When I first began working as a Rolfer, it was in a center where, as well as doctors, there was a beauty department. So I often happened to work with women who had difficulty in accepting their physical aspect. While I tried to motivate these people to feel and to perceive their bodies and not just worry about their physical appearance, I realized that these aesthetic problems could be the manifestation of a deep underlying structural disorganization. I thus began to search for possible structural troubles relative to those which were perceived exclusively as unaesthetic.
I didn’t have a scientific background, so I tried to use intuition and feeling through touch to address these problems.
A few women, for instance, asked me how to tonify their double chin, considered as a relaxation of the floor of the mouth. Under my fingers it did not feel that way: The hard thickened tissues showed me that an incorrect position of the cervical and dorsal vertebras had caused a shift of the hyoid bone thus shortening the muscles above and below it.
A vertebra out of line reflects the position of all the spine (except, of course, immediately after a trauma, when compensations are not yet there). In the same way the position of the hyoid bone affects or is affected by that of the visceral pouch. To improve the double chin, it’s not helpful to tone it (as many people say), but it is important to release and lengthen the muscles above and below the hyoid bone, and at the same time to move the vertebrae into a correct position to restore the situation of the visceral pouch.
I also notice that deep wrinkles (i.e. in the neck) go together with underlying shortened muscles.
Many women among my clients, were and are disturbed by the distribution of their fat, even if they were young, attractive, and slim.
Basically I could observe two types of people: Those who gain weight on the outer upper part of the thighs (the “culotte de cheval”) and those who gain it on their waist. I could refer to these respective types as the internal and external types. In the external ones the thing that struck me was that people actually seemed shorter at the waistline: Some of them seemed a block from the thorax to the iliac crests. Could there be a biomechanic reason for such shortening? If we think that the iliac crests in “out-flare” have a bigger “momentum” in respect to those in “in-flare,” this means that for every rotation movement of the thorax on the pelvis or vice-versa, a greater force by the obliques, internal and external, is needed.
Could it be possible then to attribute this missing waistline to an actual chronic shortening of both the obliquus, due to overwork?
And I asked myself: Given that the shortening of the oblique’s fascia effects also the transversus abdominus muscle, does this shortened, less elastic myofascial net keep the lumbars in a posterior position, in a spine (external type) that already has the tendency to reduce its physiological curvatures? Continuing to observe from an aesthetic point of view, I noticed that almost all the women from 35-40 years onwards, complain about the lack of tone in the high inner thigh (I’m speaking about Italians, whom I observe during my work).
This phenomenon is obvious in women, probably due to the bony shape of the pelvis and also to the hormonal component that gives a different density to the superficial tissues, less adhesive to the muscular plane. I was always very perplexed as to why in both types I constantly found tissues that, in the thigh, rotate externally. It didn’t make sense to me. One of Dr. Ida Rolf’s axioms that I learned during my training was that tissues counter-rotate to the underlying bone rotation. I didn’t find this happening in the thighs. (Photo 1)
If in the internal type described by Jan Sultan the bow legs have a femur that rotates internally and the counter rotation of the superficial tissues is logical and normal, it isn’t so in the opposite type: the external, X-legs type.
At the beginning I thought I was mistaken and that I wasn’t capable of reading the structural typology. Discussing this point with colleagues, some of them suggested that sometimes tissues counter-rotate the bone and sometimes they don’t. This explanation didn’t convince me.
I don’t believe that the human body works at random.
An evolution that has lasted a million years with a rigorous selection of all that was not functional and leading to survival leaves little or no space for a similar indiscriminate randomness in the final product. If this seems random it is probably because we haven’t been able as yet to keep under control the innumerable components that condition the human being as a whole or to explain how they interact.
If we look closely at the physiology of the human body and at the precision with which answers to pathological processes are formed, we can find no evidence of causality. The more the limits of knowledge edge are widened, the more the logic of the human body systems becomes evident, and the interaction they have appears more clearly congruent and rigorous. When Dr. Ida Rolf speaks of “random body,” in my opinion “random” can be considered as the consequence of a set of coinciding variables that take the structure out of balance in a way which is for us not always, at least not yet, predictable.
While searching for an answer tomy doubts regarding the rotation of thigh tissues, I have had contact with various experienced osteopaths and with therapists who practice the Mesiere method.’ Tomy great astonishment I realized that they consider and treat the femur as if it were always in internal rotation. This was the conclusion of Francoise Mesiere after many years working on thousands of people: the tendency of the femur (like the humerus) is to rotate internally.
The Mesiere therapists showed me that, observing the legs from the back, the medial condyle is always more posterior in the sagittal plane with regards to the lateral one, both with bow- and x-legs.
That was for me a source of perplexity and confusion. Who was mistaken? Jan Sultan? Following his principles I obtained some results. Was F. Mesiere wrong? Mesiere therapists showed me pictures in which, after a long and patient treatment, an improvement could be seen. The Mesiere theory explained why I found rotation in the thigh tissues always in the same sense.
At the end an idea: Couldn’t the effects of two tendencies be present? Based on the input given to the organism by the craniosacral system, there could be a basic tendency given by the straightening of the structure, that brought the femurs into internal rotation.
These two things can easily coexist. This sum of various factors is what we habitually find in the human body.
I found the most logical explanation for this tendency toward internal rotation of the femur in a book by Marcel Bienfait: Fisiologia della terapia manuale.2 Observing skeletons reconstructed in museums and referring to cave drawings, he reminds us that our ancestors appeared as quadrupeds on their hind legs, straightening around the transversal axis, like rearing horses.
That uplifting puts tension on the anterior flexor muscle, that is the iliopsoas muscle, causing lumbar lordosis. To prove the original quadrupedic position, Bienfait illustrates the hip joint: “The hip joint and its position in standing gives a further proof that man is an erect quadruped. The femoral neck is oblique inwards and upwards (inclination angle of 125 degrees) and forward (forward inclination angle of 15-20 degrees).
The axis of cotyloid cavity (acetabulum) is oriented downwards, outwards, but also forwards. It follows that in standing position the femoral neck and the axis of cotyloid cavity form an angle of 60 to 70 degrees, closed behind. Only a position of the femur in flexion and in internal rotation brings the joint surfaces to normal interlock. It’s the quadruped -position. We have seen that this position modifies the function of the ilio-psoas muscle.”3
Supposing that there is this basic internal rotation, either due to evolution, or because the internal rotators are bigger and stronger than the external rotators (check the list of femur rotators described by Robert Schleip), what could produce a different shape of the legs?
THE FORCE OF GRAVITY
If we consider Jan Sultan’s external type, we find the iliac crests in out flare position, which moves the head and the neck of the femur laterally; we find the ischial tuberosities closer together. In the pelvis the weight of the upper body comes downwards towards the center, as in a funnel, and it has lines of force which are bigger on the medial side of the femurs.
The weight is not discharged evenly on the tibial plate, but provokes a greater pressure on the medial surface. This pressure could be the cause of the X-legs.
In the opposite case, I think that the reverse occurs: The iliac crests are closer together, the ischial tuberosities stay farther apart and the weight of
the upper body is distributed largely laterally, discharging on the lateral surface of the tibia more than on the medial one and this pressure could be the cause of bow-legs.4 (Figure 1)
All that could explain why there are many legs not congruent with the rest of the structure: If a postural factor disturbs the whole, the weight comes down differently on the tibial plate and the legs have a different shape from the inherent structural type.
In my opinion the same thing happens in the ankle joint which assumes different shapes depending on how the talus receives the weight: This creates different patterns, depending on different lines of force.
If we observe the legs from behind we notice the basic tendency of the femurs to internally rotate, with the condyles not in line on the sagittal plane; if we observe them from the front we see the patella shifted, usually in a direction opposite to the pressure of the weight on the tibialplate. These phenomena coexist and they are not antithetic or in alternative.(Photo 2 and 3).
My way of dealing with the internal rotation of the femur is not very elegant, but rather efficient: The client is prone, with his feet over the edge of the table (6th hour position); one leg at a time, I put the femoral condyles parallel (photo 4) and with one hand I keep them in this position. The lower leg goes outwards, no longer aligned. Using one of my knees, I try to bring it in axis as much as possible. With my free hand I work on the whole leg, while the client is tracking with his foot (photo 5). It is important to give resilience and elasticity to the ligaments that cross the knee, chiefly laterally (photo 6). This work has a strong impact on the upper body: Balance must be given by working back and psoas (benchwork). Quality and flow of movement are really improved all the way through legs and the whole body.
I believe that is important to consider the basic tendency of the femur to rotate internally if we wish to give more congruence between superficial and deep layers, between “sleeve” and “core.”
1. Frangoise Mesiere was a French therapist who, like Dr. Ida Rolf, tried to restore harmony and balance to the body. Putting patients in positions which recreated symmetry, she asked for specific breathing and for an active lengthening of shortened muscles. Simplifying her theory: the muscles of the body work as if they were part of a chain; if one part has a problem, the whole chain is affected. Of particular importance for her was the posterior muscular chain, that goes from the occiput to the heels. This chain has a major tendency to shortening because, unlike others (e.g. the antagonist anterior chain), its muscles are mostly parallel and/or over lapping like the tiles of a roof; they thus tend to act and to shorten as a whole. Her theories have been diffused and elaborated by her assistant Ph. E. Souchard. Other authors have picked up the theory of the muscular chains. The French osteopath Leopold Busquet in his four books: Les chaines muscolaires, Ed. Frison-Roche, Paris, has given a very detailed functional description. For us as Rolfers it is very interesting to notice how he has described the “crossed chains” in a way similar to Jan Sultan’s patterns.
2. Ed. Marrapese 1990. Original title: Physiologic de la therapie manuelle S.E.D. Le pousoe Saint Mont.
3. op. cit. pg. 312-313.
4. With regard to the distribution of weight on a surface, in a tube bent or buckled, see the article by Hans Flury: “Theoretical aspects and implications of the internal external system,” in “Notes on Structural Integration,” Nov.1989, pg. 20.