When his physical body gets into difficulties, trouble spreads to the whole man. It affects his consciousness, and he calls it stress. Many approaches, physical and psychological, have been used by men in their efforts in escape – drugs and massage among the oldest of these. What is the first requirement to relieve this stress? What are the principles defining site in man? In the new approach to the physical man called Structural Integration, absence of stress is seen as balanced function – the balance of the body within the field of gravity. This is a new definition; stress is imbalance, visible as the inappropriate position of Nicky components in space.

The technique of Structural Integration is basically twofold: by manipulation, the soft tissue is brought toward its normal (anatomically efficient) position; calling for what we consider appropriate movement then allows the structure to realign itself. Change in the structure is made permanent through new patterns of movement; reciprocally, new patterns of movement are made possible by the new organization. Our attempt in this discussion is to explore principles underlying balanced functioning and to relate these to the technique called Structural Integration. The paper that immediately follows discusses experimental data validating the technique.

Rehabilitation the whole man calls for more than a random stretching of local areas. Wider implications must be considered. SELYE`S insight reported in ‘The Stress of Life’, published in 1956, that stress is a nonspecific element of disease (dis-ease), as well as its consequence, is basic. So is his concept of an adaptive energy as part of man’s biological inheritance. SELYE (1956) suggests connective tissue, fascia, as an integral component of the stress syndrome. These ideas are fundamental. They generated a universal interest, yet little significant progress has been made in applications which could add to the comfort of the individual man. Instead, obvious clues indicating the significance of fascia in personal well-being have been ignored.

After stress situations, most individuals intuitively attempt to relieve their own disturbed pattern by ‘resting’. They equate this with slumping, slouching, or lying down. Seemingly, no one has drawn the logical conclusion that the gravity disaster is a major – a very major – component of stress.

The interaction of the physical man and his surrounding gravitational field illuminates the role of gravity in stress. This interaction is based on balance and therefore on the laws of mechanics as applied to physical bodies. The musculoskeletal system, especially its myofascial component, is the intermediary between the vital organism and its outer environment. Structural balance begins in the myofascial components of the body; it affects the chemistry and thus the physiology of the organism. This has long been surmised; up to now, however, it has not been studied in this light. Realizing the role of connective tissue in manipulation, osteopathic workers did considerable research in the field.(1)

ERLINGHEUSER [1959] called attention to the tubular form of collagen fibrils, which to him suggested a circulatory role and from which he deduced its active participation in the maintenance of homeostatic equilibrium. In general, however, the classical approach of physiology to the musculockeletal system has tended toward the descriptive rather than the functional. In line with the general trend of science, earlier analyses of the gross effect of individual muscles on the action of joints have been superseded by investigations of the microbiology and microphysiology of connective tissue.(2)

If the myofascial system is considered as a functional whole rather than as a merely additive complex of tissue, it becomes apparent that this is the organ of support – a resilient unitary fascial framework which initiates, transmits, and determines movement, as well as ensheathing and supporting all individual parts. Muscles work as interconnected, balanced systems, not as individual motors for body parts. They are physiologic systems rather than anatomic elements. The myofascial system and its related neural mechanisms determine spatial movements of joints and thus the direction and quality of all movement. In turn, movement acts as a pumping mechanism; in this way, the myofascial system is an important factor in fluid exchange at all levels of the organism. Anatomically, the myofascial system thus has a part in determining metabolic levels in local areas as well as in the body as a whole. It so becomes a vital factor in the bioenergetic regulation of the body and its homeostatic and thermodynamic equilibrium.

Bodies are plastic in that they are ‘capable of being deformed continuously and permanently in any direction without rupture’.(3) This living plasticity is particularly vulnerable to entropic deterioration, the tendency of ordered systems to evolve in such a way as to increase their degree of disorder or randomness (OVERSETH, 1969]. As a result, the precision of gravitational balance is constantly endangered. The same plasticity that makes for deterioration of the body pattern can also he used to counter it. The tendency to progressive deterioration and shapelessness and roundness is the same process as what is popularly called ‘aging.’ This comforting word tends to hide the real problem, which is a loss of pattern appropriate to precise function within the gravitational field. Cultivating or reconstituting that design of the human body which creates and maintains a more balanced energy system – a system which conserves rather than expends energy – is a key to greater subjective as well as objective well-being.

The various organs and systems of the body, up to a point, constitute self- contained energy fields. Beyond this point, their algebraic sum assumes significance in that it expresses the characteristic man-as-a-whole. Man tends to perceive himself as a Gestalt; he is rarely able to differentiate the elements of his physical functioning. To him, his bad temper of a morning is part of his character, not the result of a blocked bile duct or an inadequate liver. He simply includes in his self-image his chronic aches and pains; these are a part of his behavior. To us, these aches and pains record the effect of the energy pattern of the earth (the gravitational field) on the man’s personal energy field.

Stresses, aches, and pains are the body’s language to express the strained imbalance between the field of gravity and the body integrals – weight masses of head, thorax, pelvis, legs. Such a body is unbalanced; we call it random. Return to balance is possible. Manipulation to reposition the soft tissue will give greater freedom to the muscles. This can be combined with a patterning of freer movement to achieve more appropriate balance. The mechanism for achieving improved function is perfectly logical. Within the body as a whole, the relation of individual structural units (head, thorax, pelvis, legs) is brought toward a vertical line in a position of standing rest. Logically, vertical alignment of units must give a structure capable of retaining its form within the disorganizing pulls of gravity on individual segmental units. Structural Integration has shown that it is possible to create such an alignment. The result is a man of different mechanical and psychological qualities.

Strain between body segments alters patterns of movement. In a random body, any given movement evokes response not only from the muscle primarily concerned (and its antagonist), but from a chorus of other units as well. Some of this accompanying group may interfere with, or limit, the movement, rather than support it. The resulting aberrated flow may, in fact, be an inversion of the movement demanded. It is a jangle of response, altering or even inverting the movement intended. Originally, these compensatory restrictions may well have been an effort at support on the part of the body, an attempt at ‘splinting’ or ‘relieving’ an injured part. But at the present time, they are barriers to movement; circumventing their restriction demands exhausting outpourings of energy.

Fascia ensheaths muscles and organs, Control of the position of the weight blocks in space is through these fascial sheaths. The once appropriate, but now outmoded, response reflects interference in the smooth sliding adjustment of fascial planes necessary to free, economical movement. Compensatory mechanisms originate in, and operate under, the laws of mechanics. Accident, habitual posture, or the dramatization of an emotional attitude can distort the vertical alignment of weight blocks. Then it is the total enwrapping envelope of the superficial fascia which must adjust to keep weight blocks from literally falling apart. There is, of course, always a point of originating localized fascial strain. But to make acute restrictions subjectively more tolerable, the body adjusts by spreading the strain to more distant points though the medium of the network of fascial planes. Often, reinforcement is through thickening of the fascia; this thickening usually becomes permanent, and the restriction is then chronic. In doing this, the body has adjusted throughout. In the fascia, particularly the superficial fascia, this thickening and displacement is visible in the contours of the body. But such visual cues are usually ignored because their significance is not understood.

There are many patterns of disintegration. Fascial shortening may cause a slight displacement of body parts. Or fascial envelopes may attach to neighboring myofascial units, consolidating several of these elastic sheats into a single unit of less resilient, less mobile tissue. Or the problem may focus on restricted movement at the joints, where tendons shorten or become displaced. Once started, patterns of disintegration are automatically progressive. As shortening and thickening of fascia proceeds, body cavities become smaller and distorted; visceral crowding ensues. Subjectively and objectively, the picture is one of consistently lowered energy and lessened vital well-being.

TAYLOR [1958] has called attention to the probability that the mechanism of deterioration may well be a changed chemistry and/or physics of the ground substance and the fibroareolar laminae of fascia. He has also emphasized that while energy can and does leave such systems when they are in a condition of spontaneous deterioration, by reversing the condition, chemical or mechanical energy may be added. The energy level can rise again; balance is reversible within wide limits. Elasticity can be restored, he implies, in all but those areas where the level of deterioration is such that elastic tendons have become a very inelastic gristle. This has been our observation as well. The energy level can rise again; the process is reversible by restoring pattern.

Restoring pattern calls for more than random stretching of local areas. There is little doubt that any deep manipulation of muscles does transform energy, and in so doing adds oxygen and other metabolites at the cellular level. Massage, an age-old therapy, demonstrates this. But effective, continuous, spontaneous functioning of the energy machine which we name man demands that all vital living parts of the machine be free to move reciprocally. Each member, by its movement, must spontaneously restore the energy expenditure of its antagonist. The obvious and most superficial agonist/antagonist balance is that of flexors with extensors. It is characteristic of the random body that postvertebral extensors have been overpowered by prevertebral flexors. The result is loss of tone and vigor in the extensors. They become spatially displaced, separating too far from the spine; in flexion, they spread away from the spine rather than lengthen along it. The result is what is commonly called bad posture.

Freeing movement in a random body by a series of manipulations presupposes a vivid reality concerning the individual’s overall myofascial structure. The precise spot of the initial restriction and how it occurred are interesting considerations, but neither is immediate to the problem. As we have said, local interference anywhere in the fascial structure does spread rapidly. This is true in traumatic accidents. It is fortunately also true in manipulative rehabilitation. The former creates compensations and strains throughout the body; the latter, by design, lessens them. Often, the result registers subjectively as coming from body parts quite distant from the first point of strain, or even from the original manipulative interference. If a strain is of long standing, freeing it locally -even though at the original point of traumatic impact – does not basically relieve the generalized pattern, although temporarily it may change it and the change may be welcomed by the subject.

Fundamental relief from physical stress depends on vertical alignment of centers of gravity of all major weight units (head, thorax, pelvis). In turn, this kind of alignment can only follow balanced readjustment of fascial restrictions and pulls. Each myofascial element must become resilient, within narrow limits independent, and participating in the overall picture, free to take the precise place appropriate to the pattern of movement. Emphasis here is on relieving the downward pull, the destructive effect of gravity, and so lessening the rate of disorganization in the system. At this point, as the negative pattern disappears, a new effect emerges. The direction is reversed. Just as imbalance and degeneration are cumulative, so regeneration and movement in the direction of balance, once, started, is self-feeding, This is the beneficent aspect of plasticity. The disorganizing effect of gravity on an unbalanced system increases the random involvement of compensating muscle groups. Freed from this tendency, more balance in the postvertebral extensors increasingly evokes activity in the deeper underlying structures, the intrinsic muscles of the spine. This is a new behavioral pattern. It appears to include the gravity component as a significant integrative factor. The negative burden of gravity seems transformed to a supportive lift. The individual subjectively expresses a joyous recognition of the direction man calls ‘up’.

In Structural Integration, we are willing to call movement ‘normal’ only when it satisfies the requirement that, in flexion, when flexors ilex, extensors extend – lengthen. In such ‘normal’ movement, contracting flexor muscles stretch the related extensors; movement then is a spontaneous inherent exercise for both, transforming mechanical energy into the chemical energy of metabolism. Thus, the mechanics of movement determine the economy of individual cells. Such cycles must he reciprocal, for it is this reciprocity that ensures the balance underlying well-being.

Destruction or interruption of these ideal cycles may and does occur at many levels. Limitation of movement, registering as interference and deterioration in some one member of the cycle, is the rule rather than the exception. It is average. Nutritional deterioration resulting from genetic tendencies may certainly he a contributing factor. But possibly the most basic universal disruption is mechanical interference in function. An imbalance, even though it may start as a limited, temporary situation (a sprained ankle), allows the gravity field to impose its directional force on structural elements. If limitation continues for more than a few days, compensations become built-in. Over time, these spread. Modifications penetrate to many depth levels and to diverse localities at any one depth. Thus, a’ temporary’ trauma may result in chronic restriction, and will be mirrored in inappropriate physiological function on many levels and many depths. This process can be reversed; the fascial structure can be reorganized, provided it is reorganized as a whole. Appropriate vertical realignment of weight segments restores order to structure and balance to body function.

Actual manipulative work with fascia calls to mind die lowly onion. Layer lies within layer. Deeper layers can be affected only as more superficial ones lose the rigidity that is the signature of imbalance. Mechanical energy input occurs with any manipulative pressure (for example, massage); but if manipulative pressure is designed to shift the spatial position of fascia (displaced, shortened, or otherwise aberrated) in the direction demanded by normal structural design, energy input is no longer random, but becomes specific to the task required. This is true especially if appropriate, aligned (not random) movement is demanded from the part. These are the basic methods of Structural Integration. Fascial tissue is moved in the specific direction demanded by its original design. To the degree that this is accomplished, relief from physical stress is achieved reliably and predictably. Physical stress mirrors emotional suffering; relief from physical constraint markedly affects the emotional misery. (It is tempting to speculate, at this stage, that the ‘balancing’ of a body is the outward manifestation of physical stretching of collagen molecules. According to Verzar [1963], this could result from lessening the number of ester cross-linkages, increasing the number of hydrogen cross-linkages. Such speculation, however, requires much more extensive study.)

Structure in a standing man may be evaluated in terms of horizontal and vertical lines, imaginary lines drawn through real points of the man. Thus, the anterior superior spines of the pelvis, or the centers of the patellae, should be on horizontal lines. To the extent that a body conforms to these lines, we would consider it balanced. A measuring stick to reliably evaluate balance is the pattern of the moving body as revealed in joint action. A balanced body will move along straight lines. These may be seen as counterparts of XYZ axes by which spatial position of any three-dimensional system is described. In addition to horizontal and vertical axes, the Z-axis describes a line of motion.

The vertical axis emerges from the high point of the head, the uppermost point of intersection of coronal and mid sagittal planes. The first intimation of balanced movement in a body is a slight, spontaneous elongation along this vertical axis. This happens only when not only general body flexors and extensors move reciprocally, but in addition deep intrinsic muscles of the spine cooperate with more superficial extrinsic muscles. This is a hallmark of true balance. The individual himself may not be able to tell that this ‘something new’ is such a slight elongation; but to him, whatever it is, ‘ it feels so good’. It feels light, feels as if he were floating above the ground. He is experiencing the support of the gravity field, it is no longer tearing him down. He is experiencing that his own intrinsic structure is balancing the extrinsic.

The horizontal axis describes primarily the movement of shoulder girdle and arms. When arms and shoulder girdle move appropriately, the olecranon generates a horizontal line: Any arm motion starts at the olecranon which this moves horizontally outward (perhaps only a fraction of an inch). If the movement desired is to be in a true lateral direction, it is initiated by a shortening ofthe latissimus dorsi; if in a medial direction, is the pectorales major and minor that shorten. Arm movements are thus initiated by large muscles of the trunk. The originating movement involves only the pectorals or the latissimus, although it may be immediately modified by the smaller muscles of the shoulder girdle and arm.

The Z-axis describes the line of motion of the leg. Appropriate movement of the lower limb requires that the patella follow this line straight forward. The integration involved will give rise to walking in its most economical pattern. The movement is initiated byiliopsoas and gluteal muscles, and the resulting balance of abductor- adductor- rotator adds up to minimal energy expenditure. This contrasts markedly with the average walk, iwhich the quadriceps, particularly the rectus femoris, originate the movement In balanced walking, the leg moves straight forward; it swings. The rectus lemons do not have to lift the leg.

As a body progresses towards balance, motion is characterized and defined by these axes. Calling on a random body to follow these lines will create some degree of balance. However, this may be severely limited. Permanently improved movement can only follow removal of compensatory limitations. This, followed by a program evoking a more positive pattern of movement, creates a degree of well being in the individual which he finds noteworthy. To the subject, there is no doubt that stress has been lifted. He calls himself ‘turned on’; modifications in consciousness have occurred.

Some objective documentations of the effects of Structural integration on the metabolic and mechanical dynamics of the individual are reported in the paper that follows. These, although still incomplete, are spelling out the mechanisms involved in personal stress. The role of the autonomic vs. the central nervous system in establishing and maintaining conditions which make possible the very significant intrinsic-extrinsic myofascial balance will require further specialized study. Together, these studies will point the way toward a different understanding of the mechanism that is a human being.

Notes

1. See articles by Erlingheuser [1959], Taylor [1958], Gratz [1936, 1937] and Little [1969] as given in the references. The article by Little [1969) summarizes and documents the osteopathic contributions to the field.

2. There is surprisingly little in the literature about the structure or function of fascia and the myofascial system, Sonic of the more important work is summarized here: The properties of faccial elements and their adaptation to surgical repair has been extensively explored: this phase of the research is rvpurled in detail by Lowman (1954). The tendency a fibrosis tissue to short and contract is characteristic and has long been recognized. Medical investigation in collagen diseases earls identified such contracting and contractures as the mechanism through which motion become limited and various arthritic syndromes and collagen disease, are established. Gross [1961] describes in detail the earlier work which has elucidated the structure of collagen. He summarized by saying, ‘Collagen owes its properties not only In its chemical composition, but also to the physical arrangement of its individual molecules … It is possible that disturbance, in the precise sequences of remodeling are responsible at least in part for some congenital malformations, the crippling end-results of rheumatics diseases and perhaps even for some of the changes in aging. There is little doubt that severe crippling deformities of bones and joints, and the scarring of the heart, kidneys, blood vessels, lungs and other organs are a manifestation of excessive production and aberated arrangement of collagen in the affected tissue. Verzar [1963] and his associates studied the collagen molecule in rat and frog tissue. They hoped to elucidate the tendency of fibrous tissue to shorten, and thus find an index to the aging of given tissue. Accepting that the basic collagen molecule is a triple helix which in turn consolidates into a 10-helix microfibril, then postulated that the shortened, thickened, more terse collagen variation represents more random systems at lower energy levels. These were systems, they deduced, in which increasing number of hydrogen, and ester cross-linkages between the chains had been established.

3. Webster’s New Collegiate Dictionary, 2nd eat. (Merriam. Springfield 19561. Italics ours.

This paper was originally written in 1969. During the intervening period, its publication has been delayed, but experimental programs have been carried on to further extend our understanding of the implications of Structural Integration. One of the most significant of these is the electromyographic study of muscle response during simple habitual movements by Dr. Valerie Hunt of the Movement Behavior Laboratory at the University of California at Los Angeles. The experimental details of this work are to be published shortly. Its conclusions emphasize the verbal summation given here, in particular with respect to the inversion and substitution of movement mentioned on p. 73.

References

Erlingheuser. R. F.: The circulation of the cerebrospinal fluid through the connective tissue system. Yb. Acad. appl. OsteopathN 1959).

Gratz, M.: Engineering methods in medical research. Arch. phys. Then. 17: 145 (1936).

Gratz, M.: Biomedical studies of fibrous tissues applied to fascial surgery. Arch. Surgery. Chicago 34: 461 119371.

Gross, J., Collagen. Sci. Amer. 196): 121-130.

Little, K. E.: Toward more effective management of chronic myofascial strain and stress syndromes. I. Amer. osteopath. Ass. 1969: pp. 675-s85.

Lowman, L.: Abdominal fascial transplants (Edwards Brothers, ten Arbor 1954).

Overseth, O.E.. Experiments in time reversal. Sci. Amer. 1969: 90.

Page, L_E.: The role of the fasciae in the maintenance of structural integrity. Yb. Acad. appl.Osteopathy 1952: 70.

Selye. H.: The stress of life (McGraw-Hill, New York 1956).

Taylor, R.B,: Bioenergetics of man. Yb. Acad. appl. Osteopathy (1958).

Verzar, F.: The aging of collagen. 5ci. Aher. 1963: 110411.Structural Integration (reprint)