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Structural Levels at the Pelvis

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Translator
Pages: 23-35
Year: 1986
Notes on S.I

Notes on S.I.

sds

The hierarchy of structural levels proposed elsewhere (1) consists of – from top to bottom -: intersegmental configuration, intrasegmental configuration, and shape of bones. ?Top? means high complexity, ?bottom? low complexity. It is justified to distinguish levels because the progression from considering single bones to the arrangement of all the segments of the body is discontinuous. The description of various bones may be simpler or more complex, but it is always the same set of parameters which is used. These are geometric figures and the properties of bone tissue, which can be subdivided into a few types. When looking at a single body segment, entirely new categories come into play. New tissues with different properties appear. They cannot simply be added to the already existing descriptions of the bones as they interact with them generating more something like a product instead of the sum of these various properties. In that a new kind of morphology and mechanics emerges, which is not contained in the parts, the language which describes this new whole must be qualitatively different. Another qualitative jump happens when the arrangement of all the segments becomes the object of examination. The most important new factor entering the picture and changing the language of description radically is gravity.

This is not the place to decide the unresolved question whether reality is discontinuous and in layers or not. Certainly our perception is, our mind works with levels, and thence our concepts and therefore our intentions are on different levels. Not only are our descriptive terms, the ?words?, different on the different levels, but also the way in which we relate them meaningfully, the ?syntaxes, is different. So we use eg. the term ?horizontal? for the knee ?hint heath terms belonging to the intersegmental level, which for the knee ?jointer and especially for the bones involved have little or no meaning. On the intersegmental level we refer to the segments as highly abstract rectangular blocks, the internal differentiation of which does not matter. They meet in horizontal planes which are nowhere to be found in the anatomical substrate and are organized around the line of gravity, which is a property of the environment, not of the body. So the term ?pelvis? signifies an abstraction on this levels which resembles a brick, possesses three main coordinates and two important horizontal planes where it connects to the segments above and below, which can be conceived as consisting of a homogenous mass, and which means something only inasmuch as it is related to the whole and to the gravity field. On the intrasegmental level, the other segments and gravity disappear from view, but instead we look at a configuration of bones, fascia, and muscle mass, interacting with each other. Here the term ?pelvis? acquires more concrete meaning but is again something quite different in morphology and dynamics from the bony ?pelvis?. So the term ?pelvis? has three completely different meanings according to the level under consideration, not to speak of the ?pelvis? of the gynecologist, or the chakra healer, or…

This rather detached view omits the practically so important question on which level it is that one enters the object in question. For it determines largely the result, what one finds, or if one gets ?to Pittsburgh? (2). Almost every atlas starts with the description of individual bones, then proceeds to add ligaments and joint capsules, then muscles, and so forth. It is most accurate and enlightening on the initial level, but when rising to higher and higher levels of complexity, essential factors appearing only on these higher levels are likely to be missed. Ida Rolf’s revolutionary approach to the physical body can be interpreted as reversing that order by starting at the highest level, the physical reality of the whole, which led almost logically to the discovery of gravity as the all-important factor organizing structure. And indeed the theory and practice of Structural Integration is fairly sophisticated on the intersegmental level, but the understanding of individual segments is considerably less developed. And the exact shape of bones in an actual structure is hardly a topic at all although it constitutes a clear limiting factor for integration and although it is subject to long-term change through changes of the overall structure. Usually a defensive attitude sets in which prefers to stay where one is at home. So the reductionists tend to go more and more into detail, and the ?holists? expand into more and more diffuse generalities. This paper intends to elucidate a little more the block model, but it would be welcomed if it contributed also to an ability of running more freely up and down the ladder, the steps of which are the structural levels.

The relationship between the inter- and intrasegmental levels can be illustrated by a mason building a wall with bricks. His main concern is with piling the bricks exactly on top of each other, in the place where the wall is to stand, using the plummet as his guideline. This works fine as long as the bricks are of good quality. If they are not, if the planes are not parallel and at right angles, or if they are bent, he will have to accommodate for the irregularities by adjusting with the mortar. He may even be forced to cut slices away or fill in parts cut from other bricks. The difference in levels shows when he walks away and may hold the brick in any way to shape it correctly. Neither its location nor its orientation in space matter, which they certainly do for building the wall. In the structure of human bodies the relationship is much more intimate and complex, of course. Not only does the shape of the segments affect the structure of the whole and limit its integration, but the overall structure also modifies the shape of the single segments.

Finally, it should be noted that the concept of levels has practical consequences. For, the integration of structure depends on its analysis. And when one experiments with focusing on the different levels alternatingly, it soon becomes apparent that it is virtually impossible to get a clear picture of all of them at the same time. This may simply be a reflection of the fact that in visual perception, on which structural analysis relies primarily, figure and ground cannot be seen clearly at the same time.

Intersegmental Level

Defining the position of a solid body in space takes six coordinates. Three of them are for the location of the mass center (translatory component), the other three define the orientation in space (rotational component). The long axis of the body shall be the vertical or x-axis, the planes perpendicular to it the horizontal (or transverse) planes. The left-to-right dimension shall be the transverse (or horizontal) or y-axis, the planes perpendicular to it the sagittal planes. The front to-back dimension shall be the sagittal or z-axis, the planes perpendicular to it the frontal (or coronal) planes.

This system of coordinates is for the whole body, but it must be pointed out that the vertical axis and therefore the horizontal planes have a special legitimation not shared by the others. It derives from its coinciding with the vertical of the gravity field through the mass center of the body in normal structure and standing. In theory, a difference must be made between the Line, which is a property of the gravity field, is always vertical, and goes always through the mass center of the body, and the ?line? which denotes the long axis of the physical body. The first is meant in the statement that ?man is something built around a Line?. The ?line? of course turns and bends, and it is the ?line? which lengthens in movement, not the Line, because the body lengthens and not the gravity field. In practice they are sometimes equated as when we say ?he has found his line?. This sentence can then be interpreted to mean structurally that somebody can bring the ?line? sufficiently close to the Line in standing and functionally that he can lengthen in movement. The eminent practical use lies in the fact that there is a reference line from an entity outside the body, the gravity field, to which we can adapt the structure in the vertical dimension.

This is not so with the y- and z-axes. They have to be deduced from inside the body and have therefore no absolute reference. While the direction of the Line is there whether a person is actually present or not, we need that person concretely to determine the y- and z-axis. Even then, no absolute transverse or sagittal axis can be determined. We can take the line in front of the big toes, or that between the anterior superior iliac spines, or between the ears, but anyone we choose is arbitrary to some degree. The problem is usually solved simply and sufficiently by asking the client to stand facing us, with the line between us defining the z-axis. The y-axis is then also defined as the line perpendicular to both y- and z-axes.

For the rotational component, the axes are a property of the segment in question and determined sensibly in such a way that they coincide with the axes of the body in the normal structure and position. They shall be the x’, y’, and z2 axes. The difference is illustrated at the pelvis when we rotate it around the y’-axis, tilting it, which rotates the x’- and z’-axes along with it but scarcely affects the xyz-system of the body as a whole.

A shift along the x-axis would mean that the pelvis is ?higher? or ?low? and would correspond to the impression that the pelvis is jammed down on the legs or floating above them. As this cannot be determined easily, and as it rather strains the imagination when thinking of the skeletal implications, the shift along the x-axis is disregarded. It can be replaced reasonably by the notion that it appears dependent on the other variables. So it is assumed that the pelvis is at its ?highest? possible place when no displacement along the y- and z-axes and no rotation is present.

Along the z-axis, the pelvis can be anterior or posterior, along the y-axis towards the left or right. The y’-axis allows to define an anterior or posterior tilt, the z’-axis a right or left (down) side-tilt. The x’-axis defines a right anterior or left anterior rotation(3). This definition of terms should avoid confusion between a posterior and a posteriorly tilted pelvisg., the second being usually anterior. The translatory components define the position of the mass center of the pelvis in space, the rotational components give the orientation of the pelvis in space.

In a real stack of blocks, each one of them has three degrees of freedom: it can be forward or back, left or right, or it can be rotated around the vertical axis through its center. It poses no problem in principle to expand the system to the five or six degrees of freedom postulated for the pelvic segment of the body. The question of what this means concretely in the living reality is much more intricate. It is immediately evident that the freedom of the body segments is restricted – by anatomy – much more than that of the blocks in a stack. Three kinds of limitations can be discerned, ordered according to increasing range of effect:

1. The congruency of the bone surfaces meeting in the joints must be respected. The placement of a segment can only be along the physiological range of movement possible in a joint, it the adjoining segment is to remain in place. As the hip joint has only three degrees of freedom, and the two on both sides together even have only one, the six dimensions of the block model cannot even nearly be accommodated. This reminds one again that the abstraction of blocks is on a different level from that containing anatomy and physiology. While it is obvious that something like a dislocation of the pelvis to one side with the legs remaining in place is simply crazy from the anatomical point of view, it must also be remembered that the more realistic tilt of the block of the pelvis is, at least in theory, not exactly the same as the tilt of the pelvis in the flesh. The first is around the y’-axis through the mass center of the pelvis, the second around the line through the rotational centers of the two hip joints. So the placement of the pelvic segment will always entail adaptations in the other segments, even when the tilt is examined, by virtue of the limiting factor of the congruency of joint surfaces.

2. The more linear connections between segments, mostly the fascia and tendons of muscles criss-crossing the space of the body, will also force the other segments to adapt.

3. The body fascia and its subdivisions of flat muscles en cased in it which forms a system of closed planes, the body stocking, will by transmitting tension along the whole surface of the body induce reactive changes in the other segments.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-1.jpg’>

Of course, the concrete kind of location and orientation in space of all the other segments will be dictated by gravity, within the framework of the possibilities of the fascial web and shape of bones, and modulated by the intentions and habits of a person. The immense range of factors involved renders the situation unpredictable with structural changes, which is of course the reason why Rolfing is an open-ended and fascinating undertaking instead of a dull application of automatic ?grips?.

In theory, the translatory components would be determined by defining exactly the location of the mass center of the pelvic segment with respect to that of the other segments and the Line. In practice this is not possible, and even if we had a sophisticated computer program the situation would not change because we could never give it the data it needs. In clearly aberrated cases, however, the direction of shift can be seen and even approximated quantitatively, and a better and more concise understanding of the block model could pro ably help develop intuition by visual perception. The above formulation indicates another incertitude in that it leaves it open whether we determine the shifts of the pelvis with respect to the neighbouring segments or the Line. They are possibly not identical. The functional tests described later relate the position probably more to the Line, while visual perception could tend more to the local aspect.

The second, ?intersegmental? aspect in the narrow sense, is of course the bread and butter of a Rolfer’s everyday life. The three limiting factors permit to structure the local analysis somewhat. The skeletal factor enters when comparing the segment of the pelvis with that of the thighs. An anterior shift of the pelvis willg. take the femoral heads along forward and ?tilted the thigh segment anteriorly. Or a difference in the height of the femora or a rotation of the legs around the x-axis will be related closely to the position of the pelvis. An anterior pelvic tilt could be on top of an anterior ?tilted of the thighs or, by pushing back the femoral heads, ?tilts the thighs back. The discontinuous or linear aspect of the connective tissue system may leadg. to deliberating whether a right anterior torsion of the pelvis with the consequential reduction of tension in the rectus femoris goes together with more flexion in the knee or its opposite by adaptive shortening. And the aspect of the ?body stocking? may make one look with an anterior pelvis for whether the tension in front is compensated by shortening of the front of the thorax, with thoracic kyphosis resulting, or if it continues into the chest, the thorax tilting back, and adaptive shortening occurring in the whole of the back.

Intrasegmental Level

The shape of bricks can easily be evaluated by looking at planes, edges, and angles. Unfortunately, body segments don’t resemble bricks at all, especially because their content is anything but homogenous. Their shape can sensibly be appraised by determining the relationship of their constituent bones. This does not imply at all that the bones are a causal factor, and experience confirms the theoretical conclusion that bone juggling is often beneficial for pathology but does little for normal geometry of the fascial web. The exception is of course the skull, where bones make up the most part of the structural network and the-internal connective tissue can only be influenced via the bones. The skeletal arrangement serves rather as an indicator of the situation in the fascial web, and normalizing this will result in normal spatial relationships of the bones. So they function as the starting point for structural analysis of the isolated segment and as its end point, allowing to evaluate the structural improvement achieved.

Two polarities determine the shape of the bony pelvis. Torsion is the first to be discussed. The term describes a three-part system where two parts rotate around each other in different directions or in the same one to different degrees. The third component is a mechanical connection between them which is torqued. The concept is illustrated by wringing out a wet towel. The hands and the ends of the towel they grip rotate in opposite directions around a common axis, and the rest of the towel is torqued, wrung out. In contrast to this, rotation denotes a one-part system: a body which turns around an immaterial axis. This terminology means for the pelvis that the ilia can rotate – not around the sacrum, strictly speaking – but around an axis near to a line perpendicular to the surface of the sacroiliac joints.

For torsion, the sacrum and the sacroiliac joints are ignored in a first step. The rotation of the two ilia is then around a horizontal axis in opposite directions. The ligamentous connection between them is torqued, and the sacrum is considered as something like a sesame bone embedded in the ligaments.

Of course, in the second step this model is contingent on the necessity of congruent joint surfaces, which modifies and complicates the situation greatly. The sacroiliac joint does not seem well defined as to the axes of movement. There seems to be to some degree a capability for sliding, for opening and closing in back and front and top and bottom. So when only rotation around an axis perpendicular to the joint surfaces is regarded here, it must be taken into account that this is always modulated by other movements. In another reductionist step, the joint is viewed as a flat plane. Then the orientation of the planes of the left and right sacroiliac joint in space is such that they converge somewhere below the pelvis and in back of it. The line perpendicular to the planes then goes from lateral, caudal, and posterior to medial, cranial, and anterior. This is the case for a relatively vertical sacrum, and the anterior rotation of the ilium is then in such a way that the anterior superior iliac spine goes forward, down, and lateral. The posterior superior iliac spine goes forward, up, and lateral. The ischial tuberosity goes medial, back, and up. The situation changes and some parameters can even reverse direction with a more horizontal sacrum, where the joint surfaces also converge in back but more cranial than caudal with respect to the horizontal plane. The anterior rotation of the ilia can acquire more an aspect of widening or external rotation. Anterior and external rotation of the ilium are used as synonyms.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-2.jpg’>

Figure 2 – Model of a male internal bony pelvis with right anterior torsion; -1 front view;

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-3.jpg’>
-2 same negative as but copied the ?wrong? way to show symmetrical left anterior torsion;

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-4.jpg’>
-3 top view;

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-5.jpg’>
-4 oblique view from front and top, note twist of sacrum.

Usually attention focuses more on the movement of the sacrum: notation (?nodding?). It rotates ideally around a horizontal axis which is here assumed to be in front of S2. The position of this axis actually varies widely. The assumption is based on the experience in palpating the craniosacral motion of the sacrum. There, usually a component of rotation around a transverse axis through S2 and one of sliding on the circumference of a circle with its center at the focusing point of the sacral concavity can be found. To examine the movement of the ilia that go together with the notation of the sacrum, it is easier to reverse the view. So when the ilia rotate anteriorly, the sacrum relative to them rotates back. With the ilia rotating posteriorly the sacrum notates forward relative to them.

This leads to the second polarity between both ilia being rotated anteriorly or posteriorly. It follows that in an external pelvis the ilia are rotated anteriorly corresponding to the flexion phase of the craniosacral rhythm. The anterior superior iliac spines are then wide apart, the posterior superior iliac spines are also wide, and the tuberosities are close together. The base of the sacrum is close to the anterior margin of the iliac crests, and the coccyx is forward and in. The tuberosities and the coccyx form a small and flat triangle. The pelvis appears to be broad but flat.

In the internal configuration, the ilia are rotated back. The anterior superior iliac spines are close together, the posterior superior iliac spines are also close, and the tuberosities are farther apart. The sacrum is more horizontal in the pelvic ring, with the base deep and in front of the pelvic rim, the coccyx far back out. The tuberosities and the coccyx form a large triangle with its apex, the coccyx, high on its base.

The diagnosis can easily become confused when inter- and intrasegmental levels are not kept clearly apart. For, the pelvis as a whole, i.e. the ?block? of the pelvis, usually – but not always – goes with the sacrum and therefore opposite to the direction of the ilia. With an internal pelvis, the sacrum tilts forward and down with its base intrasegmentally, and the block of the the pelvis also tilts anterior intersegmentally. The ilia rotate back, but as the range of the block movement is much greater, the anterior tilt of the pelvis overrides the opposite tendency of the ilia by several degrees. A dynamics can be postulated between inter- and intrasegmental vectors in such a way that the domineering anterior tilt of the pelvis is partly counteracted by the posterior rotation of the ilia. So with an internal pelvis, the sum of the vectors makes the tuberosities – in relation to space and not the block – go wide apart but back and up! With an external pelvis, the sacrum rotates back and the block of the pelvis also tilts back, the ilia counteracting the tendency partly by rotating forward. So the tuberosities are narrow but go down and forward!

The shape and position of the pelvis permit to diagnose, within certain limits, the position of the sacrum in space. Torsion allows to approximate the twist of the sacrum. It consists of a rotation around the long axis of the sacrum and one around an axis perpendicular to the posterior face of S2. The ilium rotating anteriorly takes the lateral angle of the base of the sacrum on its side forward and down, while the ilium rotating posteriorly takes its corresponding angle of the sacrum back out and up. The second component is given by the ilium rotating anteriorly taking the angle of the base of the sacrum lateral, while the angle on the other side is pushed medial. So the base of the sacrum is rotated towards the side of the anterior ilium, and the coccyx rotates away from the midline in the other direction, towards the side of the ilium rotated posteriorly.

Now the aspect of the external/internal configuration of the pelvis is superimposed. With the narrow internal pelvis, the sacrum can be predicted to be tilted more forward towards horizontal, in a broad external pelvis it will be closer to vertical. Then the tilt of the pelvis is checked which when congruent reinforces the rotation of the sacrum found in space. The orientation of the sacrum in space arrived at can be corrected by regarding rotation and side-tilt, and its position by approximating the shift of the pelvis along the y- and z-axes. This procedure should not be understood as a rigid algorithm which produces precise results. It is rather a guideline which may help to ?seers the structural situation in the depth of the body a little more clearly.

As the proportions of conflicting tendencies vary widely quantitatively, the reference points on the sacrum and the bony pelvis can behave quite differently. The anterior superior iliac spine of the anterior torsion sideg. tends to be anterior with respect to its counterpart on the posterior torsion side. But the rotation of the pelvic block may override and reverse this effect. Or it may even be the case that the ilium rotated anteriorly is contained and held in medially by the connective tissue or the femur on its outside so that the posterior superior iliac spine is pushed medial instead of letting to go out lateral. This modifies the position of the sacrum, of course. To further complicate matters, the shape of the bones also changes the picture considerably.

Some Methodological Considerations

The erect and easy stance is the reference line, the standard, which allows to analyze structure to some degree and to evaluate structural changes through manipulative intervention. The two criteria, erect and easy, are rather vague and subject to all kinds of influences, and even together they seem hardly trustworthy of serving as a solid frame of reference. Additional criteria like parallel feet or feet together touching each other introduce strain into the structure, rendering the situation artificial without promising a more accurately defined standard. But in contrast to these principal doubts, the method does seem to furnish some information about the structural state of one and the same person before and after interventions although not all one desires and not in a way tested to be reliable and relevant. The positive experiential fact suggests that the method could be more solid than one would think. And the experience that hardly anything can be said when comparing different persons in their erect and easy stance could lead one to assume that this is not so because of the gross incertitudes inherent in the method but in default of knowledge about structural types and patterns.

?Erect? is in the category of geometry, while ?easy states something about active muscle tension, which is proportional to energy consumption. The combination of the two is in the realm of statics as should be expected. Experientially, the two categories seem to be opposed and so must be related. They are in fact reciprocally proportional, which manifests when the energy necessary for standing is broken down into two components. One component is the energy needed to counteract the gravitational pull on the segments of the body (Eg). In an absolutely normal and therefore hypothetical structure Eg is assumed to be zero. The body would stand without help from the muscles – with no wind blowing. The more markedly the segments are displaced, the more energy is needed by the musculature to uphold the stance. For physical reasons – the law of leverage – the energy needed rises faster than the distance from normal.

In real bodies where there is always more or less of an imbalance expressed by shortness in the fascial web, there is always a choice of posturing. The more the segments are allowed to go where gravity takes them, the less passive tension there is in the connective tissue. The ?straighter? one stands posturally speaking- the more energy must be spent on overcoming fascial shortness (Es). So Es stands for the energy necessary to strain against the short fascia in ordering the segments better. It would be zero in a perfectly normal body standing erect and remain so with the segments coming apart and down – after an initial push. The goal of Rolfing would in this view lie in reducing Es. In random bodies it is at its maximum in ?normal? posture. It is in fact so high that it can usually not be overcome by muscle force and the body cannot actually assume ?normal? posture.

Fig.1 depicts qualitatively the relationship of Eg and Es to the degree of randomness of posture for a given structure. ?Normal? and ?random? refer to different postures, not structure, which is constant! Fig.2 shows the sum of Eg + Es, which is equal to the overall active muscle tension, tone. The deepest point of the curve, the ?structural pointer, indicates the easiest stance. The dotted line represents a Rolfed body, where the ?structural points? is closer to vertical alignment, ?normal?, and takes less energy to be maintained against the shortness in the fascial network. These circumstances are often taken into account intuitively when evaluating before and after pictures. First the alignment of blocks with respect to the vertical is analyzed, then the result is checked against signs of strain as a rough indicator of muscle tone. If both the alignment is better and the ease is greater in the body, the difference can be ascribed to structural change with certainty.

For the diagnosis of the position and orientation of a segment, the fact is relevant that it will first go in the direction of its aberration when muscular tone decreases. So an anteriorly tilted pelvis will tilt more when muscles relax, or a posterior pelvis will slide back more when the body is allowed to slacken. Or vice versa, when a person is pulling up, standing in more erect posture, the segments will come closer to vertical but not cross over to the other side within reasonable limits. So the difficulty of finding the easiest stance, at the ?structural points?, is offset by the apparent fact that there exists a fair range around the ?structural pointer where the direction of deviation from ?normal? remains the same although not the degree. An interesting phenomenon manifests with well-ordered bodies. As many of the structural characteristics are on a bipolar range, the arrangement of blocks can be changed over to the opposite direction relatively easily. A well-Rolfed internalg. can by slightly pushing forward the pelvis go into an external posture – not structure, of course. But he will feel that this external posture is accompanied by a minimal effort when comparing it with internal posture fitting his structure.

Another problem of the erect but easy stance should be mentionned here. It concerns the locked-knee type and possibly other structural types. There the structure is fixed. For physiological movements – always for Folding and often for Walking – the segmental arrangement has to be reshuffled and partly reversed first. For, hyperextended knees can of course not bend backwards, and so the ?posterior tilted of the lower legs has to be reversed first. While it seems true that the locked-knee stance takes less energy than the normal one, it can be excluded from the discussion. For, in the reality of life hardly anybody stands still for a longer time but moves and shifts around constantly. Then this stance becomes uneconomical because it requires a high activation energy for the body to go into movement every time.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-6.jpg’>

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-7.jpg’>

For analyzing the pelvic position and orientation, visual means often don’t suffice because the mass center of the pelvis and the edges of the ?brick? cannot be determined exactly. The only plain and clear static criterion is for the pelvic tilt. In a normal pelvis, the line between the tip of the coccyx and the tip of the pubic bone is horizontal. So if it is slanted down in front, there is an anterior tilt, and if it lower in back, the tilt is posterior.

The functional tests I use are in two steps. First the two alternatives of the direction one wants to examine are explained to the client. Often it is helpful to indicate the two by soft pressure of the hands. The client may put his hands on the hips with the shoulders and elbows hanging freely. He is then asked to reduce muscular tone and observe internally the direction of the initial movement. I tell clients that just the first millimeter is important. I observe the movement from the outside and sometimes have my hands on to sense it. If the client’s observation is the same as mine, the decision can be taken to reflect the real structural preference. I check this observation by asking the client to try to let the pelvis go in the opposite direction, too, and compare which comes easier. This alternating movement can be made gross by an initial push. Then it is observed how fluent the pelvis moves and how far the movement carries. As with the first step, the result can also be assessed from the outside visually, and again client and Rolfer should observe the same. If the first step was inconclusive, the second has to decide the question. If this is still not possible, it is best to have the client walk around a little to come together and find his natural stance again. Different images need to be offered to the clients sometimes to tune them in to the subtlety of the movement desired.

For the tilt and side-tilt it is helpful to ask the client to come up a little first by extending against the ground. He then keeps his upper body high and imagining his pelvis to hang down from it as a kettle on its chains from the roof of the fireplace he will sense the direction the pelvis swings into. For the translatory shifts he is asked to let the weight of the upper body settle down on the pelvis and to notice in which direction it is squashed out between trunk and legs.

For rotation, I ask the clients to bend slightly knees and hips and to shift the weight on one leg without the change being noticeable for an outside observer. The weight stabilizes the sacroiliac joint. Then the hip on this side is let go into a forward swing taking the upper body along passively. The side which swings easier and carries farther indicates the rotation of the pelvis. The knees can also be locked tightly the pelvis pushed forward, which locks the sacroiliac joints. Then the hips are let go to swing forward alternatingly without softening knees and pelvis. This procedure has the disadvantage of involving rotational preferences of all the segments which obscures the situation sometimes.

Torsion is determined by palpating the anterior and posterior superior iliac spines simultaneously with both hands from the back. Torquing the hands slightly in both directions helps with determining the actual torsion. It is usually more obvious with the client sitting on the bench. It can also be tested functionally by shifting the weight completely on one leg and then letting the other relax, the knee swinging forward and slightly inward. The easier movement is on the anterior torsion side. If one is not very clear about the mechanics, there arises confusion easily. So it happens frequently that inadvertently torsion is tested instead of rotation if the sacroiliac joint is not securely locked.

There is no functional test for the internal or external configuration of the pelvis. Moreover, solely inspecting the pelvis may lead to errors because the soft tissue can mask the skeletal arrangement. So in practice one may simply go from the tilt and shift along the z-axis and determine from there whether the intrasegmental configuration is congruent or not.

Patterns

Observation reveals that the seven parameters break down into two systems which are independent from each other. One is bipolar and consists of three related parameters. The other seems to be unipolar and comprises the other four parameters.

Bipolar System

The internal pelvis consists of

– intrasegmentally: internal configuration
– intersegmentally: anterior tilt, posterior shift

The external pelvis consists of

– intrasegmentally: external configuration
– intersegmentally: posterior tilt, anterior shift

The terms ?internal? and ?external pelvis? are used in a broader sense including: the same terms in the strict sense of denoting the intrasegmental configuration plus two intersegmental parameters. The nature of craniosacral movement is first a cyclic shift in the arrangement of the cranial bones. It transmits to analogue cyclic movements of the vertebrae and the intrapelvic architecture. They are intrasegmental events. In the pelvis, the flexion phase leads to a tilting back of the base of the sacrum which in turn induces the ilia to rotate externally or anterior. The intersegmental movement can be understood in such a way that the craniosacral movement coming from inside induces a tendency into the whole of the segment to go along with it. In the flexion phase, the posterior tilting of the sacrum would then drag along the whole of the pelvis into a posterior tilt.

A reasonable speculation on the genesis of the internal and external pelvis could look like this: first we would have a disposition toward internal or external configuration in what will later become the bony pelvis. This tendency could be set by hereditary factors and the intrauterine pattern of mechanical stress. The craniosacral movement which begins early in the life of the embryo or fetus would reinforce the structural bias already present just as a river washes out its bed in the direction set initially. Gravity would then act on the structural preference so established with increasing vigour and in steps: first at birth, then when the baby sits up, finally when it stands up. The intersegmental parameters would be determined relatively late in the development. This would mean that intrasegmental shape is imprinted ?deepen? in the structure than tilt and shift. The view is supported in practice by the experience that it is much easier to reverse the tilt or the sagittal shift, structurally by changing the fascial web as well as posturally. Of course each of the two lines of development are subject to modification or even reversal at any point along it through various factors.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-8.jpg’>
Figure 3 – Standard internal pelvis

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-9.jpg’>

The existence of the two patterns makes it likely that the intrasegmental type determines the tendency of tilt and shift. So an internal configuration would predispose to an anterior tilt and a posterior shift, an external configuration to a posterior tilt and anterior shift. The mechanics of this are not very clear but may eventually be understood by examining the sacrum and its suspension in the fascial network of the body more closely. In any case, the terminology proposed is such that an internal pelvis in the narrow sense designates the internal bony pelvis. The internal pelvis in the broader sense means then that this internal bony pelvis is accompanied by an anterior tilt and posterior shift. This could also be called a congruent internal pelvis if Jan Sultan’s term may be extended in this way (4). An internal bony pelvis with a posterior tilt or an anterior shift or both would then be a conflicted internal pelvis – and need specification of the conflict.

Unipolar System

The large majority of the clients shows the following combination of the other four parameters:

– intrasegmentally:
.right anterior torsion

– intersegmentally:
.left anterior rotation
.right side-tilt
.right side-shift

This system seems to be entirely independent from the bipolar one. It is noticeably different in character, too, because a symmetrical pattern where all the four parameters are reversed does not seem to exist. This combination of parameters could therefore be called ?standard?. Any one or more parameters deviating from the pattern would constitute an ?irregular? pelvis – and need specification. So a ?standard internal? or a ?standard external? pelvis would define all seven parameters. A ?standard conflicted internal? or ?standard conflicted external? would mean that the pattern of the bipolar system is incomplete. An ?irregular internal? or ?irregular external? pelvis would indicate a disturbance in the pattern of the unipolar system. Finally, we could speak of an ?irregular conflicted internal? and an ?irregular conflicted external? pelvis. All terms except the first two would need specification.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-10.jpg’>
Figure 4 – Standard external pelvis

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-11.jpg’>

Conclusion

The functional tests used for determining the structural parameters, the ?coordinates?, seem convincing theoretically and offer a sharper diagnostic tool for recognizing the ?structural state? of the pelvis. This helps decidedly in the practical work when one is to formulate the concrete intention for how to normalize the pelvis. But it is of course desirable and necessary to further examine whether the tests actually measure what they are supposed to measure. It seems also necessary to establish a sufficient interreliability, which would be given if several observers came to the same diagnostic conclusions concerning the same clients.

An interesting result concerns the reliability of the line between the tip of the coccyx and the tip of the pubic bone as an indicator of tilt. Numerous objections can be raised against this criterion. They rely mostly on the wide variation in the position and shape of the coccyx. But in the majority of cases the line corresponds to the functional test. In some cases I was uncertain, but the decision became clear when the client let go of the pelvis in front and in back (functional test). There never was a clear discordance between the palpatory finding and the functional test.

The most interesting feature of the patterns described, however, is the fact that they are not one-dimensional but comprise parameters of both the inter- and intrasegmental level. This corroborates the theoretical speculation that the different levels are closely interwoven concretely. As for the practice, it leads to the view thatg. an anterior tilt can only be normalized up to a point which is given by the degree of ?internality? of the bony pelvis. And in cases of an ?irregular? or ?conflicted? pelvis it underlines Jan Sultan’s discovery that besides adapting structure to the gravity field it is sometimes important to harmonize it internally first.

If a still broader view is adopted, the underlying level of the shape of the bones and the overlying functional level also come under consideration. As for the bones, the external pelvis tends to be broad and flat while the internal one is narrow and deep. The projection of the pelvic block on the horizontal plane approaches an oval with the long diameter transverse with an external configuration and an oval with a long sagittal diameter with the internal configuration. The anterior torsion side goes more toward the external type; the posterior torsion side resembles the internal type. The combination tends to make the right half of the pelvis look broad and flat, the left half narrow and deep in the standard pelvis. Because this leads to a different pattern of tensional and compressional forces acting on the two sides of the bony pelvis, it could be surmised that the bones develop different shapes also. Closer examination of the bony pelvis (Fig.2) suggests an impression of the left side being under compression from lateral and expanding in the sagittal dimension. of the right side being compressed from front more freely sideways.

The functional level must not only be considered because function determines structure but also because it can lead to diagnostic errors. So the pelvis may appear to be shifted to the right side in a standard pelvis, but it can also be pulled over on the left leg as a postural compensation of the structural tendency. This is especially the case when people attempt to stand very straight, exaggerating the ?erectness? at the cost of ?ease?. The functional test – when they let go will then disclose the structural shift to the right side.

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-12.jpg’>

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-13.jpg’>

<img src=’https://novo.pedroprado.com.br/imgs/1987/1023-14.jpg’>

Notes

1. Notes on S. I. 86/1, p.23

2. Feitis, Rosemary: ?Ida Rolf Talks?, Rolf Institute, Boulder.

3. ?Rotation? is reserved for the rotation around the x’-axis. ?Tilt? and ?side-tilt? are also rotations, but around the y’ and z’-axes. Note that these terms and upshifts do not actually denote a movement but the coordinates of the Structural points, the place of least energy, where the pelvis would have ?shifted? and ?rotated? to if it had been in the normal position first.

4. Notes on SI.1. 86/1: ?Towards a Structural Logic?

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