Tom Gordy, a graduate of the Guild for Structural Integration, lives, practices, and teaches bodywork in Reno, Nevada. He holds a BA from Purdue, a JD from Tulane, and is cur- rently pursuing a lifetime degree in curiosity. He is honored to be a part of the structural integration community. You can visit his website at www.ncrtheory.org and reach him at [email protected].
Understanding an extreme structural problem from a compression/pressure perspective sheds light on human structure as a whole. How we approach things and how we see things so often dictates what we accomplish. I found this to be true when I had some difficulty in applying the Rolf ten-series to a herniated disc issue. Most of the time any relief I could get the client was short-lived, and often, I could offer no relief at all. It was utterly frustrating. Seemingly at the heart of the issue was the understanding that until I could take pressure off of the nerve root that was being irritated, any treatment I provided would be short-lived or ineffective. It would just go back into pattern.
But how could I take pressure off of the nerve? How could I work more directly with this situation? First, I had to understand what structural problems were present that could contribute to the herniation. From experience it seemed pretty clear that a spine in structural distress was more prone to disc issues.
The blocks being misaligned and what flowed from spinal misalignment in the force of gravity was uneven or asymmetrical pressure on the disc spaces between the misaligned vertebrae. This type of pressure invited a bulge or herniation. In a structural sense, it seemed that in order to help resolve the bulge and the resulting nerve compression, I would need to balance the pressure on the disc. This meant balancing the vertebrae.
In examining and working with the spine, it soon became more or less apparent that no matter what overall distortion I thought I was looking at, a rotational aspect to the distortion was always present. Some painful vertebrae were in hyper-flexion, some in hyper-extension, but there was also always an element of right or left rotation. That seemed to be an important constant worthy of focus. And importantly, we know that physics dictates that shortenings will always accompany twists (rotations). If there was a twist, and a shortening, there must be compression. This compression of the disc would contribute to a herniation.
Rotation and Counter-Rotation
From a fundamental level, gravity essentially demands that if one body segment distorts and rotates to one side, another segment or set of segments above must compensate for that rotation by counter-rotating in approximately equal proportion. This is the body trying to stay upright. With this in mind, I began to look very closely at the occurrence of structural rotations and counter- rotations in the body, starting by looking at rotations and counter-rotations in the periphery. For example, if a femur rotated medially, it was likely to expect lateral rotation in the tibia-fibula. Previously, I had assumed the perspective that the shortenings in the myofascia caused the twists, but now I began to suspect that the distortions in myofascial length could also be the result of a rotation/twist in the joint rather than the cause. I began to wonder what sort of discrepancies in tissue length throughout the body could result from rotations and counter-rotations in the spine column. And I began to suspect that many if not most disc issues occurred between two vertebral segments that had rotated and counter-rotated out of position.
But, how to take the twists out? In general, the Rolf ten-series operates under a notion that if we lengthen all the sides symmetrically, we’ll take the twists out. In other words, since a shortening accompanies a twist, take out the shortening and you will take out the twist. However, what if the shortening is simply a result of the twist, rather than the causation? What if we never get to the heart of the twist? I started to wonder if I could alter the approach to focus more directly on the twist itself: the idea being that if we take the twist out, then length would follow.
Going back to our example above, if we have a rotation in one vertebra and a counter-rotation on the one above, the space between them must shorten, creating pressure on the disc and a vulnerability to bulge. If the bulge occurs, there are several consequences, one of them being a likelihood of painful pressure/compression on the nerve roots as they exit the spine.
Along with the nerve compression that is caused directly by the bulging or herniated disc, it is likely that further nerve compression results from the twist itself since space between the two vertebrae shortens. Along with that, further compression along the length of the nerve would likely be caused by the reflexive spasming of the soft tissue surrounding the nerve, with its greatest severity near the greatest compression and the nerve root itself, but certainly continuing through the length and scope of the irritated nerve.
I think we can assume that in such a case the local soft tissue shortenings are a response to the irritation of the nerve root. We often refer to the soft-tissue as being in “spasm,” but the words “holding pattern” may be just as applicable. In response to excessive compression on the nerve, the soft tissue will go into a holding pattern in order to help restrict any further damage to the nerve root caused by the compression. The soft tissue holds to prevent further movement, further compression, further rotation.
Clearly, the soft-tissue component to this problem is critical, although the contraction of the soft-tissue (“contractile” tissue), it seems, is only reaction. The control of that contraction is squarely within the mysterious nervous system.
As Emily Conrad so succinctly put it, “we are expressions of our context,” and our context is Earth, with its atmospheric pressure and gravity. If we lived in space, we’d be a formless blob. If we lived in the ocean, we’d look quite different. The nervous system has so many aspects to it, more than we realize, but pressure and pressure sensitivity seem to be rather important. We are incredibly attuned to pressure, from the slightest to the heaviest. Our bodies, in a sense, are simply composed of pressurized membranes, layers subject to hydrostatic pressure. We exist within a pressurized environment, to which we have adapted quite well.
Most people regard the nervous system as electrical in nature, which it certainly is. But often, another aspect of the nervous system is entirely forgotten about: The nervous system is hydraulic.
The structure of the nervous system is as much about fluid and tubes and membranes as it is about electrical impulses. When we think about compression on an electrical wire, it is no big deal. But compressing a hose has big consequences.
You could look at this whole herniated disc process and regard it essentially as a structural distortion in extreme. An extreme case. But what if we took an understanding of the process which was occurring in an extreme case, and started to apply that understanding to “less” extreme cases, or structure in general? What are the subtleties of nerve compression and how might more subtle nerve compression affect the contractile tissue it innervates? Understanding an extreme structural problem from a compression/ pressure perspective sheds light on human structure as a whole.
I started noticing that virtually everyone had rotations and counter-rotations in their structure and in their spine, in varying degrees. And in general, where there was a lack of a rotation, there was generally a lack of a problem; in the soft-tissue (contractile tissue) or otherwise. At some point I began to regard spinal distortion as being “primary” in determining structural symmetry, rather than the femur-to-pelvis relationship. Bipedalism and gravity still demand that the femur-to-pelvis relationship is incredibly important, but it now seems secondary to the intricate spine. The spine is, after all, the bottom of the brain.
The vast majority of vertebrates are quadrupeds. And even among other bipeds, the human structure is fairly unique, with both primary and secondary curves. In mechanical terms the human spine is much more of a vertical axis than any other vertebral spine I am aware of. The three curves in the human spine essentially demand a delicate balance point—a point of equipoise.
In any case, it seems quite clear that the vertebral spine in design was an evolutionary miracle mostly intended to distribute weight, not bear it. It was mostly intended to be a horizontal structure with quite a bit of stability (four legs) rather than a vertical structure with quite a lack of stability (two legs). It is not outlandish to assume we are using our spines for a purpose for which they were not originally designed. And if that is true, the question then becomes: What are the consequences of taking a spine meant to distribute weight, with all its movement potential, and standing it up into the irrepressible force of gravity? What are the consequences of denying the vertebral spine the stability of four legs? One likely consequence is that a vertebral spine in a vertical position is far more vulnerable to distortion in the field of gravity.
A rotation in the spine causes a shortening between the affected vertebrae in the same manner as twisting a towel. So, if one vertebra is rotated out of pattern, the space between both the top and bottom vertebrae will be compromised, resulting in neural compression.
Secondly, a rotated vertebrae will then cause the nerve roots in the affected area to physically rotate in space as well, essentially adding a distorted stretch on the nerves. This twist/shortening is also recognized through the entire length of the nerve, contributing to the demand throughout the soft tissue to hold, in order to prevent any further stretch, compression, or possible damage to the nerve. These holding patterns occur in an asymmetrical fashion throughout the periphery, shortening across the joints and contributing to rotational patterns in the periphery.
A person’s ability to stretch is very often dictated by the fluidity of the nervous system and the proper mechanics of the spine, not the contractile tissues. For instance, many practitioners have found that the ability to forward flex at the hip (hamstring stretch) is often much more a question of a balanced sacrum and healthy space opening at L5-S1 than it is length in the myofascia. It is no surprise that Ida Rolf considered balance at this space to be crucial. While a rotation is bad enough by itself, the problem is intensified by the mechanics and architecture of the facet joints on the vertebrae. The shape of these joints dictates that rotation of a vertebra is always accompanied by side-bending. This means that when a vertebra is rotated out of position, it is also side-bent (usually to the same side).
This results in several problems, some of which are:
I like to use the example of a bird to explain why asymmetrical compression results in a distorted pattern. In the theoretical bird client, innervation to the right wing is compressed by 40% and the innervation to the left wing is compressed by 10%. Obviously, in flight, the left wing is going to function at a much higher level. Because neural compression affects the speed and strength of the signal so the flight path of the bird tends to be circular, except that the bird will start compensating, either slowing down his left wing or forcing his right to work even harder—or a combination of the two. Thus, the asymmetrical neural compression will result in a distorted movement pattern that tends to display a rotational element, requiring further neurological compensation in order for the movement to be correct or “as intended.” And the asymmetrical compression would further result in asymmetrical holding patterns throughout the soft tissue that is innervated at that same spinal level.
Figure 1: Vertebral rotation and side-bending to the right side with accompanying asymmetrical distortion of the intervertebral
Now let’s apply this to a human example. Let’s say that C7 is right-rotated and right-side-bent on T1. The space at C7 and T1 is now compromised and asymmetrical compression is being applied to the nerve roots exiting the spine at C7 and T1. That aspect of the brachial plexus is now basically in a twist. The neural compression and stretch immediately causes a holding pattern to the effected contractile tissues surrounding the nerve in order to prevent further rotation and compression. The affected contractile tissue likely has an increase in tone at the level of severity equal to that of the severity of compression. And since the same vertebral-space nerve roots are compressed at different ratios, the functionality of the musculature will be asymmetrical as well. In this example, tonus throughout the contractile tissue innervated at that level of the brachial plexus will be asymmetrical, along with the movement patterns. These asymmetrical shortenings then contribute to peripheral joint rotations.
The system will compensate of course, but it can only do so much. The asymmetrical movement pattern in the musculature will then contribute to and help hold whatever movement distortion is at the vertebrae. Rather than hinging in flexion and extension, the affected vertebrae will now rotate around the more immobile side and the whole pattern will be assumed by the body.
Further, we can look from a visceral standpoint and note how lower-back issues occur so often in conjunction with gastrointestinal (GI) issues. Let’s remember that motility in the GI, for example, is rather sensitively tuned. (“Motility” is the natural rhythm and movement of the organs.) What happens when we exert asymmetrical compression on the nerve roots innervating those organs? Again, compression will affect the speed and strength of neural signal, so it is likely that some aspects of the GI will operate better than others, possibly resulting in imbalanced motility and uneven flow. I think, too, that anyone who has ever had a rib or a thoracic vertebra “out” can attest to the respiratory difficulty that typically accompanies it.
Kyphotic and lordotic curvatures are often the target of our interventions. We often seek to bring more flexion into an overly lordotic low back or more extension into a kyphosis. Often this is hit- or-miss work. As long as a rotational distortion with its unequal compression ratios and the resulting movement distortion exist in the body and at the spine, we’ll have a very difficult time influencing the overall flexion and extension of a vertebral joint.
Spinal flexion and extension require the joint to hinge in a fairly balanced manner. In order to create a balanced hinge-like motion or truly influence the position of a vertebra in the planes of flexion or extension, you must remove the rotational tendencies first. Balance the compression ratios to balance the joint space. Free the joint and the movement should normalize.
Remember that joint spaces shorten when rotations and counter-rotations occur, so some shortening in flexion or extension must occur when vertebrae are rotated out of place. Any time you see hyper-lordosis or hyper-kyphosis, there is typically a rotational distortion there as well. And if you see rotation, you also have a side-bending problem. But it’s not just rotation, and it’s not just side-bending. Some degree of excessive flexion or extension will be present also. We’re basically describing the root of a spiral. I would guess that many if not the majority of hyper-lordosis and hyper-kyphosis cases (curvature beyond the natural pattern) actually have their roots in rotational distortion. It’s really just a question of shortening and the loss of space when a twist occurs.
Figure 2: Rotation and counter-rotation of vertebral segments resulting in an overall shortening and increased curvature.
For example, if we have a rotation and counter-rotation within the mid-thoracics, the overall joint space must shorten, and because this happens within the thoracic/ kyphotic curve of the spine, then often the kyphotic curvature must increase as well. To return the spine
to its natural curvature, attention to the twists that are causing the overall loss in space seems more beneficial than focusing on the excess curvature that accompanies that loss in space.
Each spine has its own natural curvature. There is no standard, there is no perfect curvature except as to the individual, and this perfectly natural curvature is found where there is balance and freedom. I speak about balance in terms of pressure and compression: If pressure and compression are as uniform as space will allow throughout the spine, then pressure will be balanced on the discs and within the discs. The natural curvature of the spine will then be determined primarily by the bony shape of the body of each vertebra, taken in the cumulative.
The idea of balancing pressure throughout the nervous system is just a more detailed way of expressing the idea of balancing space in the body. It’s really just more of fundamental principle, but at a different resolution—a new perspective on why this idea is so important. We can’t really force the body to do anything. All we can do is create space—create the space that allows the body to re-align, to heal. If we can look with more detail, we can work with more detail.
Working with the concept of balancing compression/pressure ratios requires a different mindset in our approach to the spine. Shotgun methods, while useful, will not balance space. They are not specific enough. Structural asymmetries rooted in neurological compression require detailed, asymmetrical work in order to resolve these imbalances. In other words, if we lengthen an asymmetry in a symmetrical fashion (shotgun), all we have is a lengthened asymmetry. The distorted movement pattern will not resolve and the length will not hold.
Here’s another example: Let’s say L3 is right- rotated on L4. The right nerve root is compressed by 30% and the left nerve root is compressed by 10% (a 3-to-1 ratio). As a result, we have a distorted movement pattern both in the vertebral joints themselves and in the musculature being innervated at that spinal level. If we lengthen the sides of the joint symmetrically we will still have the exact same compression ratio and the exact same movement pattern. The problematic pattern is still there. The length will not hold. So our deeper work needs to be asymmetrical in nature. We must create space only where we need to create space. And further, we must avoid unintentionally creating space where we do not need to create it.
In a different example, let’s say that T5 is left- rotated on T6. Because we are working with the thoracic spine, we know that spatial distortion in the rib cage must be present, as side-bending always accompanies rotation. Along the lengths of the affected ribs, inter-costal space will be wide in some areas and compressed in others. Those variations will affect the innervation through the space, resulting in an upset pattern of innervation to both the soft-tissues and the viscera. A distorted movement pattern is present simply because of the spatial distortion. It is compressed asymmetrically so it will tend to move asymmetrically. And this distorted movement pattern will help hold the rotational movement pattern at the vertebrae. Because of this we must assume then that in order to correct the rotation we must correct the spatial distortion in the rib cage. We need to balance the spaces and treat the rib cage as part of the spine itself.
Facet restrictions as well nearby soft-tissue holdings must also be freed and balanced. And while I cannot go into great detail here, I would certainly recommend the works of Jeff Maitland.
On the soft-tissue side of things, distorted holding patterns in the periphery also contribute to the overall pattern of rotation. These must be addressed—typically first. In my practice I pay a lot of attention to major pathways and plexi, often finding spiraling and diagonal patterns of soft-tissue strain. The patterns tend to correlate with what I know of biomechanics—with its focus on myofascial shortenings. (I also recommend Liz Gaggini’s great study of biomechanics.) Viewing these patterns through a neurological lens, however, offers some fresh perspective on the reasons why they might occur and how to better work with them.
Superficial fascia, in my estimation, should be regarded much more literally as an integral part of the largest sensory organ in the body—just as much ‘neural’ as ‘connective.’ Or one in the same. It’s what the Chinese have been manipulating with needles for over 2,000 years. I have a hard time reconciling this apparent fact with some of the heavy-handed approaches in manual therapy. Regardless, in seeing fascia as neural in nature, we might also gain a fresh perspective on the body. Most of us in the West are all first educated in muscles, bones, and attachment points, which gives us a very mechanical mindset to begin our journey with, a mindset often pre-occupied with size. We carry this initial frame of mind with us throughout our learning, and it colors what we see. It is important and necessary information, but often the color is misleading. Because of it we see and understand neurology as a system running through and around and between muscles and organs. However, if we accept that fascia is neural in nature, and it surrounds everything, then we start to see the body in these terms: everything exists within a neural matrix.
Twenty-four articulating vertebrae capable of greatly varied patterns provide essentially unlimited patterns of distortion. And if we have unlimited patterns of distortion, we have unlimited patterns of asymmetrical neurological compression. Typically, “distortion” and “compression” are words that sound bad. But there are positives and negatives to everything. In evolutionary terms there really is no good or bad, there is only the process of adaptation. And while vulnerability to structural distortion certainly seems like a bad thing for an individual in pain, there are many other aspects we can examine. On a species-wide basis, vulnerability to compression and the resulting smorgasbord of structural distortions can be seen as helping to create an almost unlimited species variation in structure. If you structurally compare 50 cows to 50 humans, the humans are structurally much, much more diverse—all over the map. Now with that idea in mind, consider that evolution also thrives on diversity. Variation within a species can be a very good thing.
And while it is certainly egocentrically fun to imagine that our species dominates the planet because of our inherent strengths, it is more logical to imagine that our species has evolved much faster than our mammalian counterparts rather because of our inherent vulnerabilities. Vulnerabilities in a life form create constant demands to adapt, and while evolution can be described in ridiculously simplistic terms such as “the strong survive,” we are well aware that the process is much more intelligent than that. Those species that adapt well seem to evolve well. And the process of adaptation largely takes place in the neurological realm. Instability, structural vulnerability to distortion, massive compensation—all these things are present in our structure and all create a strong neurological demand to adapt. Along with neurological demand comes neurological growth.
The armor-plated dinosaurs are gone. The slow, squishy humans with their problem-solving abilities and their overwhelming sense of individuality are instead dominating the ecosphere.
I would propose that the window of opportunity for an evolutionary ‘missing link’ was very small—that once our species reached the vertical and vulnerable, our evolutionary period took off. The simple act of standing upright created a cascading demand for neurological adaption, and the variations in our structure created a different kind of awareness—a different state of consciousness and a continued demand for neurological compensation and problem- solving ability.
This is essentially a work of theory: an exploration into human structure and function through a process of observation and inductive reasoning based upon probability. These ideas have flowed from a collective intelligence—an immense range of influences and teachers that I gratefully acknowledge. Special thanks to Eric Asay who contributed the drawings you see, Neal Powers (if you change the way you look at things, the things you look at change), Liz Gaggini (the ripple effect), Jeff Maitland, Art Riggs, my clients who graciously allow me to be a forever-student, dogs in general (the wiggle is motion of joy!), and of course, Ida Rolf (pioneer in thought).