My career as an osteopathic physician is a natural extension of my Rolfing® Structural Integration (SI) practice in the 1980s. After all these decades, persistence has been a key to the learning process: the body does not yield its structural secrets in a linear timeline nor at my discretion. The various disciplines give you a starting point, then it takes treating thousands of clients to see what works.

Several other themes are noticeable in my career. One technique or system of thought does not apply consistently to all clients. I frequently refer out patients for Rolfing SI, massage, and physical therapy in combination with my treatments. My practice has given me a good body of knowledge to work from but not all the answers. The learning curve includes humility, an open mind, and knowing when another modality will work better for the client

My current style is to start and end each session with the biodynamic model of craniosacral therapy. This has given me the best reads and results on structure and function over the past decade of treatment. Sandwiched in between the beginning and end of each session are spinal adjustments, deep-tissue work, acupuncture, etc., that are used to facilitate a more balanced and stable structure. This overall scheme allows me to gauge ?improvement?. Like Rolfing SI, change continues in between sessions and is usually informative to the client?s process.

Another observation is that most of our clients are in a heightened sympathetic pattern, increasing myofascial tensions. The sympathetic dominance has to be addressed early in each session to make any headway in helping the person. Otherwise, you?re wasting a lot of effort.

Regarding craniosacral work, the head and the sacrum are great listening posts but only useful part of the time. System access has other spots of entry into the dynamics that rule the myofascial domain. The extremities are one example of this. I have noticed over the decades that a client?s body will have a preference on whether the top half wants to be treated on any particular day or whether it?s the lower half. Secondarily, there are left / right splits in the body that are deeper set than just dominant-side issues. This continuity of upper/lower preference is a familiar theme that was first pointed out in my Rolfing trainings in the 1980s, as the Eighth and Ninth Hours of the Ten Series. Integrating the extremities into the axial core can do wonders for head and sacral issues.

The other session of Rolfing SI that overlaps a lot of my experience in osteopathic manipulative treatment is the Third-Hour, lateral-line session. It is easily overlooked because we?re so busy treating the front or back sides. Compression builds up along the lateral line from life stress and trauma. Gains in length from working the front and back are easily offset by lost anterior/posterior depth from the sides. Revisiting variations of the Third Hour is worth considering.

Osteopathy and Rolfing SI are premier tools to help function and structure. Bone and fascia, however, are just some of the fulcrums to be addressed. They are the easiest to get a hold of, but there are other pieces to this puzzle, the very least of which is the client?s sympathetic tone and by extension his mental process. Clues abound to guide our decision making process when treating, but it is a long process to master. May your persistence continue to be a creative journey.

<i>Brian Shea DO practices in Boulder, Colorado.