Thomas Myers

Tom Myers directs the KMI school of structural integration, which also provides professional development courses worldwide to manual therapists and movement educators. Tom is the author of Anatomy Trains (Elsevier 2014), co-author of Fascial Release for Structural Balance (North Atlantic 2010), and numerous chapters and articles for trade magazines and journals. Tom lives, writes, teaches, and sails on the coast of Maine with his partner Quan and a number of animals.

An expanded version of this article first appeared February 2001 in Elsevier’s Journal of Bodywork & Movement Therapies 5(3): 149-159. This version has been edited and amended specifically for relevance to structural bodyworkers in response to peer review. Reprinted with permission.

Introduction

It is an apocryphal story from the late Peter Melchior (personal communication, May 1999), so there is no way to check it: Ida Rolf removed the intra-oral and intra-nasal approach from her Ten Series for a period when a student—a chiropractor by report—broke a client’s hyoid bone (too hard, too fast). Later, unsatisfied with the results obtained without it, she reintroduced this intra-cavity work into the series. Intra-nasal work was included in the work taught to me by Peter and Dr. Rolf in my very amateurish state in 1975, and I have used it to good effect, without injuring people, for the last 40 years.

At the outset, let me declare my stance: We teach both intra-oral work and intra-nasal work within the KMI training and regard it as part of the essential skill set for structural integrators (Myers, 2014). It is not appropriate for every client, but  every practitioner should know how and when to use it. We recommend using it for more clients than not, as it is salutary for beginning integration, beyond its obvious applicability with sinus trouble, deviated septa, strained breathing, or dental arch challenges.

This article is a defense of the inclusion of intra- nasal work in our training and skill set.

Boundary considerations

Working inside the confines of the general outline of the body always creates interesting dilemmas for the practitioner, a physical part of what is known generally in the industry as boundary issues. Where the boundary is encountered differs, of course, among clients and among cultures. For some, working in the armpit of the groin (the “leg pit”) would constitute “invasive” procedures; others are totally sanguine about entering the body’s cavities.

 

Leaving aside the urethra, whose sanctity is breached only in the medical procedure of catheterization, there are nine openings into the body: three pairs: the eyes, ears, nose; and three singular: the mouth, vagina, and anus. Work in the opening of the ears is usually confined to the fingertip placed delicately in the atrium, which is easily accepted by most clients (Upledger, 1983). Work within the orbit of the eye, either with a fingertip or cotton swab, is practiced in some schools1, and is often welcomed after the initial touchiness around the eye is calmed. Intra-oral work has been fairly widely accepted within the manual therapy community and with a little reluctance by the larger community of patients (Upledger, 1983).

In the USA, working the coccygeal ligaments, piriformis, or other structures via the anus has been designated largely out-of-bounds for bodyworkers, though some medically trained US osteopaths and physiotherapists employ that access with care and some circumspection. European osteopaths and bodyworkers, depending on the local regulations, use both intra-anal and intra-vaginal work with more ease due to differences in cultural acceptance of such practices (Barral, 1993).

In intra-nasal work, a finger is introduced into the nasal passages (Rolf, 1976). As schools of SI (such as our own KMI) proliferate, some are teaching and recommending the intra-nasal work, others de-emphasizing or eliminating it from the original recipe.

Interestingly, none of the above-mentioned methods penetrate the physiological membrane of the body, but rather the cultural membrane.

Acupuncture and surgery, by contrast, do cross that skin and connective tissue membrane, which places them in another category (even legally in some jurisdictions) than any of these manual techniques, whatever the varying levels of social acceptance.

These manual techniques within the mouth, nose, vagina, or anus do, however, involve touching on the endothelium, as opposed to the constantly exposed outer skin, or exothelium (Figure 1). This constitutes a fairly common cross-cultural boundary epitomized in the American joke, still popular among six-year- olds of the author’s acquaintance: “You can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose.”

Figure 1. From the very beginning of multicellular organisms, the blastosphere inverts upon itself (gastrulates) to form an outer skin and inner skin, with the muscular (pumping) layer in between.

This simple tubular shape folds and refolds itself into many complex pouches inside our bodies. Most somatic work contacts the outer skin, but the endothelium also affords unique access to the fluid- to-solid structures between the two skins.

 

 

While most clients have had other people’s fingers in their mouths—mother’s, doctor’s, dentist’s— most people have only had their own fingers in their noses. Even then, the territory explored goes not much farther than the vestibule, not far enough to do any therapeutic good (or harm) to the breathing passages or cranial balance. The practitioner entering a client’s nose with his or her finger is thus generally going into “virgin” territory, and the word is used deliberately. As odd as it sounds, and as much as some practitioners might dismiss the idea, there a sexual aspect to penetrating the nose, and this work will occasionally—often enough to warrant the caution—bring up past sexual abuse or similar issues even when it had nothing to do with the nose per  se. The sensitive practitioner will keep this firmly in mind when approaching this kind of work.

In summary, while touching the outer skin may be acceptable or unacceptable depending on culture and context, touching someone else’s endothelium via any orifice involves—in all but the very, very young who will stick their exploratory fingers in your mouth, nose, or eyes without so much as a by your leave—a negotiation with the touched. This negotiation may be verbal or not, well-handled or not, but it is universal.

Intra-nasal work does indeed afford the practitioner with unique hazards—and unique opportunities as well. Presenting any such techniques in written form without accompanying manual supervision is ill- advised, so we will not do that here. Nevertheless, a general discussion around these issues may still prove useful—so we do not propose to go into how to work within the nose in this article, but to explore why one would do it at all. Thus, the following is an anecdotal exploration of intra-nasal work, which will involve exploring the anatomy of the situation, the possible benefits, the possible harm, and some client reports.

Figure 2. Ida Rolf.

 

Nasal Work in the Recipe

The nose work sits at the very apex of the arc of the original 10-session recipe developed by Ida Rolf (Figure 2). In her original concept, the first three sessions open and organize the first layer of deep fascia (the body’s fascial “unitard”) and the superficial myofascial layers. The middle four sessions work their way up through the deeper, more intrinsic, core myofascial tissues, culminating in the seventh session on the neck, jaw, and cranium. The intra-oral and (if called for) intra-nasal work are the high point of this session, which can be said to be the high point of the entire series (Figure 3). This seventh session completes the differentiation sessions and begins the integration Sessions 8-10. Aside from its fairly dramatic novelty, what accounts for the placement of this move or approach at the peak of her series? Let’s point toward some answers to this question.

 

Figure 3. The traditional Recipe for structural integration as taught by Ida Rolf included the nose work as a culminating part of the seventh session: the final differentiation session and initial integration session.

Dr. Rolf died in 1979, and the history of how intra-nasal work came to be included in the Rolfing® series is not clear. Dr. Rolf herself acknowledged yoga and osteopathy as the two main taproots for her work (Feitis, 1978).2 Yoga, as she practiced it earlier in her life, included kriyas or cleansing practices, one of which reportedly involved passing a cloth through the nasal passages. A more likely source of nasal work was seminars that Ida Rolf took with William Sutherland, DO, the founder of cranial osteopathy (personal communication with Rosemary Feitis, October 2000). An early student of Ida Rolf says, “She once told me there was ‘an old osteopath, name of Lake’ in the northwest (Oregon or Washington) who did some intracranial work, but that they stopped because they occasionally broke cartilage, since they didn’t do any preparatory work to make the body more resilient before they went in” (personal communication with Peter Melchior, May 1999).

This author, however, has been unable to discover a reference to similar intranasal work in osteopathic texts and would welcome such a reference.

The Balloon Method

It is useful to contrast Rolf ’s intranasal work with the only other approach to intranasal work that this writer been able to locate. Certain practitioners in  the northwestern USA (this seems to be the source, although the method has now spread more widely) go into the nose with the same intent but a different method: inflating a balloon within the nasal passages. This family of techniques goes by any of several names, including endonasal technique, nasal specific, and neuro-cranial restructuring. The sources for the following section include:

• Dr. Douglas Lewis, ND, a teacher of naturopathic medicine and past head of the Department of Physical Medicine at Bastyr University in Seattle, Washington, USA, who has been performing this procedure since 1987, at a rate of about 200 such treatments per year, along with the other naturopathic and osteopathic techniques (personal communication with Dr. Dean Howell, November 24, 2000).
• Dr. Dean Howell, ND, founder of NeuroCranial

Restructuring (NCR) and author of a book of the same name, who is Dr. Lewis’s teacher and who has performed this procedure on over 50,000 patients since 1982 and who has taught his version of these techniques since 1984 (personal communication, November 24, 2000), and

• an article by Folweiler and Lynch on the nasal specific technique from the chiropractic library (1995).

Dr. Howell has found the finger-into-the nose technique referred to in a letter to the editor of the Journal of the American Medical Association ( JAMA) in 1923.

The idea with finger technique (at that time), writes Dr. Howell, was to quickly and forcibly insert a little finger through the nose into the top of the throat and push on the bones that lined the nasal-pharyngeal duct and the top of the throat. It was the first technique to push on the body of the sphenoid bone directly. However, it was extremely painful!

(personal communication, November 24, 2000)

Inflating balloons within the nose, then, was substituted in the 1930s as a less painful and nearly as effective way of moving the sphenoid. This technique, named the bilateral nasal specific or BNS, first appeared in the chiropractic literature in 1947 (Janse, Houser, & Wells), and remained more or less unchanged until the 1960s when J. Richard Stober, Dr. Howell’s teacher, refined and popularized the method.

The BNS employs a finger cot secured with thread or dental floss to the nipple on the bulb from a blood pressure cuff, and then the lubricated cot is inserted with a pick into the nasal cavity. The bulb is used to inflate the rubber finger cot inside the nasal passage. The number of cots used can vary depending on the desired force of exertion required on the mucosa and the facial bones; a larger number of nested cots requires a greater bulb pressure to inflate and thus exerts a greater pressure against the walls of the nasal cavity.

Since the inflated cot will follow the path of least resistance posteriorly into the naso-pharynx, it is often necessary to inflate the cots to tension, and then impulse the tissues with a rapid inflation which Dr. Lewis describes as equivalent to a high- velocity, low-amplitude thrust commonly employed in osteopathic or chiropractic manipulation. In some cases, a low-velocity, high-amplitude thrust is appropriate. He stresses that, as with any procedure, patients need to be thoroughly evaluated before the treatment is undertaken, and that occasionally treatment is not performed on the first visit. To prevent the cots from simply escaping into the throat, the base of the nose is pressed against the midline from outside.

According to Folweiler and Lynch:

It is common for the patient to hear “cracking” or “popping” sounds within the skull during the technique. Occasionally, they can be perceived by the practitioner. Tenderness following the treatment along the median palatine suture and other facial sutures is common, persisting for a few days after treatment. Epistaxis (nose bleed) can occur, but is not commonly long in duration nor large in volume.    (1995)

 

According to Dr. Howell, “Immediately after treatment, many patients are aware of aching and pulsations through their heads, tingling or numbness in the teeth, burning sensations, or lightheadedness. This is followed by a wonderful, relaxing sensation of peace.” Dr. Howell recommends avoiding other bodywork in the weeks following NCR treatment while the compensatory changes from deep motion of the sphenoid are ongoing.

Figure 4. The illuminated skull—chosen for its unusual symmetry—shows clearly the path that the littler finger must follow—straight back and above the palate.

Figure 5. The effects of nasal work travel up the nasal passages to the conchae to the sinus openings and the cranial-facial interface, but there is no room for a finger in the upper reaches of the nose.

The nasal cavity is comprised of six passageways, three right and three left, defined by the septum, and the inferior and middle turbinates and conchae (Figures 4 and 5). In Dr. Stober’s concept, the balloons are inflated in each of these passages consecutively, beginning with the lower right, then the lower left, and so on through the upper left. Occasionally, one or more of the sections are repeated especially in the lower pair (connected to the eustachian tubes if the patient’s ears feel plugged). The pattern of inflation may be altered depending on the findings of cranial restriction. In Stober’s opinion, the turbinate associated with inferior concha is moved superiorly and medially against septum, the septum moves toward the opposite side, and pressure is also exerted outward against the maxilla and downward towards the palate. The movement of the inferior conchae medially would be reversed when the cot is inflated in the “second story” (Folweiler & Lynch, 1995).

Again, according to Dr. Howell (personal communication):

The nasal meatus chosen for treatment exerts pressure on different parts of the pharyngeal passageway, and this pressure creates different motions in the sphenoid bone and its many associated joints. The amount of pressure required for cranial movement varies greatly from one patient to the next. As the caliber of the balloon increases, there is a change in the shape of the inflated balloon, and with this information a skilled practitioner can control where the greatest pressure is exerted within the skull.

As we will see, this concept of placement and effect, as well as speed with which the move is done, are both major distinctions between the balloon method and the structural integration method.

This treatment is “not pleasant at the moment of inflation,” according to Dr. Lewis, but due to its effi- cacy patients frequently request, however reluctantly, for him to repeat it. Dr. Lewis recommends that patients plan on at least three of these treatments initially. This gives the patient an opportunity to become accustomed to the treatment and may be adequate. Additional treatments may be necessary and are performed according to patient need.

The treatment is primarily employed for chronic sinusitis and other nasal complaints. “The nasal specific technique, when used in conjunction with other therapies, may be useful in treating chronic sinus inflammation and pain,” states Folweiler and Lynch (1995, p. 39) and they go on to speculate on the mechanism of such relief:

Numerous theories could be used to explain the benefits of the nasal specific technique for chronic sinusitis. One such explanation may be the direct elimination of mucous from the nasal passages by the force of the inflated cot, thus reducing pressure and pain and allowing increased sinus and nasal drainage. It is also possible that pressure against the thin, slightly pliable bones surrounding the sinuses allows equalization of pressure in the sinus of that of the atmosphere. It is also possible that a neural reflex exists by which the nasal specific technique causes mucous thinning and/or altered discharge. Manually compressing edematous tissues may result in a vascular response that leads to normalization of function.(p. 39)

The article also surmises that cranial motion among the bones may be helped by the technique, surmising that the popping heard during the technique may be adjustments of small bones or cavitation in the sutures.

Leaving aside the unlikely event of cavitation in cranial sutures, Dr. Lewis describes that other doctors have found the balloon technique helpful in cases of autism and Down’s syndrome. Dr. Lewis gave more than 75 of these treatments to one older female patient, who believed there was a bad odor coming from her nose, more because she could remember things (including her appointments) better with regular treatment than for any bad odor he ever detected.

It is useful to contrast Rolf’s intranasal work with the only other approach to intranasal work that this writer has been able to locate.

The general intent of these treatments, according to Dr. Lewis, is cranial manipulation, the improvement of cranial respiration. Dr. Lewis acknowledges that initially the method “can create some disturbance in [craniosacral] CS rhythm, a wobble which sometimes requires evening out through additional cranial work.” Dr. Howell adds: “There can be changes in the cranial architecture… so that the flow of blood and cerebrospinal fluid are permanently altered.” In his brochure, Dr. Howell claims that his version of the endonasal technique, combined with cranial work, “permanently improves posture, facial beauty, and mental and emotional clarity,” and that significant results are routinely expected for such diverse conditions as Alzheimer’s, ADD, cerebral palsy, insomnia, bruxism, fibromyalgia, Parkinsonism, phobias, and seizures, as well as the more proximate conditions such as sinusitis, sleep apnea, tinnitus, ear infections, headaches, and neck and shoulder pain.

Though we doubt the FDA has approved all these health benefits, we are grateful to Dr. Lewis and Dr. Howell for their help and for sharing their extensive experience. In experiencing this (BNS) method for ourselves, we found it wincingly sudden and disturbing compared to the Rolf method, but had the advantage of being passage specific to the three main air passages, whereas there is only one of these three that will tolerate even the smallest finger.

 

The Structural Integration Method

The rest of this article concerns the finger slowly introduced into the nose method promulgated by Dr. Ida Rolf, though we will refer to some instructive similarities and differences between the two approaches. The author has performed this method, as he was taught it by Dr. Rolf and teachers, for over 40 years on approximately 2,000 clients. Though figures are impossible to gather with any accuracy, there are approximately 1,200 Rolfing practitioners, and probably 3,000 other practicing similar methods under different brand names—e.g., Hellerwork®, Structural Integration, SOMA Neuromuscular Integration®, Core Institute, KMI—many of whom practice this intranasal work with varying frequency with the balloon method described above: It is done very slowly and only after thorough preparation of the patient’s entire structural system to receive it resiliently.

In structural integration practice, intra-nasal work is done with the little finger, gloved and lubricated3, with great sensitivity and concentration, with ulti- mate slowness and client communication, only after the entire rest of the body has been prepared for this work by detailed myofascial processing. It is import-ant to note from the beginning these two contrasts

No criticism of the balloon method is implied here, for the treatments are not the same. It is impossible, for instance, to introduce a finger into the upper nasal passages, which are accessible only to the balloon method or indirect cranial procedures. The structural integration approach, however, emphasizes the need to increase the client’s fascial and cranial adaptability through body-wide preparation, and is performed very slowly through tissue consent.

As Figure 4 shows, what scant room there is for a finger in the nose lies in the passage that goes straight back into the head, parallel to and above the palate. It is neither possible nor advisable to go up the nose toward the orbit, as this coronal section (Figure 5) demonstrates, as these upper reaches of the nose are quite narrow and delicate as we approach the cribiform plate of the ethmoid. In cases where the practitioner’s finger is disproportionately large for the patient’s nasal passage, it is sometimes possible to use the client’s own little finger to the do the work.

The direct purpose in introducing a finger into the nose, as with the balloon method, is to widen, open, and loosen the soft-tissues surrounding the nasal cavity. We notice indirect effects on the sinuses, the nasal septum, allergies, balance and motility in the facial and cranial bones, as well as larger issues related to development and inter-systematic communication.

 

Figure 6. The diverse connections from the maxilla to the surrounding bones earn it the desgination “sphenoid of the viscero-cranium.”

We will begin with the direct effects and some relevant anatomy, and then widen our scope to the larger issues of cranial mobility and development.

The Turbinates

Once into the vestibule, the finger encounters the “gate” around the nasal passage, formed by the maxillary bones laterally and inferiorly, and the nasal septum medially. Most normal septa and vomer bones are slightly deviated, and it is often difficult to assess before you begin which of the nasal passages is bigger; the outer shape of the nose can be deceptive. It is advisable to begin with the smaller to see if the septum can be moved toward the midline. Such motion is very slow, needs to be coordinated with the cranial rhythm, and may require repeat treatments on the order of one per month for several months to restore the midline or something approaching it, or may prove resistant to even such urging.

Nevertheless, the author has found many deviated septa to be responsive to treatment, with the results of increased opening being very gratefully received by clients. Nosebleeds are rare but possible, and should be handled in the usual way—ice and not a lot of fuss. The cartilage, we must admit, occasionally crackles disconcertingly when directed toward the midline, but we have had no reports of post-session pain or disturbance related to these sounds. Intraosseous strain within the vomer caused by cranial torque or shear forces can also be eased by sustained attention in this direction. Sustained snorting of cocaine can break down the cartilage of the septum, and is thus a contraindication for this type of manipulation.

Physiologic Motility

Having reached the limit that comfort, patience,  and tissue consent allows—sometimes slowly retreating and going back in one or two times helps the client get used to it and open further—a new phase of the treatment begins, with a different set of intents. The finger in the nose is well-positioned to sense, in exquisite detail, the vagaries and varieties of physiologic motility, particularly the so-called cranio-sacral pulse. The viscero-cranium literally and palpably moves around the finger in a rhythmic fashion. While playing in this field and riding this pulse to greater balance, it will often help to cradle the occiput in the other hand so that the neuro- cranium can be monitored as well. Alternatively, one hand can straddle the forehead so that the thumb and tip of the second or middle finger can monitor the motion of the two greater wings of the sphenoid.

The maxilla is to the viscero-cranium what the sphenoid is to the neuro-cranium, in that the maxilla has diverse connections with most of the facial bones, just as the sphenoid contacts the entire set of cranial bones (Figure 6). Each maxilla has sutural connections with its complement, with the vomer, the frontal and the ethmoid bones, as well as the ipsilateral zygoma, palatine, nasal, and the inferior nasal concha, which “hangs” from the maxilla. This means that the motion at the zygomaticomaxillary, nasomaxillary, frontomaxillary, and nasomaxillary sutures is distinctly palpable, as well as the important intermaxillary, interpalatine, and palatomaxillary sutures below the finger as well (for detail: Pick, 1999).

The maxilla also provides a home for the upper teeth, and through these teeth has contact with the mandible via the lower teeth, and is thus implicated in a host of forces and problems associated with the bite. The maxilla’s contact with the rocking flexion and extension of the sphenoid is indirect, via the palatine bones, but the wide array of contact between maxilla and the other facial bones makes it a good center for opening and restoring physiologic harmony with this region.

Without going into the myriad details of facial bone movements in response to the craniosacral rhythm (CSR) that have been so well described elsewhere (Upledger 1983; Milne 1995), we can note two frequent aberrations involving the maxillae and adjacent bones, either:

• the entire viscero-cranium can be held or “pushed” up against the bottom of the neuro-cranium, frequently by strong and slightly asymmetrical tension in the jaw flexors, which inhibits the natural motion of the sphenoid and ethmoid, and can contribute as well, in any asymmetry, to shear and torque patterns through the facial areas,

and/or

• the entire facial structure, including the nasal passages and dental arch are narrowed toward the midline, contributing to a host of problems in bite, tooth development, and the breathing problems we have detailed above.

Concerning the first pattern, given that there is little or no muscle between the viscero-cranium and the neuro-cranium, it must be presumed that the compression between them comes either from inherent developmental factors which have tightened the sutures (not so uncommon), or, more likely, excess tension in the jaw muscles (very common), which then act to compress the facial bones onto  the cranial bones via the mandible and the teeth. This points to the need for peri- and intra-oral work to accompany the nasal work, to lower the general tonus in the jaw muscles and give the decompression a chance to become normalized.

When the practitioner’s finger rests utterly still in the nose of the client, with the practitioner’s attention firmly on the cranial rhythm, still points may be observed and resolved. In some cases, very slight movements (one might better call them intentions) can be introduced into the face from this position.

For our first common pattern (pushed up), a slight downward intention, held for sufficient time for the skull to organize around it, will often result in a feeling of give between the cranium and the face as the facial bones drop slightly away from the cranium, allowing the sphenoid and ethmoid a full range of motion against the maxillae (with the palatines acting as “washers” in between) (Upledger, 1983). The goal of these movements and of Dr.

Rolf ’s intention for this work is, according to Jan Sultan, a senior instructor at the Rolf Institute®, “to re-establish span along the midline of the cranium.” He further notes that “it is the proper arch of the palate that allows the sphenoid its normal forward motion.” The nose work helps to “decompress the span of the palatine arch” (personal communication, December 2000).

Decompressing the face from the cranium can also be approached by placing two fingertips on the bridge of the nose and the thumb intra-orally on   the front of the palate behind the upper teeth, and waiting for a similar give of the face away from the cranium. While this technique can be effective, its benefits are often stymied by lesions deep within the facial structure, which are more closely followed and released from inside the nose.

Facial Narrowing

Concerning the second common pattern, the narrowing of the facial structure, we refer the reader back 60 years to the pioneering work of Dr. Weston Price on Nutrition and Physical Degeneration (1939). With some allowance for the different style of racial and eugenic thinking of inter-war era, Dr. Price established an astounding body of evidence pointing to a nutritional cause—namely Western diet with its rampant sugar, salt, and processed food—for a general and quite sudden (within a generation or two) decline in the width of the dental arch (Figure 7).

 

Figure 7. In these photos, typical of many from all over the world in Dr. Price’s book, we see how the dental and facial arches of those with a “natural” diet—be it oat cakes and fish in the Hebrides, or blood and milk in Tanzania—are wider than those whose diet is “Europeanized.” Taken from Nutrition and Physical Degeneration, 6th ed. Weston A. Price, Keats Publishing, Inc. Reprinted with permission.

Dr. Price, a dentist and prodigious traveler, also noticed a rapid rise in dental caries when such foods were introduced into a population that had eaten previously according to the dictates of accumulated tribal wisdom. Interestingly, it did not matter whether the indigenous diet was oatcakes and fish, as in the Hebrides, or blood and milk, as among the Maasai. Dr. Price associated this change in facial structure with a host of degenerative changes in mentality and behavior as well. Today, we see that pattern ubiquitously in our practices, to the point where we consider it normal. In the USA, money is put aside for children’s orthodonture nearly as routinely as it is put away for college, with little thought given as to why so many “healthy” American children need metal engineering to fix what untrammeled native tribespeople rarely suffer—misplaced and crooked teeth, or insufficient room in the arch for wisdom teeth.

Although Dr. Price, traveling extensively in the 1920s and 30s, gained access to a number of indigenous populations as yet unaffected by our Western diet, any such populations are difficult to find today. This writer has been fortunate to spend at least a little time with indigenous peoples in Africa, Asia, and Australia, including some days out of contact with whites among the Pokot tribe in rural Kenya in the 1970s. Although the British had brought their processed foods along with their colonialism, the Pokot  remained fairly true to their original diet at that time. These tribespeople, especially the children, had broad dental arches, wide smiles, soft voices, and well-placed teeth. (I wonder how they are now, in 2015.) Upon returning to noisy Nairobi, I was struck by how pinched and narrow the Caucasian faces of the English ex-pats appeared, and most of the facial structures of the urbanized Bantu and Maasai as well. It made me want to turn the  Jeep around and head back for the hills.

This narrowing of the facial structure can be observed in the narrowness of the nasal passages and cheekbones, in the tendency, especially in children, to favor mouth-breathing, by the ever- more-common impaction of the wisdom teeth, and by a ridge (torus platinus) along the midline of the palate below the intermaxillary sutures.

When the finger is inside the nose, the maxillae can be widened away from the midline by one of these subtle, intentional movements. We have seen significant (though obviously anecdotal) changes in facial structure, bite, visual acuity, general ease, and memory retention post widening the facial structure, as well as significant reduction or elimination of the intermaxillary ridge in the palate.

Although a number of techniques exist in osteopathy for widening the palate intra-orally from the palate itself, we should note that this work necessarily proceeds from below the palatine arch, and can thus sometimes act to widen the upper teeth while narrowing the upper part of the arch, namely the nasal portion. Needless to say, the intranasal technique, located so much closer to the axis of maxillary movement, acts to widen both the upper and the lower part of the arch and to provide more possibilities to apply, however gently, a direction (Figure 8).

 

Figure 8. Widening the facial arch from the palate (A) is obviously simpler and less invasive, but sometimes results in a narrowing of the upper part of the nasal cavity, near the cribiform plate.

The intranasal work allows multidirectional possibilities and results in widening of the face as a whole.

 

Is It Worth It?

Discussing the insertion of a finger into the nose in the same breath with cranial work, which is usually described as involving “five to ten grams of pressure” (Upledger, 1983) or “half the pressure necessary to collapse a vein on the back of your hand” (personal communication with Dr. J. Jealous, April 1999) may seem incongruous. There is no doubt that nearly everyone arriving at the inner nasal passages with even the little finger involves a great deal more pressure than this, pressure which can be, for some patients, intolerable. Having arrived, however, the pressure needed to make changes is minimal; often, in fact, the less pressure used, the better the result.

There remains a serious question as to whether the possible disadvantages—the pain, trauma, disturbance to the cranial  rhythm—outweigh the possible advantages. Though the author has encountered the occasional minor nosebleed, and more frequently a distinct “spaciness” in clients after this form of treatment, the benefits far outweigh any detriment. As with Dr. Lewis and the balloon method, patients very frequently ask for its reapplication when they return for further treatment. In most cases, the author allows a period of months or even years to pass before reapplying the technique.

The beneficial results, however, rest on the two caveats we put forward earlier in the article: (1) the body must be prepared by increased overall resilience by the initial sessions of the series, and (2) the technique must proceed with requisite slowness and sensitivity on the part of the practitioner.

Moving too fast can create traumatic reactions and disturbances in the cranial pulse, as well as actual damage to the conchal cartilage, not to mention the mucosal tissue.

The post-treatment dissociative feelings can most often be lessened or resolved by using generalized cranio-sacral techniques on the occiput, cranial vault, or sacrum for restoring an easy flow to the cranial rhythm. The question is whether such a shock is worth it, and whether normal motion can be restored, to which the answer is, emphatically, “Yes”—if the work is done sensitively.

Developmental Connections

If the nose work puts us just adjacent to the lower reaches of the cranial portion of the dorsal cavity, it also puts us at the upper reaches of the visceral cavity.

Uniquely in humans, though this perhaps applies to giraffes and kangaroos as well, the viscera hang from a spine that is oriented vertically instead of horizontally. This puts special tensions and emphasis on the superior end of the system, specifically the hyoid bone for the trachea, which in turn hangs from the mandible and the temporal bones, and basilar portion of the occiput via the median raphé for the pharynx and esophagus.

The autonomic nervous system, which could be said among its other functions to be the governor of the organs of the visceral space, is topped by the pterygopalatine ganglion, the largest of the peripheral parasympathetic ganglia, which lies between the sphenoid and the palate near the sphenopalatine foramen. Perhaps appropriately, the upper pole of this fluid system controller is linked to the lacrimal glands, and thus to tears of joy or sorrow. Opening the tissues around this ganglion seems to help open the parasympathetic outflow as a whole.

This brings us to our final and most general point about nasal work. Just behind the nose, we find a most fascinating and primal spot that links the early development and the three primary germ layers (Figure 9). At the bottom of the cranium lies the hypothalamic-pituitary axis, certainly a center of control for the neuro-glandular ectodermal layer.

The pituitary sits in the sella turcica of the sphenoid body. Just behind and below lies a major junction point of the mesodermal system, the sphenobasilar junction, a central junction box for the cranial flexion-extension movement that is transmitted throughout the mesodermal and perineural fascia. And just behind and below this lies the upper pole of the endodermal system, the attachment of the gut tube—the esophagus and pharynx attaching to the clivus on the basilar portion of the occiput.

Figure 9. Just behind the nose, and within a couple of centimeters of each other, are three central “junction boxes” related to the three primary germ layers: ectoderm, mesoderm, and endoderm.

All three of these centers of movement are within a couple of centimeters of each other, and it is not beyond the pale to imagine that they are in communication with each other, “listening” to each other. Does the pituitary perceive the reaching of the lips toward a ripe plum or the pull of a heartfelt kiss? Can the gut brain feel the pull of the craniosacral pulse of the occiput via the pharyngeal raphé? Self- maintenance and optimal health is composed, in the author’s opinion, from such internal rhythmic communication. Opening the middle of the head, be it through meditative awareness, indirect technique from the cranial vault or palate, or yes, even directly through the nose, is a road to juicy inter-system communication, a phrase which in itself could stand as a definition for true, body-wide structural integration.

Footnotes

1. Certain neuro-muscular therapy (NMT) method schools have included work in the orbit under the eyelids with a finger or via a cotton swab. Judith Walker Delany (by letter, May 31, 2000) states that her program “no longer includes eye work, due to possible problems such as glaucoma, retinal detachment, and possible negative response in blood pressure due to stimulation of baroceptors within the eyeball.” She and her staff recommend extreme caution to their practitioners who wish to practice this work, and a prior eye exam for retinal integrity and ocular pressure to rule out these factors.
2. The pioneering work of F. M. Alexander and the Alexander Technique, particularly his emphasis on the body’s ability to lengthen, good body use, and the person’s relationship to gravity, was probably also another central source for Rolfing, even though it was less publicly acknowledged. The author is aware, via personal conversations with senior British osteopaths such as Jocelyn Proby, Margot Gore, and Betty Herbert, that Rolf ’s teaching was directly influenced by her contact with the Alexander Technique in London before World War II. This Magic Body by Jeanette Lee, an Alexander Technique teacher, was an acknowledged source of Ida Rolf ’s. During an informal discussion in one of Dr. Rolf ’s final classes in 1978, students were asking about various pioneers in the world of somatics, and the author ventured, “What about Alexander?”“He did a good job conquering Egypt,” snapped Dr. Rolf. End of conversation.
3. When Dr. Rolf taught the method, she used latex finger cots lubricated with mineral oil with added eucalyptus. Subsequently, most structural integration schools have switched to the more inert K-Y jelly as a lubricant, and vinyl or nitrile gloves as a help for those—practitioners or clients—who have a latex intolerance.

References

Barral, J. P. (1993). Urogenital manipulation. Seattle, WA: Eastland Press.

Feitis, R. (1978). Ida Rolf talks. Boulder, CO: Rolf Institute.

Folweiler, D. & Lynch O. (1995). Journal of Manipulative and Physiological Therapeutics. 18: 38-42.

Janse, I., Houser, R. H., & Wells, B. F. (1947). Chiropractic principles and technic. Chicago: National College of Chiropractic, 623.

Lee, J. (1946). This magic body. New York: Viking Press. Milne, H. (1995). The heart of listening. Berkley, CA: North Atlantic Books.

Myers, T. (2001, 2014). Anatomy trains. Edinburgh: Churchill Livingstone, Elsevier.

Pick, M. (1999). Cranial sutures. Seattle, WA: Eastland Press.

Price, W. A. (1939). Nutrition and physical degeneration. New Canaan, CT: Keats Publishing.

Rolf, I. P. (1976) Rolfing. San Francisco, CA: Dennis Landman Pub.

Upledger, J. (1983). Craniosacral therapy. Chicago, IL: Eastland Press.

Thoughts on Intra-Nasal Work