PREFACE

In attempting to write a brief history of manual therapy I have encountered the twin challenges of quantity and diversity of information. While the history of manual therapies could rightfully fill an encyclopedia, certain crucial topics are very underrepresented in the literature. The available information also comes from a wide range of cultures, and spans a timeframe from the Neolithic to the present. Future articles in this series will present in detail selected topics from this introductory historical outline.

INTRODUCTION

Structural Integration, Osteopathy, Chiropractic, Physical Therapy, CranioSacral Therapy, Myofascial Release, Zero Balancing and most other kinds of manual therapy we have today in the Western world – as well as Orthopedics — grew out of one common root, known as “bone setting”. The lineages of manual therapy are like the growth of a banyan tree: a primary trunk and root sprouting and recombining continuously for centuries. Modern therapies have been periodically revitalized by renewed contact with bonesetters. On the other hand, some bonesetters read anatomy and other medical texts as they became available and thereby improved their skills.

Much of this brief history focuses on the British bonesetter tradition since 1500, extending into North America, and the several points of exchange between the bonesetter traditions and our present manual healing arts in the West.

HISTORICAL OVERVIEW

Manual therapies of varying sophistication have existed in virtually all traditional cultures. Stone Age skeletal remains evidence healed trephinations and well-set and healed bony fractures, suggesting astute manual therapy and surgical skill. “Iceman”, a 3,000 year old Central European found frozen in an alpine glacier, evidenced a series of lines and points tattooed on his body, most of which are identical to the acupuncture meridians we use today. Manual therapies are recorded in written documents as far back as Old Kingdom Egypt, and were present in stone age cultures which persisted into the 20th Century. Robust manual therapy folk traditions continue today in many geographically diverse parts of the world.

Of the many names traditional manual therapies have been called, the name “bonesetter” has been current in Britain since at least 1400. In the same period in German speaking lands, similar practitioners were called “Wundartze”. In Spain the name was “Algebrista”,. derived from the Arabic root meaning “to reduce”, which is also the root of our word “algebra”. Today, Mexican Curanderos reduce dislocations and remedy other joint problems, along with their application of herbal medicine and other arts. As examples of other names, in Japan bonesetters are known as the Hone-Tzugi or Seifukujitsu-Shi; and in Mongolia they are known as the Bariachi.

BONESETTER EDUCATION AND SCOPE OF PRACTICE

The form of manipulation varies from culture to culture and even from practitioner to practitioner. In most traditional cultures, skills are carefully guarded and passed down within families. There are variations on this pattern; at one end of the spectrum, the Wundartze of the German-speaking lands published many books and pamphlets describing their work, starting as early as 1500. At the other end of the spectrum, the Barachi of Mongolia are said to be born with the healing knowledge and skills, require no education, and may or may not be born to parents who are practitioners.

Some modern bonesetting traditions, including the Curanderos of Mexico, also practice other facets of the healing arts, including herbal medicine and surgery. Neolithic evidence suggests that bonesetters worldwide also often practiced a range of healing arts. In Scotland the terms “surgeon” and “bonesetter” were synonymous until 1875, as shown in lists of occupations used by the courts to interpret wills. Practitioners in some traditions set fractures as well as providing joint mobilization, as in present-day India.

EARLY BRITISH BONESETTER PUBLICATION HISTORY

While the bonesetters of Renaissance and early industrial Britain did not publish papers or books themselves, there are two contemporary publications giving more or less detailed accounts of their methods. The first, a forty-page pamphlet entitled The Compleat Bonesetter, was written prior to 1650 by an Augustine friar named Moulton. Robert Turner edited and expanded Moulton s manuscript, publishing it in 1656. We do not have Moulton’s original manuscript. Turner’s edition describes in broad terms the work of bonesetters, along with herbal remedies. Interestingly, the introduction to this book suggests that most if not all practitioners at that time were women. In a second edition, The Compleat Bonesetter Enlarged, issued in 1665, Turner added primarily more herbal remedies. Together the two editions of The Compleat Bonesetter are frequently described as the first publication in modern times on manual therapy, becoming the first publication in the lineage of all of our modern manual therapies. Prior to Moulton’s writing, the previous text on manual therapy in the Western world had been authored by the Greek physician Hippocrates, (470-410 B.C.). If there were other manual therapy In Canada there are fewer than 50 US trained osteopaths and several hundred European-style osteopaths. The Canadian osteopathic schools are all European-style. Although European style Osteopaths are much more numerous, the US-trained osteopaths in Canada are more entrenched in the governmental and medical power structure. There are now more students in Canadian osteopathic schools than there are osteopaths of any kind practicing in Canada. A turf war is heating up between the two groups using the same name.

DERIVATIVES OF OSTEOPATHY

Osteopathy in its turn has spawned several prominent therapies, not the least of which is structural integration.

William Garner Sutherland, who gave us cranial manipulation, was an early student of A. T. Still. While Still had practiced some manipulation of the cranium it was Sutherland who raised cranial manipulation to a high art.

The Sutherland Cranial Teaching Foundation, now headquartered in Fort Worth, Texas, continues to teach Sutherland’s style of cranial manipulation with very little modification or addition. Out of Cranial Manipulation has grown CranioSacral therapy, which applies some of the methods originally developed by Sutherland for the cranium to the whole of the body. It is important to note that while the cranium was a central interest of Sutherland’s, he also regularly worked on the rest of the body. The CranioSacral therapists have made further developments of certain of Sutherland’s methods and de-emphasized the cranium in their work.

Several other variants and developments of cranial manipulation have been presented by osteopaths Hugh Milne, James Jealous, Franklyn Sills and others. Other derivatives of osteopathy include: Myofascial Release, created by Carol Osbourne Sheets; StrainCounterstrain, created by Lawrence Jones, DO; and Zero Point Balancing, created by osteopath and structural integrator Fritz Smith.

CHIROPRACTIC

D.D. Palmer enrolled in Still’s osteopathic school in 1894. He stayed six weeks before leaving in the company of a third year student. The following year Palmer discovered Chiropractic. While Palmer initially used high-velocity manipulation for the spine, he also worked on the whole body and also used low- and medium-velocity manipulation. Somewhat similar to the pattern at Still’s osteopathic school, many early chiropractors developed an exclusive focus on high-velocity spinal manipulation. Now many chiropractors are rediscovering and expanding on other aspects of Palmer’s original work, as well as incorporating osteopathic and other methods.

STRUCTURAL INTEGRATION

During World War II, Ida Rolf studied movement work with US osteopath Amy Cochrane. We clearly see Cochrane’s influence in structural integration in some of the movements we use such as “toes up, foot up, toes down, foot down”, etc. In addition to movement, Rolf absorbed osteopathic philosophy from Cochrane. Cochrane’s followers, practicing “Physio Synthesis” and represented in print by Ida Thomas, accuse Ida Rolf of using much more of Amy Cochrane’s work without giving proper credit to its creator.

Dr. Rolf also took manipulative workshops with at least one other osteopath, and began to develop her own manipulative forms emphasizing the importance of the bodily relationship to gravity. The relationship of the body to gravity has long been a part of osteopathy, where it continues to play a minor role.

In the early years of her work, Rolf followed in Still’s footsteps, conducting an itinerant practice. In the 1950’s, Ida Rolf taught during summer sessions at the European School of Osteopathy at Maidstone in Kent, England. At that time she taught a seven session Rolfing® recipe. During those summers Dr. Rolf also learned more from the osteopaths. In time she came to feel her osteopathic students were just using her name to get more clients and not really practicing her work, so she shifted to teaching in London through the Gurdjieff School.

In the early 1960’s, Dr. Rolf began to teach at The Esalen Institute at Big Sur, California, at the invitation of Gestalt Therapy guru Fritz Perls. She taught at Esalen about ten years before moving her school, The Rolf Institute®, to Boulder, Colorado.

Out of The Rolf Institute have grown several major and many minor schools, including The Aston Patterning Institute, The Hellerwork® Institute, The Guild for Structural Integration, The Soma Institute, Kinesis-Myers Inc., The Postural Integration Institute, and the Utah School of Massage. The existence of these several schools, each with its unique emphasis and development, fulfills the expressed wish of Dr. Rolf, through the process by which these schools established their independence has not followed her wish for licensing by The Rolf Institute.

VISCERAL MANIPULATION

A. T. Still makes several mentions in his writing of manipulating internal organs. A small amount of organ manipulation continued throughout the history of osteopathy, but as the osteopathic literature reflects, manipulation of the viscera had a minor role in osteopathic practice until about 1980.

In most of Europe outside of Britain, the usual prerequisite to osteopathic training is licensure as a physical therapist. French physical therapist Jean-Pierre Barral began his osteopathic training at the European School of Osteopathy at Maidstone, Kent, England, about a dozen years after Ida Rolf stopped teaching there. After graduation from ECO, Barral did a post graduate fellowship under Dr. Arnaud at a cardiopulmonary hospital in Switzerland. His fellowship included extensive autopsy of patients he had treated. In these autopsies he was able to see many adhesions and contractures he had noticed from treating outside the body of these patients. Since the setting was a cardiopulmonary hospital, these restrictions were often in the pleura and/or pericardium.

Later, in private practice, Barral had a patient with a back problem whom he was not able to help as much as he would have liked. The patient reappeared after an absence of a few months reporting that his back pain was now gone. After some initial shyness, the patient told Barral he had visited a bonesetter in the French Alps, who had pushed on something in his belly, immediately relieving his back pain. This incident sent Barral back to his anatomy books to figure out how this could have been done. He recognized that the visceral support membranes are in large part anchored to the spine. Relieving the membranous tensions in the visceral support system could have relieved the patient’s spine. This anatomical connection led Barral into a decades-long study of the visceral support system and how it can be manipulated for the benefit of the whole body.

CONTINUING CONTACTOF D.O.’S AND BONESETTERS

There is a variant of osteopathy, taught in Switzerland, called Itiopathy. Itiopathy distinguishes itself from osteopathy in two ways. First, its practitoners consider themselves very lazy because they want to make the least effortful gesture possible. This economy of effort is viewed as beneficial to both client and practitioner. Second, the Itiopaths have collected manipulative strategies from bonesetters all over the world. This research and collection of techniques by Itiopaths continues today. Itiopaths Alain Gehin and Claudia Kohn have recently reported on their observations of bonesetters practicing in India.

CROSS-FERTILIZATION

Ideas and techniques continue to flow between the various schools and practitioner groups at many levels. Physicians of every kind, physical and occupational therapists, structural integrators, massage therapists, acupuncturists, and other health professionals study each other’s methods. This crossover pattern has been facilitated by John Upledger, D.O., who has made osteopathically-derived methods widely available through his Upledger Institute and the International Alliance for Healthcare Educators (IAHI). Upledger’s sharing of osteopathically-derived methods with therapists of all kinds has stirred age-old fears and 7 jealousies dating back to the bonesetters. Upledger has received death threats from US osteopaths for disseminating osteopathic methods. As Upledger continues to thrive and expand his teaching, some osteopaths have privately admitted to him that they are envious of his success and wish they had followed a path similar to his, rather than slogging away in managed care. Upledger’s success has been a great boon to those needing manual therapies worldwide. His model has done much to open the doors of other schools.

Ida Rolf’s son Richard Demmerle trained c as a chiropractor after his Rolfing apprenticeship. A small number of osteopaths and ; chiropractors have trained as Rolfers. Some chiropractors have embraced soft tissue methods from several schools to such an extent that they rarely if ever use high velocity manipulation. Physical therapists worldwide are embracing osteopathic and other soft tissue methods wholesale.

In 1958, an article on the etiology of heart disease co-authored by Ida Rolf appeared in the American Osteopathic Association Yearbook. Occasionally mention is still made in the osteopathic literature of other techniques developed by Ida Rolf, most recently a way of releasing the fascia lata. Rolfers are not just encouraged to study visceral and cranial technique, they are soon to be required to master the basics of cranial manipulation for entry into the Rolfing advanced training.

THE FUTURE

The breadth and depth of manipulative skills now available is well beyond the ability of any one person to learn in a lifetime, while the rapid growth of these skills pushes the possibility of boredom further off the map. We can hope the protectionist tendencies earlier expressed by bonesetter families and more recently in the threats to Upledger and between the two groups of osteopaths in Canada will fade with the realization that there is more than enough knowledge and more than enough skills for everyone. Both patients and practitioners will be the beneficiaries of free exchange.