In Rolfing® Structural Integration (SI) practice and lore, intra-nasal work has distinguished us from other practitioners. Pop culture seized this aspect of our work, prompting individuals (who likely have a limited familiarity with our work) to link intra-nasal work and Rolfing SI with questions like, “Isn’t that the one where they stick their fingers up your nose?”
Remarks posted (circa December 23, 2011) on the Rolf Forum LISTSERV indicate Rolfers employ a wide variety of intra-nasal practice options. Some do the intra-nasal work religiously, as a matter of course, in every Seventh Hour. Others do very little or no intra-nasal work in the entirety of their client treatment, and others employ it only on an “as needed, requested, or refused” basis. Questions regarding intra-nasal work come up in the Rolf Forum periodically, indicating more information on this subject would be helpful for our community.
This author completed the basic Rolfing training with a good bit of uncertainty regarding intra-nasal work; it was a profound yet odd entryway into the fabulous mystery of the body. Although I could competently deliver a “paint by numbers” variation of the work, I felt my understanding was theoretically and technically incomplete. Subsequent trainings, especially in craniosacral therapy, have helped me to gain a more thorough understanding. In researching this article, I was again reminded just how important the nose is to our optimal functioning, and I also am reminded why I love this work so much: with the nose, as with every aspect of our bodies, the more you know, the more there is to know.
The nose is vital – it is the body’s airway that warms, moistens, and calms our breath as it cycles through its rhythm of being drawn in and released. Many of us experienced our earliest human contact as a babe nuzzling at the breast; it is here that we were first invited into a world of smell and intimate connection through the nose. Our sense of smell is crucial to our survival and well-being. It is central to our awareness of our surroundings and keeps us safe from the dangers of poison, rotten food, and fire. Jean-Pierre Barral states: “Olfactory stimulation generates visceral responses such as salivation in response to pleasant smells, nausea in response to disagreeable odors and even the acceleration of peristalsis and increases in gastric secretions.”1
Our nose literally projects to the world information about who and what we are. Our nose may suggest we are: masculine, feminine, sexy, attractive, artistic, alcoholic, healthy, or sick. People spend significant sums of money on drugs and cosmetic surgery to alter its function and appearance. For some, the nose is a bothersome “leaky faucet,” or a locus of embarrassment, infection, irritation, and pain. For others, their nose is a calling card, passport, a badge of honor, and a symbol of prestige.
Clients receiving intra-nasal work sometimes experience profound somatic, psychological, and spiritual change. I recall a session where I was proceeding carefully and slowly with the intra-nasal work. The supine client’s eye sockets looked like two pools of water running down his face. I was alert and the client appeared engaged but not alarmed. There was an easing, an allowing, and a trusting as we continued our work. Upon completion, the client remarked: “That was the most amazing experience I have ever had.” Years later, the client still reflects on the importance of the shift that occurred as a result of that session.
Michael Salveson claims: “When you have your hands on the body, you have your hands on the whole self”2 [italics added]. The nose is a particular and literal passageway into the whole self. Due to its direct connection between the outside and the inside, intra-nasal work is a particularly potent means of accessing some of the transformational promise of Rolfing SI.
The cultural context for doing intranasal work is worth noting – the nose is stigmatized; dust, blood, and dried mucus form “boogers,” and are viewed as bodily waste. Sensory nerves in the nose and nasal cavity continue, however, to captivate nose-pickers. Toddlers naturally experience the intra-nasal space as a locus of sensation and banish their investigation from public observation only after repeated admonishment. (Intra-nasal investigation and pleasure aren’t altogether abandoned, however, as occasional observation of oblivious adults waiting at traffic lights will validate.) There is a distinguishing boundary between hands “on” the body and hands “in” the body. When we literally enter the body, a whole new level of invasiveness occurs requiring a keen level of sensitivity, awareness, skill, and responsibility on the part of the practitioner. Bodywork is a twoway street; practitioners too, are subject to the same cultural stigma regarding intranasal or other invasive bodywork and must confront and resolve, to the greatest degree possible, their own squeamishness and uncertainty about where and why they are doing the work.
This work requires not only keen anatomical knowledge, but also courage and, perhaps most importantly, clarity of intent. A clear intention will answer the following questions: What am I doing? Why am I doing it? What outcome will best serve the client?
“Fix-it” vs. Holistic Approach
Similar to other healing professions, there has been a long-running debate in the Rolfing community regarding doing “fixit”- type work and honoring the holistic intentions of the “traditional” Rolfing Ten Series. Intra-nasal work is included as part of the Seventh Hour in the traditional Rolfing “Recipe.” Broadly stated, the goals of this session include freeing the thoracic outlet and balancing the head and neck on the torso. In my training, practitioners were advised that intra-nasal work should not occur prior to the Seventh Hour since the body had not been properly prepared to accept such work prior to then. As our work has evolved, some Rolfers have moved away from the orthodoxy of reserving mouth or intra-nasal work until the Seventh Hour, and there are varied opinions in our community regarding this. Interestingly, in her classic text, Ida Rolf states: “. . . myofascial structures inside oral and nasal cavities must be brought toward equipoise before [italics added] the cervical spine can take its appropriate position.”3
Rolf admonished practitioners to “not chase symptoms” but instead to “get the whole body aligned and the symptoms will take care of themselves.” Jeffrey Maitland and Salveson recommend that the practitioner fully consider the principles of adaptability and support prior to treatment.4 In other words, with specific application of intranasal work, the practitioner may want to evaluate the following: Can the rest of the body allow for the effect of the intervention? Have limiting tensional patterns been released? Is there adequate balance in surrounding tissues? Is the head balanced, and are the major segments below the head able to support the change you are inducing?
Brief Anatomical Review
A brief anatomy review may prove helpful by reacquainting the reader with the territory (see Figure 1). A more extensive and detailed study of the anatomy is advised to ensure competent understanding and treatment of the nasal compartment. The Emory Anatomy Manual states:
The nasal cavity opens anteriorly at the nostrils. It is divided by a septum into left and right halves. The septum is formed by the perpendicular plate of the ethmoid bone above, the vomer bone posteriorly and by extensive cartilage anteriorly. Each nasal cavity has a roof and a lateral wall. The roof is formed by the cribriforrn plate of the ethmoid bone. On the roof of the nasal cavity is the olfactory epithelium containing more than 10 million smell receptors sensitive to specific odor molecules travelling through the air.
The posterior lateral walls of the nasal cavity feature three conchae or turbinates that are formed primarily from the ethmoid bone and the inferior nasal concha. The turbinates are large, medially directed bony elements that are covered with highly vascular mucous membranes. The nasal turbinates are structures within the nose that moisturize and warm the air before it reaches the lungs.5
Our basic job is to open the nasal airways for breathing; this also allows odor particles to reach the olfactory sensors in the upper nasal cavity. We also release strain and tension in the nasal structures to positively affect fluid exchange and neural transmission throughout the cavity and beyond.
Much, and perhaps enough, is accomplished in establishing the basic functioning of the nose, but perhaps a subtle yet profound gift of Rolfing SI can be realized when a holistic integration of the “neural” and “visceral” cranium is obtained through intra-nasal manipulation. Jan Sultan describes this opportunity for intra-segmental integration as follows:
The cranium is truly a meeting place of systems. The cranium is embryologically made up of neural and visceral components. The neural is the vault, spine, brain, and spinal cord systems, and the visceral is the face, jaw, gut, and the associated soft tissues therein. In this view the visceral cranium is the upper end of the ventral visceral layer. . . . Here is where nose work really comes together, as it is the bridge between the visceral and neural aspects of the head.”7
The reader may assert: “I’ve never had a client come in complaining of lack of integration between his/her neuro and visceral cranium.” Michael Waefler contends “. . . the power of working with the nose has as much to do with perception and filling in a more complete body image as [it] does [with] any structural relationship . . . . ”8 This sense of completeness, unity and presence may likely be what Rolf originally deemed so valuable. In a [Steve] Jobsian sort of way, we may be fulfilling a need of the client that he or she did not know existed.
Sultan also brilliantly suggests that the goals of the classic Fourth Hour of the Rolfing Ten Series include freeing the ventral visceral layer from the pelvis all the way to the floor of the mouth thereby allowing the goals of Rolf’s Seventh Hour to be accomplished “free of ventral visceral drag.”
John Upledger describes how this intrasegmental integration is made possible by inviting the reader to consider that the olfactory nerves arise from sensory receptors in the mucous membranes of the superior nasal cavities and, as these sensory fibers bundle together and ascend from the nasal cavity, their perineurium becomes continuous with the pia mater membrane surrounding the brain. Meanwhile, the periosteum of the nasal bones becomes continuous with the dura mater membrane also surrounding the brain, thereby establishing direct linkage of the visceral and neural cranium.9
As properly trained SI practitioners know, the tissues and bony structures of the nose are delicate and must be treated with care. Many pathologies (e.g., deviated septum, either congenitally or from injury; enlarged turbinates; allergies; non-allergic rhinitis; sinus infections) can cause difficulty breathing. If your client has chronic breathing problems and hasn’t consulted an ear, nose and throat specialist, you might advise the client to do so before proceeding with nose work.
In nose work, the client is especially vulnerable. Therefore, the client’s trust and acceptance are essential.
A practitioner may want to observe and question the client regarding the basic functions of the nose. Can the client breathe, smell, taste, and hear adequately? Does the client have difficulty swallowing or sleeping? Does the client report a chronic dry or wet nose? Does s/he complain of facial or head pain, sinusitis or sinus congestion?
Nasal congestion occurs when the membranes lining the nose become inflamed and swollen. Rolf states: “Sinuses are air cavities in the skull that serve the purpose to reduce the weight of the head. The sinuses that drain into the nose are lined with mucus membranes that secrete a mucoid fluid. In its normal flow this mucus moistens the passages of the nose, lubricates the nasal structures, picks up dust and washes it to the surface. These sinuses become a focus for infection and inflammation. Sinus congestion, genesis of the chronic sinus headache, is often the result of blocked ducts”10
The four sinuses of the nasal cavity (frontal, sphenoidal, ethmoidal and maxillary) open into the nasal cavity on the lateral wall between the superior and the middle conchae. The sinus openings are mostly covered by the conchae making them difficult to access. Rolf contends: “It is noteworthy that when the head is appropriately poised on its atlanto-occipital articulation, drainage of the blocked ducts often starts spontaneously and the chronic sinus problem, even though of years standing, may disappear.”11 Although not always reliable, this author has found that release of suboccipital tissue does relieve sinus congestion.
Prior to doing any intra-nasal manipulations, it may be valuable to attend to any significant “outside” strains affecting the nasal cavity. Such strains may involve the bones of the nose or those directly articulating with them (e.g., frontal bone articulating with the ethmoid bone). Release of contracture and strain in facial muscles affecting the nose’s functioning is also recommended.
Inside: The Three Roads to a Happy Nose
In the basic Rolfing training, the author was instructed that there were basically three paths of access when working intra-nasally: first, the “upper” or cephalad direction parallel to the bridge of the nose; second, a “middle” entry aimed posteriorly into the region of the turbinates; and thirdly, a lower directly posterior entry over the roof of the mouth. This author suggests that, in addition to the significant benefits gained by addressing tissue obstructions in each of these directions, there are special structures located in these directions that provide significant opportunities for improved neurological, vascular, and even psychological health.
Employing the upper access route, Barral and Croibier recommend careful but direct manipulation of the upper nasal epithelium to affect the olfactory nerves. Although they suggest using a long-handled cotton swab rather than a sheathed little finger, the direction, intention, and application of Barral and Croibier’s technique closely aligns with what this author was introduced to in the basic Rolfing training. The practitioner is instructed to enter the nostril parallel to the bridge of the nose and, while remaining anterior to the turbinates, direct it cephalad toward the inner corner of the eye (Barral warns that encountering an obstacle likely constitutes a contraindication and advises discontinuing the technique). The practitioner is instructed to draw slightly and very gently the epithelium of the upper nasal cavity back toward himor herself, thereby creating mechanical tension on the olfactory nerves and brain tissue. The practitioner is then instructed to “listen” to the tissue and follow it to release and balance.12
The middle access route is perhaps the trickiest since extreme care must be used when dealing with the turbinate bones. At times the turbinates seem quite sturdy and capable of accommodating direct manipulation, and at other times they seem to quiver nervously like paper butterfly wings and are best left alone. However, if a practitioner can safely proceed posteriorally between the turbinates to the rear of the nasal cavity, he or she can approach the sphenopalatine foramen. The sphenopalatine foramen lies posteriorly in the lateral wall of the nasal cavity at the level of the middle concha. Through this foremen pass branches of the trigerninal nerve and branches of autonomic nerves that innervate much of the nasal and oral cavities and the palate. The terminal branch of the maxillary artery, the sphenopalatine artery, also passes through the sphenopalatine foremen and its branches provide the blood supply to much of this region. The practitioner may affect this structure by manipulating the greater wings of the sphenoid externally in concert with the palatines intra-orally, or s/he may enter the nose and travel posteriorly between the inferior and middle conchae to directly relieve tissue strain affecting the foramen. Along the lower intra-nasal access route, Barral describes a “vomeronasal organ . . . located a short distance from the opening of the nostrils on the anterocaudal aspect of the septum.” This organ is described as a “diverticulum of the olfactory organ and is recognized as a small circular or oval depression on the septum. It plays a vasomotor and vasosensory role and participates in our sense of smell.” Barral identifies the vomeronasal organ as a “vestige of our animal life when the sense of smell was essential in the detection of both enemies and sexual partners” and contends that stored psychological tensions may be relieved through its careful manipulation.13 Further posterior along the lower access route, the practitioner can affect what Michael Murphy describes as a “mucosal bag”14 containing not only a plethora of nerve, muscle, and vessel but also the pharyngobasilar membrane that attaches to a tubercle on the basilar portion of the occiput, thereby providing a rich opportunity for neural/visceral integration.
This author recommends that the reader selfexperiment with intra-nasal work. A great deal can be learned by exploring one’s own nasal cavity, not only about the sensation and topography of the nasal cavity but also how the tissues respond and the slow rate of entry that is required to affect change.
I will leave the reader with a simple breathing meditation. The practitioner may use it to guide the client, via breathing through the nose, to greater nasal awareness as well as awareness of his or her relationship to the gravitational field.
<i>Inhale through nose and pay attention to the breath as it enters this passageway. Notice the air as it passes over and is moistened by the inner nose, slow down and notice any stories in the tissues, that may or may not have any narrative attached. Notice your breath as it flows into and through the nasal cavity – is it sharp, sweet, irritating, expansive? Close your mouth and nose and suck the roof of your mouth upward, allow this upward sensation to extend through the crown of your head toward the heavens. Breathe. Swallow and follow your awareness downward through your throat, chest, abdominal space, and pelvic bowl. Breathe. Continue this awareness though your legs and feet, extend it deep into the earth. Now, from your nose, allow your breath to connect heaven and earth.</i>
Rolf is said to have expressed concern that intra-nasal work would be the first technique Rolfers would drop after her demise.15 This author is hopeful that practitioners will reevaluate the potency and appropriateness of intra-nasal work for inclusion as part of their integrative practice.
<i>Dan Somers is a Certified Advanced Rolfer, a Certified Cranio-Sacral Therapist, a Licensed Social Worker (LSW), a Licensed Addictions Counselor (LAC), and a Hakomi Graduate. He would like to extend sincere gratitude to Dan Dyer, Jazmine Fox-Stern, Greg Perry, Jane Meyer, Michael Murphy, Jan Sultan, and Mike Waefler for their knowledge, expertise, and assistance with this article.</i>