A number of important advances have been made in the last few years in the understanding and practice of our work. Creative investigations and advances have emerged from many directions. One critical area of concern has been the Advanced work. What makes Advanced work advanced? How is it different from basic work? And how is Advanced work best taught? In this article I want to examine some of these questions by exploring the underlying theory of the C-position strategies and techniques. More specifically I want to look at why, when, and how to use the C-position in light of what we now know about how to strategize Rolfing sessions according to principles and about spinal biomechanics.
Principles, Strategies, Techniques, and Formulas
Let us look first at the implications of discovering how to articulate the principles of Rolfing. Rolfers and Rolfing instructors alike have labored for years under a Set of systematic, but unexamined ambiguities surrounding our use of the word recipe. A recipe by definition is a formula for compounding a preparation. Recipes are based on principles. They are not principles. Simply by definition alone, the principles of the art of cooking, say, cannot be contained in a recipe or any possible set of recipes. Even if the meaning of recipe is broadened to match the way Rolfers use the word (as a process to achieve structural/functional order, for example), the point still holds: recipes are not principles.
For years we have equivocated on and misused the word recipe with predictable consistency and confusion. It has served to mean one or all of the following fundamentally different concepts: 1) the principles (constitutive rules) of Rolfing, which were never fully or properly stated, but govern each and every Rolfing intervention; 2) the vast array of strategies (rules of thumb) which state how all the various deviations in structure and movement might be brought toward normal and which vary from client to client and session to session; 3) the vast array of techniques (including direct and indirect myofascial and movement techniques) by which these strategies are implemented; 4) the goal or goals of Rolfing, which like the word recipe is systematically ambiguous and most often confused with principles and/or strategies, but properly belongs as f the definition of Rolfing; and finally the only meaning that properly belongs with recipe, 5) the formulistic patterns of working which are designed to guide a practitioner toward manifesting the formulistically stated “goals” (i.e.,strategies) of the ten-series. Unfortunately, conflating these quite different meanings often has lead us astray in our understanding, teaching, and practice of Rolfing 1.
There can be no question: the ten session framework is a marvelous example of Dr. Rolf’s genius. It is a richly textured, evolving, and adaptable framework which has served as a powerful pedagogic tool and practical guide for working with some of the many different individual structures.
Now that we are in possession of the principles of Rolfing, an understanding of spinal biomechanics, and an elegant taxonomy of body types, we can understand the ways in which the recipe(s) have provided us with a profound and indispensable map of structure. We can also see with much more clarity how the recipe(s) have lead us astray. We now can easily demonstrate where any particular formulistic recipe conforms to principles and where it does not. We can also show where these different versions of the recipe are strategically biased toward certain body types and structural issues and, hence why they are incapable of handling other types and structural issues. With this clarified understanding, our work and teaching cannot help but become more effective and precise. Since we are no longer under the spell of confusing strategies, techniques, and working positions with principles, we can undertake more clearly the task of deciding which techniques belong to Rolfing and which do not.
The Basic/Advanced distinction as it is presently understood is also somewhat confused because of the above conflation of meanings. The distinction has more to do with how Rolfers strategize their work than with the inherent nature of Rolfing. When a Rolfer proceeds according to principles rather than formulas, no essential difference exists between what goes on in a ten series and what goes on in postten work. It follows that we become more effective Rolfers to the extent that we are able to cut ourselves loose from formulistic recipes and Rolf according to principles. Accordingly, we might say that we become basic Rolfers when we strategize our work more around following a formulistic recipe rather than principles. Andbecome Advanced Rolfers when we no longer rely on formulas, but instead strategize their work according to: principles.
To be sure, post-ten work can be construed around issues of repair, maintenance, and further more refined and efficient evolution/integration of the structure in ways that the ten-series tends to resist. Because the ten series accomplishes a great deal of a certain kind of preparatory and integrative work, the number of sessions strategized for an advanced series can be considerably less than ten. Thus, even though a distinction can be drawn between a Basic and Advanced Rolfer on the basis of working or formulistically verses working with principles, ex fence, training, and depth of understanding, no such distinction applies to Rolfing itself.
Before we were able to make and understand the distinctions between principles, strategies, techniques, and formulas, we hoped and believed that the Advanced Training, “would allow Rolfers to finally own the work.” Because the Advanced Training was still too firmly rooted in a formulistic five-series, however, the hoped for goal of owning the work remained unfulfilled for many of us. An Advanced five-series or three-series that follows any kind of recipe is a contradiction in terms. Therefore, by the very nature of formulism, teaching an “Advanced recipe” cannot provide the appropriate didactic framework within with Rolfers can own the work.
There is no simple, short, and easy path to “owning the work”. Many conditions must be fulfilled first. From theoretical understanding to intuition, some of these conditions are easy to state and teach and some are very difficult. A clear theoretical and practical understanding of the goal of Rolfing and a comprehensive local and global taxonomy of structure are certainly very important, related conditions. Attaining to a highly organized knowledge base coupled with embodying the perceptual vitality required to see structure and recognize how well or poorly individuals manifest structural order are clearly another set of important conditions. But without the ability to theoretically and practically distinguish between principles, strategies, techniques, goals, and formulas, “owning the work” becomes a very difficult and confusing task. Becoming an Advanced Rolfer requires, at the very least, learning how to strategize our sessions and manipulative /movement interventions according to principles and not according to formulistic recipes. To conceive of any Advanced series as a kind of recipe is a conceptual and practical mistake, a mistake that not only seriously compromises the very possibility of training Advanced Rolfers, but also threatens the structural of our clients.
From the very first session of Rolfing to the nth session, the question of how, where, and when to work is determined by observing the unique structural and functional needs of each client with respect to the goal of Rolfing and then strategizing and implementing the sessions according to our principles. The number of sessions required to bring about a satisfactory level of structural integration and functional economy is altogether a strategy question, not a principle question, not a principle question. The ten session, five session, and three session formats are typical and powerful strategies for effecting change. They are not principles. As such, no justification other than dogmatism exists for claiming that all Rolfing for a is must always begin with a ten series or that Advanced Rolfing must take place in a one, three, or five series.
Please understand that I am making a conceptual point that has important practical implications for our work. I am not saying we should abandon the ten session recipe(s). Recipes have their place in the early stages of learning how to see and Rolf. I still work and teach within the ten-session strategies. I argue, in fact, that it is very important in the early stages of learning how to Rolf that practitioners be taught to understand, recognize, and avoid the dangers of breaking certain fundamentally important strategy rules, including the strategy of “ten sessions”. Once a practitioner’s understanding has matured to where she/he is in command of our system and can make structurally discriminating choices, breaking strategy rules is not problematic. But, we need to understand that the “basic ten series” is not a principle. It is a strategy. Leaving aside practical considerations for beginning practitioners, since the words always and never only can be said of principles and not of strategies, no logical or empirical justification can be given for insisting that Rolfing must always take place in a specified number of sessions.
The same considerations apply to pelvic lifts and the various positions employed in Rolfing from the so-called sixth hour position to the Z, C, and L positions. They should not be construed as principles. They are, rather, part of the positional strategies and techniques of Rolfing. Construing an entire session around a positional strategy, such as the C, Z or L in the formulistic five-series, is problematic. It not only violates the principles of Rolfing and undercuts our goal of training Advanced Rolfers, it also compromises the structural integrity of our clients.
In order to understand some of the inherent limitations of the C- position and why it is only useful a certain percentage of the time, we first need to understand spinal biomechanics. We need to understand the complex but patterned ways normal and not so normal spines behave in order to learn how to Rolf them properly. Once we have gained some understanding about the ins and outs of side bending and rotation, we will be better able to understand when the C-position is appropriate when it is not and why designing an entire session around it is a mistake. We shall also discover why not understanding spinal biomechanics can severely limit both our ability to organize the spine and achieve structural integration and function economy.
In order to guarantee that we are all speaking the same language in describing the body, we have adopted the biomechanical language created by the Osteopaths. However, I want to emphasize at the outset that adopting their language does not imply that we are adopting their techniques for de-rotating vertebrae and treating spinal lesions. In fact, the techniques we have developed to handle the spine are uniquely Rolfing in nature. The development of these Rolfing techniques do not constitute, therefore, an encroachment of Osteopathic techniques or high velocity, low amplitude osseous thrusting techniques into our work or classes.
Before I proceed any further, I want to acknowledge our debt to Michael Salveson and Jan Sultan for their pioneering efforts in bringing the language and understanding of spinal biomechanics into our teaching. Jim Asher and others have been working in this arena also. But I was first inspired and encouraged while co-teaching with Jan and then Michael. Much of this article comes from and rests on what I learned from them. Their success in creating new techniques and positional strategies based on an understanding of spinal biomechanics finally has given us a way to handle, with Rolfing technology alone, spinal curvatures and rotations with as much clarity and precision as any other manipulative system. In fact many more times than not because of our unique integrative third paradigm orientation, the Rolfing approach is more precise and more long lasting.
Following Jan’s and Michael’s lead, I continued to study spinal biomechanics. From these studies, I learned about flexion and extension facet restrictions in what are called Type II spinal dysfunctions, As I experimented and investigated further, I realized how important understanding and undoing them is to our goal of integrating the body in gravity. In attempting to develop Rolfing positional strategies and techniques for dealing these dysfunctions, it became clearer than ever that the C- position was not specific enough to do the job and in many cases actually lead us astray 2.
For the purposes of keeping this article at a reasonable length, I will limit our discussion of spinal biomechanics to the lumbar and thoracic spine. The cervical spine is just complicated enough to deserve a separate article. As a way of easing into this discussion, begin by positioning yourself in standing or sitting (this is called neutral position), place your thumbs on your transverse processes at L5 or L4, and side bend (laterally flex) to your right. Notice what happens under your . thumbs: your left transverse process is now more prominent (more posterior) than your right. In other words It anterior surface of the body of your vertebra is left rotated. If you side bend left, your vertebra will rotate right. This kind of spinal motion is called a Type I side bending, rotation and is considered normal. Generally, with predictable variations in the amount of side bending and rotation possible throughout the spine, the lumbars and thoracics normally exhibit Type I in the neutral position. Thus we way say: in neutral position, side bending and rotation go opposite directions in the thoracic and lumbar spine.
To continue our exercise, either forward bend (this is called flexion) or backward bend (this is called extension) and then side bend to your right. Notice again what happens under your thumbs. In flexion or extension, when you side bend to the right, your right transverse process becomes more prominent (more posterior), i.e., rotates right. Side bend now to your left and your left process becomes more prominent (more posterior), i.e., rotates left. This kind of spinal motion is called Type II side bending rotation and is considered normal. Thus we may say: in hyper flexion or hyperextension, side bending and rotation go in the same direction in the thoracic and lumbar spine.
It is worth pointing out that the above description of the normal coupling of side bending and rotation in certain respects is somewhat controversial. The fact that all theoreticians are not in agreement, however, is not essential to the practical consequences derived below for Rolfing.
In general, side bending will not occur without rotation and rotation will not occur without side bending. In particular, the lumbar spine can side bend more than it can rotate and the thoracic spine can rotate more than it can sidebend.
To clearly demonstrate by exaggeration side bending rotation patterns in the spine, I have included the illustration, found on the opposite page, by Jan Sultan which displays a rotoscoliosis.
Ignore for the moment how and why spines get in trouble and realize that our spines can become dysfunctional in a number of ways that show up as motion restrictions, a in, and loss of structural and functional integrity.
Vertebrae can get locked up singly or as a group in either Type I for Type lI side bending rotations. Type I side bending rotations may or may not exhibit vertebral restrictions, but the appearance of Type II’s in neutral position in the lumbars and thoracics almost always signals vertebral restrictions. In the neutral position, for example, when Type II dysfunctions are discovered in the thoracics and lumbars, they are often the site of a great deal pain. Type I and especially II dysfunctions are also more often than not at the root of those spines that resist integration through Rolfing lengthening techniques. Providing length through direct techniques, dealing with primary /secondary “shortness”, and creating pelvic mobility typically will not undo many of these restrictions, rotations, and curvatures. Without the ability to recognize these dysfunctions and apply the correct specificity of technique, our ability to organize the spine and the body in gravity will be limited.
In order to understand Type II dysfunctions more completely, we must understand what is meant by extension and flexion restrictions. Consider that when we bend forward and backward the facet joints open and close respectively in an accordion like fashion. In Type II dysfunctions, what happens is that the facets become restricted either in flexion or extension. In a Type II flexion restriction the restricted facets are fixed open and hence, cannot close in backward bending. In a Type II extension restriction the restricted facets are fixed closed and, hence cannot open in forward bending.
From our standpoint as practicing Rolfers, it is critically important that we know how to recognize and undo these spinal dysfunctions in order to integrate the body in gravity. Experience has shown over and over again: the extent to which these spinal dysfunctions have not been handled properly is often the extent to which it is not possible to bring about the next highest level of structural integration and functional economy for our clients.
Left Side bend with Right Rotation(see image below)
Right Side bend with Left Rotation (see image below)
Clearly, undoing these dysfunctions requires knowing with some precision where the facets are restricted. A number of simple and straightforward tests have been devised for determining where and how the facets are restricted. In order to keep this article manageable, I will neither attempt to describe these tests nor explain the logic behind why the facet restrictions are located where they are. For the purposes of our discussion, then, we only need to know where the facet restrictions are located.
As I noted above, in Type II flexion restrictions, the facets are fixed open and unable to close in back bending. In Type II extension restrictions, the facet fixed closed and unable to open in forward bending. In Type II flexion dysfunctions, the restricted facet is on the side opposite to the prominent (or posterior) transverse process, opposite, that is, to the way the vertebra is rotated. In Type II extension restrictions, the restricted facet is on the same side as the prominent (or posterior) vertebra, that is, on the same side to which the vertebra is rotated.
In attempting to deal with the shortcomings of the C- position, a number of direct and indirect techniques were created. Unfortunately, rumor substitute for critical thought perpetuated the idea that these techniques were mere “fix-it-techniques” taken from other systems, and, hence had no place in our work. This rumor was fueled partly by an unexamined assumption that fix it work and integration are in some unspecified way incompatible. A clear-headed examination of the theoretical issues , involved reveals, however, that the dispute over whether Rolfers should engage in fix-it-work or in evolving/ integrating the structure is really just another pseudo dispute.
As it turns out, if we want to do our job as Rolfers and do it well, we must do a certain kind of Rolfing manipulation that might loosely and inappropriately be called “fix-it-work”. As Rolfers we are not interested in performing the fix-it-work of second paradigm corrective practices. These practices tend to deal with symptoms and only aim at restoring the restricted body-parts to their local pre-dysfunctional position. In contrast, we are third paradigm integrative practitioners interested in the kind of Rolfing manipulation that serves the larger goal of organizing the body in gravity.3 Without the appropriate kind of Rolfing-third-paradigm specificity, our ability to achieve structural integration and functional economy will be unnecessarily compromised and in many cases severely compromised.
We should realize that labeling this kind of third paradigm Rolfing manipulation as “fix-it-work” is quite misleading. Releasing facet restrictions, de-rotating vertebrae, and normalizing curvatures by means of Rolfing myofascial and movement techniques are critically important in our attempt to integrate the body in gravity. As such, they are no more or less a kind of “fix-it-work” than lengthening the hamstrings in the first or sixth hour or releasing “tight spots” in order to obtain length. Rolfing ultimately is a third paradigm system. Rolfing is not about spots, lesions, and body-parts. It is about the whole person in relation to gravity. That our third paradigm techniques happen to get rid of back pain, de-rotate vertebrae and ribs, and undo spinal curvatures with more precision and long lasting efficiency than most other system of manipulation should be a welcomed and expected outcome of our system.
The above discussion presents only the bare bones, so to speak, of spinal biomechanics. With this information behind us, let us turn our attention now to the C-position. Traditionally, the C-position was understood somewhat formulistically. It was seen as the third session in a formulistically constructed Advanced Five-series. Most of the session was done with the client in a tight side-lying fetal position. The client was instructed to find the front of his/her spine and to push from there back into the pressure exerted by the Roller on the client’s spine. This description of working in the C-position is somewhat simplified, but good enough for the present discussion.
We believed that this sort of co-operative effort on the Rolfer and client would normalize the curvatures of the client’s spine. We also believed that the C-position was especially well-suited to normalize flat spots in the spine. Sometimes we got good results, and sometimes we didn’t. And most times we were not sure why or how. Understanding spinal biomechanics, Jan Sultan’s Internal/External typology, and the principles of Rolfing now gives us a way to comprehend why and how the C-position sometimes works and sometimes doesn’t and when it is not appropriate.
Before we begin this discussion and to avoid misunderstanding, recall that the principles of our integrative third paradigm system say that spinal curvatures cannot be properly handled until certain minimal conditions have been reasonably established in the structure. If these minimal conditions are not met, then any attempt to organize the spine will either be ineffective or create strain elsewhere in the structure.
Although these conditions must be laid out in what appears to be a somewhat linear temporal sequence, please keep in mind that any one session or series of Rolfing sessions always involves the reciprocal application and understanding of all our principles at once. As the work of Rolfing progreses, some principles may become more important than others for a time and then later other principles may take precedence. Recognizing how the principles change in relative importance to each other over time does not negate the fact that all the principles are under consideration whenever we strategize and/or implement a session or series of sessions.
These conditions are: 1) the body must be prepared to be able to adapt to and sustain the changes introduced (Preparatory Principle), 2) back/front balance must established (Palintonic Principle), 3) the body must have support for the changes introduced (Support Principle), 4) pelvic mobility, pelvic order, and range of motion at the acetabulum must be established (Preparatory and Support Principles). All things being equal, the extent to which these conditions are fulfilled is the extent to which the spine can be organized (Wholistic Principle).
As we are about to see, the traditional C-position and its associated technology is not specific enough to properly handle most spinal curvatures. Instead of treating the C-position as if it were a principle and constructing an entire Advanced session around it, we, would do better to understand it for what it is, viz., a positional strategy. As a positional strategy, the C-position is just one of a number of possible side lying positional strategies. The more clearly we understand spinal biomechanics, the more specific we must become if we are to effect long last significant order in the spine. We must not only become. F more specific in where and how we apply pressure, but also more specific in where and how we strategically position our clients. The C-position has its place in our catalogue of positional strategies. But its role, like all our positional strategies, from sitting back work to tracking techniques, is limited to dealing with certain very specific structural issues. The C-position is neither the only nor the best side-lying position. It is just one of a number of side-lying positional strategies. Let us see how and why this is so.
Michael Salveson pointed out some time ago that putting most clients into a tight fetal C-position takes up most if not all of the available slack, or better, adaptability in the spine. This loss of adaptability, prevents the body from being able to absorb the changes we are attempting to introduce. In short, the tight fetal side lying C-position often violates the Preparatory Principle.
Given what we now know from Jan Sultan’s Internal/External Typology the C-position may be useful in some cases for clients with anterior lumbars, but not for clients with posterior lumbars. A more appropriate side lying position for a client with posterior lumbars is not the tight fetal-C where the knees are pulled into the chest, but one in which the client’s knees are pulled as far away from the chest as is comfortably possible. This position encourages a lumbar lordosis which enhances the effects of the manipulations.
Unfortunately, for at least two reasons the C-position is not useful for all cases of anterior lumbars. The first reason has to do with the fact that many lumbar spines (anterior and posterior alike) have one or more Type II flexion restricted facets. As we shall see in the examples below, restricted facets characteristically will not respond to techniques associated with the C-position. The second reason has to do with the fact that many lumbar spines (anterior and posterior alike) have one or two vertebrae that are caught in a retrolithesis 4. A retrolithesis occurs when a vertebra is restricted in an abnormally posterior position with respect to the vertebrae below it. One or more retrolitheses are often encountered in low back problems. If they are not handled properly, the lumbars will resist mobilization and normalization and, hence integration. Using the, C-position to deal with lumbars that have a retrolithesis by enjoining a client to push her lumbars posterior as the Rolfer pushes anterior is ineffective at best and dangerous at worst.
It was believed for a long time that the C-position and its associated techniques were ideal for normalizing flat spots and / or anterior vertebrae. But even this belief turns out to be false. Flat spots are interesting and somewhat complicated. They almost always harbor Type II dysfunctions with extension and/or flexion restrictions. Attempting to employ the C-position on flat spots or on anterior thoracic vertebrae that have flexion restrictions simply does not work. Remember, a Type II flexion restriction is one in which the facets are fixed in flexion and cannot close in back bending. Placing a client in the extreme forward bending side-lying C-position, therefore, exaggerates the flexion fixation. Applying indiscriminate pressure to the restricted area in this position rarely if ever undoes the restriction.
Flat spots will not yield unless you are very specific in your approach to the flexion and/or extension restrictions and to the curvature. Shot-gun techniques which make the back red will not, except in rare accidental cases, take care of these spinal dysfunctions. In order to give a somewhat abbreviated sense of how this specificity of approach might look, let us consider how we might deal with flat spots in the thoracic spine using a number of side-lying positional strategies.
First you must find and release all the flexion and extension restricted facets. As a general rule, remember that most traumatic facet restrictions are to be found at the top or bottom of a curve. Suppose you find a number of flexion and extension restricted facets and you decide to deal with the flexion restrictions first. Place your client in an easy neutral side-lying position. Then, put your elbow or knuckle on the restricted facet (which is opposite to the rotation), and instruct your client to back bend slowly as you apply pressure. When coupled with the appropriate direct and/or indirect pressure, back bending encourages the open fixed facet to close. In the great majority of cases this technique should release the restricted facet. Repeat this technique with the remaining flexion restricted facets. Once the flexion restricted facets are released, you then can attempt to de-rotate the vertebrae. Position your client on her other side and apply pressure (using direct and/or indirect techniques) to the spinal groove to de-rotate her vertebrae as she lies passively or pushes back.
Extension restricted facets require a slightly different approach. But, like flexion restrictions they will field, if you are specific in locating the extension restricted facets and specific in applying your pressure. Place your client in an easy C-position and apply p re (using direct and/or indirect techniques) in the spinal l groove to the restricted facet as your client curls forward and pushes into your pressure. Since the extension restricted facet is on the same side as the rotation, this technique should undo the facet restriction and de-rotate the vertebrae at the same time. Barring other contributing s such as rib dysfunctions, for example, it should not be necessary to put your client on her other side for further manipulations as you did in the flexion fixed example.
Once you have released and de-rotated all the flexion and extension restrictions in the flat area of your client’s thoracic spine, you can put your client into an easy C-position and ask her to push back as you apply pressure. Realize that the amount of change you can expect from each client will vary considerably and that limits exist in each client for how much change is actually possible.
Obviously, the above examples do not exhaust the kind of Rolfing spinal manipulations that are often required. Notice, for example, you can use a variation of the above techniques when you encounter Type II flexion restrictions in the lumbars. Put your client in the side lying position and ask him to turn his “tail” back to begin encouraging the facet to close. As your client’s lumbar lordosis increases, apply pressure to the restricted facet. After the facet releases, turn your client over on the other side and de-rotate the vertebrae. Sitting positions, including the positional strategies and techniques of the L position, often are also very effective. In some cases the L-position and other sitting positional strategies which combine movement with direct and indirect manipulations are more effective with advanced structures than side lying positions. Hopefully, however, enough examples have been provided to give a picture of how this sort work proceeds and show why the C-position is just one of a number of side-lying strategies with limited but specific uses.
Before I lay out the general strategy for organizing the spine, I want to underscore the importance of making sure the our client’s bodies are prepared to accept this level of work. It is very important that both ends of the spine a before this work is attempted. Understanding he her to recognize and manipulate toward normal the many dysfunctional patterns possible in the cranium and pelvis is absolutely essential for organizing the spine. The cervical spine also plays a very important role in all of these considerations. The sacrum, for example, can exhibit Type I dysfunctions and Type II flexion and extension restrictions. These rotations must be handled in order for the lumbars to stabilize. Many times the pelvis will exhibit a combination of complicated dysfunctional patterns, all of which must be handled properly if the spine is to find its place of order and functional economy. The pelvis can exhibit dysfunctions in rotation, torsion, tilt, shift, in-flair/out-flair, and shears Shear very often escapes detection. But recognizing and undoing it is critical for the resolution of many back problems, apparent leg length discrepancies, and the achievement of our goal of organizing the body in gravity. Shear can show up as a superior/inferior displacement of ilia on sacrum (called up-slip/down-slip) or as an anterior to posterior displacement most easily palpated at the pubes. With training and practice all of these many dysfunctional patterns can be brought efficiently toward normal with Rolfing techniques alone.
Without going into any more detail than is minimally necessary, the general strategy for organizing and integrating the spine can be summarized rather simply. Realize, however, that when viewed in the neutral position, all spines, no matter how much Rolfing they have had, will exhibit some degree of group side bending rotations. In point of fact, I do not believe that a well functioning spine could exist without some side bending rotation. I believe that a certain kind of side bending rotation is an expression of functional economy and, therefore, absolutely necessary to our well being. But such speculation is the subject of another article. The important point is that some of these side bending rotations are dysfunctional and some are not.
First, make sure the body has adequate support, back/front balance, and enough overall decompensation to absorb and sustain this level of work. Next, open and clear restrictions and rotations in the cranium, atlanto occipital junction, and in the pelvis, sacrum and lumbo sacral junction. Locate all Type I and Type II single and group dysfunctions. First undo all Type II restrictions and de rotate all associated vertebrae. Then un-do all Type I dysfunctions. Undo all rib dysfunctions.
Obviously, the work of Rolfing goes beyond the corrective second paradigm goals of fixing spots and lesions. Since our work aims at integrating the body in gravity, the next level of work should attempt to locate and deal with the remaining curvatures that are not dysfunctional but stand in the way of bringing the body structure to its next possible level of structural integration and functional economy. Every attempt should be made, within the limits of what the client’s structure will permit and what is functionally appropriate and economical, to reverse these remaining curvatures. This work can be accomplished by using a variety of positional strategies which can include but need not be limited to all the side lying positions along with a combination of direct and indirect Rolfing myofascial and movement techniques. Obviously, the number of session, required to bring about a satisfactory degree of order in any given client’s spine will vary greatly.
I want to bring this article to its conclusion by quoting at some length from I.M. Korr Ph.D., a Professor of Physiology at Kirksville College of Osteopathy and Surgery. His views are potent and important for our work. Discussing the non-segmented “symphonies” of motoractivity that are orchestrated and carried out by the spinal cord and higher centers, he says,
“The important point is that these patterns of activity involve neurons up and down the spinal cord, each being called into play according to the pattern required at the moment not according to where the neuron is located in the cord but according to what structure it innervates. Where it “lives” segmentally is of no importance…
“This presents us with an interesting paradox: the normal patterns of activity mediated by the spinal cord are completely non-segmental in nature …yet the spinal cord is obviously segmented and the physician [also Rolfer!] is very much concerned with segmental relationships … Nevertheless, in normal life segmental relationships do not appear.
“The reason for this paradox may be best conveyed by [an] illustrative simile. Consider a beautifully executed parade of skilled marching men, where the many ranks and columns are seen as patterned activity of the whole parade. We do not see individual ranks and certainly not individual marchers, we see patterned motion. But let something go wrong, let one of the marchers lose step and his rank immediately becomes conspicuous. The other marchers cannot compensate in a coordinated manner and soon the ranks on either side are thrown into confusion and then we do see segmental relationship. It is something like this that causes segmental relationships in the spine to emerge into view …A segment “in view” is a segment in trouble…
?How shall we reconcile this paradox? First by realizing that the thing that is segmented is the armor that houses and protects the cord … In normal life the segmentation is not of the spinal cord itself; the segmentation is in the assembling of the nerve fibers into “cables ” roots and nerves that can pass out to the tissues innervated. What is segmented is ingress and egress, not the function of the cord itself 6.
The implications of Dr. Korr’s ideas for the work of Rolfing are interesting and important. Obviously, given Dr. Korr’s wonderful example of the marching soldiers, putting bones “back into place” is not the best way for us to understand or visualize spinal manipulation. As Rolfers we are interested in bringing the “segments in view” to where they top acting like out of step segments and to live in step with the body’s potential organized and patterned fluidity. We are not just interested in the spine, of course. We are also interested in seeing and encouraging organized patterned fluidity throughout the entire body.
To suggest that Rolfing adjusts or puts vertebrae back into place in the manner of second paradigm corrective practices simply misses the point and power of our system of manipulation. When we look at a client’s structure and movement patterns, we look through the lens of our wholistic/integrative orientation. Part of what we look for are breaks or fixations (what Dr. Korr calls “segments in view”) in the overall continuity of structure and movement. We look for places, that is, where the body exhibits loss of integrated structure and functional economy. The “segments in view” often show up as fixations in the myofascial, ligamentous, and articular systems. These fixations create varying degrees of local immobility which in turn inhibit normal integrated movement. Once these fixated “segments in view” are identified, we strategize our sessions, in part, around releasing them in order to assist our clients in finding what constitutes normal structure and normal function for their bodies.
Although Dr. Korr is speaking only about the spine, he points out something familiar to all Rolfers: when we see normal movement and structure, we see organized patterned fluidity; we do not see the segmental nature of the body. From a certain anatomical perspective, of course, the body is segmented. However, the segmental character of the body is lost to view in normal function and normal movement. With our Rolfer’s eyes, segments come into view only when the body is in trouble, when there is a disturbance in normal function and normal structure.
The job of Rolfing is not simply to restore what w immobilized and segmentalized to its local pre-dysfunctional place of normal motion. If we discover ‘for example, that L4 is left side bent, left rotated on L5 with a flexion fixation, we are not simply interested in putting L4 right with respect to L5 and releasing the articular fixation. Rolfing is about something much bigger. Our profound interest is in bringing a persons structure and movement to a higher level of order than it had exhibited prior to its disruption. Our work is done, not when bones are “put into place” and articular fixations are mobilized, but when we see the organized flu fifty of functionally appropriate patterned activity throughout the entire body, not just in the spine. We, of course, call this functionally appropriate, organized fluidity integration. Because Rolfing is an integrative third paradigm system, it has the potential to create a transformational organized fluidity in the body person sufficient to prevent regression back into previously disordered and dysfunctional patterns, and sometimes sufficient to transform the whole person.
From our third paradigm perspective, the concept of putting body-parts back into place is, at best misleading and at worst suspect. The example of the marching soldiers is suggestive. Order is not restored to the marching columns by attempting to move the out of step soldier into some other position. Segmentalization disappears and order is restored by simply getting him back in step with the whole, by restoring, that is, normal motion.
The implications of these insights are important. Without taking into account and understanding the unique movement patterns and unique structure involved with each individual client and his/her relation to gravity, how could one know where any given vertebra or bone should be ideally positioned? Even at the local level of an articular fixation, we cannot separate structure, position, and function. Because an articular fixation involves both bony position and joint fixation, it is simultaneously a structural and functional phenomenon. The truth of the matter is that we will never understand properly the concepts of position and structure if we abstract them from the concepts of function and gravity, that is, from what is functionally appropriate for each individual client in his / her relation to gravity.
Consider any ten people with the same “out of place” vertebra. Where home is, what position each of these different vertebrae belong in is somewhat different for each person. The vertebra is considered “in place” when we see normal, non segmentalized, movement patterns. In step means not only in step with the rest of the spine but also in step with the whole body in relation to gravity. From our integrative perspective every segment must be in step both locally and globally. This recognition is an expression our Principle of Wholism.
Seeing organized, non-segmentalized, fluid patterns of movement is equivalent to seeing a body that is approaching structural integration. Out of place in our system means out of appropriate structural/functional relationship locally and globally in gravity. In place means in appropriate structural / functional relationship locally and globally in gravity. I am not denying that bones change their positions through Rolfing manipulation. But, I am saying that where they end up from Rolfing manipulation is completely determined by how they relate locally and to the whole, that is, by what is structurally and functionally appropriate and possible for each individual in relation to gravity. Local and global positioning of bodily segments and components is important in our work. But position can never be abstracted from functional appropriateness and gravity. Position is determined by appropriate function and gravity.
Abstracted from appropriate function, and gravity, there is no ideal position for vertebrae and other segments, and there is no ideal position for every body. And just as there is no ideal position for every body, there is no ideal body. This Platonic notion of an Ideal Body and its sister concept of a Template have been part of our history for a long time. They were created to fill a conceptual and practical vacuum. Without a somewhat coherent and complete local/global taxonomy of structure and without a clear statement of Rolfing principles, our formulistic recipes required these Platonic notions to guide our work. We no longer require these notions now that we have a clearer understanding of Rolfing principles and a taxonomy of structure, a taxonomy that includes, but is not limited to, the Internal/External typology and spinal biomechanics 7.
Platonism is rooted ultimately in the denial of the body, the feminine, and our earthly existence. I am not suggesting that Rolfing is rooted necessarily in the same denial. I am claiming only that we no longer need these Platonic notions to guide our work and that we would be wise to abandon them. What is ideal is what is optimal for each individual. What is optimal is what is functionally appropriate for each individual structure in his/her relation to gravity. Any Structural Ideal that ignores what is functionally appropriate, economical, and possible for each individual can never be realized in the lived reality of human life. The Line may be straight, but functional spines are never straight. They always have some degree of necessary side bending rotations. Functional bodies are not straight either. They will always display some degree of segmental rotation 8.
Without taking into account what is functionally appropriate, economical, and possible for any given body person, we cannot say with any authority or accuracy what constitutes structural integration for that person. Structure and function are not two separate and distinct realities that somehow obscure each other from view. They are two ways of talking t the unitary phenomenon we bodily are. As I have stated elsewhere, structural integration and functional economy are logically equivalent: one cannot appear without the other and the condition of one expresses the condition of the other.
All of these considerations should lead us to realize that even though a fair number of important theoretical and practical advances have been made in the last few years, we still stand in great need of a clear comprehensive phenomenolgy and science of structural integration and functional economy 9.
In any case, no matter how we look at the theory and practice of Rolfing, spinal biomechanics and spinal manipulations are critically important and essential to our work. In discussing the importance of the spine to her work, Dr. Rolf herself said, “The vertical thrust of the bipolar unit is the expression of a competent spinal structure – lumbar, thoracic, and cervical. This is a spine that moves independently of pelvic and shoulder girdles. The vital core is free of the working sleeve and is characterized by a vertical thrust.”10 If we refuse for whatever reason to properly manipulate the spine, and if we dogmatically insist on strategizing an entire session around the C-position, we risk undermining Dr. Rolf’s own understanding of her work and failing at what we claim to do best. We risk becoming inept at organizing the body in gravity and creating functional economy 9.
1 As background for the present article and for a more complete discussion of the concepts and issues involved see the following articles: 1) Definition and Principles of Rolfing by Sultan and Maitland, ROLF LINES (Spring, 1992); 2) Rolfing: A Third Paradigm Approach to Body-Structure, by Maitland, ROLF LINES, (Spring, 1992); 3) What Is The Recipe?, by Maitland, ROLF LINES, (June/July, 1991).
Unfortunately, a small amount of unnecessary confusion is beginning to accumulate around the concept of principle. See Peter Fuchs’ all too brief antinomy in ROLF LINES, (Summer, 1992), p. 34; and his further criticisms in ROLF LINES, (Fall, 1992), pp 27-28. Simply stated, Fuchs does not appear to have grasped the significance of the distinction between principles and strategies. Recognizing that differentiation might result in a lack of integration or even disorder in no way shows that our Preparatory Principle is not a principle. Our statement of Rolfing Principles allows for certain possibilities: a) differentiation may or may not create integration, b) we may fail in our attempt to create integration and/or sometimes create disorder, and c) preparatory strategies may at times produce some degree of predictable disorder as an unavoidable but essential prelude to order. In our article, Definition and Principles of Rolfing, we made two important points which allow for the above possibilities: principles state only necessary, not sufficient conditions and no principle can be fulfilled unless all are (Wholistic Principle). Fuchs’ argument seems to work only if one ignores the role of the Wholistic Principle and makes the further gratuitous assumption that the principles also state sufficient conditions.
For the purposes of argument, even if we pretend for the moment that Fuchs’ failed attempt at an antinomy were successful, at most he would have shown that we were wrong in claiming that “differentiation precedes integration” not that the Preparatory Principle is not a principle.
When Fuchs claims, “Integration or disintegration are wholly the result of proper or improper sequence of temporal interventions”, he is making a confused point about strategy and technique. Without the existence of a formulistic recipe and/or a tacit or articulate understanding of principles, no rationale (good or bad) exists for the temporal sequencing of strategies and interventions. That is, no rationale for decision making would exist for Fuchs’ “nitty gritty case by case analysis”. How do we decide, after all, what strategies and techniques to employ in any given analysis? Every analysis, by its very nature, is already a case by case strategy session which attempts to lay out an effective temporal sequence of interventions. Contrary to what Fuchs’ seems to overlook, the sequencing of interventions must be based on something. It could be based on a formulistic recipe. It could be based on a tacit, or better yet, articulate understanding of principles aiming for the goals of structural integration and functional economy. In any case, whatever it is based on, integration or disintegration cannot be, therefore, wholly the result of the temporal sequencing of interventions.
Thus, strategies are stated in temporal language and principles are not. By missing the significance of this distinction and making the un argued, unexamined assumption that the concept of logical priority “makes no sense”, Fuchs quite clearly begs the very question at issue. This logical fallacy like the remainder of Fuchs’ criticisms rests on un argued and unsupported opinion rooted in an apparent failure to grasp the significance of the concepts and distinctions at issue.
Fuchs’ question concerning which interventions create integration or disintegration has not been side-stepped. Nor is this question any more “crucial and interesting” than the ones we have been asking. It is simply one more among many important questions. However, the critical and important point is that this question, like so many of our questions, cannot be answered properly without first understanding, at the very least, the differences between principles, strategies, techniques, formulas, and the goals of Rolfing.
2 There are many excellent books on evaluation, treatment, and biomechanics. The best and most useful book in my library is THE PRINCIPLES OF MANUAL MEDICINE, by Phillip Greenman, (Baltimore, 1989). As an aside, I find it interesting that even though Greenman’s title indicates that his book is about principles, no principles of manipulation are ever articulated. Instead, the reader is treated to a wonderful discussion and catalogue of how to recognize and treat somatic dysfunctions, mostly from a second paradigm, corrective point of view. Greenman’s book is primarily about structural evaluation, treatment strategies, and techniques. It is clearly and obviously not about the principles of manipulation. I have read a great number of excellent books like Greenman´s. So far I have discovered that all the other manipulative disciplines including Physical Therapy are also confused, just as we have been confused, about the distinctions between principles, strategies, techniques, and formulas. They are also often confused about which paradigm of practice they belong to and usually only pay lip service to a rather confused inchoate notion of wholism. I was reassured to learn, therefore, that we are not alone in our struggles.
The most recent issue of PHYSICAL TRERAPY, devoted to the topic of Manual Therapy (Vol. 72, N°12, December, 1992), is a clear and interesting case in point. Missing in all the articles in this issue are: 1) a clear understanding of which paradigm of practice is being discussed, and 2) an understanding of the difference between principles, strategies, techniques, and treatment goals. The following statement from G.P is Grieve sobering: “Much of what we do is simply what has been proven on the clinical shop floor to be effective in getting our patients better – we do not always know why.” (Quoted by Farrrell and Jensen in their Manual Therapy: A Critical Assessment of Role in the Profession of Physical Therapy, p. 18/850)
3 As an interesting contrast to our third paradigm, integrative approach to manipulation, consider the following obvious second paradigm definition of manipulation from the Farrell and Jensen article, Manual Therapy, mentioned in the previous footnote: “Manipulation, in a general sense, means any manual procedure in which the hands or fingers are used to move a vertebral motion segment (i.e., two adjacent vertebra and their interconnecting tissues), soft tissue structure, or peripheral joint.” p.12/844
The consequences of making the distinction between a second paradigm and third paradigm definition of manipulation will be taken up again in the conclusion of the present article.
4 I first learned to call this sort of vertebral dysfunction retrolithesis from John Cottingham. For a radiographic picture of a retrolithesis and an excellent discussion of the effects of Rolfing on degenerative joint disease see John Cottingham’s Effects of Soft Tissue Mobilization on Pelvic Inclination Angle, Lumbar Lordosis, and Parasympathic Tone: Implications for Treatment of Disabilities Associated with Lumbar Degenerative Joint Disease, ROLF LINES, (Spring, 1992).
5 Tilt and shift are very often confused by Rolfers and other professionals. A pelvis can exhibit, for example: 1) posterior tilt-anterior shift, 2) anterior tilt-posterior shift, 3) anterior tiltanterior shift, and 4) posterior tilt-posterior shift. For an excellent discussion on the importance of learning how to recognize these different pelvic inclinations see the following articles all published in NOTES ON STRUCTURAL INTEGRATION, edited by Hans Flury: 1) Theoretical Aspects and Implications of the Internal/External System, by Hans Flury, (November,1989); 2) The Tilt of the Pelvis, by Hans Flury and Willi Harder, December, 1988); and 3) On Some Aspects of Folding, by Hans Flury, (March, 1987).
6 I.M. Korr, Vulnerability of the Segmental Nervous System to Somatic Insults in THE PHYSIOLOGICAL BASIS OF OSTEOPATHIC MEDICINE, ed., George W. Northup (New York, 1982), pp. 56-57. My italics.
7 Maintaining a belief in and commitment to the Ideal Body, the Template, and formulistic recipes leaves the Rolf system of manipulation and movement education open to many very cogent and serious criticisms. See, for example, Don Johnson’s excellent article, Somatic Platonism in SOMATICS, Vol. 3, No.1 (Autumn, 1980), pp 4-7. The following articles are not critical of Rolfing, but interesting in their own right. They were written by two gifted Physical Therapists who are friends of mine: The Ideal Body by Barrett L. Dorko, in PHYSICAL THERAPY FORUM, Week of December 17,1990, p. 9, and Wouldn’t It Be Grand by Darice M. Putterman, to appear in PHYSICAL THERAPY FORUM, early, 1993.
Formulism and Platonism are linked together so often that, I Think they maybe symbiotic notions that conceptually require each other. Fortunately, we are now in a position to break the spell that has bound us to Platonism and Formulism for so long. At this point in time, Johnson’s criticisms no longer apply to Rolfing. I strongly suspect, however, that just to the extent that any system of manipulation is addicted to formulism in any way is the extent to which that system is subject to Johnson’s criticisms. Any first, second, or third paradigm practice which unwittingly embraces formulism, more than likely will exhibit its own kind of Platonism with respect to its stated goals. Interestingly enough, many of those who have been the most outspoken critics of our past sin of Platonism are still teaching and working in formulistic ways without the benefit of articulated principles. If I am right in my suspicions, and I think I am, then our critics are committing the more insidiously pernicious sin of unconscious Platonism. By the way, I am not aiming my criticisms at the above authors.
8 Hans Flury has written a very interesting and important article that bears on this issue. He discovered that all bodies seem to exhibit a consistent pattern of standard segmental rotations. I believe that a careful examination of normal spines and craniums would reveal a standard pattern of side bending rotations consistent with and representative of the larger whole body pattern of segmental rotations discovered by Flury. If it turns out that all normal structures exhibit standard patterns of local and global rotations, then this discovery underscores the importance of understanding individual body structure in terms of function. Thus, a very important question immediately arises: what does normal function look like? As it turns out, Flury already has asked and begun answering this question. He distinguishes between extension based and flexion based modes of movement. He argues that the extension mode of movement constitutes normal function. He then gives three criteria by which to recognize and distinguish these two modes of movement. I believe that Flury’s approach constitutes an important advance in our ability to articulate and recognize normal structure and normal movement.
See Segmental Standard Rotation and Normal Function. Bothare to be found in NOTES ON STRUCTURAL INTEGRETION, (September, 1991).
The work of Gael Ohlgren and David Clark is also critically important to any attempt to describe normal function. At the January, 1993 Faculty Meeting they presente exciting and significant paper on walking. They began with an incisive critique of the standard kinesiological account of walking and then presented a phenomenology of whit king looks like for a structurally integrated body. Because of their work, we now have for the first time a way to describe and recognize economy of function in the locomotion of a Rolfed body through space. Their work constitutes a major contribution to and advance for the theory and practice of Rolfing. Also their work clearly demonstrates that we cannot understand and define structure and structural integration independently of appropriate and economical function.
9 A John Cottingham presented his latest elegant research at the August, 1992 Faculty meeting. I asked him if he thought his latest research lent some preliminary support to our claim that structural integration and functional economy are logically equivalent. He answered in the affirmative. I do not wish to make Cottingham responsible for defending our views. But I do believe that his research lends support, therefore, to the conclusions of the present paper and specifically to the view that we cannot create a third paradigm definition of structure or structural integration independently of functional appropriateness.
Peter Schwind’s excellent Science of Rolfing Lecture, Preliminary Considerations For A Theory Of Core, given at the 1992Annual Meeting (reprinted in the Fall, 1992 issue of ROLF LINES) also lends support to these same conclusions. Schwind examines the logical and empirical shortcomings of using solid state physics to completely understand structural integration. If the body were equally dense from head to toe, we could easily determine how well or poorly it approached integration in gravity by simply determining the centers of gravity of the various segments and then seeing how well they line up along the Line of gravity. Unfortunately, as Schwind points out, our bodies are not equally dense throughout and any attempt to line us up in the way just specified could seriously compromise our physiology and structure, and, hence, economy of function. I also agree with Schwind’s claim that the concepts of function and functional economy in our system must mean more that just the idea of economical locomotion through space.
I would argue further that structural integration, functional economy (in the expanded sense), appropriate movement and openness within the articular system, grace, appropriate continuity of motility and mobility, and, following Schwind’s important insight, homogeneity of certain elements/ components/tissue-types, and perhaps high vagal tone are all logically equivalent. In my view, we need to expand our concept of function just a little further to include the nervous system and psychological function. High vagal tone, after all, is associated with persons who exhibit less stereotypic behavior than average, and who might be said to have more freedom, therefore. Adding this further expanded concept of function to our list of logically equivalent concepts forces us to realize how much we need a somatic psychology that is unique to Rolfing. For this reason think that Bill Smythe’s attempt to appropriate work into a uniquely Rolfing context is extremely instant. Robert Schleip’s explorations concerning the neuro-myofascial net and its importance for Rolfing theory and practice also deserve mention. I believe Schleip’s investigations also support the conclusions of this article. See his Talking to Fascia Changing the Brain, ROLF LINES (April/May,1991).
All of these considerations add up to the same conclusion: we cannot understand or define structure or structural integration without taking into account what is functionally economic, appropriate, and possible for each individual body person in relation to gravity.
10 ROLFING: The Integration of Human Structures, By Ida P. Rolf (Santa Monica, California, 1977), p.244.