A: The cause of hypertonicity and compression typically comes from poor sitting and habitual dysfunctional movement. The crux issue is not allowing the core to move in contralateral motion while walking, sitting (even sitting should allow contralateral motion), running, or any form exercising. Contralateral motion through our core space – which includes the spine – will rehydrate and decompress our discs and keep our facets fluid and able to maintain movement through neutral space. This is the ideal healthy state in which you can ‘feel your boogie’ or inner monkey – or fish-like motion. Once we lose contralateral movement, we begin to shorten and compress the structure throughout. Ultimately both the cause and the outcome are due to habitual dysfunctional movement or injuries like whiplash, bicycle accidents, specific traumas to the body, and repetitive motion syndrome of the spine.
An example of one of the most common problems walking into my office would be a person with a long lumbar sidebend with individual vertebrae rotated right and left, posterior tilted pelvis when sitting, lower lumbar curve in extension, posterior ilium, L5 compressed and FRS (flexed, rotated, and sidebent) or ERS (extended, rotated, and sidebent), psoas and iliacus extremely tight on one side, imbalance in multifidus tone, tension in sacroiliac ligament due to pulling from poor gait mechanics, shortened thoracolumbar fascia, and tension at hamstring origins. Typically a shortened psoas can hold the lumbars in sidebend with various rotations and in flexion and/or extension. This is one of the keys to unlocking the problems.
First, each specific person must be assessed in terms of the myofascial shortening, specific mechanical dysfunctions, and related neurological components while the person is standing, seated, and walking. This is a cumulative problem. These three elements create a synergistic relationship, and each must essentially be addressed through specific steps. Here’s a thorough sequence that I find useful for most people with chronic conditions:
1. Lengthen sidebent lumbar vertebrae, derotate individual vertebrae, and normalize lumbar curve. Remember that L5 may rotate with the sacrum or opposite the sacrum. It is almost always compressed. The lumbars act like a long screwdriver affecting the sacrum.
2. Lengthen the psoas at both ends. This can be done without venturing too close to the organs. Also, reestablish normal lumbar curve, and lengthen the quadratus lumborum. These first two steps unload the lumbars from the sacrum
3. Balance the pubic bones – superior or inferior.
4. Work with sacroiliac dysfunctions: bilateral anterior nutation (flexion), bilateral posterior nutation (extension), unilateral anterior nutation, unilateral posterior nutation, anterior torsion (L on L or R on R), and posterior torsion (R on L or L on R). This can be addressed by rocking the sacrum into a neutral position and balancing the piriformis muscles.
5. Correct any iliosacral dysfunctions: anterior rotation, posterior rotation, superior (cephalic) shear, inferior (caudad) shear, medial rotation (in-flare) and lateral rotation (out-flare). I frequently begin by rocking the posterior ilium into neutral position.
6. Check the long posterior interosseous ligaments (part of the sacroiliac ligament complex) as they can compress the sacrococcygeal nerve plexus. Sometimes the problem begins in this area, and clients may need to ice this area after treatment.
7. Balance the thoracic curve.
8. Put client in seated or standing position, reestablish lumbar curve and length in lumbars using Warrior I yoga posture with stretching and upward movements. Many more excellent and effective movement stretches and exercises can be found in the book Hour Life Moves by Caryn McHose and Certified Advanced Rolfer Kevin Frank, or work and books by Certified Advanced Rolfer Hubert Godard.
9. Check the walking gait: the typical person has forward flexion of the torso, a failure of the ilia to extend, poor hinge mechanics of the feet, and one or both femurs stuck in what usually manifests as external rotation. This gait causes psoas overuse which leads back to all the other problems. For a good review on gait read Certified Advanced Rolfer Aline Newton’s “Gracovetsky and Walking” in the Journal of Structural Integration, February 2003, or Dr. Philip Greenman’s article on gait in the book Lou, Back Pain and Its Relation to the Sacroiliac joint.
10. Use post-Rolfing® movement sessions specifically to teach functional movement. This is the key component in maintaining the work and healing, and without which people return to old patterns that are both the cause and the result of the condition. Movement sessions typically include:
a. working with gait.
b. sitting properly.
c. specific yoga postures, stretching, and dancing using contralateral motion from the core for self-maintenance.
11. People need a Rolfing series to address other underlying compensatory holding patterns.
Special thanks to Anna Neil-Raduner and Elmar Abram for creative inspiration.
Credit to my teachers: Ida P. Rolf, Ph.D., Philip Greenman, D.O., Serge Gracovetsky, and Hubert Godard.