LAMINECTOMY

Technically a laminectomy is the procedure of cutting away part of the lamina, the posterior part of the vertebral arch from the transverse to the spinous process, in order to gain access to the spinal canal. A discectomy is removal of part or all of the disc. Fusion is not necessarily part of a discectomy, and they generally pack the interspace with a ground bone harvested from the iliac crest. Fusion of cervical vertebrae is generally wired together, though the lumbar fusions that I have dealt with were not wired.

The one thing to keep in mind with a fused vertebrae or two is that the space above the last fusion is at risk of hypermobility. The rehab people will have given your client exercises and ways of using their back that seem counter to the goals of Rolfing®. I recommend that you expand your goals to include whatever instructions they have been given. If the joint space becomes too hypermobile, the disc will degenerate more easily, and your client will become a candidate for a third surgery. For me, this is not the place to test Rolfing theory. You can create ease farther up the back and in the pelvis, but I’d be careful how much I worked on that adjacent segment.

GOUT

There are certain precautions to be taken with gout. Basically, don’t work on areas that are inflamed. They’ll get more inflamed. Gout is a mechanical irritation of the tissue by urate crystals which precipitate from the blood stream when the concentration in the blood becomes too high. They tend to deposit in areas such as the digits, ear lobes and elbows, because of lowered temperature in these areas. Initially they cause irritation of surrounding soft tissue. With time and more crystals they mechanically work their way into the bone creating little caverns, especially in the joints of the first toe.

For the most part, gout patients won’t let you near the site of irritation, so you needn’t worry. The typical gout medication, colchicine, is heavy duty stuff. Indocine is also used. From what patients say, colchicine is not a lot of fun. Anti-inflammatory agents generally are not kind to GI tract and kidneys.

DISC DEGENERATION

Generally, degenerative changes are caused by a trauma and take 15 to 20 years to develop. As the disc thins it also widens, pushing the anterior and/or posterior longitudinal ligaments with it. Vertebral spurring is caused by traction on the vertebral body by the ligament. There are other possible sites of spurring. Spurs can form wherever there is traction at a bony attachment and inflammation, sometimes on the facet joints or the uncinate processes (the joints on the sides of cervical vertebral bodies).

Except for surgery, there is little to be done about spurs already formed. However, reducing internal strains can help reduce the formation of new ones and growth of existing ones.

Disc thinning and spurs are not the sort of thing radiologists are likely to mistake. They are fairly straightforward diagnoses. If you have standard x-rays you might have them reviewed by a chiropractic radiologist because sometimes these changes are accompanied by a distortion of the normal cervical curve – something that medical people don’t normally look for.

If there is a distortion or reversal of the curve, my recommendation would be to find someone with experience in restoring the curve. Curve restoration is not something I’ve heard discussed in Rolfing circles, so I don’t know if there are Rolfers who have learned that. There are chiropractors who have used traction effectively to restore the curve, but you would have to do some searching for the good ones. Having seen the films correlating cervical curve displacement with degenerative changes, I think there is very little debate about the relationship. The disruption of the curve leads to altered segmental motion, which causes weakening of the disc, etc.

If there is numbness or tingling in the arms then the first step is to reduce the symptoms. Osteopathic muscle energy or a non-force chiropractic technique may be more helpful than straight chiropractic adjustments. Generally the symptoms are caused by swelling from inflammation in the tight spaces of the intervertebral foramen (the hole that the nerve comes out) squeezing and irritating the nerve, not by direct pressure of the spur on the nerve. Normalization of the motion of the vertebra should help reduce the inflammation.

Disc degenerations can be potentially serious, but depending on the severity they may be quite manageable. I have several clients whom I’ve been able to keep out of trouble for many years.

PREGNANCY

Regarding Rolfing during pregnancy, I find this work to be perfect to support the structural changes that go on, particularly from mid-term on. I’ve taken maybe a dozen women through Rolfing sessions right up to delivery, and have had a similar number of bambinos having lunch on my table while I worked on mom afterwards. Rolfing a pregnant woman allows you to reorient your goals from causing change to facilitating change, and simply retraining her how to stand as the front keeps growing can make all the difference.

Obviously, you don’t work in the body cavity. But you can get length in the psoas by working with the thigh. Try it with your regular clients first: use one hand on the psoas above the inguinal ligament to monitor your progress, and with your other arm around the leg take it gently into abduction and external rotation. Do your stretch like you do a visceral technique, lots of listening. With a pregnant woman you rely on listening not a hand for monitoring.

I probably wouldn’t do this kind of work if I weren’t fairly comfortable working outside the recipe, but it’s an even larger thrill to assist someone in getting balance when there is so much to balance. For me, in part because I don’t have kids of my own, the whole process has been deeply significant.

STIFF FINGERS

I recommend you find someone (chiropractor, osteopath, etc.) to show you how to adjust all the joints of your fingers. After 13-14 years of working my fingers started to give me problems. Now I mobilize them when necessary (sometimes several times a session), and I never have a problem. Also, learn ways to keep the shoulder girdle-elbow-wrist train open. Lying supine on a Styrofoam roll can help open pectoralis muscles which tend to receive more than their share of work. The latter becomes more of a problem as you approach 50, when the ability of the cerebral cortex to inhibit the upper extremity flexors is diminished. If you wonder why so many middle-aged people have shoulder problems, that’s it.

HEAD TILT

Regarding a tilting head, there are several possibilities to check with your client. The first is a mechanical one, the others are neurologically based.

1. The simplest possibility is that the atlas is seriously misaligned.

2. The client may have a problem with extraocular musculature. If he is unable to move his eyes (or his dominant eye) into one of the four corners of his visual field, he will compensate by tilting his head – without being aware of it. It is possible that he had been doing that all along and had found ways to disguise it, in which case it would have emerged when you straightened out the rest. To test, check his cardinal fields of gaze, especially the corners. Have him follow a pencil tip with his eyes (not his head) as you move horizontally across the visual field about a foot in front of his face. Then move on the two diagonals. Notice if one eye or both are unable to follow the pencil. If that is the case, it is a problem of either the extraocular muscle or the third cranial nerve, and Rolfing probably won’t help.

3. There is a third possibility that is related to the second. This involves what is called a functional lesion as opposed to a physiological one, and involves the vestibular apparatus. This is the circuitry which includes the semicircular canals, the eyes, and the deep muscles of the neck and back. If one semicircular canal or the ipsilateral cerebellum (to which it fires) are functioning at a diminished level, this can result in an imbalance in the muscles of the spine. It could occur at any level including the atlanto occipital joint. You can test this at the same time you do the other test. As you do the test for #2, go back and forth several times on the horizontal pass and the two diagonals. You are looking for what looks like a stutter step or a catch in the gaze in one direction or along one diagonal. Make sure the saccade (that’s what its called) occurs each time you test it (or at least the majority.)

What it probably indicates is that there is some level of cerebellar dysfunction of the side of the upper leg of the diagonal. Not to worry though if that’s the case. Cerebellar dysfunctions seem to occur in a majority of those over fifty and many younger people.

NECK PROBLEMS

Problems in the neck can most certainly be related to difficulties in the CNS, particularly if the case involves vertigo, and true vertigo may involve cerebellar function. The primary source of afferent input to the CNS is from mechano-receptors and spindle cells from the upper cervical vertebrae. Fixations in these segments produce an imbalance in the input to the ipsilateral cerebellum and contralateral cortex. Untreated, over time these imbalances could cause EEG irregularities.