Notes on S.I

Notes on Structural Integration – March 1987 – 87/1

Volume: 87/1

The Minisession consists of seven interventions each of which should not last longer than one minute.

Structural Analysis

The man has had a basic series of Rolfing (10 sessions), three additional sessions, a series of 5 ?advanced? sessions, and some problem-solving work related to the use of his hands as a musician. He has received this work over a period of three years. The following comments are based on observations made during the minisession, which were taped, and on picture evaluation after the session.

There are some torsions and rotations in the deep compartments of pelvis and thorax; and there is a critical situation at the transition axis-atlas-cranium.

Pelvis: right anterior torsion combined with left anterior rotation. This leads to a different weight distribution on both feet and is correlated with a spatial difference in the tissue arrangement of the abductors.

Thorax: compression of the posterior thoracic area, rotations at the level of T7/8/9.

Neck: contraction of the atlanto-occipital membrane, atlas rotation and sideshift of the head in relationship to the central vertical line.

Structural Diagnosis

The three compartments pelvis-thorax-neck/cranium are directly correlated in their spatial arrangement. This can be seen in the front view: a lack of horizontality of the pelvis is congruent with the side-shift of the thorax, the left part of the thorax follows the rotation of the pelvis, the shoulder girdle and arms follow the thorax, and the head follows with a subtle displacement to the left side. While the legs and feet seem to compensate the pelvis/torso structure quite well, the neck has to take more control of the static system than it is designed for. This can be seen clearly in the side view: the anteriority of the cranium is fixed in two ways – by a shortness of the hyoid sling downward to the sternum (layers around the m. mylohyoideus, m. sternohyoideus, and left m. sternocleidomastoideus), and through the m. digastricus venter anterior and venter posterior to the posterior part of the cranium. (Compare the contour of the front side of the neck before one and after seven, and compare the shoulder/jaw relationship in both pictures in the side view!)

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Concept of Manipulation

The first move is an attempt to verify the hypothesis about the correlation of pelvis-thorax-neck. It tries to give more horizontality to the pelvis and aims for a better weight distribution through the legs (left-to-right balance). The result on the level of the thoracic and the cervical area might dictate the further moves. I expect that one of the moves following has to focus on the deep ligamentous or membranous elements around S3 and another around axis-atlas-occiput (see picture zero side view). The goal of the seven moves is: more horizontality of the pelvis, less side rotation on the level of T7/8/9, decompression of the atlas-axis-cranium relationship.

The principle is in practice: each of the three critical areas is to be affected only so far that the two other areas follow positively towards a clear arrangement around the vertical line.

One

To horizontalize the pelvis, the following consideration is made: to get a significant shift which travels through the whole system, the manipulation has to involve the legs, it can’t just be ?pelvic? work. In standing upright, the right adductor compartment is arranged a little more backward. While lying on the table, the rotation of the pelvis disappears and the torsion shows up more clearly. Let’s try to influence the torsion/rotation and influence the weight distribution on the legs. This is done by going through the abductors of the right leg towards the trochanter minor and going to the ?extra tissues of the upper part of the left iliacus simultaneously. The model uses light pressure of his right heel. With his knee rising and rotating inward, a diagonal fixation is given to the pelvis.

Result front view: torsion/rotation is very little affected, leg/pelvis relationship changes as the right femur comes under the hip. The head goes more into the side shift. (Seen from behind, there is a clear rotation around T7/8/9 now.)

Result side view: the diaphragm is not as high anymore, the front part of the 5th rib comes more down, the weight shifts to the heels, and the shift around the hip joint affects both the relationship of thigh/calf and the spinal curvature. The latter affects the relationship neck/thorax: the neck appears to be more coming out of the thorax. The discontinuity between neck/cranium is more visible.

Two

The diaphragm is now used as the reference layer for horizontality. The layers in front of the 11th rib are touched, and following the client’s breathing motion, an indirect release is done for the respiratory diaphragm. While the client is on his back, the result shows up in a different breathing pattern around the 1st and 2nd rib. The manipulation is done in a very slow way which is designed to affect the pelvic floor and the thoracic inlet as well. Additionally, the costal arch is treated with subtle pressure to allow for a release of the deeper layers which cannot be touched directly. This approach comes from a bilateral touch which affects the diaphragm as well as the connection of serrati/obliqui around the 6th ribs. (That means that the costal arch is used as a framework of the diaphragm, while the connection to the axilla is being influenced.)

Result front view: the rotation around T7/8/9 has shifted upwards to the upper anguli of the shoulder blades. This was verified in the back view. So the problem has shifted upwards, the side-shift of the cranium is very clear now.

Result side view: the front dimension of the neck is showing more ease both in relationship to the sternum and the mandible. The posterior compartment around the 1st and 2nd ribs offers a new base for the neck/thorax relationship.

Three

This move is done with the client in a sitting position. The goal is a paradoxical one: the front of the 5th rib should continue to sink down a little bit, while the posterior part of the 1st and 2nd rib should sink down as well creating an inner lift in front of the thoracic spine. This should provide a more harmonious curvature of the spine and be a first attempt to balance the cranium on the vertical line. Practically, the connection of arms and shoulder-girdle is important during this move. The Rolfer is kneeling in front of the client who is sitting on the bench and has his hands resting on the Rolfer’s shoulders. The client is working with a weight shift on his sitting bones, using the hip as a hinge, while the Rolfer opens layers on both sides of the latissimus dorsi. While doing it, a new goal shows up: the opening of the upper part of the thoracic spine could help the shoulder-girdle to move forward in relationship to the lateral line.

Result front view: the neck/cranium relationship changes. This is the expression of better horizontals on the level of the ankle hinges, the hip joint, and the shoulder-girdle. There is a minimal shift towards horizontality in the pelvis.

Result side view: what happened in the front compartment of the neck during the second move is happening during the third move in the posterior compartment of the neck. The distance between upper ribs (front) and mid-cervicals is affected.

Four

Seen from the back, the medial contours of the shoulder blades are less visible. Now a unilateral move on the back will be made below the center of the thoracic rotation on the right side of the back, close to the lateral margin of the erectors. The support of the model is used in a way which guarantees length in the front of the spine, while all the three arches of the foot are in good tone, and the thighs avoid further medial rotation. This move is done from a perspective which risks a development to the worse of the pelvis and the atlanto-occipital junction.

Result front view: there is a better arrangement of the thoracic area around the center line of the body. However, some of the torsion comes back into the pelvis, and the weight distribution on both feet is less even than after three.

Result side view: the shoulder-girdle is more above the thorax and hips. The thoracic curvature appears to be longer now, probably an anteriority of T7 is resolved.

Five

Up to now, the manipulations could only give an improvement of the front-back balance. The changes which one can see from the front (and the back) might not be stable. There has to be a change in the perspective now to avoid chasing around rotations. Certainly move five and move six are a unit as they both focus on both ends of the spine in a way which should give the pelvis horizontality and balance the atlanto-occipital junction. I work on ligamentous structures on both sides of the coccyx with one hand, the other is holding the two spinae anteriores superiores. I try to establish a contact to the ?inner dimension? of the pelvis through the sacrum, while a subtle ?closing? of the two spinae allows the base of the sacrum to sink backwards. It may sound funny, but I’m after a better inner flexibility of the segments of the sacrum. This work uses approximately 10 to 40 grams of pressure. The sacrum is treated like a broad fish (sole) which is floating around. Now I give a little pressure to the right spina anterior, follow the torsion first and then guide the pelvis out of it. That kind of manipulation requires sensitivity as one hand is handling the rotation of the pelvic block and the other hand is trying to handle the torsion of the two ilia. This looks like an elegant version of a pelvic lift: my hand feels that the S2-S3 relationship opens, and we see a different pattern of breathing. The base of the sacrum is sinking back, and I change the direction of pressure now (the fingers on the side of the sacrum, the palm holding the sacrum) to create a little more ease in the lumbar curvature. Finally, I have to get my hand out without messing up the subtle changes. This situation is similar to the one we have with pelvic lifts in cases of a posterior pelvis: the hand has to sneak out while the fingers give a light diagonal impulse towards the umbilicus.

Result front view: again less torsion in the pelvis.

Result side view: the base of the sacrum is coming back wards in relationship to the ilia.

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Six

Now we have to be careful. At first I wanted to do deep neck work around the scaleni, now I’m afraid that this might cause irritation or side-shifts in the thoracic area again. I change the approach once more: while the model is on his back, I want to try to influence the upper thoracic layers and aim for an opening of the atlanto-occipital membrane. My fingers touch layers between the posterior part of the first two ribs, with the occiput resting on my forearms. The occiput remains in that position, and I establish contact with the ligamentum nuchae. Now I see the ?cores? of neck and thorax like a ?clothesline?, and the vertebrae are hanging like pieces of linnen from this clothesline. I have two ends of the ?line? in my hands: ligamentum nuchae and lower connection of the trapezii. And in a way, I create a new order of the pieces of linnen. This whole action is an attempt to bring the improvement of the pelvis and back structure up to the level of axis-atlas-cranium. Some precision is required to avoid a renewal of pelvic torsion and thoracic compression/rotation.

Result front view: the shoulder-girdle balance is acceptable; however, there is a certain instability showing up which I can’t describe exactly.

Result side view: the atlanto-occipital junction has opened. (This has to be proved by palpation.) There is the impression of ?lift” and a certain instability. Maybe that the LDH has a tendency to come forward again?

Seven

First I wanted to leave the situation as it was and hoped for a completion by itself. Finally, I followed Hans Flury’s suggestion – who insisted on the format being kept – to do ?tracking? work. This might give better support from the legs, bringing them under he pelvis. Moreover, this might uncover the pelvic torsion again! This last move is done with the model standing up. While the upper margin of the pelvis sinks backwards, the hip joint goes into flexion, and the torso comes forward.

Result front view: some of the critical expectation about the pelvic torsion turns out to be true. The lower parts of the legs work better for support of the hip, the side shift of the head is diminished.

Result side view: to get a clear picture, I have to compare photos 0 and 7. The main shifts are: the lumbar curvature appears to be longer, the pelvis has improved in horizontality. Some effects can be seen at the levels of the thoracics and the neck.

Closing Remarks

The front view after seven shows a certain incongruency between the legs and the lower abdomen. This has to do with the tendency of the femora to rotate internally and a hidden tendency toward hyperextension. This might lead to a follow-up session which should focus on the legs.

The question is whether this Minisession has offered a new quality of prevertebral and postvertebral balance.

Commentary

The analysis is mainly in terms of lateral displacements from rotation of the pelvic, thoracic, and cranial segments and the consequent disturbance of the respective horizontals. The after 7 picture shows that the structure has improved on all three counts. In addition, the knee and ankle lines are also much more horizontal.

The client shows the signs of having had much bodywork. The contours are soft but the body is differentiated, and there is that impression of iridescent deflections of planes and slight turns in the direction of lines which is characteristic for bodies which have had a lot of work. They represent superficial conflicts which can easily be reversed posturally and which make it so hard to filter out the structural. That the work has been structural is evident from the postural variations and compensations being in the service of manifesting a central vertical as the organizing principle.

From the point of view of support it appears that the vertical is slightly slanted towards a diagonal from the left foot to the right thoracic apex. This line of support is tensed and bent anterior convex with the most anterior point in the middle left abdomen, which would correspond to an anterior left 12th rib. The pelvis with its left anterior rotation is already a little back under it. The left knee is hyperextended and so this leg drops back more. Above, the right side of the thorax pulls up and back to complete the ?tension bow?.

This diagonal is external, at least posturally, with the left lower leg in light conflict. The other diagonal is internal with also the right lower leg somewhat conflicted. As it is relieved of part of the weight bearing and stabilizing duties, it hangs off the supporting diagonal relatively freely.

When considering the vector path of the weight it appears to part at the pelvis relatively far to the outside of the legs. This is corroborated by the relatively wide stance of the feet. The deviation is more marked in the internal right leg which seems to be shifted out and back as a whole with the typical ?ledge? showing in the back of the iliac crest. In the left leg, the vector path runs less far out through the groin, and its deflection to the outside is by the external rotation of the leg which comes from the bow leg type.

The aspect of core/sleeve shows a shortness of the core which manifests in its rotation. The S-shaped curve is left convex at the pelvis, right convex through the middle of the trunk as expressed by the upper linea alba and the lower sternum, and again left convex in the neck. Deep restrictions seem to be present in the left psoas with consequent shortening across the left groin and in the right side of the diaphragm. In the middle layer shortness can be suspected in the back along the right side of the spine, in the external transmission line, and in front at the level of the ribs which hold up the thorax in the inspiration phase. This holding in the chest in combination with the broad and thick rectus abdominis, representing superficial shortness, is effective in compressing the core. But it is remarkable that the pectorals and the shoulders are relatively free. The right shoulder seems rather carried back up a bit by the thorax than participating in the dynamics of balance. The external rotation of the humerus which goes with it is compensated at the right elbow.

The traditional approach to such a structure would be to build it up from the ground if no undue holding farther up ?promised? to block the release from below. At the feet, attention would be given to the heels which are drawn in and the high subtalar complexes which throw the weight outside. The hyperextended left knee would be addressed. The right leg would be brought under by releasing the fascia lata from the tensor and the gluteus medius as the most prominent pieces of the pattern. The left femur would be derotated mainly by lengthening the abductors. It would then have to be seen whether the core would take up this length or react by further shortening in the case of the restrictions not being resilient enough. It is interesting to see that the different approach chosen has brought the feet more together, the right thigh in a little, and has derotated the left femur. The left knee is about to let go of its hyperextension. The ankles still don’t allow the weight to pass through them freely, and the heels do not permit to spread it back as they should. The adductors of the left leg are still short but now show the effect in pulling down the left ramus ossis pubis. The pelvic torsion shows up more clearly afterwards, which lets one assume that the better positioning of the pelvic block has eliminated some intersegmental compensation.

Of course, Peter has chosen the opposite approach by working from the pelvis up. The effect has travelled down into the legs partly. Stops are at the ankles and, partly only, at the pubes. There, the weight vectors into the legs run a smoother path closer to center, but there remains some shortness at the rami which should prevent moving through them freely. The most obvious gain is in the length through the midbody by the diaphragm release (move 2) and the derotation of the right side of the thorax (moves 3 and 4). And this length has let out the head dramatically which seems to play a steering and controlling role with the model in almost an Alexander fashion.

Closer scrutiny of the sequence shows an interesting development which is paralleled by the facial expression of the model. After the first move, the left thigh is converted to internal. This is enhanced by the second move which as the most striking effect seems to have released both legs from the diaphragm. This breaks up the ?backbone? of the system, the tensed anterior convex supporting diagonal. After 3, the upper part of this ?pillar? also starts to tumble, and insecurity and disorientation are at their maximum. After 4, the situation is resolved in a new way: the right side of the thorax has given up completely, the whole thorax has disengaged from the head, and the trunk has settled on both legs evenly. This constitutes a different structural pattern and so move 4 should be considered to have brought about a qualitative change. The rest of the moves is quantitative improvement of the newly established system which rests on both legs now. The last move is unfortunate in that it seems to open up a new level of deeper imbalance at the pelvic floor. But this does not threaten the new pattern because the body does not go back to its former ?method of the supporting diagonal?, nor does the upper body follow down on the left leg. It balances the disturbance out in a new way, by shifting slightly over the right leg.

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