Introduction

The client walks in. He is bent over, his head leans out in front of his hips. He walks stiff-legged. His hips hurt. His back hurts. His feet hurt. Question: Is he seventy-eight or thirty-eight – or twenty-eight? Another client’s spine has lost its curves, her toes don’t bend anymore, and walking hurts her hips. Is she forty or eighty? We see this every day in our practices, regardless of our favorite lens for body readings – whether front/back balance or support or lift or core support. No matter the lens chosen, we are always looking at real or potential ‘structural aging’.

I created the term ‘structural aging’ to describe (for our profession) what we see over and over again: the breakdown of structural elements in the human body’s relationship to gravity that creates a look or a feel of ‘aging’. Commonly seen and felt physical complaints show up due to a resistance and fight with structural integrity and the relationship to gravity. It is a loss of the grace of multi-planar movement and spirals that exist throughout the body (and in nature, see Figure 1) and within which our spine and body are inherently made to move. It is where we have lost relationship to the context of our environment. Our proprioceptive sense of where the body begins and ends is altered.

Figure 1: An example of a spiral in nature.
Photo used with permission of
www.StrangeWonderfulThings.com.

One joint, one limb, or just one tendon may become fixed in movement, unable to respond to the entire constellation of the body’s attempt to being upright on two legs moving in multiple planes. A potential direction may then be lost in the possible planes of movement, and proprioception becomes limited. With this, the look and feel of aging begins to appear. The loss of easy access to the various planes and rotations of movement pushes a body part into its own isolated function, yet it influences the entire constellation of function and posture. As potential for mobility is reduced, the fear or anticipation of falling changes nervous-system tone and response to the world throughout the body. Structural aging is not necessarily age-related, and yet it feels like ‘aging’. It can occur at twenty, fifty, or seventy.

Looking around, we see a booming industry in ‘anti-aging’ products, where it is touted that aging is something one can prevent by searching out a method of slowing it down, changing its appearance, or supposedly stopping it. Most methods are extremely expensive and sometimes risky. Our work of Rolfing Structural Integration is not about preventing or avoiding aging. Our work is a process that speaks to the deeper realms of how we live in the bodily context of being a human who will live, age, and die. However, we work with structural integrity and relationship that is changeable and transformative at any moment in time. The elements of structural aging are all things that we can intercept and change in the Ten Series or later, hopefully creating grace in gravity when there is little or none, grace in locomotion and gestures of expression when they have lost their variability and finesse.

Structural aging occurs in minute steps; it sneaks in and around the connective-tissue sheath without us knowing how it will change our posture, our appearance, our movements and general well-being until the entire orchestra of fascial connections hits a crescendo of pain or strained expression in movement. We may feel it as sudden grief when we experience the loss of a younger, more agile movement. It may be the longing for the juiciness of expression instead of the stiffness one feels. One can retrace the same movements and steps one took at ten, twenty, or thirty years old and the memory is present, but the rhythm and movements are not the same. The connections have changed. This loss of connections can start at any age. Do you remember when you became afraid of leaping or jumping? What are the movements of your childhood, and do you still make them? Our way of perceiving may have changed. Our seeing, our beliefs, our injuries, our fears are not the same. The context has shifted. Perhaps our sense of environmental support is more fragile. The fear of falling may dominate our subconscious. The inner landscape may feel shaky and unconnected to anything else. Structural aging is a disconnection of our connective-tissue communication and nervous-system network from our own inner balance and balance with the outside world.

When one imitates an old person, the classic posturing is the bent-over form, head down, slowly shuffling down the street. This is the manifestation of ankles that don’t flex and extend, hips that don’t move into full extension, toe hinges that don’t work, eyes that focus tight and down, spinal curves that have lost their elegant balance between lordosis and kyphosis, flexors that dominate, heads that reach out in front of the rest of the body, a loss of lateral movement in abduction/adduction balance, and thoracic stiffness that stops any movement from coming up through the spine to support the neck and head. Phew! That sounds exhausting. Any of these patterns can show up at any age and thus begin structural aging.

In teaching workshops on this subject for the past five years, I have studied (through my own body, those of my clients, and the responses of students) basic patterns that show up and how they might be addressed in the Ten Series or post-ten work. Each of the patterns could warrant an entire article and workshop; however, for the purpose of this article, I will primarily discuss the patterns that affect the lower body to the spine. In a future Part 2 to this article, I will discuss structural aging with more emphasis to the rest of the spine, and the head and arms’ influence on the spine and grace.

Whole-Body Structural Patterns That Age Us

One of the first patterns I particularly noticed repeatedly was the knock-kneed (X-legs) stance with pronated feet and a somewhat collapsed lower belly; it seems to be more common in females. This is shown in Figure 2, and is first in my list (below) of the various patterns and phenomena of structural aging that are repeatedly seen:

• Knock-kneed stance with pronated feet and somewhat collapsed medial line / lower belly.
• Toes that begin to hammer.
• More frequent plantar fasciitis.
• Little toes curling under.
• Shoulder pain (starting in many people around age sixty to seventy).
• Increased thoracic kyphosis.
• Stiff ankles.
• Loss of rotational options in the femurs.
• Flat lumbars and a sometimes straight spine.
• Locked centrally focused gaze or downward gaze.
• Pelvis that moves side to side with upper body thrown side to side (loss of pelvic sway)

Figure 2: X-legs with pronating feet and collapse of medial line.

Considerations in Gait

All these patterns, when observed in gait analysis, reveal a loss of multi-planar movement with a reduction to two, or often one, plane. What usually dominates is the sagittal and ‘locked-in-flexion’ pattern. There is a loss of the inherent spirals in each segment of the body, thus a loss of multi-planar movement According to Stecco (2004, 39), “Every muscle of the body contains muscular fibres that activate latero or mediomotion, retro and antemotion, as well as fibres that activate intra and extrarotation.” We flex, extend, internally rotate, externally rotate, abduct, and adduct. We move in the sagittal, frontal, and transverse planes if we have full range of movement and the capacity and awareness to engage those planes of movement. Our eyes move to the space in front of us and around us, while our vestibular system (ears) responds to the lateral kinesphere. When we do engage all planes, spirals occur in the entire body. Our spine requires lordotic and kyphotic curves that are not extreme in order to accomplish sidebending and rotation of the spine. Ankles need full flexion and extension led by a spiraling foot going from slight supination on the landing cuboid, lateral arch to pronation onto the medial arch / navicular yielding to big-toe push off (see Figure 3) through a juicy mobile foot that then allows extension at the hip joint and sends movement to the spine, which fuels the ‘spinal engine’ (Gracovetsky 1988).

Figure 3: Toe hinge creating extension and fuel for the spine.

The shuffling, stiff-ankle walk of ‘aging’ is a one-plane, one-rhythm movement. There is a loss of the lateral and transverse planes in the pelvis, thus losing the spiral rotational and sidebending of the spine. This body can no longer find its way through the transverse plane to take the pelvis over the leg moving out into space to propel it forward. Hip extension is lost.

Our work is accepting the gravitational pull in the vertical on our bodies, sometimes felt as a collapse, sometimes as a ‘settling’. And, all of this occurs in the midst of spiraling gyrations. We can intervene to prevent the look and feel of collapse by learning to see which spirals are missing and which functional planes are not used, and then get to work in the fascial planes. This work of controlling vertical collapse is a part of gait that we can see and intervene in by learning to see which spirals are missing and which planes are not functionally used.

Using gait for the analysis, the key areas that create structural aging are:

• The feet: loss of ankle hinging and mobility in the forefoot that allows the toes to land.
• Lack of knee extension and the ‘screw-home’ rotation (the term used for locking the knee in the landing of the leg into a stabilized stance) needed in the femur and tibia.
• Ilial and sacral immobility that stops the translation of movement to the spine at the lumbars.
• Lack of abduction/adduction balance and strength throughout the body.
• Lack of thoracic flexion/extension resiliency to support cervical lordosis, thus the head is forward with the eyes leading.
• Overuse of the eyes in the sagittal flexion orienting mode. Lockdown in the suboccipitals and hyoid complex.
• Overall loss of the lateral kinesphere, including inner ear, peripheral vision, and the lateral arch of the foot.

Reestablishing Function and Relationship

So then, how can we approach intervention systematically and at any point in someone’s life?

Feet

One of the first breakdowns structurally is the feet. Whether the cause arises from shoes, injury, genetic formations, or habit, there is interference in the spiraling ability of the foot with an attendant lack of spring and fuel to feed contralateral movement that sets up a response in the rest of the body. It may begin with the loss of full-range ankle movement. One day a person is suddenly picking up his foot as if it were a cement block, lifting from the hip and placing it in front of himself without much awareness or sensation.

The human foot begins in babies (see Figure 4) as an ‘arch-less’ flexed segment that begins to arch and sense once we rise up to the vertical orienting we are destined for, standing and walking. We need juicy paws: pronation and supination of the foot (at the navicular and cuboid), not the ankle; landing and taking off from different parts of the foot; a toe hinge that lands like the nose of a plane and propels us forward using the earth and sending stored energy back up to the ongoing spiraling spine (Gracovetsky 1988). We need juicy paws. We need small movements in the tarsals and metatarsals that play the earth like hands can play the violin. These are the functional young feet that send a hip joint back into extension and keep us from staying in a flexed-hip, no-gluteal-use posture, which is an aging posture created from a loss of fine and resilient movement in the foot and ankle.

Figure 4: Our beginning juicy paws.

In the second, fourth, and sixth sessions of the Ten Series we mobilize the tarsals. We ask the extensors and flexors of the feet to claim their function for the toes by differentiating the fascial sheaths of the tibialis anterior and posterior from the extensors and flexors of the toes. We can do fine small-toe joint work to unwind the twisted toes that lead our feet into scoliotic patterns. Whether the aging pattern starts in the foot or higher up, this pattern has to be changed in order to support and re-create the natural spirals in the rest of the body. A locked foot will not allow the spinal wave to occur, nor will it allow femoral rotations and extension to maintain their vital role in joyful uplifting movement.

We can get a sense of other appropriate interventions from the abundance of studies in aging available to us these days. One very relevant one is Studenski’s (2011) research that gait speed and variability can predict mortality. Others show things like the better a person is able to get up off the floor without using his hands, the longer he lives. We also know now that homeostasis, regular patterns repeated over and over, are not a sign of health in our autonomic functions or in our movement patterns. Teaching our clients various ways of walking and moving are anti-aging tactics. Variability and our Rolfing principle of adaptability have to be reintroduced into the fascial networks.

Abductors and Adductors

Balance is a key issue. Our ability to maintain balance in all planes requires abductor activity to stabilize the hip in the frontal plane in a unilateral stance, including the stance phase of walking. The fragility of going up and down stairs requires abductor/adductor balance and a strong lateral arch. Many clients have lost abductor strength and stability, thus creating the X-legs, pronating-feet posture mentioned earlier (and shown in Figure 2) that started me on this study of structural collapse and aging. A collapsed navicular no longer supports lift in the adductor compartment. Many times adductor clutching exists in the pectineal fascia to hold onto the pelvis due to a lack of ground stability in the feet. In walking, we also need balance between the abductor and adductor movements leg to leg (see Figure 5).

Figure 5: Imbalance leg to leg in abductor/adductor compartments

Ankles function in anterior/posterior (A/P), dorsi- and plantar flexion when dealing with imbalance. They can also evert and invert. However, they will not handle the larger movement higher up from the ground required for balance in the presence of a larger disturbance. The width of the foot is too small but the hip adductor/ abductor “is the dominant defense in the medio/lateral direction when standing with feet side by side. The extensors and flexors of the hip will have the exclusive control of A/P balance but the M/L [medial/ lateral] direction dominant control is with the hip abductors with very minor adductor involvement” (Winter 1995). Thus, we need abduction and adduction strongly functioning and balanced for any perturbations in the lateral kinesphere and higher from the ground.

What we don’t always pay attention to is the need for lateral movement toward the swing limb that is due to the hip abductors (see Figure 6). At this point, balance moves away from the ankles and feet in the sagital plane and we now require the frontal and transverse planes to be active (see Figure 7).

Figure 6: The balancing role of abductors and adductors.

A key visual to watch for in body analysis is the lack of lateral kinesphere awareness in the person’s movement, visual perception, and foot use. The foot may show the lateral arch (mostly the little toe) curling under and shortening. The person will look eye-dominant and not be using much peripheral vision or only looking down. A study by Berencsi et al. (2005) has shown that the amount of postural sway decreases when there is visual stimulus in the periphery, resulting in a more stable stance than in the result obtained from the central vision conditions. The movement measured was primarily in the neuromuscular activity of the lower leg and ankle, which is greater in the A/P than the M/L direction, as mentioned before.

Figure 7: Lateral one-legged stability in all planes of movement.

With a stiff-ankle shuffler, we are seeing, among other aspects, a loss of the abduction/ adduction function, thus the work needed relates to the third and fourth sessions of the Ten Series, each session being one half of the other to balance these lateral and medial fascial planes of our essential frontal plane. Working to balance the gluteus minimus and medius, pectineus, and other adductors awakens the client’s legs to a youthful stability. (Individuals with diminished hip abductor muscle strength show less M/L stability and a use of their ankles to maintain balance; see Figure 8.)

Now we also need to look at keeping the femoral joint capable of internal and external rotation.

As the foot lands, the resiliency and mobility of the tarsal fascia and specifically the navicular and cuboid will send proprioceptive information and stability to the adductors and abductors that allows the hip joint to be protected medially and laterally as it finds its way forward, backward, and into the internal and external rotation needed for landing in a solid position with the knee extended. A chronically flexed knee drags the pelvis and lumbar spine into a flat non-rotating position destined to become the shuffling bent over person.

Figure 8: Weak abductors equals unstable pelvis and gait.

Screw-home – which again means locking of the knee in the landing of the leg into a stabilized stance – requires the femur to internally rotate (after being externally rotated in swing through) and the tibia to externally rotate. The knee needs to extend and come out of its flexion. Our third, fourth, and sixth sessions approach the femoral and knee fascial relationships to reintroduce these beautiful movements that again feed and energize spinal rotations. All of this requires the mobilization of the tarsals of the spiraling foot and toe hinge to trigger the various transmissions and firings of the gluteals, IT band, and sacrotuberous ligaments into the lumbodorsal fascia. Without this shift from a slightly vertical pull of hip extension to a horizontal pull that activates the lumbodorsal fascia and latissimus, we would lose a rotating pelvis.

Good Reasons to Keep Doing Back Work

Looking at the spine as initially a primary curve at birth (thoracic and sacral) that then morphs to include secondary curves (cervical and lumbar) from lifting the head and standing up to walk, we can find good reason to keep doing back work. When there is flattening of these gracious and fluid curves we become locked into one-dimensional locomotion with discs that have no space and rotations and spirals lost to rigidity.

The primary curve, the classic position we put our clients in at the end of a session for back work, is an essential integrative piece. It allows us to see where they have lost the smooth opening of the facets that will hopefully translate into closing facets in extension. With proper joint mechanics, they will be able to have the spiraling movement that is necessary for all the input coming in from the feet and legs, fueling this potential movement. Loss of the smooth transitions between lordotic and kyphotic curves leads to a loss of the rotation and transverse planar movements. To find our way forward, we need to translate our pelvis forward with abduction and adduction to get over our legs. The relationship of the femur to the sacrum to the pelvis via the lumbar curve keeps us upright and moving in a spiraling vertical gait.

Clearly, as structural integrators we know that each event of structural aging occurs in concert with another and it is difficult to know which occurred first. The Ten Series approaches all of what I have discussed. If viewed from this analysis, any of the segments could be functionally and structurally worked with to influence the others.

In further articles I will discuss the spine, the ilia and sacrum, the head, perception, arms, and the infamous ‘dowagers hump’. I will also be offering workshops in 2015-2016.

To age with grace, the body’s spirals and multi-planar movements need to be re-engaged, allowing fluidity and juiciness of spirit to carry through the years. This is a timely subject walking into our offices, and we have the skills to remove the obstacles to structural youth.

Bibliography

Berencsi, A. et al. 2005. “The functional role of central and peripheral vision in the control of posture.” Human Movement Science 24:689-709.

Gracovetsky, S. 1988. The Spinal Engine. St. Lambert, Quebec: Serge Gracovetsky (https://sites.google.com/site/gracovetsky/ thespinalengine).

Stecco, L. 2004. Fascial Manipulation for Musculoskeletal Pain. Padova, Italy: Piccin Nuova Libraria.

Studenski, S. 2011. “Gait Speed and Survival in Older Adults.” JAMA 305(1):50-58.

Winter, D.A. 1995. “Human Balance and Posture Control During Standing and Walking.” Gait and Posture 3(4):193Structural Aging Part 1 – Finding Grace in Gravity[:]