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CAPA Structural Integration 2003-03-06-Summer-June

Core Balance

Acknowledgments: The author is very grateful to: Siana Goodwin, Ellyn Lindquist, Aria Seligman, John Schewe, and Catherine Vandertuin for their generous assistance in preparing this article. The article originally appeared in the Aprill May 2001 issue of Massage and Bodywork magazine.
Pages: 12-16
Year: 2003
Dr. Ida Rolf Institute

Structural Integration: The Journal of the Rolf Institute – February 2003 – Vol 31 Nº 01

Volume: 31
Acknowledgments: The author is very grateful to: Siana Goodwin, Ellyn Lindquist, Aria Seligman, John Schewe, and Catherine Vandertuin for their generous assistance in preparing this article. The article originally appeared in the Aprill May 2001 issue of Massage and Bodywork magazine.

INTRODUCTION

The essence of Structural Integration is the dynamic tonal balance between the surface of the body and the body’s core. The nature and location of “Core,” however, has long been debated among Structural Integrators. This article explores several avenues of thought about Core and synthesizes them into a practical whole, citing research that is opening new vistas to understanding the mechanism of Structural Integration and related disciplines.

Structural Integration (SI), as exemplified by Rolfing°, is distinguished from other disciplines by its primary attention to gravity. Other bodywork systems seek tonal balance, energy balance and emotional balance. While SI attends to all of these, its primary goal is to alter the structure of the human body so that instead of fighting gravity, one can use gravity as an energy source. After a complete series of SI sessions, clients look taller and more balanced; they report that they not only feel lighter, but also feel physically uplifted. This lift is due to the client’s new relationship to gravity. Once that lift has been felt, no other state will do.

While the results of SI are long lasting, injury, illness or misuse can reduce the lift made available by SI. Such a reduction can change one from feeling like a bird soaring on a breath of air into Jabba the Hutt. Tuneup sessions, either after stressful events or at 6- to 24-month intervals as preventive maintenance, maintain that graceful and balanced dance with gravity.

SOME PRINCIPLES OF STRUCTURAL INTEGRATION

Structural Integration works with the continuity and plasticity of connective tissue. The human body has only one piece of connective tissue – all fasciae, periostei, ligaments, tendons, etc. are continuous. Collectively, these tissues make up 20 percent of the weight of the human body and form the organ of support maintaining spatial relationships among organs, bones, muscles, and all other tissues. Structural Integrators know the map of this connective tissue. With that in mind, they apply analytical skills to choose where to make the most meaningful interventions to restore damaged or habit-worn tissues. The great job in learning SI is learning these analytic skills. In classical Rolfing, most of the information is gathered visually.

In order to integrate the human structure in the gravitational field, several tonal balances must be considered. Left and right sides of the body must have similar tone and span in each segment from toe to scalp. Similarly, the tone and span of the posterior aspect of the body must balance the front of the body at each level. It is also customary to consider upper-body to lowerbody balance.

As the references to “at each level” above indicate, balance above and below the waistline must be extended to balance between all segments of the body. For example, the tone in the feet must match tone in the leg and tone in the thigh, and so on. As each of these three dimensions of balance is improved in a series of sessions, theresult will be a good level of structural integration.

In addition to these three dimensions of balance there is a fourth, which if achieved, will bring integration a quantum level higher. This fourth dimension of balance concerns surface tone balanced to core tone. This is called Core-Sleeve balance. Achieving this balance is difficult in part because the exact location and nature of Core continues to be obscure.

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DEFINING CORE

The definition of Core has been debated in SI circles for at least the last 50 years. Functionally, Structural Integrators can recognize when a person has Core-Sleeve balance. A person living in such balance quickly learns to recognize it, too. Movement can be initiated in any direction with equal ease. “Effortless” is the usual description, like a sailboat with all the sails trimmed just right and filling together.

Naming the structures that are Core and teaching another practitioner to produce this balance comes much harder than recognition of the balanced state. I will summarize and extend our understanding of Core and name its complexity.

Sleeve is easier to describe than Core. The superficial fascia is a discreet unit, enveloping the whole body. Next comes the investing fascia which is locally named as Pectoralis Fascia, Fascia Lata, Crural Fascia, etc. Deeper fasciae, such as inter-muscular septa, connect to the investing fascia. Any consideration of layered myofascial relationships deeper than the investing fascia is open to interpretation. Deeper layers overlap and interpenetrate.

The extrinsic muscles lie nearer the surface of the body and tend to move the body quickly and strongly but somewhat imprecisely. Intrinsic muscles lie generally deeper in the body and move more slowly and more precisely. When these two are functionally balanced the body can move with strength, quickness and precision. The extrinsic musculature is one definition of Sleeve, but exactly where does extrinsic end and intrinsic begin? The Spinal Rotatores muscles are clearly intrinsic. The Soleus lies deep to the Gastrocnemius and is challenging to directly contact. Yet functionally, the Soleus is extrinsic, a prime flexor of the ankle. Although structurally deep, lying next to bones, deep under a large muscle, the Soleus is functionally not as intrinsic as the pedal lumbrical muscles. Penetrating through certain portions of the distal plantar aspect of the foot, the lumbricals are the first muscle layer encountered.

So far we have considered Core-Sleeve relationships with respect to muscles and myofascial structures. There are more ways to describe Core; here are three of them:

1. Ida Rolf described Core in several ways including, “everything you can’t live without”: An intriguing statement but far from clear in its application to structural integration.

2. The Bones. We think of bones as deep structures yet in some places, such as the shin, they are directly under the investing fascia. In the human body, the bones serve as spacers in a tensional matrix similar to Buckminster Fuller’s tensegrity structures. In this model, the Core-Sleeve relationship is translated into balance between the thrust of the bones and the tension in the fascial planes enveloping and connecting them. The internal structure and tensions of the bones can be quickly modified by manual means, producing prompt improvement in the overlying soft tissue tone. CST and VM are among the therapies that work with the internal structure of the bones.

3. Jan Henry Sultan and other Rolfing instructors use “the visceral space” as Core. By this they mean not the viscera themselves, but the container of the viscera and the pressure system inherent in the visceral space and its container. Management of these p essure relationships is essential toStructural Integration, and yet this is not the whole story of Core.

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INTERDISCIPLINARY CONTRIBUTIONS TO STRUCTURAL INTEGRATION’S UNDERSTANDING OF CORE

Certain concepts developed in other disciplines are now giving Structural Integrators new and highly useful ways of defining Core.

Although CranioSacral Therapists do not focus on Core-Sleeve relationships in the way the Structural Integrators do, from the viewpoint of Structural Integrators, CST practitioners treat the dural membranes as Core. Certainly the Dura is deep in the body, lying inside the skull and within the spinal vertebrae. Cranial manipulation and its descendant, CranioSacral Therapy, ably demonstrate that altering the tone and span of the dural membranes produces profound and immediate change in tone of body tissues at any distance from the Dura. These changes maybe either highly tissue-specific or quite general. If the dura is ignored, CoreSleeve balance is incomplete.

Dural restrictions affect other tissues in three or more ways:

1. A severe Dural restriction may put directpressure on the central nervous system (CNS). Even slightly impaired CNS will result in skewed monitoring and control o body processes.

2. The spinal Dura must be mobile to an commodate spinal movement. The spinal cord must slide several centimeters to ac commodate full extension and flexion of the spine. If the Dural tube is unable to slide the spinal musculature will reflexivell stiffen to protect the spinal cord.

3. Autonomic reflexes will create localized areas of tissue tension at any distance from the spinal cord in seemingly quirky patterns.

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HOW CRANIOSACRAL THERAPY AND VISCERAL MANIPULATION INFORM THE STRUCTURAL INTEGRATION CORE SEARCH

In the classic ten-session SI recipe, work proceeds, session by session, from surface to center. The CST recipe taught to beginners starts at intermediate depth with this horizontal diaphragms of the body and proceeds deep to the dural core. Advanced CS1 practitioners may begin on some client! with the dura itself. It is important to re member that the name CranioSacral Therapy represents the historical origins o this discipline. Today CranioSacral therapists apply techniques developed in working with the Dura to tissues at any depth it any part of the body.

From the point of view of Structural Integrators, Jean Pierre Barral, creator of Visceral Manipulation, treats the pleura, pericardium, peritoneum and other membranes and ligaments that support the viscera as Core. In Visceral Manipulation, the work usually proceeds from the core out. Where the viscera are released, related musculature will automatically release in response The most effective way to free spinal restrictions is often to work on the connective tissue suspending the viscera. If a visceral structure is tense, associated myofascial structures will tighten to protect it. Specific stretches or other types of release for the visceral support system will result it prompt and lasting release of the myofascia Here are two examples:

Example 1. Roots of the Mesentery

Structure: The 30 feet of small intestine are anchored by a set of membranes called the mesenteries. All the planes of the mesenteries collect into a line running from the iliocecal valve in the lower right quadrant of the abdomen to the duodeno-jejunal junction in the upper left quadrant of the abdomen. This line, called the roots of the mesenteries, is anchored to the back wall of the abdomen, crossing the lumbar spine on a diagonal line from upper left to lower right.

Dysfunction: Because of the diagonal attachment of their root, any tension in the mesenteries will rotate the lumbar spine. By this mechanism either a stomach flu an emotional experience that “ties our guts up in knots” can result in lumbar dysfunction and pain.

Example 2. Long Chains of Visceral Connective Tissue

Structure: Consider this strong and continuous line of connective tissue:

a. Body of the sphenoid bone

b. Anterior longitudinal ligament of the spine

c. The continuous skein of ligament attaching the posterior aspect of the pericardium to the anterior surface of the bodies of all of the vertebrae C4-T4.

d. The pericardium

e. The falciform ligament

f. Round ligament of the liver

g. The umbilicus

h. The urachus

i. The anterior bladder support ligaments

j. The wall of the bladder

k. The posterior bladder support ligaments

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DYSFUNCTION

Tension in the ligaments supporting the bladder can show up symptomatically as a tendency to “dowager’s hump.” Such up-per thoracic and lower cervical displacements can affect spinal nerves, leading tc referred arm pain. Conversely, a whiplash injury affecting the base of the neck can produce pathological changes in bladder function. Because it can also displace and or distort the sphenoid, which contains the pituitary gland, a whiplash can also produce endocrine dysfunction.

RESEARCH

The two examples cited describe mechanical means by which restriction at one area can cause dysfunction in a distant area. Conversely, Structural Integrators and other bodyworkers have long observed how manual therapy in one area can produce change far away in areas without obvious mechanical linkage. A second mechanism for change at a distance is autonomic mediation.

J. Staubesand of the University of Freiburg has provided us with groundbreaking research on the structure of connective tissue that describes a physiologic mechanism whereby the autonomic nervous system may refer structural change at any distance in the body. Staubesand made scanning electron micrographs of sections of human crural fascia. He found this fascia contains smooth muscle cells scattered through it. As usual, the smooth muscle cells have autonomic nervous system innervation. This is stunning news! Up until now we knew the fascia had some contractility but did not know how. We eagerly await follow up studies looking for similar findings in other fasciae.

If smooth muscle cells are found in fascia throughout the body, it provides a key to exactly how freeing an organ or the dura consequently frees a muscle. Such release could be quickly mediated through the autonomic nervous system. Recall that smooth muscle cells do not fatigue in the same way as striated skeletal muscle. Giver adequate nutrition, smooth muscle can contract indefinitely. This enables a muscle to stay tense for decades, and then release it seconds with appropriate manipulation o1 dural or visceral tissue. To vie” Staubesand’s photomicrographs of crura fascia and read an English language inter view with him, see Robert Schleip’s wet site: www.somatics.de.

We do know that when an area of the dura or a membrane supporting an organ ha! reduced elasticity then associated muscle!tighten, limiting range of motion to protect that membrane from further injury. In CST and VM we routinely observe that releasing deep restriction will immediately release the associated musculature. Through Staubesand’s discovery, we now have a physiological mechanism to mediate this referred change.

INTERDISCIPLINARY INTEGRATION OF THE CORE CONCEPT

To our Core-Sleeve model we must add another element. There are actually two Cores, the anterior (or visceral) compartment, and the posterior (or dural) compartment. Tensional forces must be balanced within and between these two Cores, along with all the other balances mentioned above.

Contrary to the classical SI recipe which proceeds from surface to center, the experience of Structural Integrators who are also trained in CST and VM is that approaching these Core compartments first is often the most effective and efficient approach to integrating the human structure with respect to the gravitational field.

This does not end the discussion of Core and Sleeve. There are, after all, more candidates for Core. What this writing provides is practical steps toward more effective and efficient structural integration.

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METHODS, AN INTRODUCTION

Some practitioners of CST and VM will wonder why one should bring in the SI perspective at all, since CST and VM on their own greatly increase order in the body. To answer this question, we must return to gravity. Gravity is a large force that we are all subject to all the time. One way to appreciate the strength of gravity’s force is to weigh yourself, then pick up the scales and hold it against the wall at chest level. Then with your hands on the scale try to push your own body weight. Most people can only push about half their weight. Yet in standing we balance our weight against gravity with little effort. In CST and VM classrooms, gravity is rarely if ever mentioned. Balances are established between tissues in the body, but the body is treated as if it were an open kinetic chain. The closed kinetic chain balance within the gravitational field is a powerful fact largely or entirely overlooked. SI brings in this vitally important perspective on gravitational relationship.

In CST, assessment is made by several methods and is usually done with the client supine. In VM a first general assessment of the whole body is done with the client standing. Then the posterior compartment is assessed in detail also with the client standing, followed by supine assessment of the anterior compartment. From a SI perspective it is important to do all of these assessments with the client standing. It may also be useful to do them with the client supine or even side-lying, but the standing closed kinetic chain relationship must be included as primary; otherwise body parts will be related to each other but not to the earth’s gravitational field. In addition to assessing the standing body, it is frequently advisable to work on the body standing or sitting. In his recent book, Cranial Sutures,Analysis, Morphology and Manipulative Strategies, cranial manipulator Mark Pick, DC, describes compelling reasons for working on the cranium with the client upright.

Part of the VM assessment protocol includes selective inhibition, whereby tissues are induced to temporarily forget their compensations. This allows a pair-wise comparison of bodily restrictions to determine which dysfunction should be manipulated first to produce the greatest positive change for the whole body.

Using the VM comparative inhibition method, the Cores and the Sleeve can be brought into better balance within themselves and between each other. A VM strategy called stacking-a-line-of-tension (SALT) can be employed to bring the level of order even higher. In this paradoxical method, two related areas are manipulated concurrently, one with each hand. Once the two areas of dysfunction are located, each one is mobility tested in three planes. One hand is placed on each structure. Then each structure is moved into its directions of ease in three planes, until a first barrier is just reached. The therapist then waits until that barrier is felt to ease. Each structure is then again mobility tested to assess how much its previously poor directions of movement have been improved. The procedure is repeated as necessary. SALT can potentially be used to improve the tonal relationship of any two structures. Applying SALT to the relationship between the two Cores, as well as between the Cores and the Sleeve, leads to great improvement in integration of the structure, particularly if the pre-test and post-test assessment are done with the client standing in the gravitational field.

CAUTIONS

1) Mixing modalities never substitutes for thorough grounding in the theory and practice of each modality. Ida Rolf instructed her students to practice only Rolfing for five years before adding other modalities. This remains a good rule.

2) The dural membranes and the tissues they surround, as well as the internal organs and the tissues that support them, are all delicate and highly reactive. Manipulation of these tissues must be performed gently and accurately. No one should attempt to manipulate these tissues unless properly trained.

PERSPECTIVE

Bringing CST and VM perspectives to SI might appear to lengthen the session because there are more things to do. SI practitioners who incorporate one or both of these other perspectives find, on the contrary, that with a broader selection of skills, sessions are shorter and less effortful while producing better results for the client. CST, SI, and VM are all descended from early Osteopathic manipulation. The reunion of these separate lines of development is a fortuitous marriage of cousins.

SUMMARY

The most important balance achieved in Structural Integration is that between Core and Sleeve. Sleeve is easy to define. The nature and location of Core has been debated for 50 years without conclusive result. One reason for this difficulty is the existence of more than one Core. Tone must be balanced between Cores as well as between Cores and Sleeve. The practical methods outlined for assessing and balancing Core and Sleeve structures yield much better integration of human structure. The ability to use these high level integration methods requires in-depth training and experience in the three disciplines of Structural Integration, Visceral Manipulation and CranioSacral Therapy.

These considerations do not end the discussion of Core. The bones, to name one structure, deserve in-depth consideration as Core in their own right.

BIBLIOGRAPHY

Anson, B., Rolfing, Stories of Personal Empowerment. Heartland, 1991. ISBN 0-9629385-05.

Barral,J.P., The Thorax. Eastland, 1991. ISBN 0-939616-12-2.

Barral,J.P., Visceral Manipulation II. Eastland Press, 1989. ISBN 0-939616-09-2.

Barral,J.P and Croibier, A., Trauma, an Osteopathic Approach. Eastland, 1999. ISBN 0939616-32-7.

Barral,J.P. and Mercier, P. Visceral Manipulation. Eastland Press, 1988. ISBN 0-93961606-8.

Clemente, Carmine D., A Regional Atlas of the Human Body, 4th edition. Williams and Wilkins, 1997. ISBN 0-683-30305-8.

Feitis, R., ed., Ida Rolf Talks about Rolfing and Physical Reality. Rolf Institute,1978. ISBN 0930385-00-4.

Feitis, R., and Schultz, L., Remembering Ida Rolf. North Atlantic Books, 1996. ISBN 155643-238-0.

Gehin, A., Atlas. of Manipulative Techniques for the Cranium and Face. Eastland, 1985.ISBN 0-939616-02-5.

Giammatteo, T., and WeiselfishGiammatteo, S., Integrative Manual Therapy for the Autonomic Nervous System and RelatedDisorders. North Atlantic Books, 1997. ISBN 1556432720.

Johnson, D., The Protean Body. Harper Colophon, 1977. ISBN 0-06-090552-2.

Kolb, B., and Whishaw, I.Q., Fundamentals of Human Neuropsychology, 3rd edition. W.H. Freeman and Company, 1990. ISBN 07167-1973-8.

Magoun, H.I., Osteopathy in the Cranial Field.Sutherland Cranial Teaching Foundation, 1976. No ISBN.

Pick, M.G., Cranial Sutures: Analysis, Morphology and Manipulative Strategies. EastlandPress, 1999. ISBN: 0939616297.

Rolf, Ida P., Rolfing: Reestablishing the Natural Alignment and Structural Integration of the Human Body for Vitality and Well-Being. Healing Arts Press, 1989. ISBN 0-89281-335-0.

Staubesand, J., Lin, Y., “Zum Feinbau der fascia cruris mit besonderer beriicksichtigung epi- and intrafaszialer nerven”. Manuelle Medizin, 34,1996, pp. 196200.

Still, A.T., Osteopathy, Research and Practice,Eastland, 1992. ISBN 0-939616-14-9.

Sutherland, A.S., With Thinking Fingers: The Story of William Garner Sutherland, D.O. TheCranial Academy, 1962. No ISBN.

Sutherland, A.S., and Wales, A.L., CollectedWritings of William Garner Sutherland, D.O., D.Sc. (Hon.): Pertaining to the Art and Science of Osteopathy Including the Cranial Concept in Osteopathy. Covering the Years 1914-1954.The Sutherland Cranial Teaching Foundation, 1967. No ISBN.

Sutherland, W.G., The Cranial Bowl, a Treatise Relating to Cranial Articular Mobility, Cranial Articular Lesions and Cranial Technic.Free Press, 1949. No ISBN.

Trowbridge, C., Andrew Taylor Still 18281917. The Thomas Jefferson University Press, 1991. ISBN 0-943549-06-X.

Upledger, J.E. and Vredevoogd, J.D.,CranioSacral Therapy. Eastland, 1983. ISBN0-939616-01-7.

Upledger, J.E., CranioSacral Therapy II, Beyond the Dura. Eastland, 1987. ISBN 0939616-05-X.

Upledger, J.E., SomatoEmotional Release and – Beyond. UI publishing, 1990. ISBN 09627157-0-0.

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