All Rolfers™ know that the feet are important for structural integrity. Looking at the feet pictured here, you can predict that there will be trouble above, at the knee, pelvis, spine, thorax, and neck. You could even make inferences about the way in which structures above the feet would be displaced based on how the feet are distorted.
Figure 1: Disorganized feet.
All Rolfers also know that it is possible to change the structure of the feet so that they distribute the weight coming down from above in a balanced way. Dr. Rolf taught us how to do it by using our hands to alter the structure and tonus of the connective tissue that is holding the feet in an aberrant pattern.
In the ten-session series that Rolf originally taught and that forms the basis of the Rolf Institute’s® basic training, the work in the second session on the feet is designed to release strictures in the compartments of the lower leg and the retinacula of the ankle that prevent full range of motion of the foot in plantar and dorsal flexion. Additionally, this work will allow for the relatively independent motion of the tibia and fibula across the interosseous membrane of the lower leg. Directly working in the foot is focused primarily on the release of restrictions in the retinacula around the medial and lateral aspects of the malleoli, across the dorsal surface of the foot, and along the plantar surface of the foot.
To do this we rely on the assumed plasticity of connective tissue. Rolf told us we could change tissue with our hands and we have been doing it for fifty years. It is important to remember, however, that the laboratory evidence of the plasticity of connective tissue is sparse. Only recently, at the 2008 research conference on connective tissue at Harvard Medical School has evidence been presented that connective tissue can alter in ways and at speeds that we assume we see in our practice. The osteopath John Upldedger has made a good case for the viscoelastic nature of connective-tissue membranes, which will allow for some responsiveness and movement, but not of the degree that Rolfers regularly produce. We need more evidence here.
Rolf taught us that the work of the basic Ten Series is designed to go only to a certain depth in the body. Going deeper, into the complex structures of ligaments around joints was, she said, territory “where even angels fear to tread.” She designed the basic series in this way to protect the practitioner and client from the destabilizing and decompensating consequences that can result from careless release of deeper ligamentous structures. The goal of the basic series is to create a web of organized tissue that reaches down to the deep fascia and its interface with the body’s bony surfaces. Organization at this level will provide a profound supportive matrix for deeper structures, which will mostly adapt by releasing and mobilizing.
When Rolf created the advanced training, she advertised it as training in taking the work of Rolfing Structural Integration to a deeper level. The question, of course, is: “What did she mean by a deeper level?” There is much to discuss here, which this article is too short to contain. But, staying with the connective-tissue hypothesis, it is obvious that going deeper into the connective-tissue system would involve working at the level of ligaments and joints. It also turns out that work at this level is usually necessary to normalize structural displacements that occur within the larger segments of the body that Rolf was working to balance, as depicted in the Little Boy Logo (Figure 2).
Figure 2: Little Boy Logo.
For example, it is often difficult to get the pelvic segment horizontal or the feet balanced without working on the relationships within the pelvis or within the foot, i.e., torsions between the two ilia, sacrum, and lumbars or rotations between the talus and navicular, etc. To do this requires working with ligaments, which together with the anatomical shape of the joint surface define the motion of the body’s joints. (This article is too short to go further into the very interesting properties of motion that occur at this level in the body, and I am hoping to expand on this discussion in another article in a future issue.)
I can briefly say that normal motion of the joints of the body depends on the ability of any joint to move equally in all the dimensions that the shape of the articular surface of the joint and the associated ligaments allow. This will often involve mobilizing a joint and its associated ligaments in ways that are not possible using the voluntary musculature that controls the joint. For example, normal, voluntary motion of the knee joint is flexion and extension, with slight internal rotation of the femur on the tibia on full extension. However, in releasing ligamentous restrictions that are inhibiting normal motion of the knee joint, it is usually necessary to subtly shear the knee joint in the transverse plane from lateral to medial or medial to lateral. This is a non-anatomical motion, meaning that the client cannot do this voluntarily. It can only be done by the application of an outside force. It turns out that working at this level can also be very useful when balancing disorganized feet, such as we see in Figure 1. With this in mind, I will discuss four fundamental joint relationships in the foot: tibial-talar, talo-navicular, talo-calcaneal, and calcaneal-cuboid.
The basic “Recipe” works primarily with the talo-crural joint, also called the tibiotalar joint, where the tibia sits on top of and to the side of the talus, the site of dorsal and plantar flexion of the foot. But, the significance of the talus for normal function and structure in the foot goes far beyond flexion and extension at the ankle. The talus is the central structure in the foot guiding the weight coming down from above appropriately onto the medial and lateral arches and the anterior and posterior weight-bearing structures. It also has no muscular and hence tendinous attachments, so it is not available for voluntary motion. Its ligamentous structures are complex.
Because the talus articulates with the tibia above and with the fibula laterally via ligaments, it is important to notice that any torsion in the lower leg will displace the talus, by twisting the tibia on the superior and medial surface of the talus, which will significantly alter the way weight is distributed in the foot, forward to the toes and backward and inferior to the calcaneus.
Figure 3: Weight distribution through talus (from The Body Moveable by David Gorman (www.bodymoveable.com), used with permission).
In Figure 3, imagine what happens to the arrows representing weight distribution when the talus rotates even slightly. Rolf emphasized the disorganizing consequences of a fibula that has slid downward, which always happens in a sprained ankle. As the fibula slips downward, it will also usually rotate slightly posterior and the tibia rotates slightly anterior, causing a twisting on the talus. This is routinely corrected by Rolfers by putting an elbow or knuckle on the anterior surface of the distal tibia with the client standing and asking the client to bend at the knees, while the Rolfer holds the distal tibia back against its tendency to move forward, thus taking some of the rotation out of the tibia on the talus, which will take the talus with it, de-rotating the talus.
It is not possible to put your hand directly on the talus. It is buried deep in the foot, between the distal ends of the tibia and fibula and concealed behind the navicular bone in front. When Rolf emphasized releasing and organizing the medial and lateral retinacula, she was indirectly making space for the talus to normalize, as the tibia and fibula are freed to separate from the talus, especially in dorsal and plantar flexion. I use an additional technique designed to release the ligaments linking the talus with the tibia and fibula. It involves simultaneous compression of both the medial and lateral malleoli inward toward the talus, while rocking the lower leg along its longitudinal axis to initiate movement in the interosseous membrane of the lower leg.
The central role of the talus in normal motion of the foot is further emphasized by its relationship with the calcaneus via the subtalar joint. The calcaneus sits beneath the talus, which rides on the calcaneus much as a saddle rides on the back of a horse (see Figure 4). Again, Rolf’s prescription to work the fascia on the medial and lateral sides of the calcaneus directly affects the relationship of the calcaneus to the talus.
Figure 4: Talus and calcaneus relationship (from The Body Moveable by David Gorman (www.bodymoveable.com), used with permission).
The calcaneus is subject to significant distortions coming from above via the common gastrocnemius-soleus tendon, and from the plantar fascia. What is most disorganizing, however, is abnormal adduction or abduction of the calcaneus on the talus. This is seen most easily from behind with the client standing. We have all seen it many times. The calcaneus can be either pulled medially and forward, such that it rolls toward its lateral surface into supination, or the calcaneus can be pulled laterally, rolling toward its medial surface, which will give the foot a tendency to move into pronation.
Much of the distortion in the calcaneus can be relieved by organizing the connectivetissue pulls coming from the common gastrocnemius tendon above and from the plantar fascia in front. However, it is usually necessary to release the ligaments holding the calcaneus in its aberrant position at the inferior surface of the talus. To do this, I hold the calcaneus in one hand and compress the navicular toward the talus with the other hand. This will disengage the ligaments and create a momentary “neutral” position of the subtalar joint, which will initiate slight involuntary movement of the calcaneus on the talus. We refer to this as “motility” or “inherent motion.” This inherent motion will have a direction. By following the direction of the motion and adding a well-timed impulse in the direction of normal, it is possible to release the ligaments and restore normal motion to the joint.
Figure 5: Anatomy of the medial and lateral arches (obscure French anatomical text).
Normal motion of the foot relies on a combination of inversion/eversion and pronation/supination. Normally, inversion and supination are linked and eversion and pronation are linked. It is useful to look at these two motions separately because it reveals the importance of normal motion of the navicular bone on the anterior surface of the talus and the normal motion of the cuboid bone on the anterior surface of the calcaneus.
Remember that the foot has a very distinct structural division between the medial longitudinal arch and the lateral longitudinal arch. As you can see from Figure 5, the medial arch is formed by the navicular on the anterior surface of the talus and the three cuneiform bones on the anterior surface of the navicular bone, with the first three toes off the cuneiforms. The lateral arch is formed by the cuboid coming off the anterior surface of the calcaneus, with the lateral two toes coming off the front of the cuboid. There is much to discuss here but what I want to briefly emphasize in this article is the movement of the navicular and cuboid when the foot moves into inversion and eversion.
We will also make a distinction here between the front of the foot and the back of the foot. The front of the foot is anterior to the anterior surface of the talus and calcaneus. This is an important distinction as the anterior surface of these two bones lies on the same transverse axis. This is shown in Figure 6.
Figure 6: Bony anatomy of the foot, showing Chopart’s junction (the transverse tarsal joint) anterior to the anterior surface of the talus and calcaneus (illustration by John Lodge from Rolf’s Rolfing: The Integration of Human Structures).
There is a joint space formed by the anterior surface of the talus with the posterior surface of the navicular and the anterior surface of the calcaneus with the posterior surface of the cuboid that lies in the same frontal plane. This is called Chopart’s junction or, more simply, the transverse tarsal joint. Inversion and eversion are possible because of the possibility of movement across this joint space. In inversion, the navicular moves inferior and medially on the talus and the cuboid moves medially and rotates internally on the calcaneus. They move together. This movement occurs across the transverse tarsal joint. The movements are reversed in eversion.
This means that restrictions of the navicular at the anterior surface of the talus and restrictions of the cuboid at the anterior surface of the calcaneus have significant consequences for normal motion in the foot. This can be easily observed by taking the foot and passively moving it into inversion and eversion and by observing the motion of the navicular and cuboid bones. I almost always find either the navicular or the cuboid restricted, and often both. I have not been able to mobilize restrictions of these significant bones in the foot without using techniques designed to work with the ligamentous matrix in which they are embedded.
Knowing the nature of normal motion for any bony ligamentous complex will allow you to infer what needs to happen when normal motion is not present. Just restore normal motion. In the case of the navicular bone, I often find it stuck in a position that prevents the full range of motion in inversion – meaning that the navicular does not move easily all the way down and medially through its range of motion. Careful positioning of my fingers and compression of the navicular against the anterior surface of the talus will initiate inherent motion and I can then begin what I call the “stuck drawer” technique. Like a stuck drawer that you cannot just pull straight out but have to jiggle, the bony and ligamentous elements of a stuck joint will not usually release if you just pull on them. You have to compress the joint, wait for a hint of inherent motion, follow into the direction you think it is pulling you, wait again, look for a sense that the joint takes a breath or sighs as it moves into a sort of neutral position, and then coax, wiggle, and push it home.
This is the essence of working in the ligamentous bed. The technique is the same for all joints and the ligamentous matrix in which they are held. It has great advantages compared to the high-velocity techniques of other bodywork schools in that it works directly with the tonus of the controlling ligaments. By tailoring our touch to these deep connective-tissue structures and working in a way that restores motion of the joint through all its axes of motion, we restore the neutral position of the joint, which will make for a more stable correction. Working with joints and ligaments in this way is also consistent with our fundamental way of touching, which we learn when we are first taught to restore order to the connectivetissue matrix. Once one is intimate with this aspect of structure it becomes second nature to modulate touch to include ligamentous restrictions that prevent normal motion of joints.Four Fundamental Relationships in the Foot[:]