What does pain have to do with structural integration (SI) – and why should an issue of Structural Integration: The Journal of the Rolf Institute® be devoted to pain? How is the pain theme relevant to SI in particular; i.e., can anything be said about pain here that would not be equally well said in a publication devoted to physical or occupational therapy, chiropractic, acupuncture, orthopedics, or any other field whose practitioners treat musculoskeletal pain? Though some SI practitioners have developed fine and even occasionally brilliant pain-relief methods, discussions of the same should be welcome in any publication whose readers’ work is the treatment of pain.

The work of SI, however, is something other than this; and structural integrators are something other than perhaps enlightened but still unlicensed physiotherapists. Though many who come to us want to stop hurting, and despite the notion that if we accommodate them the world will beat a path to our doors, pain is not the point of SI – not in many of our practices and not according to the largest research study ever made of clients’ motivations for seeking SI and their experiences having received it.

In 2006, Rolf Institute faculty member Pedro Prado analyzed the reports of 874 recipients of the Ten Series: 160 clients of trainings in the U.S. and Brazil and 714 clients of the São Paulo Ambulatory Clinic (NAPER). The data included the clients’ responses to intake and exit questionnaires, which addressed their motives for seeking the work and the results they perceived.

Contrary to what many would expect, these data show musculoskeletal pain to have been anything but the clients’ overwhelming motivation. On the intake questionnaires, though about 80% reported pain, only about 29% identified relief of musculoskeletal pain as a goal for the process. And, of those that did, more than half identified other goals, as well – e.g., better posture, heightened body awareness, and personal growth. In fact, for only 14% of the entire sample was relief of musculoskeletal pain the sole reported motivation.

What’s more, according to the exit questionnaires, pain reduction was far from an overwhelming measure of success:

• The 29% who were motivated by pain expressed about the same overall satisfaction with the process as did the group as a whole.
• Of the 29% motivated by pain, about 2/3 (or 19% of the entire sample) identified significant improvements other than pain reduction as reasons why they were satisfied with the process.
• Only about 10% of the entire sample expressed satisfaction with the process specifically because of reduced pain.

Conversely, for over 70% of the clients, pain relief was not a motivation; and because this subset was also satisfied with the process, it seems that they sought and received benefits other than pain relief. Adding to that subset the 19% who were motivated in part by pain but reported benefits other than pain reduction yields nearly 90% reporting benefits other than pain relief.

At the risk of sidestepping the rush of humanity beating paths to the doors of others, many of us don’t aim or claim to fix pain – though during an SI series, lots of pain does come out in the wash. Claiming or attempting to treat acute pain is especially problematic on many levels: I myself address acute pain only as first aid – usually the only available aid – to someone who will not be paying me. In other words, for many of us, our work is not the treatment of pain.

That said, it’s a fact that even those of us not in the pain-relief business are often surprisingly successful at it, managing to relieve even acute pain with rare or non-obvious etiology. How can that be? Is there something about the SI training or viewpoint – or something about what an SI practitioner is – that makes us effective at doing something we don’t make a career of doing? If the answer is yes, the possibilities include:

• The importance of the therapeutic relationship.
• The pain-mitigating effect of grounded and coherent hypotheses for why the client is in pain.
• The ability to entrain with the client’s nervous system to modulate the client’s autonomic responses.
• Recognition that the origin of the pain is often remote from its site, and the ability to intervene at some distance from the site.
• Knowledge of anatomy, and the habit of thinking anatomically rather than systemically.
• Comfort with ambiguity and with not having answers.
• The mindset of not identifying with the outcome.

An acquaintance of mine, a gifted mechanic, was working brutal hours over Labor Day weekend to complete the ground-up reassembly of a 1962 Ferrari. The car carrier was picking it up Tuesday, and the engine wasn’t in yet. His boss phoned me: “Can you come to the shop right now and fix Mike’s neck?”

“I can try,” I replied. “Set up a lunch table in the back room.” Though Mike is a stoic, he and I had worked together in the past with some success, so at least he was not afraid to let me give it a shot. Besides, on Saturday of Labor Day weekend with two more days of grueling overtime ahead, who’s he going to call?

Mike was in considerable pain and having trouble walking around. To my alarm, he couldn’t turn his head without sending shooting pain into one leg. Mike explained that he had awakened that way, having been attacked by a giant squirrel and then fallen backwards off a ladder – all in his dream.

Skipping any body reading on this modest and now very crabby introvert, I put him on the table fully dressed, tuned in, and calmed down his autonomics. During that time, I explained that as far as his nervous system was concerned, he really was attacked by a giant squirrel and really did fall backwards off a ladder. What’s worse, because he was sleeping when all this happened, his system was poorly defended against it. I also reassured him I believed he was going to be okay.

Unfortunately, nothing I tried – not even remote work at the heels or the sacrum – did any good at all for his neck. Even small passive rotation caused a huge convulsive jerk in response to the stabbing pain shooting all the way to his left toes. Wondering what could be happening, I asked Mike for his take on it. The mechanic and I reasoned it out together – how turning his head a few degrees could possibly grab his toes and everything in between with such violence. We agreed the most likely culprit was interference in the electrical system: maybe in the course of twisting to brace his “fall,” Mike had put a kink in his dural tube. But even assuming the validity of that hypothesis, I knew nothing about how to un-kink a dural tube. So I faked it. Mike and I imagined that using the head as a handle, I could access that territory and encourage it to unwind.

Who knows what worked – but something must have because Mike’s coordination and demeanor were much improved. Later, one of his colleagues observed, “You must have had a good talk with Mike. He’s acting human again!”

When these little miracles happen in our practices, we’d learn something by asking why, whether due to a particular technique or something else – and if the latter, then what?