I intend this article to be a straight foreward description of a five series I completed this past year. This series included work will) the visceral fascia that proved to be significant in addressing a major structural issue. The before and after pictures of this client, who I will call Dave, are reprinted here. I want to thank this client for generously allowing Rolf Lines to reproduce these photographs. Please do him the courtesy of not reproducing or distributing these photographs in any way. I will riot be going into detail in this article on the procedures for doing visceral manipulation. I will rather attempt to demonstrate the potential that visceral work has to help us with the Rolfing goals of structural Integration. My best explanation of the changes that were rendered in this live-series has to do with the preparation of the appendicular and girdle structures in the first two sessions, the preparatory opening of the extrinsic fascia of the torso in the third session, the release of the retroperitoneal fascia, particularly that of the duodenum, in the fourth session and the adaptation of the thoracic visceral structures in the closing session.
Dave was nineteen when we did this five-series. We had done a ten-series the vein before. He was interested in Rotting because he hoped the process would change the curvature in his back, clinically known as a kyphosis. In the ten-series we were able to reduce his kyphosis some what. It was a partially non formulistic series with a focus on getting him inure support from his legs and creating adaptability in his axial structures (the spine and the rib cage). Unfortunately, we did not take pictures before or after that ten-series. Both he and I felt after our tenth session that (here had been moderate improvements in his lower body support and a moderate reduction in his curvature. I le showed further improvement in both these areas upon his return for the five series when the “before” picture shown here was taken. He felt there had been enough improvement for him to try more Rolfing.
During that original series we developed a stretch for him to do that consisted of hint silting against a wall with his ischial tuberosities as close to the corner (where the floor met ceiling) as he could get them. He would then allow his lugs to rest as straight as he easily could in from of hint. His legs could he hunt but not splayed (abducted) for was then to bring his spine into the wall gently without tilting his head back. He was to gently hold this stretch through ten breaths. In this position he would feel the stretch along the back of his legs and through the front of his torso. Doing this stretch was a way of bringing him into his body and into the Rolfing process between sessions.
This against the wall stretch also became an evaluation of his kyphosis. When he began doing the stretch during tile first series his head was about twelve inches front the wall. By the end of the ten-series it was about nine inches front the wall. When he returned for the five-series, his head came about eight inches away. When he finished the five-series his head came about three inches front the wall. When I spoke with hire over the phone four months later, he told in me was continuing to improve and that his head was only about one inch away.
The interesting thing about the five series changes is, that nearly all of the five inches of change in this evaluation came in the fourth session when we did on entire session of visceral work. When doing this visceral work with Dave the fascia of his duodenum was the most constricted. The duodenum lies in the retroperitoneal fascias deep to the peritoneum or abdominal cavity. This retroperitoneaI cavity contains the duodenum, the pancreas and the kidneys. The duodenum lies in a horseshoe shape in the mid abdomen just above the area of the umbilicus. It has strong; fascial investments in the pre-vertebral fascia at 13, 12, and L1. The strain in this fascia directly affects the position and function of this area of the spine. It we look al this area in the before live photographs we can see that the upper lumbars are positioned strongly anterior. The effect of strains in the visceral fascia transmits to the structure through the sheaths of fascia that run vertically and horizontally through the torso, neck and head. The visceral structures have ligamentous attachments and fascial investments in these sheaths. If there is shortening, tightness, or twisting ithe visceral organs it is transmitted via these attachments and investments to the structure which is thereby also shortened lightened or twisted. In Dave’s structure the restriction in the duodenal fascia directly correlates with the anterior positioning of the upper lumbars.
An additional structural effect of this pre-vertebral shortness that is not as apparent in the photographs was the positioning of the ribs in this area. This is a reproduction of a sketch I put into my notes of Dave” spine and rib cage. I made this assessment during the second session of the five-series.
Normally the ribs angle inferior as they encircle the torso. In a normal ribcage if the lines of the twelfth through tenth ribs were extended they would arrive at the anterior midline far inferior to the positions indicated in this sketch. In Dave’s situation the ribs twelve through ten are wrapping much less obliquely interior than normal. Given the degree of extension in the twelfth through seventh vertebrae, the more superior than normal passage of the ribs twelve through ten is not unrealsonable. However though this same extended position is also the case for the ninth, eighth and seventh thoracic vertebrae, ribs nine through seven are angling strongly to the inferior. In my evaluation of Dave I found the inter costal space between the ninth and tenth ribs was quite wide in the back yet complete; closed in the front. Ribs nine, eight and seven were in the difficult situation of being pulled acutely inferior in flexion, while their associated vertebrae (T9, T8, T7) were tilting, superior in extension. This produced a triangle in the rib cage the apex of which was, interior of the duodenum. This indicates that the strain produced by the duodenal Fascia was also affecting the structures of the anterior torso, not just those of the vertebral column alone.
It is important to note here that Dave’s structural situation, the process of the Rolling, and the results with these tissue sessions was not precisely measured and quantified. This assessment occurred as it usually dots in our work, with very intricate analysis yet, casual measurement. The work also proceeded as it usually does in Rolling. The principles of wholism, support, adaptability and closure guided the process to address those patterns of strain and fixation in the facial network that seem to be preventing a more full expression of ease and balance within the gravitational field. The explanations that I may have of what was producing the shape and balance of Dave’s posture before and alter the work is oily my informed speculation. It is presented here not In the hope that it he taken as a prescription or protocol but as a description of events that might spark investigation and discussion. It is also Important It relate that my work with the visceral fascias is based on my studies for the past twelve years with various Osteopaths and Rolfers including Jean Pierre Barral, DO, Tom Shaver, DO, Didier frail, DO, Michael Shea, Michael Salveson and Jeff Maitland. I twill not detail any visceral techniques here. These techniques are best learned in the presence of those with experience and knowledge of visceral manipulation.
I made detailed notes of the sessions with Dave. Because of this I can report that, in the first session I worked to correct a pattern of posterior tilt and posterior shift in the left side of the pelvis and left leg, aid a pattern of anterior tilt and posterior shift in the right side of the pelvis and right leg this included rest ‘lying a slight loft side bend in the sacrum and a stronger right side bend and left rotation in the lumbars. In the second session the axial complex was addressed including the custal fascia and the erectors. As well in the second session I worked to resolve an anterior tilt pattern of the shoulder girdle and to lengthen the anterior fascia of the neck. In the third session the extrinsic abdominal fascia including the rectus, obliques and transversus were generally opened and lengthened to increase the extrinsic dimension of the abdominal cavity. We also worked with the psoas and quadratus lumborum from the posterior with Dave in a sealed position. Extrinsicaly, all of the serratus fascia were addressed. Moving more to the interior, I worked to expand the fascia of the peritoneal bag. In the fourth session, where the greatest result was achieved, I assessed and worked with the perinea, peritoneal and retroperitoneal viscera by evaluating the mobility and inherent Million (motility) of all structures and releasing any strains I encountered starting with the rectal fascia, proceeding through the colon, small intestine, duodenum, stomach, spleen, liver, pancreas and kidneys. I encountered only in, incidental in all areas except the duodenum. The inherent motion of the duodenum was virtually undertectable. Additionally the preaddressed size of the duodenum was significantly smaller than to he expected. Alter working with the duodenal fascia with visceral manipulation techniques the duodenum was approximately throe times it preaddressed size and more normal inherent motion was present. In the fifth and final session I worked with visceral manipulation techniques to release any strain I could users in the plural fascia including that of the lung, and mediastinum.
As best as I can theorize, Dave’s pattern was produced by the shortening, of the pre-vertebral fascia arising from the duodenal investments anterior to L3, L2 and L1. This shortening influenced the costal structures above this area via the peritoneal bag and diaphragmatic fascia. This produced a three dimensional shortening outward from the pre-vertebral space occupied by the duodenum. I suspect that this duodenal strain pattern was present in Dave from early in his life and that his axial ermines and his entire structure necessarily adapted to this strain throughout his growth and development. In working to achieve verticality and balance ho needed to take some significant portions of his structure posterior to balance the anterior displacement of the LDH. Therefore, the pelvis and the tipper thoracic spine have moved posterior. To complete the vertical balance Dave’s femurs, shoulder, neck and head have moved anterior. Correcting the posterior shift in the pelvis and logs prepared these segments to align. Correcting the anterior till in the shoulder girdle, opening the thoracic viscera and lengthening the anterior cervical fascia prepared these structures to align. Opening the extrinsic fascia of the abdomen, ribcage and spine prepared the torso for a change in shape. It was however, the release of the duodenal fascia in front of the upper lumbars that finally freed this area to lengthen and move posterior. This allowed the thoracic spine, the area of the kyphosis, to reposition forward. The intercostal space between the tenth and ninth ribs and the angle of all of the ribs front the seventh downward normalized. It was not until the work on the duodenal fascia in this fourth session that Dave was able to utilize the realignment of the girdle segments. The work in the fifth session with the plural fascist had the effect of allowing the neck and head to, lift further superior and, interestingly, resulted in the jaw relaxing downward and fm ward while his occiput moved posterior.
It is my general theory that vital happened to Daves structure as he grew was that the strain in the duodenum would not allow the pre vertebral fascia to lengthen in pace with the growth of his axial structures. As the bones of his spine and rib cage grow, his entire torso was not able to lengthen, By opening the fascia of the duodenum after preparing the entire structure to realign, the pre-vertebral fascia could hen thin to match more neatly the dimension of the bones of the spine and ribs.
Including work with the visceral fascia in the process of Rolfing allows us to further explore the structural importance of core integration. In Rolfing our most conservative definition of core is the visceral space Increasing end balancing the dimension of the visceral space increases the dimension of the horizontal structures of the lots(,, i.e., the pelvic floor, the respiratory diaphragm and the thoracic aperture. Extending our notion of visceral space to the neck and cranium even the cranial base can be included as a horizontal structure with the potential for increased dimension. All of these effects can be seen in Dave’s structure. This increased dimension and ha lance enhances the adaptability support and palintonicity of the torso and cranium.
Expanding our notion of COW to include the appendicular structures and expanding our notion of horizontal structures to include the major joints of the arms, legs and cranium (the mandible) would tic helpful in understanding the wholistic effect of work with the visceral space. With a more liberal definition of core we cum explain the effects that an increased dimension of the visceral space will have on the dimensions of these appendicular structures. Dave’s entire structure was not able to fully utilize the work: of his previous tenseries or even the first three sessions of the five-series until the primary strain hi his visceral cavity was released. His legs remained tight and without any noticeable sequencing through his steps. His arms also remained stiff and unmoving as he walked. Once the core space was addressed in the fourth session, Dave’s arms and logs became more supple and responsive to the motion of his walk. They also visually appeared larger in circumference. The interosseous spaces appeared more open and activated in all of his motions. This would indicate that there is core space to be considered in the appendicular structures and that it can be enhanced by addressing the core visceral space.
The most promising potential I have found for including work with the viscera into the Rolfing process is this activation and integration of the core space (both axial and appendicular). There have been different descriptions of core and sleeve in our community. I use the terms in the talk ‘wing ways: sleeve refers to all the extrinsic structures which are the fast twitch muscles involved with phasic motion. The sleeve is often associated with external interactions, boundaries and armoring. Core refers to the internal structures of the viscera, diaphragms. interosseuus membranes and the slow twitch muscles involved in tonic support. The core is often associated with internal experience and emotional expression. Working to integrate both core and sleeve requires making inquiries and strategies about the whole person. Is the outside congruent with the inside? Do these two elements get along, communicate, share? Is there ease and function in both? Is who a person is inside congruent with how they act outside? The core or sleeve can have a different quality in tine place or another. The interaction between the two can be occurring in one place and not in another. In structural integration we work toward the activation of both core and sleeve, an adaptability and support or each and a palintonicity that includes the two. Working with the visceral fascia will allow these inquiries and objectives concerning cure/sleeve integration to have a greater and in- ire satisfying place in our work.