Deconstructing Pain in Structural Integration

Siana Goodwin, Certified Advanced Rolfer, has been practicing since 1980. Her innovative work includes using Structural Integration principles for the prevention of repetitive motion injuries to the workplace; she has been a consultant for Starkey Laboratories, Inc., in Eden Prairie, MN since 1991. She lives and maintains a private practice in Minneapolis, MN, and can be reached at [email protected].
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Pages: 101-106
Siana Goodwin, Certified Advanced Rolfer, has been practicing since 1980. Her innovative work includes using Structural Integration principles for the prevention of repetitive motion injuries to the workplace; she has been a consultant for Starkey Laboratories, Inc., in Eden Prairie, MN since 1991. She lives and maintains a private practice in Minneapolis, MN, and can be reached at [email protected].

<center>Introduction</center>

Pain has always, justifiably or not, been associated with the experience of Structural Integration. This is exemplified in jokes from the early days of Structural Integration about a Rolfing practitioner ?sharpening his elbow,? and seems to be the main thing that the public at large knows about the process. During Structural Integration training, the issue of pain is variously addressed?it is sometimes explained as ?already being in the body and being released by the work,? or as the client?s resistance to the changes brought about by the practitioner, or as simply an inevitable and maybe desirable part of the work itself. After all, if the client is experiencing pain, then a practitioner knows that her work is having some effect. If pain is seen to be an inevitable part of the process, then it?s not hard to come to the conclusion that the more effective the work, the more pain the client will experience.

However, this acceptance of pain as a necessary aspect of SI overlooks the experiences that I?m sure many of us have had with SI?that it need not be painful, that it may even be pleasurable. It also raises the question of why there are effective bodywork approaches, particularly the osteopathic offshoots of craniosacral therapy and visceral manipulation, which are not painful. Although these approaches don?t have the same understanding of integration and relation to gravity as Structural Integration, as more SI practitioners study and include in their practices at least some aspects of these approaches it?s worthwhile to raise the question of the inevitability of pain in the SI process. The experience and interpretation of pain are so subjective that it has been easy to dismiss the pain often experienced in SI as being the responsibility of the client, or as a natural effect of deep bodywork?at any rate, out of the control or responsibility of the practitioner. On the contrary, while I believe the practitioner can?t determine what the client will feel, a good proportion of the pain experienced in SI is due in some way to the practitioner?s relationship to the client?in the sense of conceptual and physical relationships, not the interpersonal.

Over the last fifteen years or so of my own practice, I?ve tried to distinguish the factors that seem associated with my clients? experience of pain. In this article, I will describe how I came to be interested in this as a particular focus, what contributed to my developing ways of working that are not painful, and what I believe contributes to the experience of pain. I will also give suggestions for eliminating or reducing those factors in one?s own practice.

<center>Origins of the Inquiry</center>

I became interested in the phenomenon of pain through my own experiences as a SI client. Sometimes I experienced pain, and sometimes I didn?t, and this didn?t seem to be related to the skill of the practitioner. I was probably offered a variety of explanations as to why some sessions, or parts of sessions, hurt, but what intrigued me most was my reaction to the different experiences. When there was no pain, I was aware of varieties of sensation in my body. I was engaged in the session, interested in what was occurring. I felt in communication with my practitioner; I felt I could perceive what they had seen and what they were interested in changing in my body. I was curious. I could follow altering sensations and relate them to what my practitioner was doing. On the other hand, if I was experiencing pain, my curiosity vanished. All I could focus on was immediate sensation, and not on change? either in the sensation itself or any other change I experienced in my body. My feeling of connection with my practitioner disappeared?I lost the sense of being able to track what they were trying to accomplish. Both painful and non-painful sessions brought positive changes, but I much preferred the curious, engaged experience, the feeling of silent communication with my practitioner. My curiosity was aroused as to what contributed to my feelings of pain, and how I as a practitioner might avoid whatever it might be in my own practice.

One of my first clues in addressing this inquiry came from the sensation of change I felt in my own tissue when I was not experiencing pain. When I was engaged with the process, there was often a sensation in my body of rippling, a liquid like spreading through my tissue. This particular sensation seemed to arise in response to slow pressure and slow movement of my practitioner?s hands. If the movement was fast, the pressure seemed heavier; I didn?t feel the wave-like sensation. Moreover, I couldn?t tell what was being addressed in my body?I couldn?t follow my practitioner?s intention. Quicker movement seemed to ignore my body?s own rhythm of change and was often accompanied by burning sensations?sensations that are sometimes considered characteristic of Structural Integration.

Here was a revelation: there was a rhythm of change that I experienced as a pleasurable rippling sensation. This seemed to be associated with slower movement and not facilitated by heavy pressure. Nevertheless, these pleasurable sensations produced effective change in my body. I sometimes asked my practitioners to slow down, or lighten up during the session because ?I can?t follow you.? That is, I couldn?t locate changes in my body as they occurred. This was occasionally a challenge to practitioners who felt ?you have to get in there? to be effective, but I?ve come to believe that ?get in there? means to understand what it is you want to affect?and effect. It doesn?t necessarily mean, ?Push harder,? despite common interpretations. In the same way, the concept of working ?deep? has often been approached as meaning to press into the body – as if it were earth to be dug through. But the body is a continuity. It?s the continuity that responds to specific touch with rippling sensations, and the continuity that?s engaged in the source and result of those sensations.

I thus was able to identify for myself at least one element that distinguished non-painful SI work?the sensation of rippling, or a spreading feeling in my tissues. But how would this help me in working without pain, given that I can?t ever know exactly what my clients are experiencing? I had the clue of the rippling sensation, and its opposite?the feeling of being pushed, and the resultant burning sensation. One interpretation of painful sensations is that pain is a result of the client?s ?resistance.? So I thought perhaps if I learned to work in a way that didn?t meet resistance, I would not produce pain for my clients. Lighter touch seemed to produce the sensation that I called good, but could consistent light touch produce good Structural Integration?

<center>Elements of the Inquiry</center>

I found my way through this dilemma through several apparently random remarks. One came from Peter Melchior, one of Dr. Rolf?s original designated teachers, who said during a discussion about layers of fascia in the body, that you could conceive of the body as infinite layers of fascia. As I thought about it, since the fascia is continuous and every cell of the body is invested in fascia, then every small investing piece of connective tissue forms a layer of its own. Was it possible to make use of this idea? I began to experiment, to train my tactile sense to feel for distinctions of layers as I worked with a client. These experiments led to what became one of my principles of working painlessly: when I ran into an area of ?resistance,? a place where I could not feel that tendency of the tissue to ripple, to liquefy, I found that if I retreated to what I thought of as ?the next layer above,? if I modified my pressure even in the slightest, I would find that the tissue would easily move, open, spread. I came to believe that there is always somewhere in the client?s body that will easily respond to gentle or moderate pressure with that sensation of opening, and that areas of resistance, of persistent inflexibility, can be accessed through the areas that easily respond.

Other statements that influenced my explorations came from Gil Hedley, Ph.D., Director of Somanautics Workshops, Inc., and anatomist extraordinaire. In an interview in the Rolf Institute publication Rolf Lines, he said that patterns in the body were apparent from the skin layer right down to the bone?that a torsion or restriction could be traced all the way through the body. This said to me that if I perceived an issue with the psoas or sacrum, for instance, it wasn?t necessary to try to feel I could touch the sacrum or psoas?I could access the issue as I perceived it through any layer of the connective tissue system. This eliminated that need to try to get through a depth of tissue to reach some specific site in the body. I was encouraged to continue to experiment with touch involving less pressure, but not less contact.

When I took Jeffrey Burch?s series of ?Visceral Manipulation for Structural Integrators? classes, my sense of touch and contact changed radically. Since a large part of the course concerned the relation of the visceral fascia to the structure as a whole, my concept of fascial connections, and hence my ability to imagine more ?layers,? expanded. The particular kind of touch involved in visceral manipulation was also essential to my developing a less painful way to work. The methodology of using the whole hand, of determining the movement already available to the tissue, then working with available movement as an alternative to than forcing another movement?in short, the practices involved in ?listening? to the tissue?were all important to my development of a different way of contacting the fascial tissues during Structural Integration.

Being exposed to the idea of manipulating organs broadened my sense of what I could touch, was touching, in the tissues. This echoed another idea that I remembered from the Gil Hedley interview, the idea that in dissection you can find any kind of structure you can imagine in the body. If you go searching for a particular ligament, for instance, a structure that you think must be there to support something else, you will find it. It seemed to me that what was true in dissection might also be true in tactile experience of the living structure. I began to ponder the question of how much what I imagine to be ?the body? influences what I feel when I touch someone. Do I actually touch a muscle or other structure I want to influence, or do I just interpret what I feel as the tissue I?m looking for?

When I attended one of Gil?s dissection workshops, I saw and touched for myself the extent of the connection from the skin and superficial fascia into the deep body, and I realized how dense those layers can be. I am now aware that most of the time I am touching superficial fascia when I work. However, I get results that I assumed early in my practice depended on ?deep? work?touch that involved a lot of pressure. I think now that in trying to ?get deep? by increasing pressure, the superficial fascia is just compressed, and since superficial fascia is well invested with nerves, this compression can cause pain. My practice of backing off when I meet resistance is essentially providing a decrease in compression in the superficial tissue, including the embedded nerves. I also realize that, since there are fascial connections throughout the superficial layers extending to deeper body structures, I can feel into deeper body structures through those fascial connections, affecting them with a more ?superficial? touch. What I affect seems to depend on what I am looking for, both in my conceptual process, and in my tactile approach.

I began to ask myself, ?What can I really feel? What can I distinguish with my hands?? From training in visceral manipulation and craniosacral therapy, I learned that I can feel quite subtle distinctions in the body, and I feel these even though my hands are in contact with superficial fascia. And, as Gil predicted for dissection, what I feel I can distinguish depends largely on what I imagine to be there. Often this is determined by my study of anatomy from books, as I imagine layers of muscle with different angles or action, the intricacies of ligamentous tissue around a joint, or the possibility of organ fascia adhering to and impeding the movement of other structures. In a living body, the tissues are not separate from each other?any place that I touch is the home of multiple structures. I find that I can manipulate deep structures from touching the superficial fascia. I imagine the direction or placement of fibers of deeper structures under my hands, and direct my pressure on the superficial fascia toward the change that is appropriate.

This ability to feel into the body and distinguish the variety of tissues from the surface grows from the state of awareness referred to as ?listening.? People sometimes puzzle over the term, since how can you listen to something you?re touching? Listening in this context means being receptive to information from the world outside oneself, and just as a wild animal listens to sounds from the environment before taking action, a practitioner can be receptive to information from the body. This receptivity has a body component. I learned that one important element of working with less pain was the posture in which I worked. Listening demands an alertness, and flexibility?I need to be relaxed, in contact with my client, and supported within myself so that I can move easily.

My question when I began the inquiry, whether or not light touch could produce effective SI results, was answered by making a further distinction. It isn?t a matter of more or less pressure, but more precision?in understanding specifically where my pressure is directed, and in feeling where there is already available movement in response to my touch. After many years of pursuing this inquiry into the issue of pain in Structural Integration, I have identified for myself several elements that are present when work is perceived as painful, and the counterbalancing elements that result in work that is not painful. I know I?m not the only Structural Integrator whose work is not considered painful, so what I outline below is not a conclusive approach, by any means. It is one attempt to delineate some factors that may enable other SI practitioners to consider the role of pain in their own work.

<center>Outcomes of the Inquiry</center>

These are factors I have identified as being key issues in whether SI work is perceived as painful or not:

? The position of the practitioner?s body

? The practitioner?s perception or imagination of the body

? The angle of pressure while working

? Concentrated or diffuse input from the practitioner

<i>The Practitioner?s Body</i>

Many bodyworkers tend to fall into a pattern of stiffness when working?shoulders hunched, with fists or fingers pressing downward near to a right angle to the client?s body, and arm, wrist, and finger joints compressed and held rigid. I think of this as a position I?ve taken when I have an idea about what ?should? happen in the body, and am determined to make it happen. It?s virtually impossible in this position, due to the rigidity of my arms and hands, to get information back from my client?s tissues?whether of increasing fluidity, or of subtle changes in breathing or pressure that also indicate changes in the body. My focus becomes a change I imagine, in a body I imagine as flawed. I?m not alert to other changes that are happening, nor am I using the present resources in the client?s body?for instance, the place where the tissue easily responds to my touch.

The key to remaining responsive to my client?s body, to not developing this rigidity in working, is the flexibility of my own spine. It?s not possible to feel fluidity in my spine in the posture of shoulders up and arms pushing down. From studying with Hubert Godard, I relate the flexibility in my spine to being able to extend through the natural lordoses at cervicals, lumbars, and knees. I notice that when I am pushing I tend to flatten my lumbar lordosis, and become closed in my shoulder joints, knee joints, and pelvic floor. As my spine loses its resilience, so does my tactile contact. When I am working I sometimes exaggerate my lumbar and cervical lordoses, then gradually extend my spine to move out of the exaggeration. This lengthening practice relaxes the tension in pelvic floor and limbs. In addition, I feel more supported by my spine, and my upper gravity center moves forward of the angle of my arms, rather than being pushed back by my pushing. From this position, my center of gravity provides the weight into my hands, rather than my pushing force. My arms relax, my hands become receptive.

<i>The Practitioner?s Image of the Body</i>

How I perceive a situation in my world determines the action I will take in that situation. When I was first working with my idea about feeling infinite layers, I showed an SI student, with extensive massage experience, how you could find the responsive layer of tissue in the body adjacent to an area that felt hard or immobile. ?You mean when you run into resistance you back off?? she asked. ?I always push harder.?

When the sensation of feeling tissue that is unresponsive to the touch is described as resistance, the practitioner is set in a relation of conflict with the client, or at least the client?s body, however unwittingly. The possibility of communicating with the body, of listening, is lessened. Similarly, I had a prospective client tell me that he had experienced a mini-demonstration of Structural Integration from a practitioner and had found it very painful. The practitioner had explained to him that there were ?crystals in the tissue? and that ?they needed to be broken up.? If a practitioner?s view of the body is that it contains hard foreign objects that need to be broken, they will use their hands as though breaking foreign objects, despite the possible softness and resilience that might be available to feel. Even if one accepts the metaphor of ?crystals? in the body, there are other ways that crystals are transformed? through melting, for instance, or through distortion by providing pressure to the area around them. A practitioner who believes that their action melts tissue will work quite differently than one who believes they need to break up something in the body.

<i>The Angle of Pressure</i>

Quite simply, pressure at or near 90° is more likely to be painful than pressure at an oblique angle. I think this is because it tends to compress layers of superficial fascia. It is also the angle of work that seems to follow the posture of stiffness described in the section above.

<i>Concentrated or Diffuse Input</i>

When I press on a single point in the body, I concentrate sensation for the person to that area. That sensation will dominate the person?s attention, and it isn?t hard from there for the nervous system to interpret this concentrated sensation as ?too much? ?which is the experience of pain. It?s possible to mitigate this sensation of ?too much? by breathing, visualization, movement?anything to add more sensation and change the nervous system input. It?s possible also to engage the nervous system differently, with diffuse sensation that is less likely to produce pain, and more likely to produce sensation that the client can become curious about, even enjoy.

The first stage of learning of any kind, verbal or non-verbal, is to notice difference, to make distinctions between one thing and another. As a client learns through body experience in Structural Integration, the opportunity to have an experience of ?difference? is important. Single-pointed pressure doesn?t allow this. The simple use of two hands applying pressure in different areas of the body allows the client to make a distinction between sensations? ?this? is not ?that.? A second hand can engage sensation in an area that feels okay, while the other works on an area that?s painful. I believe that the ?this not that? information, even if not conscious, not only facilitates change in the tissue, but begins a different organization in the body schema.

A further step toward effective painless work can be taken when a third point of contact is added. This concept of engaging a third point came to me from some exposure to energy healing work, in which three points in the energetic body were always engaged in a treatment. When a third source of sensation is added during an SI session, I believe the body then references relationship within itself in a new way. Dr. Rolf?s directive to ?Take the tissue where it belongs and ask for movement? is essentially a recipe for providing more sources of sensation/information for the body in its self-organization. Movement can be the third source of information, or the practitioner can use tactile pressure to direct sensation toward a third point of reference.

Using a third point of contact allows a perceived issue or problem to be addressed without directing focused attention (tactile pressure) on the ?problem area.? This is where it?s important to have a very detailed image of the body. In addressing a specific problem area a client has reported to me, I think about structures involved in the issue and their relationship to each other, most often in terms of an anatomical map. That map may be gross anatomy, the shapes of familiar anatomical structures, or I might be imagining fascial connections within and between gross anatomical structures. I imagine the direction of the fibers of the structures, or the vector of their movement, and I direct the pressure of my hands along the lines that I visualize, with the perceived problem area as a point of convergence. In other words, the problem area is one point in a triangle, and I find two other points that seem related to it in terms of vectors of movement that, ideally, would move through the problem area. From those two places I direct pressure toward the perceived problem, and simultaneously feel for a relationship between the tissues of the places I touch, so that the sensation of my touch presents the client with a different perceptual relationship to the problem. The change in tissue effected by my hands is directed not only to the area I?m touching, but another, related area as well.

For instance, if I evaluate lack of extension in the psoas, rather than pressing down on the psoas to ?free? it, I might place my hands on other muscle groups that modify movement across the hip joint?such as the adductors and rotators. Then, in inviting action of the hip joint?by the client raising the knee, for example?I can feel their participation in the action of the psoas, and the client?s attention is directed to the complexity of the movement of the joint, rather than the sensation of pressure alone.

I once worked with an SI practitioner who had chronic tightness and pain in her upper back, a persistent ?knot? near the scapula. She had been told by other SI practitioners that she needed to get work often, from someone who knew how to ?really get in there.? She always anticipated that this would mean a lot of pressure? and pain?but that this was the only way to deal with the problem. I used the approach described here of working with the responsive layer of the tissue, and using two hands directing two vectors of pressure toward the perceived problem area. After a few minutes, she took a deep breath and said, ?I feel like I can finally relax in there!? ?which is really the point of the work: to suggest to the body schema an alternative organization that is easier, less stressful, less energetically costly.

<center>Conclusion</center>

It is impossible for a practitioner to know what a client is experiencing without specific feedback; it?s not unusual for what feels to the practitioner as light touch to produce intense sensation for the client. Similarly, strong pressure can sometimes feel pleasurable to a client. Experiencing some discomfort in the process of SI may not be something that can be avoided completely. Additional pressure to an area of the body that has been injured or otherwise experienced as painful may trigger the sensation of pain. What I offer here are ways to work that are far less likely to result in painful sensations. A guideline for acceptable or ?appropriate? pain during the process is if the client is able to stay engaged with and have some interest in observing their body sensations.

This way of working is not the only effective way. There are always clients who need some intensity of sensation in order to feel met, to feel as thought something is happening for them. Some other methods essentially provide the same elements I advocate here: for instance, involving the client?s movement is, I think, essentially the same as adding a point of contact, in that both effect an increase of awareness. It?s my belief?from personal experience, as I have indicated?that SI work which is not perceived as painful is incorporated more easily into the body schema.

I hope that what I have outlined here provides some ground for personal exploration for those practitioners who may also be questioning the phenomenon of pain in the SI process. I find that attending to facilitating change without pain feeds my pleasure in the inherent mystery of Structural Integration work. The client is allowed to rest in the experience of varying sensation, and for myself, the communication with the changing body of another person, with its demand for attention, and the awareness of subtle shifts in the body fabric, leaves me deeply happy.

Resources Referenced

Dr. Gil Hedley, Somanautics Workshops, Inc. and Integral Anatomy videos <a href=’http://www.gilhedley.com’ target=’_blank’>http://www.gilhedley.com</a>

Jeffrey Burch, Visceral Manipulation for Structural Integrators
<a href=’http://www.jeffreyburch.com’ target=’_blank’>http://www.jeffreyburch.com</a>

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