that lateral movement can be
Transverse lines, transverse undulation
expressed - as lateral flexion and lateral undulation. But
we are also bipedal, which means that, in standing, our Movement in the transverse plane is possible because
spine and legs have the same longitudinal orientation our major axial segments - the head, and the thoracic
as the trunk, so this longitudinal wave can continue and pelvic segments - are stacked vertically above each
PRACTICAL MANUAL
of the matador to rotate around his own axis, the mata

dor will usually win out (Feldenkrais 1949). Many of
the Eastern forms of martial art capitalize on the power
of helical and rotatory movements, whereas in the West
we seem to focus on orthogonal planes of movement in
our exercise regimens and in the design of exercise
equipment, paying less heed to rotatory patterns.
KE EPING A LEVE L HE AD
A perfectly functioning spine-pelvis complex has the

potential for all three kinds of undulation in movement,
particularly in gait. Yet on top of this whole mobile
Figure 15.5 Lateral translation of the hips in the frontal plane arrangement is a head that needs to be relatively stable
(after Versalius). in movement.
This presents the interesting scenario of a pelvic seg
ment with the potential to undulate in a highly complex
fashion, and a swaying sacral base connected to a spine
on top of which is a head that ideally should not sway
in movement too much. Our vertebrae are designed
to allow flexion-extension and side-flexion-extension
throughout the entire length of the spine, and rotation
through the thoracic and cervical regions, and this
would suggest that with good co-ordination it should be
possible to have a moving sacral base, a complex undu
lation of the spine and a head that is able both to remain
vertical and to track forward in space during walking
External
without too much lateral displacement. And this kind of
oblique gait is quite evident in many traditional cultures, and is
Internal seen in its most beautiful expression in the flowing gait
oblique of some African cultures, particularly when it is normal
Midline practice to carry heavy loads on top of the head. However,
(linea alba) this elegant way of moving is seen much less in the
West, where cultural constraints often will not allow the
full and natural expression of movement.
W hat we so often find are hips that move very little
Figure 15.6 Transverse undulation.
and a head-thorax-pelvis complex that virtually moves
as one piece; there is very little differentiated movement
between the segments, and the thorax-abdomen-pelvis
other and able to rotate relative to each other around a becomes the trunk (with an obvious semantic relation
longitudinal axis, to the degree that the spiral lines and to tree trunk!). And we know that if any constraint is
the facet joints at each spinal segment permit (see Fig. placed on the full expression of our movement poten
15.6). These rotatory movements are driven by the spiral tiality then eventually that constraint will become con
ling orientation of the muscle fibres, which suggests solidated in the flesh; it will manifest first as a fascial
that the human body is designed to support spiral or restriction, and later as joint stiffness and immobility.
helical movement patterns. But why does the head need to be stable in movement?
Feldenkrais suggests that a rotation around our lon As was outlined in Chapter 12, the head is the reposi
gitudinal axis is an extremely efficient kind of move tory of our main orienting senses of sight, hearing and
ment in humans. He notes that when the enormous sense of smell, and also of the semi-circular canals or
linear momentum of a bull is pitted against the ability vestibular complex that informs us of our orientation in
A FIRST APPROXIMATION TO BALANCING STRUCTURE
space. Our senses will generally work better atop a FIVE STRU C T U R A L T HEMES
stable platform. The perceptual processing involved in
vision, for instance, is a much simpler process in a non In the following technical chapters we will address five
swaying universe. And anyone who has visited an structural themes - three axial and two appendicular:
amusement park knows the effect of too much move
ment of the semi-circular canals! So what is necessary to • working in the sagittal plane
accommodate the ideal poise of the head when every • working in the frontal plane
thing below is in complex movement? W hat are the • working in the transverse plane
options open to the body? And how is this affected by • addressing shoulder girdle displacements
the extremely common pattern of an undifferentiated • addressing the external rotation of the legs.
head-thorax-pelvis complex?
We have spoken a lot about the sensory-motor intel For each theme we will first examine the relevant
ligence of the body. Let us imagine that this intelligence myofascial lines and structures that may need to be
could articulate its reasons for choosing to move in a addressed. This will be followed by a pictorial section
certain way. How would it try to solve the following outlining a series of techniques that can be used to
movement problem? address these myofascial lines. The three axial themes
How can I help this body maintain a stable platform for the will also include some simple Feldenkrais-style integra
head given that the thorax and the pelvis move as one piece? tive work that can be used following structural work.
Its 'reasoning' might proceed as follows: The integrative work will be shown firstly as a
Feldenkrais Awareness Through Movement (ATM) script,
a. If a lateral swaying of the hips is permitted then the followed by a pictorial exposition of the kind of 'hands
head can only remain stable in space if the lateral on' movement work that is typically used by Alexander
movement at the hip is counter-balanced by a con or Feldenkrais practitioners. In Feldenkrais circles this
trary (and possibly excessive) side-flexion of the neck. is known as Functional Integration.
b. Another solution might be to dispense with the The Feldenkrais ATM scripts consist of a series of
swaying of the hips entirely, or at least to inhibit their verbal directions that guide the client through a care
lateral sway as much as possible. This will not only fully structured movement exploration. These ATMs
stabilize the head, but the whole trunk as well! (This are typically conducted with the client lying down on
could be called the 'brick on legs' syndrome, a pat the floor or on your table; this eliminates much of the
tern very common in the West.) 'anti-gravity' processing required of the nervous sys
c. The only other alternative is to accept that the head tem in standing and gives the client more 'space' in
will displace from side-to-side in walking, and this which to attend closely to new sensory information.
will result in a swaggering gait like the motion of an ATMs typically begin with a process of sensorial
inverted pendulum. focussing: an attempt to bring the client's awareness to
their inner world of sensory and kinaesthetic impres
Each of these 'solutions' has its associated problems. sions, and to 'awaken' areas of their body that will be
In solution a., by minimizing movement in one place engaged in the exploration. Verbal directions are then
we encourage excess movement elsewhere, and all the used to guide the client towards some specific move
repetitive stresses that this entails. In solution b., we are ment patterns or coordinations that usually start sim
employing large-scale co-contraction of muscle groups ply and build in complexity. These movements must
to inhibit the expression of natural movement. This is never try to challenge the client's structure; they are
inefficient mechanically and ultimately very destruc usually performed slowly, with small amplitude and
tive of joints. Or in solution c., the inverted pendulum with eyes closed, so they can be more deeply sensed.
syndrome, the centre of gravity of the head and chest is ATMs will often then take the movement pattern into
being systematically displaced from the midline. Apart other bodily orientations. You will notice also that
from the fact that the head is not stable in walking, the 'rests' are given fairly often. These are not a rest from
movement is mechanically inefficient because energy physical exertion but a space to allow the nervous sys
is expended in bringing the upper centre of gravity tem to integrate the new impressions. It is suggested
back to the midline twice each gait cycle. All such that you experience the lesson yourself before using it
inefficient gait patterns will leave their imprint in the with your clients. In the ATM scripts that follow, a cer
structural body. tain amount of anatomical language has been used; this
PRACTICAL MANUAL
may not be appropriate for your clients and you may direct or enhance aspects of the clients' movements.
need to find a more colloquial language that is appro They can be used by themselves or as a means of
pria te for them. enhancing the ATM work.
Following each ATM script you will find a pictorial
section that shows how you can use your hands to
RE FERENCES
Feldenkrais M 1949 Body and mature behaviour: a study of Gracovetsky S 1988 The spinal engine. Springer, Vienna
anxiety, sex, gravitation and learning. International Myers T 2001 Anatomy trains: myofascial meridians for manual
Universities Press, New York and movement therapists. Churchill Livingstone, Edinburgh
WORKING IN THE
SAGITTAL PLANE
Work in the sagittal plane means addressing the spinal

curves, dealing with dysfunctional patterns of rib
organization, finding an appropriate tilt of the pelvic
segment and finally 'getting the head on top'. Working
with the spinal curves means directing attention to
exaggerated or diminished primary and secondary
curves and finding a more balanced relationship
between the pelvic segment and the spine. This neces
sarily also entails working with the anterior and poster
ior aspects of the lower limbs as these are major
myofascial determiners of the tilt of the pelvic segment.
FA SC I AL LINES TH AT A FFECT
MOVEMENT IN THE S A GIT T A L PLANE
Figure 16.1 shows the fascial continuities that run

through the dorsal and ventral aspects of the whole body
that, here, will be called the front line and the back line.
The front line runs through the anterior aspects of
both the legs and the trunk. It consists of the connected Figure 16.1 The front and back lines.
fascial continuity that flows from the dorsum of the
feet, through the anterior aspect of the crural fascia, the
anterior aspect of the fascia lata overlying the rectus fascia that invests the calcaneus, calcaneal tendon and
femoris, reaching to the anterior superior iliac spine the gastrocnemius, and the posterior aspect of the fascia
(ASIS). In the trunk there is a primary line running from lata that invests the hamstrings and the fascial environ
pubic bone up to and induding the sternal fascia and ment of the sacrotuberous ligament. In the trunk there
thence flowing into the anterior fasciae of the neck. is a primary line consisting of the multiple fascial layers
There are also key areas more lateral to this line that that overlie the multifidus and erector spinae group,
'feather off' laterally: the more anterior attachments connecting the multifidus triangle over the sacrum into
of the obliques, the costal arch and the more anterior the galea (epicranial aponeurosis) of the scalp. There
fascia overlying the ribs. are also key areas lateral to this primary line: the thora
The back line consists of the fascial continuity running columbar fascia and the fasciae overlying the posterior
from the plantar fascia, the posterior aspect of the crural aspect of the ribs.
PRACTICAL MANUAL
THE FRONT LINE (SEE TECHN I Q UES simple formula that can be applied without considering
T 1-T 2 3 ) the organization as a whole. It is again emphasized that
the order in which any of these areas are opened up
In the technical section that follows, a series of techniques depends on coming from a broader strategic perspec
will be outlined for addressing the following areas: tive, for instance by applying the 'rules of thumb' for
strategizing sessions that were outlined in Chapter 14
• the antero-Iateral compartment of the leg (tibialis
(see Box 14.1, p. 133).
anterior and the more anterior of the peroneal group)
and the fascia overlying the flat, anterior surface of
Excessive cervical lordosis
the tibia (Tl, T2)
Lengthen the local erector fascia, open the suboccipital
• the anterior aspect of the fascia lata, in a line connect
area and perhaps also the sternocleidomastoid and
ing the patella and the ASIS, and more laterally to the
scalenes (T48-T55, T73-T75).
tensor fasciae latae and the sartorius attachments,
then more medially to the short adductors (T3-Tl6)
Diminished cervical lordosis
• the ASIS and the superior-anterior aspect of the iliac
Lengthen the anterior cervical compartment including
crest (Tl7)
the infrahyoids (T22, T23, T73-T75).
• the costal arch (Tl8)
• the anterior belly wall (Tl9)
Excessive kyphosis
• the sternal fascia and the more medial aspects of the
Generally lengthen the entire ventral aspect of the trunk.
pectoral fascia (T20)
Give counter-curve stretches to the thoracic spine,
• the ventral aspect of the trunk generally (T21)
aiming to influence the anterior longitudinal ligament.
• the anterior fasciae of the neck, and the deeper layers
Strongly lengthen any ventral area that is found to be
that invest the longus collis (T22, T23 and also T73,
tight during a counter-curve stretch (Tl7-T21).
T74 and T75).
Diminished kyphosis (flat thoracics)

THE B AC K LINE (SEE T ECHNIQ UES Lengthen the thoracic erectors and the posterior aspect
T24-T 5 5 ) of the ribs after positioning the client in a flexed, even

foetal position (T39-T41, T86).
These areas will be addressed in the technical section

that follows: Excessive lumbar lordosis
Lengthen the lumbar erector fascia, then more broadly
• the plantar aponeuroses (T24)
into the thoracolumbar fascia. Lengthen the psoas
• the posterior aspect of crural fascia, calcaneal tendon,
(T36-T39, T42-T44, Tl2, Tl3).
the heads of the gastrocnemius, and more laterally to
the edges of the soleus (T25, T26 and also T78) Diminished (or flat) lumbar lordosis
• the hamstrings (T27-T35)
Lengthen the hamstrings, the anterior belly wall and
• the multifidus triangle, the thoracolumbar fascia, the
the superior attachments of the ASIS. Perhaps also
erector spinae from mid-sacrum to the nuchal liga give lumbar extension stretches or exercises (T27-T35,
ment and occiput (T36-T55). Tl7-Tl9).
We will also look at the internal ligamentous structure

of the spine, especially the anterior and posterior longi Forward lean (from ankle to hip)
tudinal ligament. Lengthen the plantar fascia, the fascia investing the cal
caneus and around the calcaneal tendon (to decompact
the calcaneus and give 'more heel'). Broadly lengthen
SOME GENE R A L PROTOCOLS FOR the antero-Iateral compartment and the superficial
ADD RESSING IM B AL ANCES IN fascia investing the tibia (T24, T25, Tl, T2).
THE S AG I T TA L P L A NE
Excessive anterior pelvic tilt
W hat follows is a summary of some common features of Lengthen the thoracolumbar fascia, the lumbar erectors,
the front and back lines in which one would normally the rectus femoris, the vasti group, the anterior aspect
consider some lengthening work (see Fig. 16.2). However of the short adductors and the iliopsoas (T36-T39,
these 'point form' suggestions should not be taken as a T42-T44, T3-Tl6).
WORKING IN THE SAGITTAL PLANE
Anterior cervical fascia, Atlanto-occipital

SCM, scalenes. For head junction. Open up if
�
forward syndrome lengthen all the neck is habitually
anterior fasciae, particularly hyperextended.
around the rib and sternal
insertions. Posterior cervical fasciae
Usually requires
Sternal and pectoral fascia lengthening for head
.
Lengthen if chest is forward syndrome.
'collapsed' or expiration fixed. Upper trapezius and
Take the work more laterally -----/ levator scapulae
for shoulder girdle protraction. May shorten as an
aspect of head-
Rectus abdominis forward syndrome.
Lengthen for clients with an
expiration-fixed chest pattern Thoracic spine and medial
or for a strongly posterior aspect of ribs
pelviC tilt. If too flat, lengthen
erectors and rib fascia. If
ASIS
kyphotic, give extension
For externals, work on the
stretches.
superior/anterior attachments
to the ASIS.
Lumbar spine
For internals, work inferiorly:
Too flat, work on hamstrings
over the tensor and the gluteal
and anterior/superior connections
fascia in the anterior half of the hip
into ASIS. Too lordotic, lengthen
'deltoid'. Also take the work medially
lumbar erectors, rectus
towards the short adductors.
femoris and psoas.
Quadriceps and fascia of the groin
For internals, lengthen. Hamstrings
Antero-Iateral compartment For externals,
and the tibial flat lengthen.
Lengthen when there is an For clients with
exaggerated 'forward lean' from anterior pelvic shift,
the ankles, usually associated lengthen more broadly
with an exaggerated anterior -------\ and superficially.
pelvic shift. Posterior fascia of
lower leg and plantar
Ankle retinaculae fascia. Lengthen
Release around retinaculae if generally for clients
the ankles seem too tight, or -------/
with a posterior pelvic
the retinaculae seem to be shift.
compressing the underlying
tendons too much.
Figure 16.2 The sagittal organization showing key areas that often need to be addressed.
Excessive posterior pelviC tilt abdominis, and the pectoral-sternal fascia (T4-T7,
Lengthen the hamstrings, the lower abdominals and T17-T21).
the more anterior oblique attachments superior to the
ASIS. At a ligamentous level, lengthen the anterior long Expiration fix
itudinal ligament in the lumbar spine through lumbar Lengthen the sleeve of the thorax generally. Work
extension stretching (T27-T35, T17, T19). between the ribs, under the costal arch and the length
of the tendinous borders of the rectus abdominis. Use
Excessive anterior shift - shortened back line stretches to influence the internal fascial connections
Broadly lengthen the back line: the plantar fascia, fasciae between the costal arch-xyphoid process and the crural
of the calcaneus, the calcaneal tendon, the gastrocnemius, attachments of the lumbar spine (T18-T20, T39-T47,
the hamstrings, the fascia investing the sacrotuberus liga T70-T72).
ment, the thoracolumbar fascia, the erector spinae group,
the nuchal ligament, the suboccipitals, the occipital fascia Inspiration fix
and the fascia of the scalp and brow. Most effect will Lengthen the dorsal aspect of the thorax. If the shoulder
come from broad work on the hamstrings and along the girdle is retracted, lengthen the fasciae investing the
full length of the back (T28, T39). mid-trapezius, rhomboids and superficial scapular
musculature (T39-T41, T86).
Excessive posterior shift - shortened front line
Broadly lengthen the front line: the dorsal fascia of the The forward head syndrome
foot, the antero-Iateral compartment of the leg, the fascia This is a large scale pattern and is thus a longer-term
overlying the flat of the tibia, the rectus femoris, rectus project that includes lifting the ribs, lengthening the
PRACTICAL MANUAL
pectoral and clavipectoral fasciae, opening the sub Thoracic inlet syndrome
occipital region, lengthening the upper trapezius, the Lengthen the pectoralis minor and the scalenes. Broadly
levator scapulae, the sternocleidomastoid and scalenes. work all the connections into the axilla. Consider giving
Broadly lengthen the entire ventral aspect of the trunk a neuro-stretch for the brachial plexus if you are confi
especially the upper abdominals and the costal arch dent there is no nerve inflammation (T96, T23, T73-T77,
(Tl8-T23, T45-T55, T73-T75, T83-T93, T96-TlOO). T94-TlOO).
S A G I T TA L ORG A N I ZAT ION
Front line
� -
T1
MFR technique - shin

Use the 'octopus grip' for a
broad contact since it is only """ I
_� " -
-'
. ..
the superficial fascia that
needs to be engaged. Slide ....... ...�
�
'�'�'�',
superiorly. You can work
specifically on the flat of the
yj ,. ',J:
tibia, then use fingertip

contact to work on the
borders of the tibia.
Assisting movements
Ask for a slow
flexion-extension of the
ankle.
Lateral head of
gastrocnemius ---I'-f-
Head of fibula
Tibialis anterior
Soleus ----\-\-k:b'!ll .Hf-- Extensor digitorum

Crural longus
Interosseus Calcaneal tendon

membrane
Lateral malleolus
Anterolateral
compartment
Fibula
� " ,
T2
MFR technique - antero-Iateral

compartment
i '
��
.
Slide superiorly using the forearm blade . ,. " ....•..
.
but avoiding any hard contact with the
tibial border. The client can be placed in a
side-lying position if you require specific
access to the peroneals.
Assisting movements
Ask for a slow flexion-extension of the
ankle.
Alternative
Use doubled thumbs along lateral tibial
border.
The quadriceps
It should be borne in mind when
working with the quadriceps that
the four muscles in the group have
two kinds of action. The rectus Iliopsoas -h�H'"'
femoris is a two joint muscle,

spanning the knee and the hip, and Tensor +.--\---.-\11-- Pectineus
fasciae
acts as a hip flexor as well as a knee latae
extensor. The vasti only extend the Adductors:
Sartorius -t++t+,....-;,. . h:'f--o-il:'-4
-+1- Long us
knee, yet they are packaged in the i"t-t++-+-,+--t-t t- Gracilis
same fascial compartment of the Vastus -f--'--+--tti- Magnus
lateralis
anterior thigh (see Fig. 9.4, p. 61). Vastus
Rectus --+1f.'-'-�- " intermedius
Hence a generalized lengthening of
femoris
the quadriceps, including the vasti,
will assist hip extension. Vastus --\\\'0-"",,-\-'-1-
medialis
Semimembranosus
PRACTICAL MANUAL
T3
Test for hip flexors

The client lays supine and hugs one knee to the chest in order to
flatten and stabilize the lumbars. If the hip of the suspended knee
remains slightly flexed then the psoas is short. If the knee lifts as it is
passively flexed (as in this photo), then the rectus is short.
T4
MFR technique - quadriceps

Work along the rectus to the ASIS.
Repeat with more lateral and more
medial strokes taking in the vasti. Work
along the 'valley' of the sartorius, which
separates the adductor mass from the
quadriceps.
Assisting movements
Ask for a gentle pelvic rock, assisted if
necessary by having the opposite leg
flexed with the foot flat on the table.
Alternative
Use the 'octopus hand' to spread
the work.
TS
MFR technique - insertion of sartorius

Gently settle on the sartorius tendon
close to the ASIS. Gradually lean and
increase the pressure while sliding
laterally very slowly.
Assisting movements
Ask for a gentle pelviC rock, assisted if
necessary by having the opposite leg
flexed with the foot flat on the table.
T6
MFR technique - quadriceps, lateral

aspect
This area can be tender and full of trigger
points and is close to the femur, so this
work should be relatively superficial and
using the 'fleshy' part of the forearm blade
to avoid sharp contact.
Gather the superficial fascia and work
medially or laterally.
Assisting movements
Ask the client to breathe into the area
or to perform a small pelvic rock.
MFR technique - quadriceps, medial aspect

Using the full length of the forearm blade, settle in the valley of the
sartorius, gather the mass of superficial fascia and work laterally.
Assisting movements
Ask the client to breathe into the area or to perform a
small pelvic rock.
T8
MFR technique -
quadriceps, medial aspect
Grip the quadriceps with
both hands and lean your
body weight into the tissue
under the 'heel' of the
palms.
Assisting movements
Knee flexion. 'Slowly draw
your heel towards me.'
PRACTICAL MANUAL
T9
MFR technique - inner thigh,

adductors
Place the client's leg on an
angled roller or Torson bolster.
Using the 'forearm blade' and
the softer surrounding tissue as
the tool, sink into the tissue of
the inner thigh. (If you do not
have a bolster use a pillow for
support and work without the
client's assisting movement. )
Assisting movements
Leg abduction. 'Slowly draw
your knee towards me.'
T10
C-R stretch - quadriceps

Passively flex the knee to the first
bind.
Isometric contraction
Knee extension. 'Press your foot
into my shoulder.'
Next position
Knee flexion. 'On the out-breath
let me bring your heel towards
you.' For clients with a strong
lumbar lordosis, place a pillow
under the abdomen to stabilize
and flatten the lumbars.
T11
Self-applied C-R stretch - quadriceps

This stretch is similar to the traditional sports stretch for
the quadriceps, but without the need to maintain balance
on one leg. Clients can use a table or desk with the edge
padded with a towel.
Knee extension. 'Press your foot down into the table.'
Next position
This is an important and versatile stretch with various ways
of increasing the stretch:
• hip extension, 'Drop your knee.'

• knee flexion, 'Lean back, using your hands for support.'
• flexion of the lumbar spine, 'Tuck your tail under.'
Tn
C-R stretch - groin area and psoas

Have client sit on the edge of the table with sit-bones sliding off the table.Ask
them to hold one knee and roll back leaving the other leg behind.The client can
stabilize the lumbars by drawing the held knee closer to their chest and resting
their foot against your hip.
Hip flexion. 'lift your knee towards the ceiling.'
Next position
Hip extension. 'On the out-breath drop your knee towards the floor.' Some
gentle assistance may be necessary.
PRACTICAL MANUAL
T13
Passive stretch - fascia of groin and psoas

This is a passive form of the above stretch - allowing gravity to
do the work.
Iliofemoral
Pubofemoral ��_ligament
ligament _---.''--_. . ...:"''\..
T14
ligamentous challenge
Sometimes the iliofemoral ligament is
the chief limiting factor that prevents a
fuller extension of the hip. In this
ligament stretch you lift the client 's
knee while leaning with the other hand
into the femur. Repeat in a bouncing
fashion.
T1S
Self-applied C-R stretch - fascia of groin and psoas

For this 'lunge ' stretch to be effective, it is often necessar y first to
teach the 'pelvic rock ' so that clients know how to stabilize the
lumbars while doing this stretch.
Hip flexion. 'Attempt to slide your kneeling knee forward.'
Next position
Keeping the spine upright, the tail 'tucked under' and, with a sense
of lengthening upwards through the trunk, gently lunge forward
extending at the hip. If the distance travelled in this lunge is large
then probably some points of form were missed. Usually only small
increments are possible.
When comfortably balanced, it is possible to introduce a slight twist
away from the extended hip to reach more lateral fibres.
T16
Self-applied C-R stretch - hip flexors and knee extensors

This is an extreme stretch that works on both the hip flexors and
the knee extensors.As for other hip flexor stretches the lumbars
need to be stabilized with a 'tail tuck'.
Knee extension. 'Press your foot down into the chair.'
Next position
Knee flexion, hip extension. 'Lean back and bring your buttocks
closer to your heels. '
MFR technique - superior to the ASIS

Make initial contact with the lateral-superior aspect of the iliac
crest and slowly slide anteriorly towards the ASIS while maintaining
contact with the crest.
Assisting movements
Hip extension-adduction. Starting with both hips flexed: 'Slowly
straighten your leg and reach back with your heel till your foot slides off
the table.'
PRACTICAL MANUAL
T18
MFR technique - costal arch

Starting close to the xiphoid process (but avoid pressing into it), slide
laterally while maintaining contact with the inferior surface of the ribs. If
the rectus is ver y tight use the free hand to take up the slack in the
superficial fascia of the ribs.
Assisting movements
Ask for breathing in the upper chest.
Tn
MFR technique - rectus

abdominis
Work bilaterally on the fascial
borders of the rectus and the
obliques.The direction is medial,
as if trying to reach beneath the
rectus, then slide either superiorly
or inferiorly.
Assisting movements
Ask the client to exaggerate breath to the upper chest, or even to
slightly raise and lower their head.
.
,.
T20
�.
MFR technique - rectus
tendons and sternal fascia "
"
. r
Anchor in the tissue of the rectus '. . �.' '/'
..4If!
.
'
!!!tt iii
tendons, then continue along the
sternum and work over the
sternal origin of the pectoralis
major.
Assisting movements
Neck flexion. 'Gently raise your head a little, as if to look to your feet.'
Suggest they support their head with both hands.
The thoracic visceral fasciae

Ultimately, lengthening through the front line needs to be of the diaphragm. These fasciae are inevitably linked
matched with an internal lengthening of the thoracic together forming a network from the base of the skull,
visceral fasciae. The thoracic cavity is densely networked through the thoracic outlet, and connecting to the crura
with visceral fasciae: prevertebral and pretracheal fasciae, of the diaphragm. We can perhaps only influence these
the mediastinal ligaments, the pericardium and the fascia fasciae indirectly, by stretches such as the following.
Superior epigastric vessels ---+"",,,,"�-+-=----6;L...,j.1I
Seventh costal cartilage --+---A-'ieR...,1-

Lateral cutaneous nerves
Intercostal nerves
External oblique
IA-+----
Tendinous intersection
Posterior layer
1-+--- Rectus abdominis
of rectus sheath ---+-'��-+=-

Transversus abdominis ------,I---if-�
Iliohypogastric nerve --+B,'V..;.. 11"----:;.-+�4-1I--- Cut edge of rectus sheath

Inferior epigastric vessels --j-��"'
Arcuate line --l-�:.;...:.::!%':""":" -+----1-+--- External oblique
aponeurosis
Transversalis fascia -+----'\�.:-:..--"'��,...,.
Medial umbilical ligament _+-_��....:...1I-11/,-I1
Spermatic cord emerging -+-------"'� -l--:"';"�"':-�L-----+-- Linea alba
from deep inguinal ring If��"----\-- Spermatic cord emerging
Ilioinguinal nerve -/-------./ through superficial
Spermatic cord in inguinal ring
-------'"
inguinal canal
T21
C-R stretch - ventral aspect of trunk

A good stretch for unifying previous MFR work on the trunk, generally
opening up the front line. When constructing the pillow mound, try to
make the apex coincide with the maximum point of curvature in the
kyphosis. Clients with a strong lordosis should be asked to bend their
knees and flex their lumbar spine to prevent the stretch affecting the
lumbars.
Shoulder extension. 'Try to lift me.'
Next position
Shoulder flexion. Gently traction the arms while taking them further
into shoulder flexion and trunk extension.
Alternative
Lever from the elbows if the previous technique is too stressful for
the shoulders.
PRACTICAL MANUAL
T22
Passive stretch - infrahyoid area

This stretch actually lengthens the infrahyoids but also seems to reach into the
chest and affect the thoracic viscera. For this stretch, the client needs to sense the
difference between cervical and capital extension, and may need to be tutored in
this, then:
• open the jaw wide

• drop the head backwards (more cervical extension than capital extension).
Clients can be told 'Think of lengthening up through the front rather than
folding at the back'.
• close the mouth bringing the teeth together gently
• reach up towards the ceiling with the chin. ' Feel yourself lengthening through
the front including the ribs.'
• relax the jaw
• repeat.
T23
Self-applied C-R stretch - scalenes and sternocleidomastoid

This is one of the most difficult stretches to get right, but it is one of the
most important for mitigating the effects of the forward head syndrome.
Clients need to sense exactly where the stretch is acting, and if necessary
modify the vectors of the stretch to place the stretch directly into the
scalenes.
Caution: It is important not to jam the facet joints on the side opposite the
stretch, so an emphasis on lengthening in the front of the neck while
performing this stretch needs to be conveyed to the client.
Neck flexion. 'Press your forehead into the hand using about a 10% effort.'
Next position
Neck extension. 'Take the head a little further back at a diagonal while
maintaining a general sense of lengthening in the neck.'
Back line
T24
MFR technique -
plantar fascia
Using the phalangeal
surface of the fist and with
the elbow stabilized against
your own knee, work
slowly toward the heel.
Assisting movements
Toe and ankle flexion
extension. 'Curl your toes Digital vessels
and nerves
-HllIlI\\-II<lIIm
up. now your foot.'
Digital bands
Medial plantar
artery
hallucis
Central part of
plantar aponeurosis
Abductor minimi digiti
Medial calcanean
T25
MFR technique - calcaneal tendon

Using the forearm blade work superiorly. Take care when approaching
the heads of the gastrocnemius as this area can be quite sensitive and often
has active trigger points. Use a broad technique like the octopus hand
over the heads to the gastrocnemius.
Assisting movements
Ankle flexion and extension. 'Slowly flex and extend your ankle.'
Alternatives
Use the 'octopus grip' to broadly lengthen the crural fascia. Use the finger
chisel bilaterally starting from the calcaneus and working superiorly along
the tendon.
PRACTICAL MANUAL
T26
Self-applied C-R stretch -

gastrocnemius and soleus
Using a straight leg to stretch the
gastrocnemius or a flexed knee to
stretch the soleus.
Plantar flexion. 'Press the balls of your
foot into the floor.'
Next position
Hip extension, dorsiflexion. Translate
your pelvis toward the wall.'
Gluteus medius
Gluteus minimus
Piriformis --0--""':".101 Gluteus maximum

Gemellus superior
Sacrotuberous ligament
Obturator internus tendon
Gemellus inferior
Quadratus femoris
Adductor magnus
Biceps femoris, long head
Vastus lateralis
Gracilis
Semitendinosus
Semimembranosus
T27
Straight leg raise test - to check hamstring length

When first lifting the heel allow the whole leg to be suspended loosely
in a relaxed hand. This will encourage the client to relax the quadriceps
before doing the test.
Then elevate the foot to the place where the hamstrings begin to
'put on the brakes', at which point the knee will tend to flex slightly.
T28
MFR technique - the

hamstrings
First perform a broad
stroke with the forearm
blade from distal to
proximal to 'warm up'
the tissue.
Then, with more
point loading, follow the
lines of the medial and
lateral hamstrings. On meeting the ischial tuberosity, work around the
common tendon of the hamstrings.
Assisting movements
Slight hip flexion. 'Gently and rhythmically, press your knee into the
table.'
T29
MFR technique - medial

hamstrings
Using the forearm blade,
work medially with short
transverse strokes, gradually
working inferiorly.
Assisting movements
Slight hip flexion. 'Gently and
rhythmically, press your knee
into the table.'
PRACTICAL MANUAL
T30
MFR technique - lateral hamstrings

Using the forearm blade and starting from the fascia-rich area behind
the trochanter, work towards the knee.
Assisting
movements
Slight hip flexion.
'Gently and
rhythmically, press
your knee into the
table.'
T31
MFR technique - hamstrings, distal aspect

Using a soft fist, work in turn the medial and lateral tendon areas.
Assisting movements
Use the free hand
to lower the leg to
the table. If the
client cannot relax
the hamstrings,
have them extend
the knee gently
while you resist.
'Gently press your
foot into my hand.
I will resist a little.'
Using reciprocal inhibition

This technique makes use of reciprocal inhibition. If the the hamstring antagonists, the quadriceps, to enable the
client is unable to 'give' you their leg, oblige them to use hamstrings to release.
T32
MFR technique - inner

line of the medial
hamstrings
Begin with the knee as
flexed as possible, and then
using soft fists bring your
weight to bear on the
hamstring. Use the knuckles
as if to separate the
hamstrings from the
adductor mass.
Assisting movements
Knee extension. 'Slowly
straighten your leg.'
T3 3
C-R stretch - hamstrings

Test for the first bind by doing a straight leg raise, and begin the
stretch at the first bind. For clients with a tendency to hyperextend at
the knee, apply the counter-force as close as possible to the knee to
avoid stressing the posterior ligaments.
Hip extension. 'Keeping a straight leg, push into my shoulder.'
Next position
Hip flexion. On the out-breath take the hip further into flexion
until you feel the next bind. Alternately use the CRAC method and
ask the client to actively move to the next position (using their hip
flexors).
General comment on hamstring stretches

Any major flexion at the hip (as for instance in the 'dog form are vital in hamstring stretches otherwise the
pose' of yoga) will impart a lengthening tendency stretch will not go where it needs to go. When giving
throughout the entire back line, from the scalp to the hamstring stretches to external clients it is important to
toes. However, where the stretch 'goes' depends on which show them how to flex at the hip without flexing in the
sections of the back line are shortest. For instance, lumbar spine.Ask them to visualize an axis through the
external clients typically have very shortened hamstrings trochanters. Have them take their chest forward,
and a loosened posterior longitudinal ligament in the maintaining the straight relationship in everything above
lumbar spine. Therefore, when they flex at the hip the the hip.They will not go far. Language is important so ask
stretch inevitably goes to the lower back (which will flex them to 'hinge' rather than 'curl' forward. You can even ask
too easily) instead of to the hamstrings. Hence, points of them to maintain a slight lumbar lordosis.
PRACTICAL MANUAL
T3 4
Self-applied C-R stretch - hamstrings

This stretch is unusual in that each
hamstring is contracted successively prior
to moving to the next position. Using a
chair or table for support, hinge forward
from the hips (taking care not to flex the
lumbar spine).
Knee flexion. 'Draw your heel backwards
as if trying to bring your heel to your
backside.' Then repeat for the other leg.
Next position
Hip flexion. 'Pivot from your hips, taking
your chest forward and keeping a straight
back.'
T35
Passive stretch - hamstrings

A stretch from the Iyengar tradition. Try to keep the sacrum on the floor and the
sit-bones in contact with the wall. The knees need to be straight and the feet
need to be in as neutral position as possible, neither in plantarflexion nor lateral
rotation as these will decrease the effectiveness of the stretch.
For clients with an external pelvis, placing a roll under the lumbars can increase
the stretch. This also tends to encourage more of a lumbar curve. However,
extreme externals may not be able to do this stretch straight away as their entire
sacrum will be lifted from the floor. They may need to use a C-R approach first.
T36
MFR technique - multifidus triangle

and inferior erectors
Similar to 'the pose of the child' of yoga,
this working position allows good access
to the most inferior erectors and less
directly to the iliolumbar ligaments.Ask
the client to use their elbows and head to form a triangle of support in
order to resist being pushed forward. A pillow placed between the heels
and the buttocks can prevent excessive compression of the patella.
Assisting movements
Ask the client to breathe into the lower back.
.--_____ Ligamentum
Rectus capitis
nuchae
posterior minor -------,
.------. Semisoim,llis capitis
Obliquus capitis
superior --�� Longissimus
Rectus capitis capitis
posterior major ----"'81- Semispinalis
Obliquus capitis cervicis
inferior Longissimus
....
::-llioc<ost"liis
.. cervicis
Levatores cost·
arum breves
External
intercostal
Quadratus
lumborum
Transversus,
origin from
thoracolumbar
fascia
Lateral inter-
transverse
muscle
T3 7 Multifidus
PSIS
MFR technique - thoracolumbar fascia

This working position allows good access to the thoracolumbar fascia
as it meets the iliac crest. It also allows broad access to the fascia
overlying the floating ribs. Use the octopus hand or soft forearm blade.
Assisting movements
Ask the client to breathe into the lower back.
T38
C-R stretch - lumbar erectors

This technique follows naturally from the previous one. Place several
pillows on the table and ask the client to lie face down. Take care to
align the edge of the pillows with the ASIS. Place the heel of your palm
at about 52 or 53, depending on which gives the better purchase.
Lumbar extension. 'Arch your lower back
and stick your backside out.'
Next position
Lumbar flexion. 'Tuck the tail under and
allow your lower back to lengthen.'
PRACTICAL MANUAL
T39
MFR technique - erector fasciae

Ask the client to place the feet slightly in advance of their knees. This allows
them greater control during the folding forward. Starting at around C7, make
broad contact with the tissue either side of the spinous processes and
gradually glide inferiorly. This can be taken right to the apex of the sacrum.Ask
the client to allow their arms to hang to reduce tonus in the rhomboids.
Proprioceptively, this technique can give a strong unified impression of the
whole back and, incidentally, provides the practitioner with an ideal
opportunity to check on any scoliotic tendency.
Assisting movements
Spinal flexion. 'Allow your chin to drop to your chest then slowly roll
forward, allowing your arms to hang down like old ropes.'
T40
MFR technique - upper thoracic area

The support beneath the chest removes the need for
stabilizing tonus in the erector group. It gives good
access to the thoracic erectors, the rhomboids and
central trapezius, and to the more lateral fascia of the
ribcage.
Assisting movements
Ask the client to exaggerate the in-breath and allow
the ribs to expand backwards.
T41
MFR technique - upper thoracic

area, whilst side-lying
This is an ideal position to work on
the upper trapezius, rhomboids and
the more superficial rotator cuff
muscles. Use a bolster or rolled
pillow to pack the chest of the client -HJ---- Splenius
and allow a supported and rotated capitus
position of the thorax. The support 1'tI.----- Levator

scapula
minimizes the need for resisting tonus
Rhomboids
in the trunk when pressure is applied.
��-l-P-...L...f7"r-cH- Trapezius
Bring the knees up towards a foetal
position.
Assisting movements
Ask the client to breathe into the area.
T42
MFR technique - erectors

This is a general technique that can be
used anywhere along the spine,
wherever more detailed work is
required. Position the client with a
supporting roll as in the previous
technique. Using the point of the elbow,
make longitudinal strokes along the
erectors or in short lateral strokes
from the laminar groove.
Assisting movements
Ask the client to breathe into the area,
or minimally flex the spine into you.
T43
MFR technique - erectors, laminar

groove
Using either a reinforced finger chisel or
the point of the elbow.Apply successive
transverse strokes laterally from the
laminar groove.
Assisting movements
T44
MFR technique - erectors, working

medially
Use reinforced double thumbs to make
several transverse strokes towards the
spine.
Assisting movements
PRACTICAL MANUAL
Passive stretch - thoracic spine, ALL

This is a counter-curve stretch of the thoracic spine. It is one of the
few means of lengthening the ventral surface of the trunk while
directly influencing excessive kyphosis.
The hands should be clasped behind the head to prevent neck
hyperextension and to lengthen the pectoral fascia at the same time.
This is also a good working position for myofascial work on a
shortened front line.AII of the myofascial techniques for lengthening
the ventral aspect of the trunk can be used with the client in this
position. Clients can be asked to sense the specific areas of tightness
in the chest, which may then be released.
Clients with a gym ball can be encouraged to use this stretch as
homeplay.
T46
C-R stretch - thoracic spine and ALL

NB: This is identical with T21, which is used for lengthening the
anterior thorax.
Construct a mound out of pillows, rollers etc, ensuring that when
the client lies back the neck does not hyperextend.
Shoulder flexion. 'Gently try to lift me.'
Next position
While maintaining a slight traction through the arms, assist the client
further into spinal extension.
Alternative
Use flexed arms if the shoulders are stressed.
Anterior
longitudinal
The anterior longitudinal ligament (ALL)
ligament
For clients with a pronounced kyphosis, it is often the shortened anterior
longitudinal ligament of the spine that is the chief factor maintaining the curve.
POSSibly the only way of influencing this ligament directly is with a counter-curve
stretch.A rolled towel,Torson bolster or several pillows can be used (in Iyengar
yoga a wooden block is sometimes used), using graded thicknesses to avoid strain.
, T47
C-R stretch - pectoral

fascia
This stretch follows
naturally from the previous
one.Ask the client to
interlace their fingers
behind the head.
Arm adduction. 'Raise your
elbows to the ceiling.'
Next position
Arm abduction.
Caution: Any pain felt deep in the shoulder on either side should be a
contraindication as there could be some dysfunction in the rotator cuff.
T48
MFR technique - posterior cervical fascia

Starting around T2, press up into the laminar grooves. Work bilaterally
with finger chisels, using the back of the hands on the table to obtain
leverage. Work superiorly each side of
the nuchal line to the occiput and then
into the galea aponeurosis.
Assisting movements
None, or perhaps a very slight capital
flexion. 'Draw in your chin.'
T49
MFR technique - occipital ridge

This technique looks severe but the contact can be firm, yet gentle.
The first and second knuckles contact the mastoid process, while the
third and fourth contact the cervical fascia.The head is compressed
slightly into the pillow. Slide medially
whilst maintaining a vector of force
towards the centre of the cranium (i.e.
try to avoid making the client tense up
to stabilize the head).
Assisting movements
Eye rotation. 'Look towards the pillow.'
PRACTICAL MANUAL
T50
MFR technique - occipital ridge

An alternate method is to reach under the neck
and work on the opposite side of the occipital
ridge. Using finger-pad pressure, slowly slide
along the occipital ridge Semispinalis
capitis
from the mastoid
Rectus capitiis
process to the nuchal post. major Protuberanlia
occipitalis ext.
line.
n.fU:��"'-'<--;:---'l�
Obliquus
capitis sup. Rectus capitis
post. minor
Sterno-
Assisting movements cleoidomastoid
Occipital
None. Splenius capitis
condyle
Longissimus
capitis
Rectus capitis
T51
Movement education - the chin tuck

Few clients are able to flex their neck
while keeping the head parallel with
their mid-line.This technique is a first
approximation to discovering this
movement.
Using a roller or flattened Torson
bolster, show the client how to flex
their neck in a way that opens the
junction of the neck with the occiput.
The roller takes away the friction of
the head with the table and allows a
free exploration of this movement.
T52
Passive stretch - atlanto-occipital junction

This neck retraction is the 'chin tuck' of yoga.
Initially ask the client to stand with heels and buttocks touching
the wall.Ask them to draw in or tuck in the chin, while at the same
time lengthening through the back of the neck.The aim is to keep the
face parallel with the wall. Once this unusual neck flexion is sensed, it
can be performed without using the wall.
This stretch is very useful for dealing with the consolidated results
of the head forward syndrome.
TSJ
C-R stretch - atlanto-occipital junction

Flex the neck to the first bind. If you feel insufficient weight then
the client is trying to 'assist' by tensing the abdominals and is not
resting back into your hands. If so, ask them to relax the abdomen.
Cervical extension, capital flexion. 'Press gently back into my hands,
at the same time taking the tip of your nose towards your chest.'
Next position
Cervical flexion.Ask client to maintain
the pressure while taking a big breath
and then release.At the same time take
the head to the next barrier.
Semispinalis capitis
Splenius
capitis
Longissimus
capitis
Obliquus --'cI'\7l:::"'-II!I�:
capitis sup.
T ransverse
process of C1
Rectus capitis Vertebral artery

post. major
Obliquus capitis info
TS4
Self-applied C-R stretch - occiput and posterior fasciae of

neck
This stretch can lengthen the entire posterior fascia of the neck,
including the occipital region. It flows naturally into the following
technique, which then concentrates the stretch at the atlanto
occipital junction. By performing a pelvic rock in this position, the
point of the stretch can be localized in different parts of the upper
back and neck. If the stretch is being felt more in the mid to lower
thoracic region then try lifting the sternum more.
Cervical extension. 'Press your head gently back into your hands.'
Next position
Cervical flexion. 'Draw your chin to your chest.'
PRACTICAL MANUAL
T55
Self-applied C-R stretch - sub-occipitals

Maintain the final position of the previous technique. This technique can also be
repeated with a slight rotation to reach the oblique sub-occipital muscles.
Capital extension. 'Tr y to tip your head back, using your eyes to look up
through your forehead.'
Next position
Capital flexion. 'On the out-breath tip your head forward, using the eyes to
look down.'
This vital stretch is unusual in that it works best as a self The use of the eyes is very important. Research
applied technique. The hand position of the doer is ideally has shown that looking up will induce generalized
placed to resist the powerful forces of capital flexion spinal extension, and looking down: generalized spinal
and extension.A practitioner's help does not easily flexion.
duplicate this.
MOVE M E NT WORK FOR S AG I T T A L tactile guidance. It begins with a supine exploration of

UND ULAT ION a sagittal rocking motion that in Feldenkrais circles is
known as 'the pelvic rock'. This will be generalized into
A key movement exploration will now be shown that different orientations of the body and will finally be
can give the client a kinesthetic feel for sagittal undula taken into walking.
tion. First there is an ATM script and then a section on
Feldenkrais Awareness Through Movement (ATM) exploration - the 'Pelvic Rock'
Sensorial focusing to gently cradle your ASIS. What is happening to your

pelvis? How is it moving? Note the tendency for the
Lie on your back with your arms and legs long. Sense your
tailbone to 'tuck under' and move towards the ceiling as
contact with the floor. Which parts of you are in contact
you press your lumbar region towards the floor. Rest.
with the floor? Which parts are not? Sense the shape of
Again rhythmically press your lumbars towards the floor.
the spaces behind you. Sense the cervical lordosis - how
This time palpate your abdominal region and notice which
far from the ground is the highest point of that curve?
muscles become active.
Move your attention further down your spine.At what
point does the spine re-contact the ground? Sense the
Feet in standing, posterior pelvic tilt, lumbar
ribs that contact the floor each side of the thoracic
flexion
vertebrae. Where does the lumbar lordosis begin? How far
from the ground is its highest point? Sense the contact of Lie long and sense the areas of contact with the floor.
your pelvis with the floor. Rest. Notice the pattern of curvature of the entire spine: the
extent of the cervical and lumbar lordoses and the thor
acic kyphosis. Flex at the hip, bringing your feet up into a
Flattening the lumbar lordosis, with legs long
.. - ------- standing position. Notice how the whole shape of the
Remain lying with legs long. Rhythmically and gently press spine changes to accommodate this new position. From
your lumbar area towards the floor. Use your own hands this neutral position, gently press your feet into the floor
and release. Repeat in a slow rhythmical way. Sense what motion. Repeat many times. Notice whether you inhale
is happening to the pelvis. Note the rocking motion of the while flattening the lumbars, or the opposite. What does it
sacrum as the tailbone 'tucks under'. Rest. Continue, but feel like when you do the reverse? Rest.
palpating the abdominals to better sense their activity. See
if you can allow the abdominals to do less work. Rest.
Including a full-length flexion of the spine
Feet in standing, anterior pelvic tilt, lumbar Bring your feet to standing. Interlace your fingers and
extension place them behind your head. Find a way of comfortably
cradling the back of your skull. Begin to raise the elbows
From the "neutral position, gently rock your pelvis in the
from the floor and towards each other. When your
reverse direction, as it were, by pressing your tailbone
elbows are at their highest point, raise your head as if to
towards the floor while at the same time gently arching
examine your feet.After your head returns to the floor,
your lumbar area away from the floor. Release and relax
allow the elbows to drop back to the floor like wings. Do
back into the neutral position. Repeat a number of times
this a few times, noticing how the cervical and thoracic
sensing how your abdomen swells towards your knees.
spine responds. Rest. Repeat, but gradually introduce a
Sense how this movement translates through the spine and
pelvic rock so that the lumbars flatten as the head is
evokes a gentle rocking of your head. Rest.
raised. Repeat many times, using minimal effort. Briefly try
to do the opposite!
Combining posterior and anterior tilt
-- ----------- This basic 'pelvic rock' exploration can be undertaken
Now alternate these two opposite rocking motions to in other orientations:
create one coordinated movement. Repeat many times
• Sit on the floor, resting back with your hands behind
while sensing the rolling contact of the sacrum with the
you, soles of your feet together and knees dropped
floor. See if there are any points in this movement where
wide. Begin a slow pelvic rock in this position.Add in
there is a sense of jerkiness, and try to smooth it out. Try
head and neck flexion and extension, i.e. as the lumbars
to reduce the effort and bring a lazy, cat-like quality into
curve back towards the floor, allow your head to drop
the pelvic rock. Rest.
to your chest.As the lumbars arch forward and the
abdomen swells towards your knees, allow your head
Expanding the focus of the attention to include
to look up to the ceiling and have a sense of a general
the breath
lengthening throughout the entire front of your chest
Check in with the rhythm of your breathing. Sense what and neck. Sense how the chest can slide back and forth
areas are moving most. Least. On the in-breath sense how between the scapulae.
the expanding ribs gently press against the floor. When the • Explore the same movement but change the previous
rhythm of your breath is clear, begin to synchronise your position so that you are resting back on your elbows
pelvic rock with the rhythm of the breath, so that for instead of your hands.
every breath cycle there is a cycle of the pelvic rocking • Explore the same movement seated upright in a chair.
PRACTICAL MANUAL
'Hands-on' movement exploration - the pelvic rock
Pelvic rock - neutral position, sensorial focussing

The client lies supine with standing legs. Have the
client sense their contact with the table. You could use
some aspects of the sensorial focussing that were sug
gested in the preceding ATM script. Ask the client to
press their feet into the table, noticing how their pelvis
and lumbar spine respond.
Pelvic rock - lumbar flexion phase, posterior

pelvic tilt
With your hands gently moulded around the anterior
pelvic crests, thumbs contacting the A5I5, use your
hands to suggest a posterior tilt, and then allow a relaxed
return to neutral. It is important not to use your hands
forcefully here: the client provides the necessary mus
cular force, you just indicate the trajectory.
Pelvic rock - lumbar extension, anterior pelvic tilt

In the same way, use your hands to suggest an anterior
tilt, then relaxing back to neutral.
Ask the client to combine the flexion and extension
phases into one coordinated movement. You could then
draw the client's attention to how this movement
'ripples' through the system - how it demands a coord
inated response from the rest of the spine, the chest and
the head.
,.
Pelvic rock - in sitting, full spine extension and

flexion
Bring the client to sitting then recapitulate the pelvic
movements just rehearsed in the supine position, pos
itioning your hands over the ASIS as in that work. W hen
the slow pelvic rocking is established, reposition your
hands as in these photos to encourage full spine flexion
and extension. Have the client use their eyes to assist -
looking up during spinal extension and down during
spinal flexion. Use your hands as a guide wherever you
see there is more potential for movement in the pelvis,
the ribs or the spine.
Now the client is sensitized to this undulatory pat
tern, have them walk around while noticing what is
happening to the pelvis and lumbar spine. You can then
ask them to exaggerate the rocking motion into a 'Jar Jar
Binks' walk.
They can then drop the exaggerated pattern to find
a natural degree of sagittal undulation might be right
for them.
WORKING IN THE
FRONTAL PLANE
When working in the frontal plane in any particular ses

sion there will inevitably arise the question of whether
to work symmetrically or asymmetrically. For com
pressed structures a general lengthening each side of
�--Lateral
the mid-sagittal plane is required. A generalized short cervical area
ness in both iliotibial tracts, for instance, will inhibit the
lateral sway of the hips, while shortness in the lateral
abdominal and thoracic fasciae will restrict side flexion -+-+-+-- Lateral thorax
and lateral undulation of the spine, and in both of these
cases symmetrical work will be called for. For struc LATERAL LINE ---1'---1 -+-t-f--- The waist
tures in which a left-right imbalance predominates, it -+-\--- 'Deltoid' of
may be necessary to work asymmetrically, addressing a the hip
different pattern of shortness either side of the mid
Iliotibial tract --t-�
sagittal plane. Such imbalances may arise from asym
1-4--- Inner thigh
metrical usage or from skeletal asymmetries such as leg
length discrepancy (LLD). It will be recalled from the LA"1r--- MEDIAL
'rules of thumb' suggestions for strategizing a series of LEG LINE
sessions (see Box 14.1) that generalized lengthening Medial

work usually precedes work on left-right imbalances, Peroneal area --+r tibial border
so in most cases in which significant such balancing is

required, the asymmetrical work would be taken up
later in the series following initial work to decompress
the structure. Let us now look at the key fascial conti
nuities that will affect movement in the frontal plane. Figure 17.1 The lateral line and medial leg line.
The lateral line

T H E F A S CI AL LIN E S T H AT E F F E CT
L AT ER AL MOVE MENT The crural fascia wraps the lower leg. On the lateral side
it is anchored to the malleolus and the head of the fibula.
If we consider the gross myofascial lines that influence It hugs the knee very tightly and is continuous with the
lateral movement, we have the lateral lines, running from fascia lata above. The lateral line in the upper leg is
the lateral malleolus to the mastoid process each side, defined by the iliotibial tract (which is nothing else than
and the medial leg lines, running from the medial malle a localized thickening of the fascia lata), and it runs
olus to the ischio-pubic ramus and pelvic floor (Fig. 17.1). from the head of the fibula and lateral tibial condyle to
WORKING IN THE FRONTAL PLANE
the greater trochanter and thence to the crest of the WOR K I N G WI TH A SY M METRIE S I N
ilium, blending with the lateral gluteal fascia. T H E FRON T A L P L A N E
Immediately above the iliac crest arise the aponeu
roses of the transversalis and obliques, which become I n Chapter 4 w e spoke of two kinds o f working strat
the several layers of the lateral abdominal fasciae that egies decompressing and balancing. Sometimes we find
-
span the space between the crest and the lower ribs, the a 'balance' in the frontal plane in which there is overall
transversalis fascia being the deepest. More posterior is shortness in both lateral lines. Decompression means
the lateral edge of the thoracolumbar fascia, and deep lengthening both sides equally, thereby giving more
to that the fascia of the quadratus lumborum. potential for lateral sway in gait. Sometimes there is
The fasciae on the lateral seam of the thorax are not asymmetry between the left and right lateral lines.
continuous but span the intercostal spaces, and in effect Balancing in this case means deliberately working
span the lateral seam up to the axilla and thence beneath asymmetrically, trying to 'equalize' or at least bring
the shoulder girdle to the base of the neck. More poster more congruence to the fascial continuities either side
iorly is the lateral margin of the latissimus. From the base of the midline. Working in this asymmetrical fashion
of the neck several layers of cervical fascia reach up to somehow needs more integration than work to achieve
the mastoid process. front-back balance, and usually requires definite pre
In practical terms, the following are the key areas in paratory work. Some of the main themes for working
the lateral line that can be addressed: with frontal organization can be found in Figure 17.2.
1. The peroneal area, which extends from the peroneal Working with scoliosis
retinaculae at the lateral malleolus to the head of the
fibula (T56). After the general work of decompressing and lengthen
2. The distal aspect of the iliotibial tract, extending from ing, it is possible to take some of the strain out of the
the head of the fibula to the trochanter (T57, T5S). scoliotic system by lengthening work on the concavities
3. The 'deltoid of the hip', which includes a broad fan of the curves. It may seem as if the erectors are hyper
of fascia that radiates from somewhat below the toned on the convex side of the curve; however, this
trochanter up to the full arc of the iliac crest, and is actually more likely to be the erector tissue being
includes the gluteals and tensor fasciae latae (T59-T65). pushed out by the transverse processes on that side
4. The waist, which spans the iliac crest and lower ribs, since vertebrae tend to rotate in side bending.
and the quadratus (T66-T69). If the scoliosis has been induced by a LLD then the
5. The lateral seam of the thorax (T70-T72). following adaptations typically occur:
6. The superficial laminae of the lateral cervical fascia • The hips will displace laterally towards the side of the
(T73-T77). longer leg, giving it a fuller appearance on that side.
• The sacral base will slope towards the shorter leg,
Like the front and back lines, these are not sharply initiating a scoliotic adaptation that initially curves
defined areas and are best seen as 'feathering off' the towards the side of the shorter leg.
more we move anterior or posterior from them. • The following fascial planes will shorten: on the side
of the shorter leg - the iliotibial tract (ITB), the more
lateral aspect of the gluteal fascia superior to the
The medial leg line trochanter; on the side of the longer leg - the fascia of
This line starts at the medial malleolus and follows the inner thigh and adductors.
the medial border of the tibia to the pes anserinus at the • There will be a torsion set up within the pelvis which
medial tibial condyle. From here it continues into the will cause one ilium to rotate forward and the other
medial aspect of the fascia lata to the ischio-pubic ramus back.
and blends with the obturator fascia of the pelvic floor. • The pelvic torsion will set up an asymmetry in the
In practical terms there are two key areas that can be associated soft tissues: the external rotators, the hip
addressed: flexors (including the iliopsoas) and hip extensors,
the abductors and adductors, the sacrotuberous, sacro
1. The medial border of the tibia as it blends with the spinous, sacro-iliac, iliolumbar and lumbosacral
crural fasciae of the soleus and gastrocnemius (T7S). ligaments.
2. The inner thigh line (T79, TSO). • There will probably be asymmetry in the quadrati.
PRA CTI CAL MANUAL
Lateral line of the neck and upper

trapezius
There will always be
compensations for left/right
imbalances further down. So the
shorter side should be addressed
Lateral seam of the ribs after any balancing work further
Selectively lengthen for down.
left/right imbalances in the
trunk. For shoulder-girdle
tethering from below, work
along the border of
Ribs
the latissimus. Open up
Generally decompress for
generally for respiratory
breathing restrictions. Work
restrictions.
between closely approximating
ribs that are part of a scoliotic
adaption.
When checking for left/right

symmetry compare the two
'negative spaces' between the Erector spinae group
arms and the trunk. This can Will tend to be short on the
give useful information about concave side of scoliotic
left/right imbalances. curves.
The iliotibial tract superior to the The 'waist' and the quadratus
greater trochanter lumborum
Bilateral shortness will restrict a This space often needs
lateral sway of the pelvis in gait. opening bilaterally when the
For LLD this line will usually be thorax has 'collapsed' onto the
shorter on the side of the pelvis. It will need selective
shorter leg. lengthening for left/right
imbalances.
The adductor group Iliotibial tract

This line is often bilaterally tight This line is usually bilaterally tight for those
for clients who somatize their who exercise hard. Bilateral tightness will
tension in the pelvic floor region. inhibit the lateral sway aspect of gait. For
For LLD this line will usually be LLD this line will tend to be shorter on the
short on the side of the longer side of the shorter leg (along with the
leg. adductor line on the longer leg).
The peroneal line

This line will often mirror any
shortness in the iliotibial
tract above.
Figure 1 7.2 The frontal organization showing key areas that often need to be addressed.
Scoliotic patterns will inevitably induce adaptations convex. If X-rays are not available then the areas of
in the rib cage, so the lengthening work should be taken the ribs that need to be opened can be found by careful
wider into the surrounding ribs. Ribs will have com palpation. Laughlin outlines some excellent protocols
pressed on the concave side and expanded on the for examining and treating LLD (Laughlin 1998).
FRONTAL ORG A NIZATI O N

-
Lateral line
The peroneal area in the frontal plane. It also marks the functional separation
The fascia of the peroneal area is continuous with the of the front and back of the leg, so work in this area can
iliotibial tract (ITB). Therefore, it may usefully be help to functionally differentiate the anterior and
lengthened along with the ITB to address hip asymmetries posterior compartments and free up the ankle.
TS6
MFR technique -
peroneals
First work the area
broadly, then use more
point loading to
separate the
underlying muscular
compartments.
Assisting movements
Ankle flexion--extension.
'Slowly flex and extend Iliac crest
your ankle.'
TS7 Tensor
fascia lata
Ober test - test for

Gluteus
shortness in the maximus
iliotibial tract
With the hip in a
Iliotibial tract
neutral position and
the knee flexed at Vastus
lateralis
Biceps femoris.
right angles, support long head
the knee with one

hand to inhibit any
Tractus
medial or lateral iliotibialis
fasciae latae
rotation of the thigh
while stabilizing the Semimembranosus
pelvis with the other.

Allow the knee to drop to the table, sensing the tension in the -f/---- Patella
ITB.A drop to just below horizontal is considered to be a

normal length.
iiff---- Lig. patellae
PRACTICAL MANUAL
The iliotibial tract

The ITB is often a sensitive area to work, particularly for present about two-thirds of the way down to the knee.
athletic clients. The underlying vastus lateralis is easily So check with the client as you approach the spot and
compressed onto the femur. Trigger points are commonly ease the pressure as necessary.
T58
MFR technique - ITS

Starting on and around the
trochanter work towards the
fibular head. Either use double
soft fists to contour to the shape
of the thigh, or use the forearm
blade to 'iron out' the ITB.
You can use various transverse
strokes to 'feather out' from the
midline of the ITB.
Assisting movements
If the ITB is particularly sensitive
you can ask the client to 'breathe
into' the area.
T59
MFR technique - hip

deltoid
Start with the hip and
leg flexed. Using the
forearm blade, sink
into the gluteal fascia
at the trochanter and
work towards the
crest. The successive strokes can progress anteriorly or
posteriorly, depending on the area that needs most release.
You can work over the trochanter itself with soft fists.
Assisting movements
Hip flexion-extension. 'Slowly lengthen the leg, reaching
through the heel, then draw your knee forward again.'
T60
MFR technique - iliotibial tract,

above the trochanter
T his deeper technique can be used
following the broader work of the
previous techniques. Using doubled
thumbs or elbow, work in short
strokes across the ITS.
Assisting movements
Central sector
Deltoid of the hip

Fibres radiate in a broad fan from a point below the trochanter towards the
arc of the iliac crest, not unlike the shoulder deltoid. Work in this area can
allow freer lateral translation of the hips and can also influence pelvic tilt.
To encourage freer lateral translation of the hips concentrate on the
central sector.To encourage anterior tilt work more in the gluteal sector.To
encourage posterior tilt work more in the tensor sector.
T61
MFR technique - tensor fasciae lata

Start with the hip and leg flexed. Use the
forearm blade or finger chisel to work from the
trochanter towards the anterior superior iliac
spine (ASIS).
Assisting movements
Hip extension. 'Slowly reach back through your
heel. Straighten the leg till it hangs off the table.'
Encourage the client to slide the leg, not
elevate it, so as to minimize the tonus in the
abductors.
PRACTICAL MANUAL
T62
MFR technique - gluteal fascia in side-lying

Use double fists to hook into the tissue behind the trochanter and
work medially towards the sacrum.
Assisting movements
Hip flexion and internal rotation. 'Draw your knee towards your chest.
Then allow it to drop to the table.'
T63
C-R stretch - ITB and hip deltoid

This stretch focuses on the full length of the ITB, from the crest to
the fibular head.T he operator stabilizes the hip with one hand on the
ASIS while the other is near the
knee. The operator can avoid wrist
strain by leaning onto the fist.
Leg abduction. 'Press your leg back
towards the midline.'
Next position
Assist the client to adduct the leg to
the next position.
T64
C-R stretch - ITB, hip deltoid and quadratus

This stretch is less specific than the previous one and, depending on
where the client has shortened, may include the lateral abdominal fascia
and quadratus. It is important to position the client precisely side-on to
the table.This prevents them from rolling back and engaging the hip
flexors in the isometric contraction,
instead of their hip abductors.
Leg abduction. 'Draw your leg towards
the ceiling.'
.�
� �
....
l�: · Wf
Next position
Stabilize the client at the ribs and ask them to drop the leg to the floor
on the out-breath.
T65
Self-applied C-R stretch - the entire lateral line

Instruct the client to maintain a straight arm, allow the head
to hang sideways and keep most weight on the outside leg.
Abduction of the supporting leg. 'As if you are trying to slide
your foot sideways.'
Next position
On the out-breath, drop further into the hip.After 3 or 4
repetitions, stay there, breathing into the hip and allowing the
stretch to work.
Latissimus
dorsi
External
oblique
Gluteus --___
medius
Gluteus -----...,..
maximus
The waist
When you palpate the crest you often find what seems like a large investing
fibrous pad.This is actually the collective thicknesses of all the aponeuroses that
attach there, making this is an effective area to work.
As for the hip deltoid, a different emphasis in the work here can produce
different outcomes:
• Working the most lateral line will influence lateral translation of the hip.
• Working more posteriorly will encourage posterior tilt.
• Working more anteriorly will encourage anterior tilt.
PRACTICAL MANUAL
T66
MFR technique - waist

This working position allows good
access to all the fasciae that connect
into the iliac crest: the lateral
abdominal fasciae and the most lateral
aspect of the thoracolumbar fascia.
It also allows broad access to the
quadratus and the fascia overlying the
floating ribs.
Assisting movements
There are several possibilities: a slow
pelvic rock, a rhythmic reaching
through the heel of the upper leg, or
a reaching of the arm combined with
the breath.
T67
MFR technique - anterior

aponeuroses of the abdominals
You can ask the client to drop the
upper leg off the table to further
open the line you are working on.
The client may feel more stable using
a hand to grip the edge of the table.
Assisting movements
'Reach through the heel then relax
back.'
T68
MFR technique - quadratus

This detailed work can follow the
more generalized freeing work of
the previous techniques. Use
doubled thumbs to reach the lateral
border of the quadratus. Entry can
be from the 12th rib end, or from
the crest end by following the line of
the crest medially until you meet the
fibres of the quadratus. Work very
slowly.
Assisting movements
Ask for deep breathing into the
region or a slow pelvic rock.
T69
C-R stretch - lateral abdominals and the quadratus

lumborum
This stretch has two phases. In order to reach the
quadratus, the lateral abdominals must first release, so the
direction of this stretch is first lateral and then with a slight
anterior rotation to allow the stretch to reach the
quadratus.
Side extension. The client laterally extends into your hand,
which is placed at the axilla. Repeat.Then to reach the
quadratus, the vector needs to be slightly more posterior,
so as the operator you will need to reposition yourself
further behind your client.
Next position
Ask the client to drop further into side-flexion on the
out-breath.
PRACTICAL MANUAL
MFR technique - lateral

seam
Using an octopus handgrip,
mould your hands to the
shape of the ribcage using
some compression. Try to
engage the whole
underlying superficial fascia
and shear the tissue
superiorly. A bolster
beneath the client can
assist in opening up the
ribs you are working.
Assisting movements
Ask for deep breathing
into the ribs coordinated
with reaching through
the arm.
T71
MFR technique -
intercostal spaces
This technique can be
used to ease respiration
generally, or to encourage
opening in specific areas of
the ribs, as in scoliosis.
Using the finger chisel,
work between the ribs
that need to open more.
Assisting movements
Ask for deep breathing.
The lateral seam of the thorax

Using MFR in the lateral seam we can influence the more Work in the lateral seam can affect respiration as well
superficial layers: the superficial thoracic fascia and the as postural organization in the frontal plane. For clients
deeper investing fasciae of the obliques and serratus.The with respiratory restrictions this work should be
deepest layers can probably only be affected by stretching - supplemented with more pointed MFR into the intercostal
particularly the transversalis fascia, which is continuous spaces.
with the endothoracic fascia beneath the ribs.
T72
Passive stretch - lateral seam

There are many possible variations for this stretch, using a
gym ball, a bed, piles of cushions and so on. It can be turned
into a C-R stretch by using the upper arm to reach
alternately to the ceiling and the floor. If using a table it is
important to pad the edge for comfort.
The superficial cervical fasciae - a word of caution

In this general area there are sensitive structures such as described below are soft, and although it is possible to
the brachial plexus, the jugular vein and carotid artery, work more directly and more deeply in this area, it is best
so it is essential to get to know the area by gentle to wait and learn in a supervised context from someone
exploratory palpation. Explore your own neck first before experienced in handling necks.
moving on to other people's necks. The techniques
T73
MFR technique - superficial

cervical fasciae
Start with the client facing
ahead. You can use the finger
pads as if to reach beneath the
clavicle towards the scalene
insertions, or broadly contact
the 'scalene triangle' using
either the finger pads or the
dorsal surface of the middle
phalanges, using the 'soft fist'
to anchor the superficial
tissue. Sink in until you begin
to sense the underlying
transverse processes, and then ask for movement. Maintain a firm smearing pressure as you work posteriorly, successively
working the sternocleidomastoid ( SCM), scalenes and the upper trapezius.
Assisting movements
Cervical rotation. 'Slowly rotate your head away.'
PRACTICAL MANUAL
T74
MFR technique - sternocleidomastoid (SCM)

With one hand contacting
the jugular notch and the
other lateral to the SCM,
scoop beneath the SCM and
slide the fingers in opposite
directions, placing a shearing
force through the fascia that
invests the SCM.
Assisting movements
Ask the client to make
micro-movements of
rotation or flexion-extension.
T75
MFR technique - SCM bilaterally

Keeping the back of your hands resting on the table, contact the dorsal aspect of
the SCMs bilaterally. In a slow scooping motion slide ventrally while maintaining
contact with the mastoid process.
Assisting movements
Ask the client to have a spatial awareness of their 'overhead' region. Such a simple
perceptual shift can assist the neck to relax and lengthen.
T76
C-R stretch - lateral cervical fasciae

When working with neck stretches it is important to impart the sense
of a genera/lengthening of the neck even while stretching one side.
Note the operator's hand positions here and how one arm is used as
a brace.
Lateral extension of the neck. 'Gently draw your head towards the
midline.At the same time be aware of a general lengthening of your
whole neck.'With neck stretches it is important always to remind the client to use a 5-10% effort in
the isometric contraction.
Next position
Side flexion of the neck. You can apply a slight traction to the head as you assist the client to the next position.
T77
Self-applied C-R stretch - lateral cervical fasciae

First stabilize the shoulder girdle by grasping the edge of the seat
and leaning away until the shoulder girdle is felt to sit firmly on the
upper ribs. Bring the fingers close to the ear, using finger pad pressure
alone. Without forcing, allow the head to drop sideways.
Side extension of the neck. 'Press the head into your fingertips
using no more than a 10% effort.'
Next position
Side flexion. 'On the out-breath let gravity take your head to
a new position.'
Medial leg line
Medial tibial border

This area should be worked in conjunction with the inner work in the peroneal area, work in this line can help
thigh line, particularly when there is a side-shift establish a functional differentiation between the back and
asymmetry in the frontal organization of the pelvis. Like front of the leg.
T78
MFR technique - medial

tibial border
Stabilize the foot in a
plantarflexed, inverted
position to obtain
maximum slackness in the
tissue. Using the finger
chisel, work slowly along
the tibial border, reaching
successively for flexor
digitorum longus, soleus
and gastrocnemius.
Assisting movements
With your free hand,
passively evert-invert the foot.
PRACTICAL MANUAL
Inner thigh
Different structural results can be obtained by emphasizing either the anterior or posterior aspects of the inner thigh
line:
• Working the most medial line will influence lateral translation of the hips.
• Working the hamstring side will encourage anterior tilt.
• Working the quads side will encourage posterior tilt.
T79
MFR technique - adductor group

Slide superiorly using a broad forearm blade. Repeat if necessary with more point loading. Then work in transverse strokes.
You can work separately over the pes anserinus using a finger chisel.
Assisting movements
Ask for a slow pelvic rock. You can ask clients to emphasize different phases of the pelvic rock - extending the lumbar spine
to encourage anterior tilt; flexing the lumbar spine to encourage posterior tilt.
Ant. superior
iliac spine
Sartorius ---'ri-
Adductor
longus --HI-+- 4-1-+,c....r-- Adductor
magnus
Gracilis --+t+f\--'/t+
VI'+-l+1,----- Semimembranosus
Rectus
I'lIIHlH+-- Semitendinosus
femoris ---++--
Vastus
medialis -----+'i'- 'lHl-H--- Pes anserinis
MEDIAL VIEW
-t--+\\\--\--- Tibia
T80
C-R stretch - anterior adductors

This is one of a group of techniques in which it is useful to employ some
compressible material as a support. Here the use of pillows removes the
need for the client to engage the adductors protectively. Clients find it easier
to release into a supporting surface. Stabilize the contralateral ASIS.
Hip adduction and internal rotation. 'Lift your knee towards the ceiling.'
Next position
Hip abduction and external rotation. Press the knee into the pillow taking it
to a more abducted position.
MOVE MENT WOR K F OR FRO N T A L pelvis each side of the midline, and 2) the alternating
U NDU L ATION 'hitching' of the hips around a sagittal-transverse axis.
Generally they appear together in gait patterns, both
A key movement exploration will now be shown that involving contralateral abduction and adduction at
can give the client a kinesthetic feel for frontal undula the hip joints. The photos that follow show how this
tion; again, first as an ATM script and then using tactile movement pattern can then be generalized into stand
guidance. It looks at two closely related movements in ing and walking.
the frontal plane: 1) the pure lateral translation of the
Feldenkrais Awareness Through Movement (ATM) exploration - frontal undulation
Sensorial focusing, the mid-sagittal plane closed visualize that someone is tracing your own midline;
Lie on your back with your arms and legs long. Sense your starting from your crown then moving through the midline
contact with the floor. Which parts of you are in contact of your scalp and forehead, between the eyebrows, the
with the floor? Which parts are not? With your eyes bridge of the nose, the septum of the nostrils, the cleft of
PRACTICAL MANUAL
the upper lip, the cleft of the chin, the sternal notch, the left and right of the midline, keeping it parallel with the
middle of the chest to the xiphoid process, the umbilicus, floor. Now the displacement left and right is achieved over a
the pubis and around the line of the perineum. Continue smaller length of spine. Only displace as far from the
along the cleft of the buttocks to the tailbone, through the midline as is comfortable and without strain. Rest.Try a few
middle of the sacrum and gradually trace over the spinous more times, each time forming a smaller, lower bridge. Rest.
processes for the full length of the spine - the lumbar area,
the thorax, the central ligament of the neck, the OCcipital
2. Hip-hiking
bump and returning once more to the crown. Have you
drawn a straight line down the front of your body? Do any Reaching through the heel
of the body's segments feel displaced from the midline or Lie down with your arms and legs long. Reach through your
non-symmetrical? Compare the left and right halves of the right heel, trying to slide it away from you along the floor;
body: do they feel the same? How are they different? relax back to a neutral position. Repeat in a rhythmical way
reaching through the heel and noticing the response further
1. Lateral translation of the pelvis up your body. Keep the movement small, just a few
centimetres. What are the left and right hips doing? Allow
A pelvic rock, lifting the spine 'like a chain' to
the hips to participate more. What is happening in the
forming a 'bridge'
lumbar spine? Rest. Continue reaching through the right
Bring your feet into a standing position. Begin a slow pelvic
heel in this rhythmical fashion but use your hands to gently
rock: alternately flattening and then arching the lumbar
palpate your ribcage, noticing how the ribs respond to this
spine. Rest. Continue with the pelvic rocking but each time
reaching movement. How is the head responding? Rest.
you flatten the lumbar area go just a little further and,
eventually, the pelvis will lift from the ground. Continue, but Hitching the opposite hip
with each pelvic rocking motion allow the spine to 'peel' a Lying with arms and legs long, keep your left leg straight as
little further from the floor, vertebra by vertebra, like a you draw your left heel towards you, hitching your left hip.
chain being lifted link by link from the floor. Gradually you Repeat in a slow rhythm noticing once more how the rest
will approach a 'bridge' position.As you return to the floor of the body responds: the lumbar spine, the ribs, the
try to reverse the movement precisely, vertebra by shoulders and the head. Rest.
vertebra until your pelvis reaches the floor. Rest.
Combining the reaching and the hitching
Forming a 'bridge', lateral translation Now combine both of these movements: as you reach
Bring your feet to standing about hip-width apart. Press through the right heel, draw your left heel in towards you.
though your feet, tucking the tail under, lifting the pelvis, Repeat in a slow rhythm trying to make the coordinated
and successively peeling your vertebra from the ground movement as smooth and effortless as possible. Notice
until finally you reach the shoulders ( the thoracic-cervical now the partial undulation of the spine. Rest.
junction in anatomical terms).You are now bridging from
your feet to your shoulders. From this position begin to Repeat on the opposite side
take your pelvis just a short distance left and right of your Recall the sequence for the right side: reaching through
midline, trying to keep the pelvis parallel to the ground. the right heel, hitching the left hip and then combining
Rest.Again come up into the previous bridge position. both. Now recapitulate this sequence of movements on
Again take the pelvis left and right of your midline but the opposite side, starting with reaching through the left
now go just a little further each time, still keeping the heel. Take a few minutes then rest.
pelvis level with the ground. Only go as far as you can

Contralateral movement including the shoulder
without strain. Rest.
girdle
Forming successively smaller bridges (isolating the Lying with legs long and arms lying long beside you, reach
movement further down the spine) alternately through the right and left heels. Gradually make
Form a bridge resting on your shoulders and resume the the movement larger. Sense the undulatory pattern
movement left and right of your midline. Rest. Next time throughout the entire spine. Rest. Continue with this
you roll up your spine to form the bridge do not go so far movement but now slide your hands alternately down
up the spine - stop before you reach the shoulders, making towards the hip that is hitching. Notice how this movement
a smaller bridge. In this new position, take your pelviS to the enhances the undulatory pattern through the spine. Rest.
<Hands-on' movement exploration - lateral

undulation
Lateral translation ofthe pelvis - neutral position
Guide the client through a series of pelvic rocking move
ments. Gradually allow the lumbar flexion to increase
until the pelvis leaves the table; each time moving fur
ther up the spine till this 'bridge' position is reached.
Lateral translation ofthe pelvis - displacement

from the midline
Ask the client to shift the pelvis left and right of the
midline. Initially keep the shift small - a few centi
metres perhaps. Use your hands to suggest a movement
absolutely in the frontal plane as there may be a strong
tendency for the pelvis to rotate through a transverse
plane; you could suggest the client aims to keep both
buttocks an equal distance from the table.
Allow the amplitude of the movement to increase
gradually but stop well short of a position of strain. As
in the preceding ATM script, ask the client to repeat the
movement with successively smaller 'bridges'.
Rotation of the pelvis through the frontal plane -

hip-hitching
Follow a sequence of movements as in the preceding
ATM script.
Ask the client to reach through one leg; use your
hand beneath the client's heel to reinforce the sense of
lengthening from that hip. Next, ask the client to hitch
the opposite hip. Then combine the 'reaching' of one
leg and the 'hitching' of the opposite hip into one coord
inated movement.
Repeat for the other side.
Ask for alternate reaching through the heels.
PRACTICAL MANUAL
Have the client continue this movement on their

own. Use your hands now to amplify any complemen
tary movements of the ribs and head that you find, as
well as the undulatory response of the entire spine.
Then bring the client to standing.
Frontal undulation in standing - stabilize head

Position yourself behind the client and use your hands
to track the lateral displacement of the hips from the
midline. Note the overall response to this movement. Is
the amplitude of movement limited in this plane? Is the
head stable in space or does it tend to displace left and
right with the trunk?
When the movement is established use your hands
softly to stabilize the head in space. Then progress
through the following series of constraints that are
designed to elicit differentiated movement between the
pelvis, thorax and head.
Frontal undulation in standing - stabilize shoulders

Now have the client continue the side-to-side move
ment of the pelvis but position your hands lightly on the
shoulders and ask the client to maintain their position in
space while the pelvis and spine continue their swaying
movement below. It is important not to restrain the
shoulders forcefully; merely use your hands as sources
of proprioceptive feedback for the client. Ask the client
to maintain their shoulders relatively immobile.
Frontal undulation in standing - stabilize ribs

Shift your hands to softly palpate the client's ribs. They
should continue the lateral undulation but limited
more to the lower spine. You could indicate that this is
the kind of differentiation required in much of Latin
American dance.
Then ask the client to walk and notice any difference
in their gait.
Ask them to exaggerate the lateral sway of the pelvis.
You can evoke images of the 'Marilyn Monroe' walk (or
the 'power' walk for male clients!).
Then ask the client to drop the exaggerated pattern
and find what is an appropriate degree of lateral sway
in walking.
RE F ERENCE
Laughlin K 1998 Overcome neck and back pain. Simon and

Schuster, New York
WORKING IN THE
TRANSVERSE PLANE
For 'first approximation' structural bodywork it is suf lumborum and psoas (T17, T18, T20, T37, T66, T67, T68,
ficient to release all around the abdominal attachments shown in Chapters 16 & 17).
before using the C-R stretches and then performing The C-R stretches should be used after assessing the
the functional work required to give the client a sense longitudinal rotational tendencies, taking careful note
of differentiated movement of the chest and pelvis. of the winding direction of the rotation (from standing on
Release all connections between the thorax and a stool behind the client, see Fig. 14.1, p. 132), and per
pelvis: the pubic bone, the iliac crests from posterior to forming the stretch contrary to the winding direction
anterior superior iliac spine (PSIS to ASIS). The oblique of the existing rotational pattern. There should then be
attachments on the lower ribs, the rectus attachment more emphasis on engaging the obliques in movement
around the sternum, the thoracolumbar fascia, the lat explorations that differentiate the pelvis and thorax
eral and posterior ribs, the latissimus dorsi, quadratus (T81, T82).
TRA NSVERSE ORGA NIZA TIO N
The following two techniques are excellent means of and the second addresses rotations in the thoracic region.
addressing the soft-tissue adaptations to rotatory patterns There are ways of working spiral adaptations of tissue
around the longitudinal midline. The first technique using MFR techniques but these require a sure geometric
addresses rotations at the lumbo-sacral end of the spine, vision of patterns of shortness.
T81
C-R stretch - lumbo-sacral region

Use this technique as part of the general alleviation of a rotoscoliotic
pattern, or use bilaterally to promote more rotational ease of the
pelviS in walking. Have the client look to the outstretched hand.
Apply counter force at the PSIS.
Ask the client to unwind the trunk by pressing back into your hand.
Next position
Ask the client to go further into rotation by reaching through the
upper knee. After 3 or 4 repetitions ask the client to breathe deeply
into the lower back.
WORKING IN THE TRANSVERSE PLANE
T82
C-R stretch - thoracolumbar region

In this seated position, have the client grip the back of the chair
and pull into a rotated position of first bind. Stabilize the shoulder
girdle.
Ask the client to unwind the upper torso into you.
Next position
Ask the client to pull further into rotation.
MOVEM EN T WORK FOR TRA N S VERSE other around a longitudinal axis; then the head is
UNDULA TION added in a counter-rotatory pattern. Efficient gait
requires that the head should track forward in space
A key movement exploration will now be shown that in a relatively straight line. This means that, with the
can give the client a kinesthetic feel for transverse pelvis and chest counter-rotating against each other,
undulation - first as an ATM script and then using tact the neck must constantly adjust the orientation of the
ile guidance. Using the classic Feldenkrais 'knees to the head so that it remains facing forward. This ATM is con
side' exploration, it shows how the movements of the ducted in a supine position, and the photos that follow
pelvic and thoracic segments can be differentiated, that show how this movement can then be explored in
is, allowed to rotate somewhat independently of each standing and in walking.
Feldenkrais Awareness Through Movement (ATM) exploration - <knees to the side'
Sensorial focusing
Lie on your back with your arms and legs long. Sense your imprint changed? Maintaining a constant distance between
contact with the floor. Which parts of you are in contact the knees, begin to take them to the left a little, just a few
with the floor? Which parts are not? Sense the weight of centimetres, then bring them back to the midline. Repeat
your different segments as they rest on the floor: the in a rhythmical way sensing how the pelvis responds.
head, the thorax, the pelvic segment, the arms and the Rest. Continue now taking the knees to the left but each
legs. Sense the shape of the imprint of the soft tissues of time going a little further. Note how at a certain point the
the pelvic segment on the floor. Can you visualize this pelViS begins to follow the knees in rotating to the left.
imprint? Is it symmetrical? Does one side seem to rest Sense how the weight of the entire pelvic segment shifts
more firmly on the floor? Can you sense where the bones to the left then returns to the midline. Rest. Repeat,
of the sacrum and ilia press through the soft tissues to this time explore the sensation of taking the knees to the
the floor? Rest. right. Rest.
Knees to one side Taking the knees to both sides

Bring your feet up into a standing position, about hip Bring your feet to standing and begin taking the knees to
width apart and the knees apart. Again sense the contact the left and the right. Make it a small movement at first
of the pelvic segment with the floor. Has the shape of its but increasing the amplitude by degrees. Sense how the
PRACTICAL MANUAL
pelvis rolls from side to side and how different parts of Neck-eye coordination
the pelvis come into contact with the floor. As you Lie with legs and arms long. Sense the weight of your head
increase the size of the movement note how the trunk on the floor. Roll your head to the left and right; allow it
responds - how, after a short delay, the ribs follow the to roll (rather than rotate around the midline) so that
pelvis in rotation. Note how this 'twisting' movement the chin moves towards the shoulders alternately. Pause.
progresses up the spine until one shoulder begins to leave Notice some detail on the ceiling above, a speck or a
the ground. Use your hands to gently mould to your own detail of the surface texture, and fix your eyes on that
ribs and 'urge' them into further involvement. Rest. point as you now rotate your head to the left and right.
Pause. Continue rolling the head but now allow your
Counter-rotating the head eyes to rotate opposite to the head's movement. You can
Bring your feet to standing and begin taking the knees to imagine you are following the movement of a train on
the left and the right, very gradually increasing the size of the horizon. Rest.
the movement. This time allow the head to rotate in the
opposite direction to the pelvis, which leads in time to Include eye fixation into the pattern
a twisting motion through the full length of the spine. Bring the feet to standing and begin taking the knees to
Coordinate the movement so that both the head and the the left and right. Now introduce a counter-rotation of
knees reach their comfortable end limit at the same time, the head while, at the same time, keeping the eyes fixed
and so that on their return they pass through the midline on that point on the ceiling. Continue now but try to
together. Tr y to bring a lazy, luxurious quality to the bring an even and relaxed quality to the movement.
movement. Rest. Try to luxuriate the movement. Rest.
<Hands-on' movement exploration

- transverse undulation
Transverse undulation - knees to

the side
The client lies supine with standing
legs, and with feet and knees about
hip width apart. Ask the client to
begin a small movement, taking the
knees to the left and right, and main
taining an even distance between the
knees.
Have the client slowly increase the
amplitude of the movement and use
your hands successively to encour
age a rotation of the pelvis, ribs and
shoulders (as in these photos).
Then, ask for a contrary movement
of the head; this requires a transverse
rotation through the full length of the
spine.
Bring the client to standing.
WORKING IN THE TRANSVERSE PLANE
Transverse undulation in
standing - stabilize
the hips
Whilst gently stabilizing the hips,
ask the client to rotate the chest to
the left and right as if scanning the
horizon with the chest. Allow
the head to follow the rotation of
the trunk so that they move as
one. Agam use your hands only to
provide proprioceptive feedback,
not to actually restrain the move
ment of the hips as that is the
client's job.
Transverse undulation in standing - stabilize

the hips, counter-rotate the head
Ask the client to continue rotating the trunk whilst
keeping the hips still. Then ask for a contrary move
ment of the head. You can ask them to turn their head as
if to look over the shoulder that is moving forward.
This coordination is vital if the client is to be able
to counter-rotate the shoulders against the hips in
walking while at the same time maintaining the head
oriented straight ahead.
PRACTICAL MANUAL
Transverse undulation in
standing - stabilize
the shoulders, counter-rotate
the hips
Ask the client to rotate the hips -
taking one hip forward while the
other moves back, and then the
other side. You could ask them to
recall the 'Twist'. Rest your hands
gently on the shoulders to assist
the client in tracking the tendency
for the shoulders to rotate with the
hips.
For completeness, you could
also extend this exploration to
include a counter-rotation of the
head, first against the hips then
against the chest.
Transverse undulation in walking - counter

rotating hips and chest
Ask the client to combine all of the above rotatory
movements into walking. You can walk behind the
client using your hands to suggest the counter-rotation
of the axis of the shoulder girdle against the pelvic gir
dle. When that is established, use your hands to stabil
ize the client's head such that it tracks directly forward
in space. Then ask that the arms be completely relaxed,
that their swing is determined solely by the fact that
they are suspended from a moving shoulder girdle.
Ask the client to exaggerate the pattern into the
'cat-walk' of trained models.
Next, ask the client to drop the exaggerated form and
find an amount of counter-rotation that feels appropriate.
WORKING WITH THE
SHOULDER GIRDLES
W hat follows is a summary of the chief kinds of shoul Protracted shoulder girdle
der girdle displacement and the areas that one would Lengthen the pectoral fascia and the superficial fascia
normally consider for lengthening work. Once again of the clavicles. Work deeply into the delto-pectoral
these 'point form' suggestions need to be considered in groove (T97-TlOO).
the context of working with the organization of the body
as a whole. It is emphasized once more that the order in Retracted shoulder girdle
which any of these areas are opened up depends on Lengthen the posterior aspect of the shoulder girdle
coming from a broader strategic perspective. including the mid-trapezius, the rhomboids, the infra
spinatus and teres minor. If the arms are habitually held
Elevated shoulder girdle hyperextended at the shoulder then lengthen the
Lengthen the upper trapezius, the levator scapulae, triceps (T40, T41, T86).
especially its insertion onto the superior angle of the
scapula. If the arms are abducted then work on the mid The elevated/protracted pattern
deltoids too (T83-T93). This is due to the synergistic operation of the shoulder
girdle elevators and the pectoralis minor and is usually
Depressed shoulder girdle an aspect of the forward head syndrome.
Lengthen the pectoralis minor and the lateral border of
the latissimus dorsi (T94-T97).
SHOULDER GIRDLE DISPLACEMENTS
Elevated
Shoulder girdle - in elevation

Trapezius
The shoulder girdle elevation is an aspect of 'the body pattern of anxiety'
insertion
and is one of the most common structural dysfunctions found today.The
upper trapezius and the levator scapulae are mostly implicated, but this
pattern is often combined with the depressive action of the pectoralis
minor. Working synergistically, these muscles act to bring the scapulae 'up
and over' the upper ribs into the common round-shouldered pattern.
Levator scapulae
insertion
PRACTICAL MANUAL
T83
MFR technique - spine of scapula

The fibres of the upper trapezius insert onto the spine of the scapula,
making this an effective place to work. The space between the first and
second knuckles fits nicely
over the ridge of the spine.
Starting at the acromion,
follow the spine of the
scapula medially.
Assisting movements
Ask the client to breathe into
the area.
T84
MFR technique - upper

trapezius
Use one hand to stabilize the
shoulder girdle so that it sits
firmly on the upper ribs, and
then starting at the acromion
work medially following the
border of the upper trapezius.
Assisting movements
the area.
T85
C-R stretch - upper trapezius

Stabilize the shoulder girdle.You can vary the direction of your counter
force to engage different muscles or different groups of fibres.As a subtle
cue not to side-flex the neck
you can gently rest an elbow
on the side of the client's
head.
Shoulder elevation. 'Lift your
shoulder into my hands.'
Next position
Shoulder depression. 'Gently
reach towards your feet.'
WORKING WITH THE SHOULDER GIRDLES
T86

trapezius, rhomboids,
serratus posterior
superior or levator
scapulae insertion
This is an alternative
position for working into
the upper trapezius or the rhomboids, so it is also useful for clients with
habitually retracted scapulae - the 'military squared' shoulder girdle. It can
be used very specifically to work on the levator scapulae insertion by
maintaining strong contact with the superior angle of the scapula.
Ask the client to place their palms together in front of them. Gently
depress the shoulder girdle (it will elevate when relaxed in this
orientation), and then using the forearm blade contact the upper
trapezius and work medially and inferiorly.
Assisting movements
Shoulder protraction. 'Reach slowly through your upper arm, sliding over the lower palm.'
It is important that the upper arm be supported on the lower arm in order to minimize the eccentric tonus in the
rhomboids.
T87

trapezius, lateral
This technique blends naturally
with the next.
Keeping fists at right angles to
the upper line of the trapezius,
slowly work laterally to the
acromia.
Assisting movements
Neck retraction. 'Draw in your
chin and lengthen through the
crown.'
PRACTICAL MANUAL
T88
MFR technique - the upper trapezius, posterior

Use your knees to support the upper back.This reduces the need for the client
to engage the trunk flexors in performing the assisting movement. Gather the
mass of tissue in the mid-trapezius region as if to bring over and back.
Assisting movements
Neck flexion. 'Slowly drop your chin to your chest and have a sense of
lengthening through the crown.'
Upper
trapezius --+7-
+----- Clavicle
Scapula -,1---
Serratus
anterior ---t---�fL
T89
C-R stretch - upper trapezius

Using your body weight through locked arms bear down upon the shoulders.
Alternatively, place a pillow in the lumbar region of the client and ask them to
slump back into your legs 'like into an old armchair'.This lessens the need to
mobilize the trunk muscles to resist the downward vector from the shoulders
and allows the client to concentrate on the shoulders rather than in maintaining
an upright posture.
Shoulder elevation. 'With no more than a 20% effort shrug your shoulders into
my hands.'
Next position
Shoulder girdle depression. 'On the out-breath allow your elbows to drop
towards the floor.'
This is a very strong stretch and should be performed gently if the client
seems soft-bodied or loosely ligamented (it is possible to stress the
sternoclavicular joint).
T90

trapezius, seated position
Sink into the upper trapezius
tissue and work medially and
inferiorly.
Assisting movements
Cervical rotation and flexion.
'Slowly rotate your head away
and then drop it forward and
diagonally to your chest.'
T91

trapezius, seated position
Stabilize the thumb close to the
shoulder joint. Direct the fingers
as if trying to reach beneath the
layer of the upper trapezius.
During the application of this
technique it is useful to keep
asking the client to retract the
neck, the chin-tuck position.
Assisting movements
Cervical rotation. 'Slowly rotate
your head away from me.' It is
common to get trigger point
referral to above the eyebrow.
T92
MFR technique - levator scapulae insertion

Work superiorly along the vertebral border of the scapula towards
the superior angle. You can use the forearm blade or reinforced
thumbs.This area is usually rich in trigger points.
Assisting movements
the area.
PRACTICAL MANUAL
T93
Self-applied C-R stretch - levator scapulae

Rotate the head 45°. Bring the hand overhead and grasp near the nuchal line.
The eyes should be looking at the crook of the elbow. Grasp the chair behind
and lean forward to stabilize the shoulder girdle.
Cervical extension. 'While lengthening through your crown, press back gently
into your hand.'
Next position
Cervical flexion. 'Drop your chin to your chest.'
Depressed
Shoulder girdle - in depression

As a singular dysfunction, a shoulder girdle in depression is with an elevating tendency, which brings the shoulder
relatively rare and is found mostly in soft-tissue types. girdle into the common, round shouldered 'up and over'
Paradoxically, however, it is often found in combination pattern.
T94
MFR technique - latissimus

Using a 'soft' forearm blade,
follow the lateral edge of the
latissimus.
Assisting movements
Arm abduction, shoulder
girdle elevation. 'Reach
overhead through your
elbow.'
T95
C-R stretch - latissimus

Reach through the extended arm keeping the thumb
uppermost while supporting the body weight on the other
forearm.
Arm extension. 'Press the side of your hand into the floor.'
Next position
Arm flexion. 'Drop the shoulder towards the floor and reach
though the arm.'
T96
MFR technique - pectoralis minor

Using doubled thumbs, reach under the pectoralis major to the origins
of the pectoralis minor. Work superiorly
with successive transverse strokes.
NB: this is a sensitive area!
Assisting movements
Arm abduction.Ask client to breathe
into the area, or slowly reach overhead.
Alternative
Use finger chisel to reach for pectoralis
minor.
T97
MFR technique - latissimus tendon

Find the latissimus tendon between the biceps and triceps and
anchor with finger pressure.
Assisting movements
Arm abduction. 'Slowly reach overhead, straightening the arm
at the same time. Bring
the arm as close as
possible to your head.'
PRACTICAL MANUAL
Protracted
Shoulder girdle - in protraction

The protracted shoulder girdle is associated with various anxiety'. It is also seen as a gesture of withdrawal,
emotional patterns. It is an aspect of 'the body pattern of protectiveness or emotional hiding.
T98
MFR technique -
superficial pectoral fascia
For shoulder girdle
protraction or depression.
Starting mid-sternum,
work laterally towards the
coracoid process. Use several
parallel strokes. Take care
when working through the
top of the breast tissue of
women.
Assisting movements
Ask for deep upper-chest
breathing.
Infraspinatus ---f.---+-,*,,�':"" ';::'"

Sternocleidomastoid V-?--'-1J--<�-J
Teres minor
Teres major -+-+-+-==""-.,:*" .'
Delto pectoral
T rapezius
groove
Deltoid
--"....i.:lm-t\-- Pectoralis minor
Pectoralis major-f-Ft-,---'-::
Xiphoid process
Latissimus
Biceps brachii dorsi
T99
MFR technique - deltopectoral groove

Gently place fist in the deltopectoral groove. Gradually increase the
pressure by bringing your weight more vertically over the client.Tend
to slide inferiorly.
Assisting movements
Cervical rotation. 'Slowly
turn you head away from
me and sense the stretch
beneath your collar-bone.'
T1 00
MFR technique - pectoral fascia, pectoralis major tendon

and deltopectoral groove
This is an alternative to the previous technique. Starting
midway along the clavicle, work in slow strokes at right angles
to the fibres of the pectoralis major muscle, ending up in the
deltopectoral groove.
Assisting
movements
Cervical rotation.
'Slowly turn your
head away from me
and sense the
stretch beneath
your collar-bone.'
Retracted
Shoulder girdle - in retraction

The 'military squared' organization of the shoulder girdle address this pattern have been covered previously and are
is often a habit arising from the common postural 'advice' those that address the posterior aspect of the thorax
- 'Shoulders back'. It leads to a chronic holding pattern in (T40,T41 andT86).
the rhomboids and mid-trapezius.The techniques that
W ORKING WITH THE
EXTERNAL ROTATION
OF THE LEG
The 'toe out' pattern is usually associated with the • The posterior aspect of the gluteal fascia (T59, T62, Tl03).
external organization, or flat-backed tendency. Some • The medial insertion of the gluteus maximus, from
typical myofascial adaptations to it are: a shortening of coccyx to PSIS and beyond on the iliac crest (TlO1).
the external rotators, the gluteus maximus, the medial • The soft tissue overlying the linea aspera up to the
hamstrings, the medial aspect of the gastrocnemius greater trochanter (Tl02).
soleus complex, the tibialis anterior and the fascia of • The deep rotators, especially the piriformis (TlO4-Tl06,
the lateral arch of the feet. It should be remembered, TlOS).
however, that a certain asymmetry between the legs is • The medial and inferior aspect of the calcaneal ten
expected from segmental standard rotation . don and soleus (T7S).
The following areas can be worked: • The lateral arches of the feet (T24).
DE-R O T A T E LEGS
The following techniques can be applied when there is arch of the foot, stretching the ligaments and encouraging
marked external rotation of the feet when walking or pronation, and bunion formation in the longer term.
standing, and when the external rotation comes from the Note that it is common for the right foot to be more
hip rather than from a segmental rotation of the lower externally rotated than the left (segmental standard
leg. Marked external rotation of the feet will produce an rotation), so it is not necessar y to work for exact
inefficient waddling gait and will tend to stress the medial symmetry of the feet.
T101
MFR technique - medial gluteus

maximus insertion
Initially contact the sacrotuberous
ligament then slide superiorly in a slow
are, maintaining pressure against the
gluteal insertions.
Assisting movements
Internal rotation of the femur. 'Slowly
rotate your leg inwards, then relax
back to a neutral position.'
WORKING WITH THE EXTERNAL ROTATION OF THE LEG
T102
MFR technique -
lateral rotator
insertions, gluteal
insertions
Using the point of
the olecranon sink
down as if to reach
the lineae asperae
and slide superiorly.
If there is too much
resistance in the
tissue, re-enter in
a series of
applications
working superiorly.
Work as if reaching
for the lesser trochanter, then work around the greater trochanter.
Assisting movements
Internal rotation of the femur. 'Slowly rotate your leg inwards, then
relax back to a neutral position.'
T103
MFR technique - gluteal region

Gently contact the PSIS and edge of the sacrum. Increase the pressure
by bringing your weight more vertically over the client. Slide towards
the greater trochanter, or else make several applications moving
laterally.
Assisting movements
Internal rotation of the femur. 'Slowly rotate your leg inwards, then
relax back to a neutral position.'
T104
C-R stretch - external rotation of leg from hip

While holding the leg in traction, rotate the foot internally.
External rotation of the femur. 'Rotate your leg outwards.'
Next position
Internal rotation of the femur. Check with the client that the knee
ligaments are not being stressed.
PRACTICAL MANUAL
220
T10S
MFR technique -
piriformis, broad
Holding the heel of the
flexed leg, locate the
approximate position of the
piriformis (on the line
connecting the mid-sacrum
to the tip of the greater
trochanter). Gently sink
through the gluteal layer
with the free hand.
Assisting movements
Passively rotate the leg internally-externally.
T106
MFR technique - piriformis,

specific
Use doubled thumbs to first
locate the posterior aspect of
the greater trochanter. Slowly
work medially.
Assisting movements
Internal rotation of the femur.
'Roll your foot inwards then
release.'
WORKING WITH THE EXTERNA L ROTATION OF THE LEG
T107
Tracking
Rolfing tracking techniques are used to gently challenge ligamentous
restrictions, or perhaps they work more by 'educating' joints proprioceptively
into feeling different possible planes of movement.
For this technique ask the client to bring the inside of the feet unnaturally
parallel (they will probably feel pigeon-toed).Ask them to perform slow knee
bends. Use your hands to guide the knees forward over the big toe.The knees
'
will want to track inwards. Clients may report feeling ligamentous challenge in
the collateral knee ligaments and around the ankle joint. Persist if it is not
experienced as stressful.
Then ask the client to take this into walking, consciously increasing the
internal rotation of the leg say 10°.The preceding soft-tissue releases should
make this quite easy.
T108
Self-applied C-R stretch - piriformis

Sit on a table or massage table with the knee flexed at a right angle. On the
breath lean forward from the hip (avoid flexing the spine).Take the chest
towards the foot (not the knee).
Press the heel down into the table.
Next position
Take the chest forward and down to the next limit.
222.
STRUCTURAL AND
FUNCTIONAL
BODYWORK
TRAINING
STRUCTURAL APPROACHES-TRA IN ING The Rolf Method of Structural Integration

AND MEMBERSH IP ORGAN IZAT IONS
Guild for Structural Integration
3107 28th St.
Rolfing Boulder, CO 80301
United States
Rolf Institute
Ph: 800-447-0150 (toll free, US only)
5055 Chaparral Ct. Ste. 103,
Fax: 303-447-0108
Boulder, CO 80301, USA
Web: www.rolfguild.org
Ph: 303-449-5903
Email: gsi@rolfguild.org
Fax: 303-449-5978
Web: www.rolf.org
Email: info@rolf.org Hellerwork
Australian Rolfing Association The Hellerwork Foundation

PO Box 1511 Neutral Bay, NSW 2089 3435 M St
Australia Eureka CA 95503
Ph: 61 (0)2 9953 5302 United States
Fax: 61 (0)2 9908 3508 Ph and Fax: 1-707 441 4949 or 1-800-392-3900
Web: www.rolfing.org.au (in the US)
Email: info@rolfing.org.au Web: www.hellerwork.com
European Rolfing Assoc. e.Y. ®

Zentherapy
Kapuzinerstr, 25
D-80337 Munich International Zentherapy® Institute, Inc.
Germany Melim Building, Suite 801
Ph: +49-89-54370940 333 Queen Street
Fax: +49-89-54370942 Honolulu, Hawaii 96813
Web: rolfingeurope@compuserve.com Ph: (808) 528-2666
Email: www.rolfing.org Fax: (808) 523-3052
Web: www.zentherapy.org
Brazilian Rolfing Assoc. Email: Iziiorg@aol.com
Alameda Casa Branca, 600
01408-000 Sao Paulo- SP
Postural Integration
Brazil
Phi fax: + 55-11-3887-6070 The International Council of Postural Integration
Web: rolfing@rolfing.org.br Trainers
Email: www.rolfing.org.br Toekomststraat 99
APPEND IX
B-9040 Ghent/St. Arnandsberg Feldenkrais Guild UK

Belgium Email: enquiries@feldenkrais.co.uk
Ph & fax: +32(0)92284911 Ph: 07000 785506
Web: www.body mindintegration.com Fax : 01224 .861530
Email: icpit@posturalintegration.info T he Australian Feldenkrais Guild Inc.
Web: www.feldenkrais.org.au
STRUCTURALAPPROACHES
The Alexander Technique
MEMBERSH IP ORGAN IZAT IONS
The Society of Teachers of the Alexander Technique
International Association of Structural Integrators (lASI) (STAT)
P.O. Box 8664 1st Floor, Linton House
MISSOULA, MT 59807 39-51 Highgate Road
Ph: 1-877- THE-IASI (1-877-843-4274) Toll-free US only London NW5 IRS
Web: www.theiasi.org United Kingdom
Ph: 0845 230 7828
Fax: 020 7482 5435
FUNCT IONAL APPROACHES - TRA I N ING Web: www.stat.org.uk
A N D MEMBERSH IP ORGAN IZAT IONS
American Society for the Alexander Technique
Many countries have their own membership and (AmSAT)
training organizations. Only a few are shown here as Ph: 800 473 0620
first contacts.
Australian Society of Teachers of the Alexander
Technique (AUSTAT)
The Feldenkrais Method
Ph: 1800 339 571
Feldenkrais Guild® of North America Web: www.alexandertechnique.org.au
3611 SW Hood Ave
Suite 100
The Trager Approach
Portland, OR 97239
United States Trager International
Ph: (503)221-6612 or (800)775-2118 24800 Chagrin Blvd.
Fax: (503)221-6616 Suite 205
Web: www.feldenkrais.com Beachwood, Ohio, 44122
United States.
Feldenkrais® Movement Institute Ph: USA 216-896-9383
721 The Alameda Web: www.trager.com
Berkeley, California 94707 USA Email: trager@trager.com
Ph: 800 342-3424
Fax 510 528-1332
Email: info@feldenkraisinstitute.org
Web: www.feldenkraisinstitute.org
INDEX
A ATM see Awareness Through Movement body-reading 131

attention,outward flow of 40 body-shaping technologies 11-12
abdominal cavity 97 attitudes bone (osseous) tissue 68
abdomina Is parallel physical and emotional bones 69,94-5
C-R stretch for lateral 193 meanings 31 adaptability of 31-2
MFR technique for anterior structural change through shift of 17 extracellular materials 66
aponeuroses 192 autonomic nervous system 89 sagittal plane 95
action research 31 Awareness Through Movement (ATM) bonesetters 12

acture 32 exploration brachial plexus 107
adaptability principle 19 frontal undulation 199-200 breath,use of,in C-R stretching 143
adductor group sagittal rocking 180-1 breathing 81
C-R stretch 199 transverse undulation 205--8 "breathing into" an area 137-8
MFR technique 160,198 scripts 151-2 bruising 141
adhesions 63 axial skeleton building block model,human structure
adipose tissue 64,68 assessment of 131-2 52,53
aging,and connective tissues 73-4 postural dysfunctions 98-115 bursal sacs 69

agonist-antagonist tissues 28 axial-appendicular design 97-8
Alexander technique 32,40,43,49,50 Ayurvedic medicine 14
ALL see anterior longitudinal ligament c
"anatomy trains" metaphor 19,128
antagonists,CRAC technique 143 B calcaneal tendon,MFR technique 167
anterior longitudinal ligament (ALL) 176 cancellous bone 94, 95
C-R stretching 176 back line,sagittal plane 153 Cartesian tradition 23
anterior pelvic tilt 102, 108 techniques 154,167-80 cartilage 68
protocol for excessive 154-5 balance,postural 104 cells
anterior shift,protocol for excessive 155 balancing 26,28,185 connective tissue 71-2
anterior superior iliac spine (ASIS) 102 balloon metaphor 120 human embryogenetic development
MFR technique superior to 163 balloons 49-50
antero-lateral compartment,MFR structural integrity of 55-6 in structural organization 38
technique 157 tensegrity principle 54 central nervous system,myofascial
anxiety see body pattern of anxiety Barnes myofascial approach 135 restrictions 126
architecture,of the body 41,50-1 basement membrane 65 cervical extensors 104
areolar tissue 64,68 behavioural conservatism 18 cervical fasciae
arthrokinematic perspective,movement behavioural patterns,structural C-R stretch for lateral 196
and posture 93-4 dysfunction 88-9 MFR techniques
assessment 130 being,changing 30 for posterior 177
essential background information 131 beliefs (clients) for superficial 195
of gait 133 assessment 131 self-applied C-R stretch for lateral 197
palpatory 132-3 structural change through shift of 17 cervical lordosis 99,108
of posture 131-2 bilateral symmetry 95 protocols
assisting movements,myofascial release biomechanics 10,118 for diminished 154
137-8 biomedical model 13 for excessive 154
Aston,Judith 19 blastosphere 49 character armouring 18,30,86
Aston Patterning 19 block model,postural dysfunctions 93 chest collapse,forward head syndrome
asymmetrical usage 97 "blocks in a sack" model 52,53 107
atlanto-occipital junction blood 68 chin tuck 178
C-R stretch 179 body armouring 18,30,86 Chinese burn 141
head forward syndrome 105-6 body image,concern with 12 Chinese medicine 21,23
passive stretch 178 "body pattern of anxiety" 110, 124 chiropractic 12,14
INDEX
chondroblasts 71 sequence 142-3 elastic energy,recycling of 81

clients shoulder girdle techniques elastic structures,oscillatory properties
care of, myofascial release 142 latissimus 215 81
experience of myofascial release 136 upper trapezius 210,212 elasticity,connective tissue 72-3,76
collagen 51,66,72-3 transverse plane techniques elastin 66,74
collagen fibres 51,70,85-6 lumbo-sacral region 204 elevated shoulder girdle 110
compact bone 94,95 thoracolumbar region 205 techniques for 209-14
complementary therapies 10-11 use of breath 143 elevated-protracted shoulder girdle
core practices 21,22 verbal patter,developing 143-4 110
Maitland's three paradigms of 23-4 see also passive stretching; self-applied techniques 209
meaning of somatic 38,39 C-R stretch embodiment process 7
conflicted types 117,118 contractile elements,musculature 61 embodiment-training 19
congenital differences,connective tissue contraction,C-R technique 143 embryonic connective tissue 67
77-8 CORE bodywork 18 emotional patterns
congenital factors, structural dysfunction corrective approaches 23 muscular organization 124
88 cosmetic considerations 30 structural dysfunction 3,88-9
congruent types 117,118 costal arch,MFR technique 164 encephalization 104
connective tissues 51,64 Cottingham-Maitland protocol 46 endoderm 49,50,65
aging 73-4 creep 76 endodermic systems 50
biomedical view 64-5 critical interfibre distance 67 elements which relate to structural
as composite materials 65-7 crural fascia 184 bodywork 52
congenital differences 77-8 cumulative and constant tension endomysium 61
functions of 69 complex 84 energetic systems 14,19
histology of 71-3 cumulative stress disorder 84 energy crisis hypothesis 85
implications for structural bodywork Cyriax, Dr James 12 environmental stressors,structural
77 dysfunction 88
recycling of stored elastic energy 81 epidermis 58
structural bodywork perspective of epimysium 60,61,70
o
77 epithelial tissues 65
structures composed of 69-71 erector fasciae,MFR technique 174
Dalton, Erik 19
types of 67-9 erectors
decompression 28,185
constitutional practitioners 21,22 MFR techniques 175
deep fascia 59-60
continuous assessment 130 laminar groove 175
deep tissue techniques 19,136
Contract, Relax,Antagonist Contract working medially 175
deltopectoral groove,MFR techniques
(CRAC) 143 see also inferior erectors; lumbar
217
contract-relax (C-R) stretching 142 erectors; thoracic erectors
dense connective tissue 68-9
back line tedmiques executive control 41
dense irregular connective tissue 68
atlanto-occipital junction 179 exercise systems 12
dense regular connective tissue 68
hamstrings 171 expiration fix 107,109-10
density,of tissue 77-8
lumbar erectors 173 protocol for 155
depressed shoulder girdle 110
pectoral fascia 177 extension lesion type 117
techniques 209,214-15
thoracic spine and ALL 176 extensor tone 89,99
dermis 58
external rotation of the leg,from hip externally rotated legs 115
differentiation,human cells 49
219 structural bodywork 218-21
disc health 101
front line techniques extracellular matrix 65-6
dorsum of the hands,using 139-40
groin and psoas 161
doubled thumbs 140
quadriceps 160
Dowager's hump 107
ventral aspects of trunk 165
golden rules of assisted 144 F
homeplay 144
lateral line techniques E fascia 69,70,71
hip deltoid 190 as antagonist to movement 80-2
iliotibial tract 190 ecology,structural bodyworks' similarity elasticity of 72-3
lateral abdominals 193 with 27 functions of 60
lateral cervical fasciae 196 ectoderm 49-50,65 metabolic flux 75
quadratus 190,193 ectodermic systems 50 microstructure 74-8
medial leg line techniques,anterior elements which relate to structural response to mechanical stresses 29
adducers 198 bodywork 52 views on plasticity of 75-7
partnership with myofascial release ectopic bursae 63 see also deep fascia; myofascial
144 elastic connective tissue 68-9 network; superficial fascia
INDEX
fascia lata 62 G hard-tissued clients 77-8,132-3

fascial elements, musculature 61 lfatha yoga 12,13
fascial lines 147 gait head 104-5
frontal plane 184-5 carrying heavy loads on 82
assessment of 133
sagittal plane 153 hip movement 82 misalignment,and influence on
fascial maps 128 shearing movement of pelvic girdle 111 movement 99
fascial network 2, 120 "toe out" position 115 stability in movement 150-1
meaning of 7 head forward syndrome 105-7
undulation 148
response to stress 9,77 lateral 149 importance of sequencing approach
working within 28-9 sagittal 148-9 26-7
fascial sheaths 74 transverse 149-50 protocol for 155-6
fascicles 61 gamma touch 132 secondary aspects 107
"fast-twitch" muscle fibres 83-4 gastrocnemius, self-applied C-R stretch lfedley,Gil 64
fat cells 71-2 heel of the palm 140
168
Feldenkrais ATM see Awareness Through genetic extensors 126-7 heel-strike 101
Movement genetic flexors 127 height 101
Feldenkrais, Moshe 48,101,104, gluing, musculature dysfunction 62 lfeller,Joseph 17
124 gluteal fascia,MFR technique, in side- lfellerwork 17,21
female pelvis,and gait 148 lying 190 hemipelvis 95
fibreglass 66 gluteus insertions, MFR techniques 218, hip deltoid
fibro-fatty intrusions 77 C-R stretch 190
219
fibroblasts 71 gluteus region, MFR technique 219 MFR technique 188
fibrous elements,in connective tissue glycoproteins 67 working with 189
66 glycosaminoglycans (GAGs) 66-7 hip flexors
"filter up" effect 44 good pain 141 self-applied C-R stretch 163
finger chisel 138-9,141 Grabowski-Tortora map,connective test for 158
first bind, in ROM 142 tissue 67 hip hiking 200
fixing approach 26 gradual pace,of structural body work 27 hips
flat-backed clients 101,108,109 gravity C-R stretch,external rotation of leg
flatness,of thoracic spine 107-8 in myofascial release 137 from 219
flexibility, parallel physical and in Rolfing approach 15 lateral translation of 149,150
emotional meanings 31 Green Light Reflex 126 use as inverted pendulum 82
flexion lesion type 117 groin histamine 72
flexor tone 89,99 C-R stretch 161 historical factors,structural dysfunction
fluid mechanics 54 passive stretch 162 88
Flury,lfans 55,97,118-23 self-applied C-R stretch 163 holding pattern 28
folklore 31 ground substance 51,66-7 holism principle 19
forearm blade 138,139 holistic approach 23,25
forward head syndrome see head Holistic Approach to Working with Posture,
forward syndrome A. 1
forward lean,protocol for 154 H homeopathy 14
fractal pattering 60-1 human body,as a tensegrity structure
front line,sagittal plane 153 habit,soft-tissue restrictions 9 54-6
techniques 154,156-66 lfakomi Integrative Somatics 19,39 human embryo,startle response 125
frontal plane hamstrings human embryogenetic system 49-50
fascial lines that affect lateral C-R stretch 171 structural bodywork 51-6
movement 184-5 leg raise test to check length 169 human maps
spinal curves 103-15 MFR techniques 169 scientific 37-8
working with asymmetries in distal aspect 170 for structural bodywork 40
185-6 lateral aspect 170 human potential movement 14
frontal undulation medial aspect 169,171 human structure see structure
movement work 199-203 passive stretch 172 humanistic psychology 14
of the pelvis 148 self-applied C-R stretch 172 hyaluroniC acid 67
function stretches,general comment on 171
anatomical and developmental hands,using dorsal side of 139-40
perspective 49-50 "hands-on" movement exploration
and structure debate 48-9,57 lateral undulation 201-3
functional body 56 pelvic rock 182-3
functional integration 48 transverse undulation 206-8 ideal form,human structure 16
functional intervention 9-10 lfanna, Thomas 39,40,124-6 idiopathic scoliosis 103
INDEX
228
•
iliotibial tract 184-5 L lumbo-sacral angle 100-1

C-R stretch 190 lurnbo-sacral junction 100-1
MFR technique 188 Landau response 125-6 lurnbo-sacral region,C-R stretch 204
above the trochanter 189 lateral line 184-5
Ober test for shortness in 187 techniques 187-97
working with 188 lateral seam
imaginative directionality,in movement M
MFR technique 194
138 passive stretch 195
immobilization 85-6 working with 193 macromolecules 66-7
individualized approach 27 lateral undulation,gait 149,150 macrophages 72,75
industry, composite materials in 66 lateralized functionality 95 Maitlands, three paradigms of
inferior erectors, MFR technique 172 latissimus complementary practice 23-4
infrahyoid area,passive stretch 166 C-R stretch 215 Marilyn Monroe walk 148
inner thigh MFR technique 214 massage tables 142
C-R stretch, anterior adductors 199 latissimus tendon, MFR technique 215 massage therapy 31
MFR technique,adductors 160,198 lattice analogy 72-3 mast cells 72
working with 198 leg length discrepancy (LLD) 95-6, Materia Medica 31
innominates 95,111 103-4,113-15 mature connective tissue 67-8
inspiration fix 109 legs mechanical characteristics, of fascia 74
protocol for 155 assessment of 132 mechanical forces 56,76
integrated approach, need for 46 postural dysfunctions 115 mechanical stress
integration walk 145 see also antero-Iateral compartment; fascia response to 29
integration work 145 externally rotated legs; shin; myofascial release 135
intercostal spaces,MFR technique 194 thighs medial leg line 185
4.nterdisciplinarity 19 Leigh,William "Dub" 18 techniques 197-9
internal-external model 2,19,101-2, lengthening, diminished capacity for 9 medial tibial border
117-23 lengthening process 2,27-8 MFR technique 197
interosseous membranes 69 levator scapulae, self-applied C-R stretch working with 197
"inverted pendulum" model, of hips 214 medical histories,in assessment 131
82 levator scapulae insertion, MFR Mennell, Dr James 12
isometric contraction, C-R technique technique 213 mesoderm 49,50,65
143 libidinal efficiency 57 mesodermic systems 50
ligamentous challenge 162 elements relating to structural
ligaments 69,70 bodywork 52
ageing 74 metabolites 74
J
anterior longitudinal 176 metamembrane 74
elasticity in 72-3 MFR technique see myofascial release
Janda'S approach 123-4
structural support micro-movements, myofascial release
Jar Jar Binks walk 148
of the pelvis 111,112 137-8
jaw 107
of the spine 103 mid-sagittal plane,non-paired bones 95
Johnson,Don Hanlon 16
the Line 16,120-1 mid-thigh,recursive packaging of fascial
Johnson,Will 19
listening,to one's body 82 bags 61-2
joint capsules 74
listening-touch systems 135 "military squared",shoulder girdle 110,
joint manipulation 18
Little Boy Logo 52,53 217
LLD see leg length discrepancy mineralization, of tissues 73-4,85-6
locked knee internal structural type 122 models
K current postural 1-2
locomotory system 41
long bones 94-5 for understanding structure 52
keratin 58 loose connective tissue 68 for working with structure 2,117-28
kinesiology 10 lower crossed syndrome 124 movement
knee extensors,self-applied C-R stretch lubricants, in myofascial release 140-1 appreciation of aesthetic in 80
163 lurnbar erectors, C-R stretch 173 arthrokinematic perspective 93-4
knee pain 108 lurnbar lordosis 99 economical 56-7
Kousaleos, George P. 18 misconceptions about 108 fascia as antagonist to 80-2
kyphosis pelvic tilt 102 influence of head and neck 99,104
general protocols protocols see also Awareness Through
for diminished 154 for diminished 154 Movement
for excessive 154 for excessive 154 movement work
lumbar lordosis 108 "tuck the tail under" advice 101 Flury's 118-20
steam and traction method 11 lumbar spine 108 frontal undulation 199-203
INDEX
hard-tissued clients 78 piriformis N

sagittal undulation 180-3 broad 220
transverse undulation 205-8 specific 220 natural health movement 13-14
multifidus triangle,MFR technique fascial resilience,increase in 44 near-bilateral symmetry 96-7
172 front line techniques neck
muscle cells 51,61,64 antero-Iateral compartment 157 crucial role 104
muscle energy technique 143 costal arch 164 misalignment,and influence on
muscles inner thigh, adductors 160 movement 99
lengthening and shortening of 83 insertion of sartorius 158 self-applied C-R stretch,occiput and
subclassification 83--4 quadriceps 158 posterior fasciae 179
weakness, C-R stretching 145 lateral aspect 159 nerve entrapment 85
working of,in rhythmic motion 80 medial aspect 159 nervous system see autonomic nervous
muscular forces 56 rectus abdominis 164 system; central nervous system
muscular inflammation 62,85 rectus tendons 164 nervous tissue 64-5
musculature 83-9 shin 156 neuromuscular techniques 43-4
inner structure 60-2 sternal fascia 164 see also contract-relax (C-R) stretching
near-bilateral symmetry 96-7 superior to the ASIS 163 non-individualized approaches 27
overuse 84-5 gravity,using 137 normal movement theory 118
processes that can lead to structural lateral line techniques Notes on Structural Integration 120
dysfunction 86-9 anterior aponeuroses of the
structural bodywork representation of abdominals 192
62 gluteal fascia in side-lying 190
structural interventions 62-3 hip deltoid 188 o
trauma 86 iliotibial tract 188
underuse 85-6 above the trochanter 189 Ober test 132
Myers, Thomas 19,128 intercostal spaces 194 shortness in the iliotibial tract 187
myofascial bags 60,61 lateral seam 194 occipital ridge,MFR technique 177,178
myofascial interventions peroneals 187 octahedral tensegrity structure 54
Barnes 135 quadratus 192 octopus hand 140
Hellerwork 17,21 sternocleidomastoid 196 Ogden,Pat 19
myofascial levels,musculature 61 bilaterally 196 orange analogy,of myofascia 60
myofascial network 60 superficial cervical fasciae 195 organ of structure see fascial network
fractal pattering 61 tensor fasciae latae 189 organ systems,scientific map 38
polar postural types 118 waist 192 orienting sequence 104
potential spaces within 63-4 medial leg line techniques Oschman,James 19,75
myofascial release (MFR) 135-6 adductor group 198 oscillatory properties,fascial network
assisting movements 137-8 medial tibial border 197 80-2
back line techniques partnership with C-R stretching 144 osteoblasts 71
calcaneal tendon 167 perception of pain 141 osteopathy 12,13, 14
erector fasciae 174 self care 141 overuse,of musculature 84-5
erectors 175 shoulder girdle techniques
laminar groove 175 deltopectoral groove 217
working medially 175 latissimus 214
hamstrings 169 latissimus tendon 215 p
distal aspect 170 levator scapulae insertion 213
lateral aspect 170 pectoral major tendon 217 pain
medial aspect 169,171 pectoralis minor 215 perception of,myofascial release 141
inferior erectors 172 rhomboids 211 unawareness of mild signals 40
multifidus triangle 172 spine of scapula 210 pain "history" 30
occipital ridge 177,178 superficial pectoral fascia 216 Painter,Jack 17-18
plantar fascia 167 upper trapezius 210,211 palintonic principle 19
posterior cervical fascia 177 lateral 211 palpatory assessment 132-3
thoracolumbar fascia 173 posterior 212 parasympathetic activation 89
upper thoracic area 174 seated position 213 passive stretching 144
whilst side-lying 174 tables used in 141-2 atlanto-occipital junction 178
client care 142 tools 138-41 fascia of groin and psoas 162
external rotation of the leg vector of application,varying 136-7 hamstrings 172
gluteal region 219 visualization,use of 138 infrahyoid area 166
gluteus insertions 218,219 myofascial restrictions,CNS 126 lateral seam 195
lateral rotator insertions 219 Myoskeletal Approach 19 thoracic spine,ALL 176
INDEX
pectoral fascia improvement through structural regular internal structural type 122
C-R stretch 177 bodywork 32-3 Reich, Wilhelm 17,30,88
MFR techniques 216,217 standing assessment of 131-2 reinforced concrete 66
pectoralis major,MFR technique 217 potential spaces 63-4 relaxation approaches 23
pectoralis minor,MFR technique 215 power walking 148 repetitive strain injuries (RSI) 84,85,107,
pelvic girdle 110-15 pre-performance stretching 145 141
pelvic rock see sagittal rocking primary control 104 repressed emotion 88-9
pelvic segments 102,121 primary line,of trunk 153 research,benefits of structural bodywork
pelvic shift 102,121 primary shortness 121,123 31
pelvic tilt 102,121-3 primary spinal curves 99 resonant frequenCies 81
pelvic undulation 148 synergistic relationship between restricted movement patterns 9,88,102
pelvis secondary and 102-3 reticular connective tissue 68
assessment of 132 procollagen 72 reticulin 66
Flury's postural-structural typology proprioceptive neuromuscular retinaculae 69
121-3 facilitation 143 retracted shoulder girdle 110
lateral translation of 200 proprioceptor information,sensory techniques 209,217
perimysium 61 motor amnesia 89 rhomboids,MFR technique 211
periosteum 94 proteoglycans 67 rhythmic movement, bodily activities
peroneal area 187 protracted shoulder girdle 110 54,80,81
peroneals,MFR technique 187 techniques 209,216-17 rib cage 108
personal growth 17-18 psoas adaptation to leg length discrepancy
phasic musculature 83,84,123-4 C-R stretch 161 115
phYSiological mechanisms,contributing passive stretch 162 movement of thoracic spine 99
to structural dysfunction 87 self-applied C-R stretch 163 postural dysfunctions 109-10
Pilates 16,22,102,138 psoas walk 148 ribs,right-left differences 95
piriformis psychiatric disorders,disordered somatic robotic model,structure 52
MFR techniques 220 self 30 Rolf,Ida 14-15,75,115,130
self-applied C-R stretch 221 psychological patterns,structural Rolfing 12,13
plantar fascia,MFR technique 167 dysfunction 3,88-9 basic themes 15
plasticity,of fascia 75-7 psychological-emotional practitioners early offshoots 16-18
Platonism see Somatic Platonism 21,22 evolution of 18
pleural cavity 63 psychotherapy,somatic 30-1 gravity as therapist 15-16
poised head posture 104 pioneer of 14-15
polar postural types 117-18 "recipe" of structured sessions 15
post isometric relaxation (PIR) 143 Somatic Platonism 16
Q
posterior closure,AO junction 106 structural integration,principles 19
posterior pelvic tilt 102,108 superficial fascia 59
quadratus
protocol for excessive 155 Rolfing Movement Integration 17
C-R stretch 190
posterior shift,protocol for excessive 155 ROM see range of motion
MFR technique 192
posterior superior iliac spine (PSIS) 102 Roshi, Tanouye Tenshin 18
quadratus lumborum,C-R stretch 193
postural correctness,spiritual dimension rotation
quadriceps
31 around longitudinal axis 150
C-R stretch 160
postural dysfunctions see also externally rotated legs
MFR techniques 158,159
block model 93 rotatory asymmetry 97
muscle action 157
head 105-7 rules of thumb, strategizing sessions 133
potential spaces 63-4
legs 115
self-applied C-R stretch 161
lumbar spine 108
meaning of 98
pelvic girdle 110-15 s
rib cage 108-10 R
shoulder girdle 110 sacrum 111
spinal curves 99-104 random bodies 7,8 sagittal plane
thoracic spine 107-8 range of motion,testing for 135,142 back line techniques 167-80
postural integration 17-18,21 recipe,of structured sessions 15 bones along 95
postural models see models reciprocal inhibition 143,170 fascial lines that affect movement
postural-emotional tendencies 124-6 rectus abdominis,MFR technique 164 153
posture rectus tendons,MFR technique 164 front line techniques 156--{)6
arthrokinematic perspective 93-4 recursive patterning,fascial bags of mid- protocols for addressing imbalances
definition 32 thigh 61-2 in 154-6
distinguished from structure 93 regular external structural type 122 spinal curves 98-9,99-103
INDEX
sagittal rocking 148 short-leg syndrome 115 static posture 32

"hands on" movement exploration shortened tissues 121,123 steam and traction 11
182-3 shoulder girdle 110 sternal fascia,MFR technique 164
sagittal undulation adaptation to leg length discrepancy sternocleidomastoid
gait 148-9 115 MFR techniques 196
movement work 180-3 assessment of 132 self-applied C-R stretch 166
sartorius,MFR techniques for insertion displacements 111 straight backs 101,107
of 158 techniques for working with strategic approach 26-7
scalenes,self-applied C-R stretch 166 209-17 strategizing sessions 133-5
scapulae,potential space beneath 63 thoracic spine,scoliotic patients 1 1 1 stress, postural and phasic muscle
scar tissue. 86 silk stocking analogy 73 response 84
Schleip,Robert 76,125,126-8 skeletal asymmetries,structural stretching techniques 136
scientific human map 37-8 bodywork 31-2 structural body 56
scoliosis 103-4 skeletal system 94-5 structural bodywork
structural bodywork 31-2 postural dysfunctions 98-115 assessment see assessment
thoracic spine and shoulder girdle skin 58 brief history of 13-19
111 skull position, postural balance 104 concepts 1
working with LLD-induced 115, sleeve supported stance 122 in the context of other complementary
185-6 "slow-twitch" muscle fibres 83-4 therapies 21-4
seated position,lumbar kyphosis 108 soft-tissue definition 25
seated work,client care 142 changes of structural bodywork 25 distinguished from massage 31
secondary shortness 121 restrictions 9,88 external rotation of the leg 218-21
secondary spinal curves 99,100 soft-tissue interventions 44 in the frontal plane 184-203
synergistic relationship between curvature of the spine 102 human embryogenetic system 51-6
primary and 102-3 manipulation 14,48 implications of connective tissue 77
segmental standard rotation 97 see also myofascial release; passive LLD-induced scoliosis 115
self care,myofascial release 141 stretching main characteristics 25-9
self-applied C-R stretch 144-5 soft-tissue restrictions 102 maps for 40
entire lateral line 191 soft-tissued clients 78,133 meaning of structure 55
gastrocnemius 168 sol-gel hypothesis 75-6 overview 7-12
groin 163 soleus,self-applied C-R stretch 168 perspective of connective tissue 77
hamstrings 172 soma,defined 39 posture improvement 32-3
hip flexors and knee extensors 163 SOMA Bodywork 18 reasons for turning to 30-1
lateral cervical fasciae 197 somatic innovators 14 representation of musculature 62
levator scapulae 214 somatic organization research into benefits 31
neck,occiput and posterior fasciae correspondence of techniques and in the sagittal plane 153-83
179 levels within 45 shoulder girdles 209-17
piriformis 221 importance of addressing all levels skeletal asymmetries 31-2
psoas 163 45-6 sol-gel transitions 76
quadriceps 161 levels within 40-2 somatic viewpoint 38-9
scalenes 166 setting process 9 strategizing a series of sessions 133-5
sternocleidomastoid 166 Somatic Platonism 16,102 techniques 43-7
sub-occipita Is 180 somatic practitioners 21,22 improvements in posture and
self-sensing 7,40 somatic viewpoint 38-40 functionality 9-10
sensory motor amnesia 40,89,136 Somatics 38,39 see also contract-relax (C-R)
sensory motor intelligence 39,86-8 Somatised,emotional problems 30 stretching; myofascial release
degree of work 134 Spiegel,Rosie 19 in the transverse plane 204-8
economical movement 56--7 spinal curves 98-9 structural change,need for shift in
leg length discrepancy 114 assessment of 131-2 attitudes and beliefs 17
recycling of elastic recoil 81 deviations structural dysfunction 7-10
stability of the head in movement 151 in the frontal plane 103-15 musculature 86-9
sequencing of interventions,importance in sagittal plane 99-103 structural improvement 2
of 26 spinal rigidity 74 structural integration see Rolfing
setting process 9 spine, motion of,in gait 82 structural models see models
shin,MFR technique 156 spine of scapula,MFR technique 210 structural types,Flury's 121-3
shock absorption spiral lines 147 structure
lumbar lordosis 108 spiritual dimension, postural correctness anatomical and developmental
of the spine 101 31 perspective 49-50
short extensor pattern 126, 127 standing posture,Flury's analysis 120 architecture 41,50-1
short flexor pattern 126,127-8 startle reflex 125 distinguished from posture 93
INDEX
structure (cant.) thoracic cavity 97 unsulphated GAGs 67

economical movement 57 lateral seam see lateral seam Upledger,John 117
and function debate 48-9,57 lengthening of visceral fasciae 165 upper crossed syndrome 107,124
ideal form 16 thoracic erectors 108 upper trapezius
models thoracic inlet syndrome 156 C-R stretch 210,212
for understanding 52 thoracic outlet syndrome 107 MFR techniques 210,211,212,213
for working with 2,117-28 thoracic spine upright,parallel physical and emotional
overview of 95-8 C-R stretch 176 meanings 31
specialized meaning of 7,55 passive stretch 176
traditional approaches to 13-14 postural dysfunctions 107-8
see also tensegrity systems role of rib cage on movement 99
v
sub-occipital muscles 104 and shoulder girdle, scoliotic patients
importance of 106-7 111
self-applied C-R stretch 180 thoracolumbar fascia,MFR technique 173 vasodilation 72,89
subjective experience 39 thoracolumbar region,C-R stretch 205 vector diagram,myofascial release 136
sulphated GAGs 67 three-level protocol 2,46-7 verbal patter,developing,in C-R
Sultan,Jan 14-15,117-18 tissues stretching 143-4
superficial back lines 147 layering of 58-64 visceral complex 50
superficial fasciae 58-9 primary and secondary shortness viscoelasticity,connective tissue 76,136
MFR techniques 121, 123 visual assessment,of posture 131
for cervical 195 scientific map 38 visualization,in myofascial release 138
for pectoral 216 see also connective tissues Vitamin C 72
superficial front lines 147 tonic musculature 83,84, 123-4 von Bertalanffy,Ludwig 57
support principle 19 tonic neck reflexes 99,105-6

sway back 108 tools,of myofascial release 138-41
symmetrical external structural type trabeculae 59-60, 94-5 w
122 tracking 221
sympathetic activation 89 traction 11
waist
synovial capsules 69 Trager approach 43,78,136,138
MFR technique 192
synovial sheaths 70 transverse plane,techniques for working
working with 191
systematic approach 26-7 in 204-5
walking see gait
transverse undulation
wavy spine 149
gait 149-50
Western approach
movement work for 205-8
T osteopathy 13
of the pelvis 148
to yoga 13
trapezius see upper trapezius
tables,in myofascial release 141-2 wholism see holism
trauma,musculature 86
Taylor Still, Dr Andrew 14 Williams,Bill M. 18
trauma history
techniques see structural bodywork, Wolff's Law 31-2,75,95
essential background information 131
techniques possible effects on movement and
templates,postural 16 posture 88
tendons 69,70,74 trigger points,within musculature 85 y
see also calcaneal tendon; latissimus trigger-point therapy 18
tendon; rectus tendons tropocollagen 72 yogic practice 12, 13
tensegrity systems 52-6 "true renaissance persons" 21
tension myositis syndrome,proposed trunk
pathophysiology 89 C-R stretch for ventral aspect 165
tensor fasciae latae,MFR technique 189 primary line of 153 z
tent tensegrity structure 53 "tuck the tail under" advice 101,102
thighs Zen Bodytherapy 18
deep fascia of 59 zig-zag line 120-1
see also inner thigh; mid-thigh
third-person perspective 39 u
thixotropy 75, 135
thoracic area,MFR techniques for upper ulna 138
174 underuse,of musculature 85-6
TECHNIQUE LIST
T1 MFR technique -shin
T2 MFR technique -antero-Iateral compartment
T3 Test for hip flexors
T4 MFR technique - quadriceps
T5 MFR technique -insertion of sartorius and rectus
T6 MFR technique -quadriceps, lateral aspect
T7 MFR technique -quadriceps, medial aspect
T8 MFR technique -quadriceps, medial aspect
T9 MFR technique -inner thigh, adductors
T10 C-R stretch -quadriceps
T11 Self-applied C-R stretch -quadriceps
T12 C-R stretch -groin area and psoas
T13 Passive stretch - fascia of groin and psoas
T14 Ligamentous challenge
T15 Self-applied C-R stretch -fascia of groin and psoas
T16 Self-applied C-R stretch -hip flexors and knee extensors
T17 MFR technique - superior to the ASIS
T18 MFR technique -costal arch
T19 MFR technique -rectus abdominis
T20 MFR technique -rectus tendons and sternal fascia
T21 C-R stretch -ventral aspect of trunk
T22 Passive stretch -infrahyoid area
T23 Self-applied C-R stretch -scalenes and sternocleidomastoid
T24 MFR technique - plantar fascia
T25 MFR technique -calcaneal tendon
T26 Self-applied C-R stretch -gastrocnemius and soleus
T27 Straight leg raise test -to check hamstring length
T28 MFR technique -the hamstrings
T29 MFR technique -medial hamstrings
T30 MFR technique -lateral hamstrings
T31 MFR technique -hamstrings, distal aspect
T32 MFR technique -inner line of the medial hamstrings
T33 C-R stretch -hamstrings
T34 Self-applied C-R stretch -hamstrings
T35 Passive stretch -hamstrings
T36 MFR technique -mu�ifidus triangle and inferior erectors
T37 MFR technique - thoracolumbar fascia
T38 C-R stretch -lumbar erectors
T39 MFR technique -erector fasciae
T40 MFR technique -upper thoracic area
T41 MFR technique - upper thoracic area, whilst side-lying
T42 MFR technique -erectors
T43 MFR technique -erectors, laminar groove
T44 MFR technique -erectors, working medially
T45 Passive stretch -thoracic spine, ALL
T46 C-R stretch -thoracic spine and ALL
T47 C-R stretch -pectoral fascia
T48 MFR technique -posterior cervical fascia
T49 MFR technique -occipital ridge
T50 MFR technique -occipital ridge
T51 Movement education -the chin tuck
T52 Passive stretch - atlanto-occipital junction
T53 C-R stretch -atlanto-occipital junction
T54 Self-applied C-R stretch -occiput and posterior fasciae of neck
T55 Self-applied C-R stretch -sub-occipitals
T56 MFR technique -peroneals
T57 Dber test -test for shortness in the iliotibial tract
T58 MFR technique -ITS
T59 MFR technique -hip deltoid
T60 MFR technique -iliotibial tract, above the trochanter
T61 MFR technique - tensor fasciae latae
T62 MFR technique -gluteal fascia in side-lying
T63 C-R stretch -ITS and hip deltoid
T64 C-R stretch -ITS, hip deltoid and quadratus
T65 Self-applied C-R stretch -the entire lateral line .
T66 MFR technique -waist
T67 MFR technique -anterior aponeuroses of the abdominals
T68 MFR technique -quadratus
T69 C-R stretch -lateral abdominals and the quadratus lumborum
T70 MFR technique - lateral seam
T71 MFR technique - intercostal spaces
T72 Passive stretch -lateral seam
T73 MFR technique -superficial cervical fasciae
T74 MFR technique -sternocleidomastoid (SCM)
T75 MFR technique -SCM bilaterally
T76 C-R stretch -lateral cervical fasciae
T77 Self-applied C-R stretch -lateral cervical fasciae
T78 MFR technique -medial tibial border
T79 MFR technique -adductor group
T80 C-R stretch -anterior adductors
T81 C-R stretch -lumbo-sacral region
T82 C-R stretch -thoracolumbar region
T83 MFR technique -spine of scapula
T84 MFR technique -upper trapezius
T85 C-R stretch -upper trapezius
T86 MFR technique -upper trapezius, rhombOids, serratus posterior superior or levator
scapulae insertion
T87 MFR technique -upper trapezius, lateral
T88 MFR technique -the upper trapezius, posterior
T89 C-R stretch -upper trapezius
T90 MFR technique -upper trapezius, seated position
T91 MFR technique -upper trapezius, seated position
T92 MFR technique -levator scapulae insertion
T93 Self-applied C-R stretch -levator scapulae
T94 MFR technique -latissimus
T95 C-R stretch -latissimus
T96 MFR technique -pectoralis minor
T97 MFR technique -latissimus tendon
T98 MFR technique - superficial pectoral fascia
T99 MFR technique -deltopectoral groove
T100 MFR technique -pectoral fascia, pectoralis major tendon and deltopectoral groove
T101 MFR technique -medial gluteus maximus insertion
T102 MFR technique - lateral rotator insertions, gluteal Insertions
T103 MFR technique -gluteal region
T104 C-R stretch -external rotation of leg from hip
T105 MFR technique -piriformis, broad
T106 MFR technique -piriformis, speCific
T107 Tracking
T108 Self-applied C-R stretch -piriformis

Structural Bodywork PDF

Uploaded by

Copyright:

Available Formats

Structural Bodywork PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Structural Bodywork PDF

Uploaded by

Copyright:

Available Formats

Structural

Structural Bodywork focuses on issues of posture and structure

T hll product II appropriate for:

Commissioned illustrations by:

Somatic Therapist, Sydney, Australia

© 2005, Elsevier Limited. All rights reserved.

No part of this publication may be reproduced, stored in a retrieval system, or

First published 2005

ISBN 0 443 10010 1

British Library Cataloguing in Publication Data

Library of Congress Cataloging in Publication Data

your source for books,

1 Structural bodywork: an overview 7

Section 2 Our somatic organization 35

Section 3 Practical manual 91

12 A catalogue of some common postural dysfunctions 93

Appendix 1 Structural and functional bodywork training 222

2. A brief history of structural bodywork 13

3. Structural bodywork in the context of other complementary therapies 21

4. What is structural bodywork? 25

5. Structural bodywork: some frequently asked questions 30

I NTRODUCTI O N connective tissue structures, from the fascial web to the

Figure 1.1 Random bodies (after Rolf 1977).

Structural dysfunctions in bodies typically arise from:

• gradual adaptation of soft tissues to repetitive strain

Creative movement Figure 1.3 The vicious cycle is reversed.

Figure 1.4 Before and after Rolfing.

trained and highly respected of contemporary somatic B O D Y- S H APING T E C H N O L OGIES

gymnastic and movement systems such as eurhythmy.

tation to the structural struggles in the gravity field. 1. respiration

gravity's effect. 7. relationship of head to rest of body - primarily

(Sultan 1986) occiput-atlas (OA) relationship, then to rest of body

Structural bodywork today owes a great debt to INTEGRATING SESSIONS

Gravity as the therapist

Ida Rolf felt that many of the dysfunctional bodily pat­

unflattering contour of his body, another as constant

Part of Rolf's vision of the integrated structure was

Don Hanlon Johnson (1980), himself a trained Rolfer,

to respond to this work. It is clear that Rolf herself came

Figure 2.4 Jack Painter.

Figure 2.5 Dub Leigh.

Zen Bodytherapy - William 'Dub' Leigh

Box 3.1 Three core complementary practices

naturopathy Bodywork - Hands-on approaches

Jin Shin Jyutsu Rosen method

Reiki functional approaches

CONSTITUTIONAL PRACTICES Watsu

BioEnergetics neuromuscular (trigger points etc.)

ANOTHER PERSPECTIVE ON For these practices a more extensive training is required

Third paradigm: integrative, holistic systems

Second paradigm: corrective

First paradigm: relaxation

Figure 3.1 Maitland's three paradigms of practice.

DEFINITI O N • is a strategic, systematic process

to be just a partial solution. It may alleviate the discom­

Any structural change in the body will require a period of

Agonist­ Agonist­ - Antagonist

(a) (b) (c)

• to deal with what they perceive as their postural

Ida Rolf felt that many of the dysfunctional bodily pat

to be just a partial solution. It may alleviate the discom

Agonist Agonist - Antagonist

prioceptive senses, a categorically different phenom make this attempt.

(Hanna 1995) domain of structural bodywork? Structural bodywork

and affected, elongation of the structures becomes facili

If we could repeat the experiment, but this time dis