Three years after my Rolfing® certification I took my first visceral manipulation class with Jean-Pierre Barral. Since 1994, I have been assisting Didier Prat, D.O., with visceral classes as well as continuing to learn from Jean-Pierre. That might be the reason I was asked to write for this issue of Rolf Lines. I am going to explain some of the basic concepts of visceral manipulation and how, since becoming “infected” with them, they have changed my work, methods of evaluation, and concepts of Rolfing.

All schools of manual therapies have their own concepts and perceptions of the human organism, how to work with it, and what constitutes health. I would like to compare several of these to begin with so that you can better understand how visceral manipulation differs.

1. In our school of thinking (at least in my training) we asked the question, “What needs to be done within this session (series) so the organism comes closer to being ‘built around a line’?” This is expressed by the horizontality of the pelvis and evaluated visually.

Jan Sultan’s internal/external model, inspired by the craniosacral system, distinguished the myofascial organization of each type and developed treatments accordingly.

Hans Flury further differentiated the idea of the line with the distinction that the ideal line does not exist. Rather, the line is the most economical approximation given the slight anterior tilt, posterior shift and establishment of ACMOT (Anterior Convex Midline Of the Trunk).

2. In Visceral Osteopathy the working hypothesis is that joints, myofascia and viscera in good health have physiological motion. Any adhesions in the viscera may over time affect the organ, and even the structure of the whole organism. “A healthy organism always produces, gains and loses energy in a balanced manner. In this sense, osteopathy is the art of provoking self-correction on the part of the organism.”2

These aims all sound similar to our idea of Rolfing – but if we are doing that already, why do we need these other modalities, why visceral manipulation? In our training we learn to visually evaluate the shape of our clients while standing or moving. This is the “final” evaluation tool we were given and is still the means by which we evaluate our success and failure to integrate a human structure. Ida Rolf said that seeing is touching from a distance. Another person said that she could see with her eyes wha the inner shape felt like, not what the contour looked like. This is what visceral manipulation had to offer me: a guided tour into the making of the core, the inner shape and its influence on the structure.

Although we speak of the 3-dimensional aspect of the body in our tradition, I now feel that we don’t go far enough. Before being exposed to Barral, I focused on changing the myofascial, tensional forces of the “chasse” – the myofascial linings of the core. It now feels to me as if I wa! actually trying to rearrange the “straps,” the gummibands that hold up the nylon stockings. I was not aiming for what determines the forrr and the inner shape of the leg. Barral’s first course was very shocking to me in that my whole concept, understanding and capacity to perceive with my hands, and therefore an ability to have a precise influence, shifted dramatically.

In what sense you will ask. First and foremost, the quality of touch is very different. You learn to use the palm c your hand (phenar and thenar eminences) with a clear contact on, for example, the abdomen in a perceptive mode. You listen to when your palm is attracted within the 3-dimensional spider web. Your palm could be attracted in any direction – cranially, caudally, deeply or superficially, left or right. The organism and the tissues call you to where they are immobile or immotile, and to a very specific place in space. You do not need to poke with your fingertips, testing which tissues are more resistant, hard or dry, and meeting the resistance and defenses of your client. Rather, you are called and invited in to find which place is either immobile or immotile (I shall define those terms later).

Secondly, I was impressed by the minimalist approach Barral espouses and finally convinced (after year long doubts) that it actually works: listen to what the body tissues tell you precisely, treat them and let the organism do the rest. This idea is so contrary to our classical, very orderly approach of peeling an onion, that it took me some years of practice to be convinced that it works not just for the moment, but astonishingly, stays integrated over time.

In my first attempts at using a “listening hand” ten years ago, I was amazed at how clear some of my “listenings” were and how foggy the others. The clear ones did show a very precise place. I was suddenly perceiving a sound through my hand where previously I had heard nothing from the body. In my first years as a Rolfer, I learned to compare the density, dryness, thickness, range of motion, hyper- and hypotoncity of the myofascial envelope. I tried to explain the manual perceptions with visual evaluation, physics and as emotional “restrictions.” I was only “lip reading” the soma of my clients, but now I could “hear!” What was I hearing? My hand was picking up the locality, for example, in the abdomen, where there was silence (you know how silence gets really noisy) and no motion in response to either diaphragmatic breathing or its normal motility.

So what does this “eye of the storm,” this least secondary lesion, have to do with the shape of the body in a Rolfer’s world? Barral explains: “Adaptive scoliosis following some thoracic surgeries or therapeutic pneumothrax is a familiar phenomenon. This suggests that the forces generated by changing visceral mobility are significant and over time, also able to grossly deform the skeletal structures. In support of these observations, we also noted that a relatively minor pleural injury could be responsible for a considerable pathology which, in turn, could lead to other disturbances, such as chronic cervical neuralgias. A small disturbance in motion, repeated millions of times over months or years, can provoke problems seemingly disproportionate to the origina cause. This illustrates the law of geometric progression: from minor causes flow major effects, which can be at some distance from the source of provocation. For example, the kidney moves 3cm with each breath which cumulatively amounts to 600 meters a day! With extremely forced respiration it will move as far as 10 cm. A minor disturbance in the response of the kidney to breathing can therefore cause a major problem over time.”3

This explained my experience of being able to change a pattern in a client, but three months later the same pattern would have returned. After some practical experience witf visceral manipulation I began to understand how “unresolvable” patterns and pathologies actually could be resolved.

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DEFINITI0NS AND CONCEPTS

For those of you who are not familiar with visceral manipulation courses, I will summarize some of the basic concepts and teaching methods.

1. MOBILITY is defined as the passive physiological movement of any organ in response to diaphragmatic breathing.

2. MOTILITY is an intrinsic active motion of the organ itself. This motility-motion (or lack of it) can only be perceived by an educated hand so, as yet, there is no scientific explanation of this phenomenon. The theory is that motility resembles the growth pattern organs take during fetal development. The unfolding and folding rhythm of motility happens at a frequency of 7 – 8 cycles per minute.

3. The CAVITIES, their PRESSURE SYSTEMS and TURGOR. The body’s cavities are the neurocranium, throrax, upper abdomen and the pelvic basin. Each has a different pressure and because they are in contact with each other these pressures affect the gravitational response of each organ. Barral writes, “The pressure in the abdominal cavity is lower than that of the viscera. The viscera contact each other as much as possible, taking up only a small volume considering their number. It is this phenomenon which makes the abdominal cavity only a virtual one. Although the abdominal viscera enclosed in the peritoneum are of different shapes and composition, they are encircled by a muscular belt and form a relatively homogenous column of viscera, due to intracavitary pressure and turgor. Thus, the thoracic ‘drawing up’ (due to the negative pressure in the thorax) is transmitted to the whole column.”4

4. Gravity intervenes in the abdomi¬nal cavity although its effects are diminished by thoracic suction. Moving inferiorly down the body, the effect of gravity increases. It becomes more noticeable as thoracic suction diminishes. “The pressure in the abdominal cavity of a woman lying down has been measured as 8cm H20. With the subject standing, the pressure varies from 30cm H2O in Douglas’ pouch (at the pelvic floor) to 8cm H2O in the epigastrium and -5cm H2O in the region under the diaphragm.”5

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5. Structure acts on structure; viscera act on structure; viscera act on emotions; emotions act on structure; and vice versa. There is no hierarchy or order to how these causalities occur. This means that a liver, for example, that has lost contact with the diaphragm will not be “sucked up” anymore, and this will have consequences for the structure of the right shoulder and thorax as well as an effect on its neighboring viscera. A “sunken chest” due to psychoemotional patterns or mechanical trauma may affect the structures of the neck and so forth.

6. Last but not least: ONLY THE TISSUES KNOW!

TEACHING METH0DS

Barral is very systematic in his teaching. He begins with a lecture on the anatomy of each organ and then moves on to explain their physiological motions in response to inhalation and exhalation. This is looked at in terms of x, y and z axes within an organ and the resulting movements. HE then explains the axes of motility and what he calls inspir and expir (in paired organs inspir is the movement away from the central line, and vice versa).

Barral then leads the student into the practical hands-on work which is done with a partner, finding first the location of a specific organ by percussing or other types of palpation. Then the student is given a list of tests to perform in order to find specific limitations in the axes of motility and to learn to identify motion restrictions clearly. After a diagnosis is made Barral outlines the various possibilities for treatment, and even though the student partner may not require treatment, all the options are learned anyway. Students learn that during treatment the mode of touch has the listening character. While treating the right triangular ligament of the liver, for example, students learn to perceive what the surrounding tissues are doing in response to their intervention. Then there is time to re-evaluate the tissues and determine whether the restrictior is still there or not.

After the hands-on training, Barral then lectures from his immense experience on all of the possible pathologies of the organ that was just under examination. He also connects the pathologies to emotional contexts he has found predominant. These seem to draw from acupuncture theory.

During my training ten years ago we had only 18 students on average in each class so we had a lot of personal supervision. My ability to perceive manually and my manual vocabulary increased rapidly. After each course I practiced on my clients, so that after the first course all of their livers were checked, after the next all of their kidneys were checked. Within three years of practice I was not only able to “listen” but to speak that language quite well.

VISCERAL MANIPULATION AND R0LFING

After my first course with Barral, I wondered how many of my clients needed a “factory recall” especially in reference to my 5th hour work. I wondered how many ptosed kidneys I had poked, wondering about the hard place in that psoas, trying to make it softer. I had many things to wonder about, but I felt that I had been given some effective tools to evaluate my interventions with. Did my 2nd hour have an effect on the local listenings and findings in the thorax? If it did, great, if it did not I explored what else I could do or how I could change my approach to the 2nd hour so that it would affect the local listenings as well as the shape of my clients within gravity.

Back in 1991, inspired by Barral, we organized a small group supervised by Peter Schwind that met bimonthly. We took up the challenge to translate visceral work into our global fascial and membranous approach, but now looking for efficiency and treating selectively instead of treating every square inch of territory. We were making sure that the few clearly diagnosed structural lesions were moved in the right directions through our interventions.

My Rolfing became more exciting because I was able to look at similar shapes and treat them very individually using the visceral concepts, the perceptive quality of touch and the strength of our holistic, shape-oriented approach. I became able to influence the transitions of this 3-dimensional fascial web in a manner that helped global shapes change while local lesions improved. Not only my work became more exciting, but my capacity to deal with pathological conditions improved, and in turn, my practice increased.

In closing I want to state a few points that I think are very important to our individual and communal futures: our “Scope of Practice” draft document states many values which I subscribe to, but in practical reality I think we still have a long way to go before we reach what we promise. One way we could improve is through our quality of touch and ability to perceive the inner shape of bodies. We could learn to be more self-critical and to translate knowledge from people like Jean-Pierre Barral and Didier Prat into our own tradition. We need to train our hands and minds in anatomical precision and pathological knowledge without losing the uniqueness of our method¬ology. We are not osteopaths but we could learn a lot from them.

? We may find that what Ida Rolf handed via our teachers to us, may have only been a teaching tool to make it safe to work in a fascial body, but it is not the ten commandments.

? We may see that the ten sessions are not what our clients need, as the non-formulistic approach is saying.

? We may see that our hour and a half sessions, given unselectively, may do harm to all levels of the organism. Less may be more!

? We may see that the society has changed its needs since the late sixties.

The service we provide needs to be more efficient and clients may not care about our philosophies but more about their well-being and whether we can facilitate that.

I want to close with Jean-Pierre Barral’s summary of osteopathy the is also valid for Rolfers: “The osteopath is a mechanic in the noblest sense of the word – really a micromechanic. We all have two hands, but really who amongst us knows how to use them? No one argues with the wine taster who, bi using his palette, can tell us the characteristics of a wine – its regior its vineyard or even its vintage. The education of touch can go at least as far.”6

REFERENCES

1. Rolf, Ida. Ida Rolf Talks, The Rolf Institute, 1987, p.34

2. Barrall, Jean-Pierre and Mercier, Pierre. Visceral Manipulation, Eastland Press, Inc., Seattle, WA, 1983, preface VIII.

3. Ibid., p.11.

4. Ibid., p.74.

5. Ibid., p.74.

6. Ibid., p.29.