A central component of Rolfing® is the assessment and description of our clients’ geometric organization. Despite the importance of this part of Rolfing, I have encountered many different and ambiguous ways of describing structural geometry. I have felt frustrated with first having to clarify what was being described before I could think or talk about its implications or consider how to work with it. I feel that we collectively suffer from not having a systematic, unambiguous vocabulary that reflects and serves the unique needs of Rolfers. This paper proposes such a vocabulary.
It seems that very few, if any, other fields, including medicine, require the extensive capacity for detailed structural description that we do as Rolfers. None of the methods of describing structural geometry I have encountered seem to fully serve the needs of Rolfing.
Some terms such as “varus” and “valgus” are touted to have a defined meaning, but I have found these particular terms used in opposite senses in professional books and papers. Further, these and other similar terms do not come close to providing the specificity that is required for structural bodywork. I believe it is essential that we have a structural vocabulary that matches the level of specificity of our work and vision. I further believe that having such a vocabulary will increase the specificity and sophistication of our thinking and of our work. Having an efficient and effective vocabulary will also allow us to discuss complex patterns and subtle distinctions that may otherwise be lost simply for the inability to describe them.
For instance, to say that a foot is “pronated,” which implies at once several relationships among tibia, fibula, talus, navicular, and calcaneus does not allow us to express the finer distinctions of the individual relationships among these bones that are so often significant in our work. Further, many terms are jargon, and thus intrinsically set up an “us and them” dynamic which I feel detracts from the sense of personal authority we can offer our clients as Rolfers.
What are the goals for a vocabulary that is suited to Rolfing? I feel that it should be unambiguous, simple to understand and in plain English without hard-to-remember, disenfranchising jargon. It should be capable of. efficiently describing general features and impressions, and yet also capable of accurately presenting the finest of details. I present here a vocabulary that I feel meets these goals. This system was originally inspired by Jan Sultan’s lectures on spinal biomechanics, and brought to its current level of refinement by the needs of my practice and of Kinesis Myofascial Integration classes with Tom Myers, where much of its development took place.
TILT, BEND, ROTATE AND SHIFT
I propose that four descriptors can do the job. They are tilt, rotate, shift, and bend. These four descriptors are modified with the directions anterior, posterior, left, right, superior, inferior, medial, and lateral. If there is concern about these more technical terms, we could substitute forward, backward, up, down, “towards the midline,” or “away from the midline” without loss of clarity or accuracy.
We must also choose some references for the directions. For example, note that if a generally cylindrical object like the spine is rotated clockwise when looking from above, the front of the object is moving to the right and the back is moving to the left. So is this a “right rotation” or a “left rotation?”
For this vocabulary I propose that we reference the front or the top of the named structure. Thus, the spine example above would be a “right rotation.” This is an arbitrary convention, but we must choose some convention, and this one seems to make the most intuitive sense.
We must also state, when it is not otherwise clear, what the tilt, bend, rotation, or shift is in relation to. For example, imagine a thorax that is right-rotated. We might next ask, “relative to what?” It might be right rotated relative to the pelvis, but not to the feet or the head. Or we might have a head that is right-rotated relative to the thorax but not to the shoulder girdle. Whenever there is any confusion, we can simply state what the tilt, bend, rotation or shift is relative to. Note that vertical (gravity) and horizontal are some of the references we might choose.
Following is some further discussion of the descriptors and their use.
Tilt. Tilt describes simple non-curved deviations from vertical or horizontal Tilt is actually a rotation around a horizontal axis. We could use “rotation” here as well, but “tilt” seems to have a more reliably understood meaning.
Commonly “tilt” will be used with the shoulder girdle, the pelvis, the head, and the spine. If a pelvis were tipped so that the left side were lower than the right, this would be called a “left side tilt” because the top of the structure would be facing more to the left. A person who tilted their head so that the left ear was closer to the left ribs would have a “left side-tilted head relative to the ribs.”
Tilt can be used broadly, such as “a right side tilt of the torso,” or very specifically such as, “an anterior tilt of the left scapula relative to the right” or “a posterior tilt of the right innominate bone.”
A common use of “tilt” is with the pelvis. Anterior and posterior tilts of the pelvis are ubiquitous themes in Rolfing. It is especially important, in the case of the pelvis, to note what the tilt is in reference to; a pelvis might not be tilted relative to horizontal, but posteriorly tilted relative to the femurs if the femurs are anteriorly tilted.
Rotate. Rotations are commonly found in tibias, femurs, pelves, spines, heads, scapulas, humeruses, thoraces, torsos, and so on. The term “rotation” is used to describe rotations around a vertical axis. For unpaired structures like the spine, thorax, and pelvis, we would simply say “right rotation” or “left rotation.” In the case where a rib cage is rotated so that the sternum is facing further to the right than the pubic bone, we would call this a “right-rotated rib cage relative to the pelvis” because the front of the named object (the ribs) is facing to the right of the front of the pelvis. We might also say “a left-rotated pelvis relative to the rib cage” and equally describe this same relationship between ribs and pelvis.
With paired structures such as femur, or scapulas, we can use medial or lateral rotation. So for a pair of scapulas that are rotated around vertical axes so that the anterior (front) surfaces are facing more towards the midline, we would say that these scapulas are “medially rotated.” We could also say that “the right scapula is medially rotated,” if only the right scapula is so rotated.
Shift. Shift is usually a broad descrip. for used in initial assessments. Shift describes a displacement to the left of right, up or down, or forward or backward. When we first see a person, we might see a thorax that is still vertical (i.e. not “tilted”), but displaced to the left. We know that somewhere there are some bends and tilts in the spine to get the thorax over to the left, but before we have made a detailed enough evaluation to say just how and where, we can simply say, “a left side-shifted thorax.”
Shift is also used in detailed descriptions, such as with the scapulas. Individual scapulas can be shifted superiorly, inferiorly, anteriorly, posteriorly, medially, or laterally.
Another place where shift is frequently used is with the pelvis. Pelves are often shifted anterior or posterior relative to the malleoli. They can also be shifted left or right.
Bend. Bend is a curved variation of tilt, or, seen another way, a series of tilts. It is most commonly applied to the spine, though it can also be used with knees, ankles, hips, and others. If each of the vertebrae in a person’s spine is tilted relative to the next, the result is a curve. So, if L5 is righttilted relative to the sacrum, and L4 is right-tilted relative to L5, and so on through T12, we would call this a right side bend of the lumbars.
We also expect to see forward bends and backward bends in the spine. The lumbars generally have a back bend and the thoracics a forward bend. We might describe someone as having a “deep back bend in the lumbars” or, if we wanted more specificity, we might say, “the lumbars are strongly back-bent in the S1, L5, L4 section, and then flat above that.”
The essential difference between a tilt and a bend in the spine is that a tilt goes off to one side or the other in a straight line, while a bend goes off to one side or the other in a curve. Anytime we see a bend in the spine, we can assume that there is a tilt somewhere that starts the spine off on its bend. The only exception would be in the unusual situation where the tilt occurred at a single vertebra with no further tilts in subsequent vertebrae. Note that any single vertebra can only be tilted relative to another, not bent. Bend only happens over a series of vertebrae.
As discussed above, the bend is named for the top (or front) of the named structure. If we say a “forward bend of the cervicals” this means that the top of the cervicals is displaced forward.
Note that this vocabulary allows for both general impressions and minute detail. We might initially describe a person as having a “right side-tilted torso,” knowing that there were more complexities behind this preliminary description. As we come to understand the person’s structure better, we might learn, for example, that there is a right side tilt of the low lumbars relative to the pelvis, and a left side bend in the thoraco-lumbar junction area.
THE SPINE, SCAPULAS AND FEET
This vocabulary works well for descriptions of relationships of individual vertebrae. (It was originally inspired by spinal biomechanics terminology). We can be as detailed as we want in describing the spine. We could say a spine is “rightrotated” to give a general description, or we could give a fuller description such as, “left side-tilted and rightrotated from the sacrum to L3,” “leftrotated from L3 to the low thoracics,” “right side-bent through the lumbars,” and “left side-bent across the thoraco-lumbar junction.” And, of course, individual vertebrae can also be described: “T3 is right-rotated and forward-bent relative to T4, with the left facet of T3 anterior-shifted relative to the left facet of T4 and the right facets not shifted.”
The feet are complex enough to warrant special focus. When we use “rotation” in describing the head or spine, we have a good intuitive sense of what is meant. The same is true for tilts of the pelvis, shoulder girdle and so on. In part, this reliable intuitive sense results from the spine having an obvious vertical axis. The femurs and humeri likewise. When we get tc the feet, however, the long axis of the metatarsals and of the foot itself is horizontal. So what is a “lateral rotation” of the foot? We could either mean that the toes are further lateral than the heels, or that the tops of the feet are further lateral than the soles. Intuitively, either could make sense. In order to maintain consistency, I suggest that “rotation” always refer to a rotation around a vertical axis. Thus a “lateral rotation” of the foot would mean toes more lateral than the heel. To describe the foot with its top more lateral than the sole, we would say “lateral tilt” since the rotation is around a horizontal axis. The person whose toes reflect the too long wearing of pointy shoes (bunions) would have a “laterally-rotated hallux” (choosing the midline of the body, rather than the midline of the foot, as the reference).
Since the calcaneus is often the focus of our attention, I offer a few examples of calcaneal descriptions. For the person who has the top of their calcaneus more lateral than the bottom we would say, “lateral tilt calcaneus.” If this same calcaneus also has the lateral side further forward than the medial side, we could describe its geometry as, “a laterally-tilted, medially-rotated calcaneus relative to the tibia.”
Scapulas are particularly interesting because of their great mobility. To simply describe a shoulder as “protracted” or “retracted” can easily, even necessarily, miss much of the detail that is at the heart of Rolfing. Imagine the scapulas described as follows: “scapulas medially-rotated, anteriorly-tilted, and posteriorlyshifted.” The term “retraction” migh be applied to these scapulas, but could not distinguish medial from lateral rotation, or superior from inferior shift. Both characteristics could have significant implications for how we understand the person’s pattern of use and our strategy for work. With this level of description, we can begin to approach our work with greatly increased sophistication.
OTHER TERMS AND ABBREVIATIONS
There are some common situations where using this vocabulary might be awkward or cumbersome, and where we would want to use common terms that are straightforward and unambiguous. Some common examples are “high” or “low” arches of the foot, “X” and “0” legs, and inversion and eversion of the feet. I do not propose to exclude other terms of geometric description when they meet the needs of Rolfing, but rather to propose a vocabulary that serves our particular needs for most situations.
In writing notes on clients, I have found that I use abbreviations for these terms which allow me to efficiently record, or relate to other practitioners in writing or on the phone, a geometric description. Here are a few sample descriptions of structures from my practice in abbreviated form. Three letter abbreviations such as “LSS” are translated as “left side shift” etc.
AS/AT/RR PG. PT/LR Thorax. PS/ SS/MS SG. MR left Scapula. MR Femurs. LatR Tibias v. Femurs. Low medial longitudinal arches. PT Head v. upper Cervicals. FB upper thoracics and lower cervicals.
LSS/PT Thorax. LST/AT/LR/AS PG. LST SG v. Ribs. RST Head v. ribs. Flat spinal curves. LatR femurs. High medial longitudinal arches. RSB Thoracics. PS/MR Scapulas. Left leg weighted.
LIST OF COMMON ABBREVIATIONS
Pelvic Girdle PG