SI: Do you call all of the bodywork you do “Rolfing”?
ED: Since the primary focus of my practice is on assessing and correcting neck and back pain, I do not feel justified defining my work as Rolfing in its purest form. But as my schedule allows, I still perform the “tenseries”, usually with five or six clients a year. It’s still a thrill to revisit Dr. Rolf’s marvelous body of work. At heart, I am and always will be a Rolfer, but my path has taken me, for better or worse, in a slightly different direction. In the Jan /Feb issue of Massage Magazine, Tom Myers said, “From the outset, let me be clear that I am not saying that Daltori s Myoskeletal Alignment Techniques (MAT) work is a knock-off of Rolfing. Each of the heirs of Ida Rolf – even those who claim her mantle have built upon her work and made innovations (and maybe lost some of her broad perspective, though who will admit it?).” This eloquently illustrates the problems therapists encounter when altering or straying from Dr. Rolf’s teachings. I openly admit that it is impossible to challenge the broad perspective Dr. Rolf achieved in her fifty years of accumulated knowledge.
From reading a few personal letters written to Byron Gentry over the years, I believe her perspective probably encompassed even more than we imagined. I do not call the work I do Rolfing because it does not meet that broad perspective. My work has evolved to one of “specialization”, a word I once condemned in the world of medicine because I envisioned it as the archenemy of wholism. But with all the complexities inherent in the human body, I now believe specialization can sometimes become the mother of invention. A disabling neck injury introduced me to the fascinating world of spinal biomechanics, and my practice hasn’t been the same since. Specialized to be sure – but a lot of fun.
SI: Are you aware of the Gate Control Theory of pain?
ED: Yes, Melzack and Wall’s popular neurological discovery introduced in the mid sixties has been instrumental in helping us understand the intimate relationship between nociception and mechanoreception.
SI: How do you account for it in your work?
ED: Aside from creating myofascial alignment and balance to neck/back structures, the MAT system seeks to normalize articular afferent input to the central nervous system to recover muscle tone, joint play, and sympathetic activity. Melzack and Wall found that impulses travelling in the larger myelinated mechanoreceptive fibers take precedence over the smaller-diameter nociceptive fibers and can inhibit or dampen the transmission of painful nociceptive signals to the spinal cord and brain. So when joint fixations initiate a decrease in mechanoreceptive input, nociception can’t be effectively controlled or inhibited, causing the client to experience more pain. Therefore, when dealing with neck /back pain, the key is to develop a technique, other than highvelocity thrust, that can safely coactivate all three types of mechanoreceptors in the joins capsule, thus inhibiting nociception and the perception of pain. Gillette found that only forty Newtons of force were needed to coactivate all these mechanically sensitive receptors.
The MAT system uses slow, sustained finger /thumb pressure directly to transverse processes or articular pillars to release fibrotic transversospinalis muscles that often lock spinal joints open or closed. I call this procedure “mobilizing muscles through joint manipulation.”
Advanced Myoskeletal techniques add a post-isometric relaxation component and specific ventilatory maneuvers to help release stubborn, adherent joint locks. For example, if the right T4-5 joint won’t open, the client is placed in a left side-lying fetal position with her left arm behind her back She is instructed to grasp the side of the therapy table with her right hand, then take a breath to the count of five while gently pulling up against the isometric resistance of the table. This action fires the deep spinal rotator muscles, causing the dysfunctional vertebra to right-rotate against resistance from the therapist’s thumbs. By applying direct pressure to the bony transverse process while the deep rotator muscles are firing, a strong GTO (Golgi tendon organ) release occurs in the sensitive transversospinalis muscles.
As the client relaxes and exhales, a post-isometric relaxation response follows, allowing the therapist to continue with deeper cephalad thumb pressure to the joint. This maneuver coactivates irritated joint receptors, resulting in less compression and more joint play. If a palpable reduction in multifidi, rotatores, levator costalis, and intertransversal muscle tone is not immediately felt, either the joint did not open, in which case the procedure should be repeated, or the T4-5 facet restriction has chronically altered the joint’s axis of rotation, causing the adjacent ipsilateral rib to get stuck in external rotation.
Microtrauma to costotransverse joints from chronic vertebral fixations often produces an ornery “dual vertebra/ rib fixation” requiring specific rib treatment. Therapists should treat both joint fixations in the same session, starting with the vertebral dysfunction. Unfortunately, this dual fixation is often overlooked, and clients continue to suffer with interscapular pain and weakness in surrounding paravertebral tissues, including the lower shoulder stabilizers. Retraining exercises for the weak, inhibited lower shoulder stabilizers are useless until the therapist successfully addresses dysfunction in both joints.
SI: Why do we hurt?
ED: Historically, the medical and manual therapy communities have considered soft tissues such as ligaments, fasciae, joint capsules, and intervertebral discs as purely mechanical structures and not neurological mediators. But recent technical advances in nerve staining techniques and histologic sectioning have revealed the presence of neural elements in all these spine-related tissues. Rolfers are aware of the many ways toxic muscles progress from soreness into painful spasm, contractures and trigger points.
Relatively less recognized, however, is the important role joint dysfunction plays in the development of muscle spasm and other myofascial pain syndromes. Biomechanical researchers are finding that ligaments, discs, and facet capsules are all blessed with a rich supply of mechanoreceptors and nociceptors that warn the brain of undue stress to joint-related tissues. Nociceptors and chemoreceptors are activated when nerve fibers are depolarized by high mechanical stresses in joint capsules or by exposure to inflammatory agents such as histamines, prostaglandins, kinins, potassium ions, and lactic acid.
When nociceptors fire in response to actual tissue damage from macro- or microtrauma, they quickly become major myofascial and spinal pain generators. Long-term central nervous system agitation from angry nociceptors causes the brain to twist and torque the body in an effort at pain-avoidance. Regrettably, the cerebellum and gray matter have the ability to memorize these aberrant patterns and re-learn them as normal. When the dysfunctional pattern persists long after the painful stimulus has been removed, the condition is referred to as neuroplasticity, reflex entrainment or spinal learning. This, of course, is one reason why Rolf movement therapy, by re-establishing proper neuromuscular movement patterns, has been so successful in treating the negative effects of neuroplasticity.
The longer these powerful asymmetric myofascial forces are allowed to twist and compress the body’s bony framework, the more noxious stimuli are generated. Left untreated, these aberrant movement patterns form the beginning of a devastating, self-sustaining, pain/spasm/pain cycle. This degenerative “Catch 22” cycle originates in two distinctive ways: altered joint position = muscle spasm = greater joint dysfunction – or – muscle spasm = altered joint position = increased muscle spasm. Amazingly, researchers still do not know if impaired function of a muscle is the primary cause of joint dysfunction or if the reverse is true. Of course, there are many other reasons why we hurt. Hyper- and hypomobility, viscero-somatic dysfunction, central nervous system malregulation, energy blockages, habitual movement patterns, cranial imbalance, and limbic system emotional stressors are but a few common pain generators we encounter each working day.
SI: Why are the procedures that physicians use so unreliable?
ED: Our current medical model, particularly the “drug” division, is often based on biased studies using old science. I’m expecting, and my bio-tech stocks are praying, that human genome research will soon dramatically change the face of medicine including spinal surgical procedures. I’m told that more stock market money is being invested in research and development of new spinal devices than any other medical modality, including cancer and AIDS.
As baby-boomers’ backs continue to selfdestruct, orthopedists and neurosurgeons grasp at any straw that might boost their surgical success rate. Intense pressure from medical appliance manufactures has caused the FDA to prematurely approve many new surgical devises before long-term studies have proven them safe and effective. The highly-touted “cage-fusion” surgery is but one example of a seemingly good idea gone awry. Although the device appears beneficial in the first few months post-op, if bone density decreases or osteoporosis develops, the cages work loose and lumbar de-stabilization prevails. Many patients suffer intractable lumbar pain and permanent disability simply because long-term studies on the effects of bone loss were not adequately addressed. Having said all that, we still have the best surgical system in the world. Many promising new inventions are hitting the market that appear to be less invasive and more reliable long-term.
SI: Do Rolfers do a better job than physicians?
ED: My personal opinion is that the evolution of Dr. Rolf’s work combined with innovative therapeutic additions by the Rolf Institute faculty over the years are finally paying off in chronic pain management. We seem to be meeting the challenge imposed by a sedentary society living in a highly overstimulated environment. Many other alternative health modalities are also helping alter the medical model of health without the help of expensive double-blind studies to prove their effectiveness. Nicholi Bogduc’s famous quote, “In God we trust; all others bring data!” may prove unnecessary if somatic therapists continue to provide strong subjective evidence showing that we are, indeed, helping people in pain. Manual therapy should be the first line of defense in the battle to prevent neck/ back pain. Today is the most exciting era somatic therapy has seen since the early 1900’s. I’m delighted and honored to be a part of it.
SI: What about the pinched nerve? Is it really just a myth?
ED: In the past, the nerve root has been blamed for pain arising from spinal misalignment, although today many disregard any theory that discusses “pinched nerves” because of the absence of neurological signs. However, nerve root compression syndromes are still alive and well in a certain population of subjects. Although clinicians agree that nerve compression from herniated discs and spinal stenosis can cause radiculopathies such as sciatica, most do not believe that improper joint alignment necessarily causes pain. Garfin noted that isolated, acute compression of a normal nerve leads to paresthesias, sensory deficits, motor loss, and sometimes reflex abnormalities – but no pain. However, if an inflamed nerve suffering intraneural edema is compressed, pain occurs. This silent nerve root compression syndrome hypothesizes that time is required for functional alterations to cause mechanical nerve fiber deformation and pain.
As opposed to nerve roots, compression of a dorsal root ganglion, even if normal, may produce radicular pain without chronic irritation or inflammation. Personally, I believe that the sinovertebral nerve is the real culprit in many mysterious spinal and myofascial pain disorders in clients presenting with a clean MRI. Innervating the posterior longitudinal ligament, nerve root dura, posterior facet joints, ligamentum flavum, and the annular fibers of the disc, it can sympathetically spasm neighboring nerve dura, producing “sciatica-like” symptoms in the absence of radicular signs.
I have always felt that hot discs and inflamed posterior longitudinal ligaments are the “Big Kahunas” in most low back pain cases, while osteophytes and facet fixtions contribute more to cervical pain syndromes. Much of the confusion surrounding the pinched nerve myth begins with the disc itself. Findings clearly show that the disc can be a source of pain without evidence of rupture or herniation. Circumferential tearing of the disc’s annular fibers allows twigs of the sinovertebral nerve to penetrate the cracks. with some fibers actually encroaching upon the nucleus. In his presidential address to the American Back Association, Mooney stated that “the disc itself is the most common source of low back pain.”
Discs live for motion and receive their nutrition by sucking in water and metabolic substrates when unloaded in gravity or as the tensegrity system springs joints open during gait. Prolonged compression flattens discs, causing joint hypermobility from ligament laxity. Ligaments must be stressed but not strained. Local hypermobility has a profound effect on the posterior longitudinal ligament. Structurally, it is less stable in the low back, where we really need it, than in the neck. Improper lifting and overall poor ergonomics causes this ligament to tear from the disc margins. Internal pressure fills the tear with calcium, causing osteophytes or bone spurs to form in the intervertebral foramina. The sinovertebral nerve hates prolonged disc compression, posterior longitudinal ligament strain and periostial tearing. It usually responds by generating lumbar pain that can move from side to side. The sinovertebral nerve can also flare when excessive lumbar lordosis or flattening of the cervical curve transfer’s excessive weight to the posterior facet joints.
SI: Say something about your training.
ED: During a rock show at San Francisco’s Fillmore West, the original drummer from Janis Joplin’s “Big Brother” band mentioned that his playing and posture had improved after being Rolfed. Merv Griffin’s Carmel Valley Inn was our next gig and someone there told me of a crazy old lady who could straighten bodies. Ida Rolf was her name and he had heard that she occasionally presented her work down the road at the Esalen Institute. Two weeks later I was sitting in the back of a room full of friendly and enthusiastic people. Although Dr. Rolf’s presentation was brief, when I returned home to LA, I immediately began looking for a Rolfer. My background in clinical psychology at the University of Oklahoma, biofeedback with Elmer Green at Menninger’s, and a neurolinguistics Ph.D. with Dr. Krasner at the American Institute of Hypnotherapy sucked me right into the body/ mind stuff Dr. Rolf and the participants at Esalen had been talking about. A few years later, while employed at the Health Institute of San Diego, a fellow staffer told me of a great Rolfer in Del Mar. Subscapular pain from hours of sitting in recording studios pounding that two and four rock beat with my-left arm left me in agonizing pain, and nothing helped until Rolfing.
The immediate recovery I experienced definitely got my attention and soon I found myself enrolled in Mueller College of Holistic Studies preparing for the much-anticipated Rolf training. By the time I arrived for my interview in 1982, the body/ mind aspect of Rolfing was definitely the area that piqued my interest. But when a clumsy judo fall in 1989 caused a non-displaced neck break at C4-5, my therapeutic goals suddenly changed direction. Self treatment to my dysfunctional cervical joints following the accident created an interest in myofascial/skeletal relationships. During a memorable conversation with Jim Asher one evening, he encouraged me to seek out old-time manipulative osteopaths and chiropractors and try to learn their techniques. This turned out to be the most valuable advice anyone had ever given me. The search led me to bond with a few great old manipulators, including Byron Gentry, DC, whom I have been treating weekly for many years while casually picking his brain.
But my lack of biomechanical knowledge still left me feeling terribly inadequate, so I decided Physical Therapy school was the answer. While in class only a few months into the program, I was complaining to a fellow student about the lack of hands-on work in the program and he suggested I check out manipulative osteopathic schools. I soon discovered the real manipulative hotbed was hidden up in East Lansing, Michigan at Michigan State College of Osteopathic Medicine. PT students were allowed to take postgraduate continuing education courses along with DO’s and MD’s. At last I had found a home. For the past nine years I have spent over 1,400 classroom hours with Dr. Phillip Greenman. The very first time I observed his effortless, intuitive and confident style, I knew he was the therapist I wanted to be when I grew up. Watching him gracefully travel through the body assessing and treating dysfunctions while exquisitely blending a multitude of therapeutic modalities to fit the particular condition was enlightening. I soon realized that he had probably forgotten more than I would ever know. Regrettably, prostate and heart surgeries this past year may soon put him on the golf course in Tucson and away from the classroom. What a terrible loss for all somatic practitioners.
SI: What would you recommend for body workers who want to work with clients in pain, both in terms of trainings and other information sources?
ED: All therapists should take Jim Asher’s advice and seek out the “wise ones” before it’s too late. I try to learn something from every professional therapist or student I meet. For me, no workshop is a bad workshop. Bodywork becomes boring and predictable when we are not challenging our potential. Other than Rolfing, some favorite courses that have contributed to my personal toolbox of touch include: neuromuscular therapy, muscle energy, strain counter strain, active isolated stretching, myofascial release, cranial, visceral, dissection, and mechanical link.
Because I’m a manual therapy video junkie, every morning while on the treadmill I watch old and new hands-on therapy videos. It helps my mood in the office if I can pick up some new little tid-bit to integrate into my practice that day.