Through her study of Alfred Korzybski and General Semantics, Dr. Rolf became familiar with the catch phrase, “The map is not the territory.” While one could apply this to Rolfing® Structural Integration (SI) in the sense of keeping our conceptual working frameworks relative to the reality of what is presented in the individual, by extension I find that it is often useful, or even essential, to use multiple maps to get a clearer picture of the territory in question.
I recently had a fellow who was going to be in town from Europe email me for an appointment. He was in chronic back pain, stemming from a luggage-carrying incident coupled with heavy coughing from pneumonia after a case of swine flu. He had exhausted the possibilities of his country’s health system, and was finally getting some relief from his second or third physical therapist and a chiropractor he’d happened upon previously in Seattle. The D.C. suggested that he check me out.
I had the opportunity for one session, with a possibility of a follow-up, to do what I could to help the fellow’s situation. He was 6’3”, 250+ pounds, noticeably overweight with a large belly, not in the best of physical shape, fed up with allopaths, and somewhat frustrated. His thorax was acutely leftrotated and forward bent, with his lumbar spine reflecting this leftward, forward lean, and had a sharp recovery of his spine to the vertical at the level of about L2-L3. This was in addition to a strong lordosis exacerbated by the pull of the bulk of his abdomen.
It was apparent to me on looking at him that the major postural restriction was deep. There was something very deep inside associated with the dramatic, sharp bend in the lumber spine that was hanging things up, and that doing a “First Hour” or superficial work was not going to address the problem with lasting results. Certainly, doing a Ten Series would do this fellow a ton of good, but without the luxury of another nine sessions, it didn’t seem appropriate to follow that tack. To my eye, cracking loose the deep restriction was key, and I had a hunch that a restriction of the left kidney was a major contributor to the pattern.
I used osteopathic listening techniques to confirm that indeed, the left kidney was primary. Its motion was restricted, being pulled superiorly, and it was adhered to the stomach indirectly through the lesser omental bursa (an uncommon pattern, in my experience), creating a very tight shortness close to the spine. I found other restrictions in his body, but this major problem was at the top of the list.
I started the session with some prep work to take some stress off the kidney/ stomach lesion and prepare some space to accommodate its release. I found that there was also a dural adhesion at the level of the upper lumbars, anchoring the vertebrae there that would also inhibit release. After attending to the dura restriction and cranium, I did a little traditional Rolfing work to the posterior diaphragm area, including the areas of the erectors, quadratus lumborum, and more superficial structures, but found that these levels of the fascia weren’t really contributing to maintaining the problem; the kidney/ stomach lesion still appeared to be the main event, and it released fairly readily at his point after the preparatory work. I then normalized both the kidney and stomach individually, and integrated the client with a pelvic lift, focusing on releasing whatever compactions or distractions I found between T12 and S1. I followed up with neck work from T3 up to the occiput, being sure that the occiput and the upper cervicals were free.
The moment of truth was when my client stood after the session. I have to say that I surprised and impressed myself when I saw that all his side/side aberration had resolved. It was one of those times one kicks oneself in the butt for not having taken photos. Granted, his lordosis was still present, perhaps not as acutely, but the pain was dramatically reduced and mobility dramatically increased from the normalization of the upper lumbar and ancillary areas. We were both happy. As he was leaving, the gentleman slung on his shoulder bag, the carrying of which perfectly reinforced his injury posture. I cautioned him and recommended he do his best to change that habit, which he promised to do. He flew out of town the next day.
As it happened, I was able to do a followup session with the man on his way back through Seattle two and a half weeks later. He related to me that, while he was a little stiff that day from travel, he had realized huge improvement from the session and was in much less pain, and he’d been diligent about limiting wearing his shoulder bag. I saw that while he still walked with a bit of a forward lean to his posture, his side/side balance was still significantly improved. I estimated he had retained about 75% of the gains of the previous session, which I considered quite a success.
I found that the visceral work had held well. This time, the left kidney was slightly superior, but was not adhered to the stomach, and the stomach itself was sticking superiorly to the diaphragm. My take was that these restrictions were remnants of the original lesional pattern that I had not completely resolved. After releasing these restrictions, I dealt more in the sleeve, working in the quads and quadratus lumborum to ease the lumbars and horizontalize the pelvis, and in the left iliotibial tract and hamstrings, giving more pelvic balance and a little length for the shortened left side.
On standing, the client had once again evened-out side to side (where was the camera?) and the lumbars showed less strain, but by no means had the lordosis disappeared—the two sessions had only made a dent in that situation. Nevertheless, the sessions were a success, and an email once the man returned to Europe confirmed that he was still maintaining his gains. He was going to seek a Rolfer near home, and contact me again on his next U.S. trip.
My work with this client reinforced for me the importance of seeing, discerning, and working at different depths within the body, and served as a reminder that the continuity of the fascial network spans the entire organism, in niches not examined within the traditional Rolfing concept. It is tempting to speculate on the changes that may or may not have occurred had I never learned visceral and cranial manipulation. I don’t think I would initially have been drawn deep, or targeted the region around the kidney so specifically, and I certainly would not have identified the dural adhesion for what it was. I think the approach would have been much more centered about balancing the general shape, and would not have incorporated as much specific work within the abdominal cavity. Certainly, without awareness of the anatomy and visceral and cranial relationships, at best, I would not have been as efficient in working; at worst, I think I would have been orders of magnitude less effective. I absolutely believe that the degree of lasting resolution we achieved would not have been realized. While initial results of sessions may have showed some resolution, I think the gains would have rapidly dissipated, owing to the nagging deep restrictions that would have remained unresolved.
I think this case could have been one of those never-ending, ever-frustrating scenarios of “do the work and pray,” hoping that one finally hits the magic session that nudges progress forward, rather than being a situation of recognizing the problem from a wider perspective of inquiry. But it’s really a moot point, because we haven’t yet figured out how to do multiple, parallel approaches on the same client and compare results! In the mean time, I think the solution is to broaden our perspectives; sometimes we need to utilize a different viewpoint to access the same territory, and being able to approach the project of instilling the balance, alignment, and order of Rolfing SI by referencing multiple maps can enable much more effective results.
<i>Allan Kaplan has been a Rolfing® practitioner since 1988. He has studied visceral manipulation with Didier Prat, D.O., and assisted him teaching several classes. More recently, he completed osteopathic studies at the Canadian College of Osteopathy.