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CAPA Structural Integration 2004-03-06-Summer-June

NMT and Rolfing

Pages: 35-38
Year: 2004
Dr. Ida Rolf Institute

Structural Integration: The Journal of the Rolf Institute – Summer/June 2004 – VOL. 32 nº 02

Volume: 32

When a Rolfer tries to establish connections between Rolfing and another soft-tissue discipline, particularly when considering an interface, there is an involuntary knee-jerk reaction from many in the community who see such an inquiry as a potential dilution of the purity of the work. This territorial response stems from the ramifications of igniting the tinderboxes that lie within and adjacent to the Pandora’s Box we lovingly call our “scope of practice.” Since we are describing a moving target with multiple appendages, septa and genetic recombinations, trying to clearly spell out what we mean when we attempt to merge another modality with Rolfing often degenerates into an emotionally charged “Fractured Fairy Tale” (to borrow from my favorite cartoon perversions of our most beloved tales from childhood). With this in mind, I would like to add some kindling by offering a test case for a modality that some erroneously confuse with integrative deep tissue work, said modality being the widely taught NeuroMuscular Therapy, more particularly the incarnation of NMT as described and taught by Dr. Janet Travell’s former student, Judith WalkerDelany.1′

Before exploring some elements of NMT and how they relate to our work, we must first deal with an obvious “modeling” problem. That being how NMT fits into Maitland’s three paradigms of bodywork, a model familiar to, but perhaps not clearly understood by many in our community. My intention here is to briefly summarize Maitland’s ideas and use them as a springboard for our discussion. I rely mostly on his presentation of these ideas in his 1995 book, Spacious Body: Explorations in Somatic Ontology.2 By citing only this and a few other primary sources, I hope to avoid the problems that led to a recent debate be tween Maitland and Maskornick in whicl Maitland pointed out numerous distortion of his ideas and addressed other larger is sues concerning egregious co-opting anc misinterpretations of his clearly articulates model.3

In Spacious Body, Maitland states that after a detailed consideration of the systems o health care, he determined that they canal be placed in one of three broad classifica tions. “A careful look at the great variety a systems of health care that are practicec throughout the world, from allopathic medicine to shamanism, reveals that then are actually three fundamental, hierarchically related models. These can be called the three paradigms of practice, and they underlie all systems of health care, whether they are devoted to the physical, the mental, the spiritual, or all levels at once.”4

These classifications – relaxation, corrective and holistic – are Maitland’s three paradigms. The first or relaxation paradigms is “oriented toward promoting health anc well-being by creating the relaxation response.” Examples of this paradigm are some forms of massage (i.e., Swedish) anc biofeedback. The second or corrective paradigm contains practices that “aim at the symptomatic and often piecemeal treatment of disease, pain, dysfunction and structural problems.” Maitland lists as examples: allopathic medicine and non-medical modalities such as most forms of physical therapy, deep muscle and myofascia] release therapies, as well as some forms of osteopathic manipulation. The third or holistic paradigm includes those modalities whose primary goal is “devoted to enhancing the functioning of the whole person, body, mind and spirit.” The key element for a third paradigm practice is that improving the order and health of the entire organism takes precedence over symptomrelief. “The symptomatic remediation of disease, pain, dysfunction, and structural disorders is obviously not the focus of this paradigm. Nevertheless, because of the allencompassing nature of the holistic approach, the remediation and correction of disease, pain and dysfunction are more often than not the welcomed and expected outcome of balancing and organizing the entire person.” Maitland lists a few examples: Rolfing, “energy systems that are the focus of many disciplines of Oriental Medicine,” and homeopathy. Maitland also points out elsewhere that many osteopaths are holistic in both intent and practice.’5

With this structure in mind let us look in a bit more detail at NMT and see where it fits into Dr. Maitland’s classification scheme. NMT has a rather complex history with two main traditions, the so-called “European” and “American” Schools. This discipline was first described in the 1930s by its primary European exponents: Lief, Nimmo, and Boris Chaitow, and later by the prolific Leon Chaitow, Boris’ son. The American school includes several important practitioners and theorists, such as Vannerson, Simons, and Travell, and Travell’s former business partner Paul St.-John.6

The basic principle behind NMT is that there exist sensitive areas called trigger points (often abbreviated: TPs) in muscle fibers. These regions are palpable, refer pain and can be released through sustained pressure. All TPs have clearly-mapped pain patterns and by working backwards from local symptoms, anyone versed in the method can trace causative pathways for any point-specific pain. These TP referral patterns are well-researched and described quite explicitly in their literature .7 The key to understanding NMT is therefore based on a working understanding of the nature of TPs an ability to determine referral patterns, and an ability to structure sessions to alleviate the client’s resulting symptomatic pain.

A good if somewhat lengthy definition of a TP is this. ATP is a region of hyperirritability caused by any of the six physiological factors associated with them (see below for more on these factors). It is further caused by a chemical imbalance at a cellular level that refers pain. These regions are caused by chronic contracture, which is defined as an involuntary sustained activation of a muscle’s contractile elements in the absence of action potentials, where a muscle’s fibers are chronically and involuntarily contracted. An NMT therapist is therefore one who uses a variety of techniques to treat TPs.

The integrative dimension of NMT comes into play when we look at the larger scope of how these protocols are structured and what should inform the thinking of the NMT therapist as he evaluates his clients and structures his sessions. The two key integrative elements of Delany’s model of NMT are what she calls the three umbrellas and the six physiological factors. The “three umbrella” construct is a metaphoric image for a classification system which groups all somatic complaints into three broad causative categories: biomechanical, biochemical, and psycho-physiological. The second idea is that there are six physiological factors that contribute to the formation of TPs: 1) ischemia; 2) trigger points (an odd redundancy that I never did quite understand); 3) entrapment, which involves soft tissue restrictions and compression, which involves bone impingement on nerves; 4) postural and biomechanical dysfunctions; 5) nutritional imbalances; and 6) stress-related matters. Failure to address all six contributing factors in a comprehensive manner will inevitably result in a recycling of the symptoms and will fail to effect a permanent resolution to the problem. All the factors are found under each of the three umbrellas and it is argued that working in this multi-tiered manner gives the NMT therapist a comprehensive and integrative model for conceptualizing TPs not as isolated aberrations but as system-wide events with complex interrelated causes, all of which must be addressed for a satisfactory resolution of local symptoms in order to improve the health and efficiency of the organism. This approach as described may seem integrative in scope and intention, but is it uniformly applied in a way that is truly holistic?

Before answering this question, let’s look a bit closer at the nature of the training NMT practitioners receive and how they might structure their protocols into coherent units. If we consider a typical NMT session, we would assume that it usually consists of a sequencing of routines learned in their training. Some 90 to 100 are taught in Delany’s 125 hour certification program and there undoubtedly exist many other routines taught at higher level seminars and in teacher training classes.” So, we might reasonably infer that a novice or moderately experienced NMT practitioner would use these basic routines to structure a session or group of sessions in response to his client’s issues and that these sessions would be symptom-specific with connecting routines added to address related compensatory patterns. The sophistication of the organization of these routines would be commensurate with the practitioner’s evaluative skill and knowledge of the myriad ways in which large-scale issues affect local TPs. The NMT practitioner’s detailed knowledge of pain referral patterns, which should not be confused with dermatomes (although there seems to be some overlap), is obviously the most critical factor in formulating sessions.

Other factors that shape the nature of an NMT treatment program are the guidelines provided for determining the timeframe required for adequate results. This interesting yardstick suggests that if the therapist works within normative expected guidelines, they should assume that for each year the person has had a given problem it will take a month of treatment (with an average of two sessions per week) to resolve or dramatically improve their client’s pain. So, a ten-year old problem should take ten months or some 80 sessions to resolve. This is quite different from our model but rather interesting and it might be intriguing to test its accuracy.

Now, if the NMT practitioner replies that he is really devoted to improving the entire system and is involved in a comprehensive program of system-wide change, only one component of which is soft tissue release, then said practitioner would be closer to Maitland’s third paradigm. To meet all the requisite criteria of a third-paradigm practitioner, the NMT, as suggested by their own definition, would have to be integrative soft-tissue experts, nutritionists, experts in biomechanical principles, experts in their understanding of the nervous system and very knowledgeable about integrative psychological therapies, preferably ones with a somatic orientation. While this is possible for its most elite practitioners, it would certainly not apply to most.

The further we look, the clearer it becomes that the training for a basic NMT therapist is hardly holistic, but is, rather, local in nature. First, owing to the incredible amount of technical information and protocol memorization involved in a good NMT class, it is unrealistic to assume that anything like an integrative understanding can be expected. The best that can be hoped for is that the student has had sufficient practice to grasp the basics and is then willing to refine his technique through repetition, receive additional training to further his skills and become ever more skilled at building coherent sequences of sessions to treat the offending issue or issues in a way that calms the system and improves the nature and quality of the client’s tissue.9 Here again, given the nature of the teaching and time involved in mastering NMT at even a basic level, it would be a leap of faith to infer that more than a few elite therapists would potentially perform their work with creating higher levels of order and coherence as their primary intention. Another clear reason for not considering NMT as an integrative modality is that there was no teaching of integrative seeing and thinking in the training class I attended. Rather, the focus of the training was pain patterns, treatment protocols, a brief introduction into their detailed literature on pain referral patterns and how and why NMT works. The integrative elements addressed along with a brief presentation of postural analysis whet my appetite to matters integrative but were never sufficiently developed so that they rose to the forefront and set the groundwork for developing a truly holistic model for creating and seeing integration.

On the other hand, for a Rolfer to be considered a third paradigm practitioner, he must follow Dr. Rolf’s goal of always attempting to integrate the system at every step of the process in accordance with the principles he learns in his basic training. Said training is intended to teach third paradigm work from the outset, the limits of the practitioner’s ability to see, feel and create order in his clients being the main impediment to achieving system-wide integration. The criteria for creating and seeing order as well as teaching it are established in our training and are well understood by many in our field. Those seeking a clearer understanding of how to work holistically may return to such resources as the writings and taped lectures of Dr. Rolf, Emmett Hutchins (video and A Searcher’s Handbook), Peter Melchior (two video ten series) and the writings of Jeffrey Maitland, Peter Schwind (Alles irn Lot) and the forthcoming two-volume exploration of Rolfing principles by Ec Maupin, to name just a few.10″

One limitation of the integrative potential of our work is the degree to which our attention on the local symptom overrides out concerns of order and integration. Maitland clearly acknowledges this possibility, explaining that second paradigm elements may occur in third paradigm practices, although the opposite crossover will not While we may temporarily be interested in treating a local problem, we must as often as possible be deliberately and consciously integrating any local gesture into an ideally omnipresent holistic vision of the client’s evolving system.

The obvious challenge is that we are all predisposed to work locally and it will for most of us take considerable time before global thinking is foremost in our minds. This may be why the best basic teachers-Tom Wing comes to mind – might lead a student across the room to show him the global effects of a single local intervention; or why Jan Sultan admonishes his students to stop at least once during every session and simply watch for “what comes up next” as the client experiences and responds to the work. Holding these and similar global notions in our awareness as much as possible will ultimately help us move more and more into a Gestalt mode of working and experiencing. The best way to move in this direction is simply “to live in the tissue”11 while attempting to at all times hold these fundamental ideas foremost in our thinking and sensing as we engage and transmute the tissues under our hands.

I think that here perhaps is a pathway through which the NMT technology may have third paradigm implications. In order for this transmutation to begin, we would have to engage in a bit of abstraction that may disconcert some. We must first broaden our definition of the techniques that Rolfers may employ in the context of their sessions and accept connections that may challenge our model of the work we do. To strengthen my case that many now work outside the “pure Rolfing” model, we might for example look through our own literature and see how many in our community have argued for the value of alternate means for locating and resolving local strain patterns. For instance, Stanley Rosenberg has recently refined his arguments for the presence of “acu-stripes” as organizing patterns in fascia, and pointed out their value for our work.” We might further suggest that concepts like the “control points” taught by Sultan, his gateways for effectively resolving local problems in the context of an integrative advanced session, are analogous to the trigger points taught to NMTs. We can also find numerous articles in our publications on visceral work, craniosacral biodynamics, biomechanical manipulative techniques, Godard’s and Conrad Da’oud’s work, among numerous others, all of which many of us have studied and currently integrate into our sessions. If we accept that using these other technologies is a valid part of our sessions, it begs the question: can we use NMT trigger points holistically?

I would argue that a highly specific technique like NMT may be transformed from a local intervention into one with larger structural implications. There is for example a description of an NMT release technique for the upper back as a part of the protocol for the splenii tendons. One part of this protocol involves placing the thumb “anterior to the trapezius and posterior to the transverse processes, while pointing the thumb toward the person’s feet.”13 The goal here is to feel for a small opening called “the pocket,” which lies lateral to the spinous processes of T2 or T3 (the middle origins of the splenii which attach to the spinous processes of approximately C7-T6) and, once in there, release these muscles to ease shoulder tension and pain. Finding this location is a bit tricky, but once you do, it provides a nice access to some tenaciously shortened structures.

If we follow the normal NMT protocol, we would hold here for eight to twelve seconds per release. In the NMT model if this specific region proves resistant or slow to change we do not remain there longer, as this can prove an irritant. Rather, we return to said region up to three or four times per session and may repeat this in several subsequent sessions.

Obviously, this is not an integrative approach. The first thing that needs to happen is that we abandon the eight to twelve second protocol. Another thing that must be set aside is the tendency of most NMT practitioners to enter the tissue too quickly and directly. This can prove overwhelming and is inherently antithetical to an integrative sensing of fascial restrictions. How we might counteract this tendency is to slowly and securely ease into and precisely locate “the pocket.” As we work our way in, we must have as our primary intention feeling the entire related fascial sheet (in this case, the second muscular layer of the back). We might then begin exploring larger relationships down into the thoracic and lumbar articular pillars inferiorly to the sacrum. We could subsequently branch out along the semispinalis or “ride” to the pelvis and legs via the psoas, pelvic ligaments, or the quadratus lumborum. It is also possible to feel superiorly into the cranium and upper cervicals, although owing to the position of the thumb, lateral and inferior relationships are considerably easier to sense.

The range and subtlety of the relationships that can be felt and transformed using this approach are limited only by the Rolfer’s patience, skill and tactile sensitivity. Such subtle sensing is not a part of the NMT’s basic training, as far I know. We, however, are introduced to such fascial gliding from our earliest training and most of us explore this feeling daily and continue to do so in ever more subtle ways as the years pass. In my view this “hidden” access to the splenii can provide a locus (a term NMTs use often) for a profoundly rich “fanning” and gliding through multiple myofascial structures and fascial layers and be applied in an integrative manner. Therefore, by analogy, any such protocol or local gesture can be executed with integrative (read: holistic) intention. This may be why, for instance, using NMT protocols for our intraoral 7th hour work opens up many possibilities for higher levels of order through extremely specific releases, when performed in themanner described above .14

The question of whether this work is truly fascial and “real Rolfing” is mooted by the fact that all Rolfers develop abilities to affect fascial planes by deliberate and static work. And, while many Rolfers may not initially work in this way, most will eventually incorporate more of this mode of affecting tissue, particularly in their integrative sessions. This of course presupposes that they or other practitioners before them have released the sleeve, cleaned out the deeper restrictions and done the fundamental core work without which such mid-layer integrative work cannot possibly transfer and resonate throughout the system.

Ignoring this relatively static yet constantly morphing work or arguing that it is not an essential component of the integrative process would seem a rather difficult positior to defend. In order for our work to be truly integrative, it must address all layers using a variety of fascial techniques to access, release, balance and reconfigure every structure we affect. Just as focusing on symptoms prevents NMT from being considered a third paradigm practice; so, applying maximal pressure in the final three basic hours limits the integrative potential of these (and other) sessions. Local work properly paced and integrated into the session has at least as much transformative and cohering potential (most particularly, when combined with movement and internal explorations) as classically integrative fascial strokes.

If we are more interested in defending our territory than expanding our vision, we limit ourselves and the work (which is as dynamic and mutable as the structures that it transforms). We further fail to grow and may consequently lack the capacity for the type of visionary and critical thinking that Dr. Rolf so tirelessly tried to communicate to her students.

NOTES

1.All the material in the NMT discussion, unless otherwise cited, comes from lecture notes and the 2003 revised Power Point presentation prepared from Delany’s work by Dr. Rebecca Birch-Blessing and Dr. Marti Costello of Rising Spirit Institute of Natural Health in Dunwoody, Georgia. I am grateful to Dr. Blessing in particular for her excellent and clear presentation of this material and her challenging discussions with me as this paper was gestating.

2.Maitland, Jeffrey, Ph.D., Spacious Body: Explorations in Somatic Ontology (Berkeley, CA: North Atlantic Press, 1995): 145-62. Dr. Maitland was kind enough to discuss these matters with me and requested that I take my quotes from this source rather than from his contemporaneous 1995 Rolf Lines article: (“Rolfing: A Third Paradigm Approach to Body-Structure,” Rolf Lines, Vol. 20, No. 2 (Spring 1992): 46-49, which he said was largely a restatement of the book’s discussion. The article, however, is also recommended, as it does offer a few interesting additional details such as his brief discussion of the importance of the word paradigm as articulated in Thomas A. Kuhn’s The Structure of Scientific Revolutions, one of the most influential books in the field of Philosophy of Science of the past 50 years. Let me also here thank him for taking the time to read and critique this article.

3.Maskornick, Michael, “Rolfing as a Third Paradigm Practice,” Rolf Lines, Vol. 24, No. 2 (Spring 1996): 25-27; and Maitland, Jeffrey, Ph.D., “Conceptual Drift and the Erosion of Thought,” Rolf Lines, Vol. 25, No. 3 (Summer 1997):24-32.

4.Maitland, Spacious Body: p. 146.

5.All three definitions are quoted directly from Maitland, Spacious Body, pp. 147-48. The remaining discussion in this section of his book is devoted to why and how Rolfing is a holistic practice. Since this material is familiar to most and does not really advance our argument, a summary of said discussion is deliberately omitted. N.B.: the article’s remark about osteopathy as second or third paradigm in nature was further clarified in an e-mail Dr. Maitland sent to me in which he requested some refinement in my original presentation of his views of osteopathy.

6.See for example, Travell, Janet, C., M.D. and Simons, David G., M.D., Myofascial Pain and Dysfunction: The Trigger Point Manual, 2 Vols. (Baltimore: Williams and Wilkins, 1992).

7.For a typical discussion of a major muscle, see Travell and Simons, Myofascial Pain and Dysfunction: The Trigger Point Manual: The Lower Extremities, Vol. 2, Chapter 4. Quadratus Lumborum Muscle, “Joker of the Lower Back” (Baltimore: Williams and Wilkins, 1992), pp. 28-88.

8.There are in fact NMT training programs at many schools that are in excess of 200 hours. Whether these longer programs are any more successful at teaching integrative thinking is a matter I cannot directly address here, although I have serious reservations based on discussions with instructors and graduates of these longer programs.

9.The time factor for developing a basic proficiency in NMT is a minimum of two years. This is based on a personal conversation with my teacher, Dr. Blessing, a senior national instructor for Delany.

10.Thanks to Dr. Maitland for his discussions on these matters and for sending me an article of his which explores these issues in much greater detail. For more, see: “Cultivating the Vertical: The Rolf Method of Structural Integration,” which appeared in the collection: Principles and Practice of Manual Therapeutics by Patrick Coughlin (Philadelphia: Churchill Livingstone, 2002). For an alternative look at the problems of defining integration, the reader might also consult my article, “What is Integration?” Structural Integration, Vol. 30, No. 4 (December 2002)-.9-12, although it in some ways contradicts what is written here.

11.A special acknowledgment to my dear friend Anita Acevedo, from whom I shamelessly borrow this exquisite phrase.

12.Rosenberg, Stanley, “The Role of AcuPoints in Rolfing, Rolf Lines, Vol. 22, No. 3 (October, 1994): 24-27; “The Role of Acupoints in Rolfing,” Structural Integration, Vol. 31, No. 3 (Summer/August, 2003): 16-17 and “Acupuncture Points, Meridians and Stripes,” Structural Integration, Vol. 31, No. 3 (Summer/August, 2003):21-23.

13.Delany, Judith Walker, LMT, Neuromuscular Therapy: Care of Soft Tissue Pain and Dysfunction: Splenii Tendons (St. Petersburg, PA: International Academy of NMT,1994): Spine 2.

14.This at least has been true for me. I wish to acknowledge my friend Olixn Adams with whom I discussed these intra-oral protocols early this year and who echoed my feelings about the power of these techniques in elevating the quality of our 7th hours.

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