In the cases reported below, the clients were treated with Rolfing Structural Integration and Beatriz Padovan’s Neurofunctional Reorganization (www.padovan.pro.br). In the view of human functionality on which Padovan’s work is based, organization of the mouth and the body are considered interdependent.
Evanice: The Opportunity for Interdisciplinary Cooperation
Practitioner: Yahra Silveira Perdomo, Certified Rolfer, Rolf Movement Practitioner
The client, Evanice, a nursing student twenty-five years of age, was referred to NAPER by her orthodontist. At the time she first visited the referring orthodontist, Evanice’s occlusion was open in excess of one centimeter, and several other orthodontists had declined her case.
A year of treatment with orthodontic appliances had substantially reduced the occlusion to 0.5 cm; however, the effectiveness of the orthodontic treatment seemed to have reached its limit, and the orthodontist could achieve no further progress. At that point, the orthodontist referred Evanice for ten sessions of Rolfing(SI).
When Evanice arrived at NAPER, her ribs and sternum were elevated and anterior; her upper thoracic spine was straight, with a prominent seventh cervical vertebra; her medial arches were elevated; her head was anterior of her “Line”; her mandible was protracted; and the muscles of mastication were tight and shortened. The left side of her face appeared smaller than the right side. She suffered jaw pain each morning, as well as low back pain.
As early as the first session, I began manipulation of her head, neck, and TMJ. When Evanice arrived for her second session, she reported that following the first session – for the first time in years! – she had been free of pain for a substantial period of time. In the second session, we introduced exercises for sucking, chewing, and swallowing, which Evanice was instructed to perform twice daily.
As the process continued, each week brought notable improvements. By the time we came to the tenth session, Evanice was practically pain-free. The arches of her feet were relaxed, she had recovered her “Line”, and was well-organized. At the close of the intervention, her occlusion had improved by a few millimeters, and the orthodontist was then able to make further progress with her.
Ida Rosa: Reversing the Course of a Pathological Process
Practitioner: Beatriz Pacheco, Certified Advanced Rolfer, Rolf Movement Practitioner
Rosa, age sixty-five, sought out Rolfing to improve the mobility of her head, neck, and arms, and also to relieve pain she felt along the back of her neck, in her arms, and at the back of her head. She suffers from sclerodermata(1), as well as osteoarthritis in her hands.
Taking Tom Myers’ Anatomy Trains as a reference point, I saw that her deep front line(2) was quite short, especially on her right side. Her head inclined slightly to the left, which suggested a minor cervical torsion. The hypertonicity of the muscles of mastication seemed to spread throughout the cervical musculature, and to induce hyperactivity in their antagonists, the suprahyoids, and infrahyoids. And, one of the dangers of sclerodermata is that loss of esophageal mobility can impede swallowing.
Key structural strategies were to open the thoracic inlet, to differentiate the head from the neck, and to bring adequate muscle tonus to the visceral compartment of the neck. These produced structural and functional balance, manifest in a dialogue between the muscles of mastication and the hyoids, which stimulates chewing, sucking, and swallowing. To advance these same goals, I added to the Rolfing Recipe oral exercises, to be practiced together with exercises in pushing the feet and legs into the support of the table, ground or wall.
At the outset, I advised Rosa that because the scleroderma had left her skin and subcutaneous fascia more rigid than average, I would have to repeat sessions that addressed the particularly rigid territory of the feet, the lateral line, and the thoracic inlet. I will highlight here how the work differed from the classic Rolfing series.
The Third Hour took place in two sessions. In the first, I worked to bring support to the lateral line by addressing the fascia from the feet to the serratus anterior. Following Padovan’s view of the interconnectedness of the organizations of the mouth and the body, the lateral line should include the fascia of the temporalis muscle and the TMJ. Under this view, the muscles of mastication are very important: as powerful, richly innervated anti-gravity muscles, they have the capacity to tighten the entire lateral line.
During the second session on the lateral line, I initiated chewing exercises to be used after the manual work (which addressed the temporalis and cranial fascias, the TMJ capsule and its ligaments, the insertion of the masseter on the mandible, and the posterior belly of digastric). I did trackings to lengthen the hyoids; differentiated the visceral compartment of the neck from the cervical spine; and worked the diaphragm, starting at the costal arch.
The Fourth Hour began with sucking exercises, together with motor exercises for the legs, which were made more challenging by adding the use of force during execution of the chewing, sucking, and swallowing exercises. To advance her progress, I asked Rosa to do all of the exercises during the week at home.
Rosa performed the exercises religiously and began to feel the benefits. By mobilizing the muscles of mastication and the hyoids through the chewing, sucking, and swallowing exercises, Rosa was able to avoid the accumulation of tension in those muscles. This, in turn, facilitated the work by rendering more accessible not only these particular muscles, but also their counterparts at the pelvic and respiratory diaphragms.
When we began, the hypertonicity of Rosa’s hyoids seemed to permeate her entire body. Rolfing provided greater adaptability in the rest of her body than in the hyoid region itself, which tended to tighten rapidly. The contraction of the hyoid region, which is typical in sclerodermata, puts the tonus of the rest of the body at the mercy of the hyoids. I myself believe that tension in the omohyoid disorganized Rosa’s shoulder blades, which in turn affected her entire spine.
After fifteen sessions, Rosa reported that her pain had diminished. The photos below show the changes in the mandible and hyoid regions. Note the great difference in muscle tonus at the throat and jaw, as well as how the work affected the entire spine.
Judith: Using Oral Exercises to Restructure Obesity
Practitioner: Rosângela Maria Baía, Certified Rolfer, Rolf Movement Practitioner
Judith, a woman sixty-two years of age, makes delicious sweets and savories, as well as knit and crocheted handicrafts. Five years ago, she underwent gastric reduction surgery, and she’s waiting to have a second surgery to reduce excess skin. She is married, with two children (delivered by cesarean section) and four grandchildren. Twenty years ago, she lost her uterus to a tumor. She has an umbilical hernia. Her legs, which are heavy and poorly articulated, hurt her. So do her knees – especially the right one. Last year, she had a steroid injection in her right knee.
Her obesity and lack of independence leave her depressed. She is afraid of falling. At 1.4 meters tall, she weighs ninety-two kilograms. She used to weigh 150 kg. Recently, she joined a senior citizens’ group, and goes to a fitness class once a week. She has never had any kind of massage or physical therapy – not even after the gastric reduction surgery. Surprisingly, she takes no medication other than muscle relaxants as a last resort for her pain. She came to NAPER at my invitation to participate in our research, and to improve her balance. Her goals include greater personal independence through better movement.
We did thirteen Rolfing sessions, which included both structural and functional work. We devoted three sessions to the Seventh Hour territory. Now, she has lost five kilograms, but it is clear she must lose more. She has tightened up two centimeters. Her clothes are loose, and the doctor said that now is the right time for the skin reduction surgery. It is scheduled for January 2010. She has more movement in the girdles, spine and neck (which has gotten longer). The right side of her body aligns with the left. Her bosom does not suffocate her neck so much.
She reports: “I don’t feel so many pains, and I can walk more lightly and evenly, not like a warped wheel. I look better in clothes and shoes. My disposition is better. I get on and off the bus better. My self-esteem is improving, and finally I’m going to get the surgery I’ve been waiting for.” Older people speak about their physical changes, and Judith now takes greater care with her appearance. In the fitness classes, she gets up and down on her own without help from anyone. “I’ll continue to do all the exercises, especially the mouth ones, and I think they will help me control my weight.”
Since the first session, we talked about the digestive system, about its physiology and anatomy and its influences on the emotions. We worked with the mouth and mandible starting in the first session. In many sessions, we discussed obesity and other digestive system pathologies such as anorexia, diets, exercises, self-discipline, self-esteem, and body image. Thinking along these lines, movement of the mouth and the feet, in every session re-establishing this connection.
In the eighth session, to enhance the work of the Seventh Hour, we used Beatriz Padovan’s techniques, as adapted by Beatriz Pacheco. Right then, we captured an amazing quality of support, which was maintained, above all, by the client’s own discipline. At home, she followed the recommendations and did the oral exercises (to chase away the temptation to eat), the respiratory exercises, and the abdominal exercises especially to strengthen transversus abdominus. The core, which had gone flaccid, was gathering strength.
Notes on the Process
First Session: On the right, the knee, thigh and foot are valgus and the whole leg is more forward. The lumbars are straight, with kyphosis in the upper thoracics and lower cervicals forming a small dowager’s hump. Her neck is short. So is her breathing. She seems only to inhale. Rapid and forceful movements. Lumbering gait. Fixed girdles. Arms imprisoned at the shoulders by trapezius. To walk faster, she likes to fold her arms and grip her elbows. She’s easily startled – as if assaulted, on the defensive and reacting quickly. Really high tonus – hypertonus in the abdomen. Supine, her right side is higher, and her bosom rises to suffocate her neck. Standing, her head turns to her left and inclines to her right, the retracted mandible pulling toward the back of the neck and head. The mouth, small with tension and sadness, speaks pessimism, embitterment with pain and obesity. But despite the fragility she describes, she is very communicative with respect to the aging process.
At the conclusion of the first session (to which her daughter had brought her) she couldn’t even manage to put her shoes and socks back on by herself. Still, during that session I had taught her how even just breathing and relaxing her jaw tension made her gait less lumbering.
Before we did the second session, her weight went into the lateral arch on the left, and the space between the halux and the second toe on the right. By the end of the second session, after having practiced pushing toward the wall through her feet without tension in her mouth or jaw, she came to feel more weight through the middle of the third toe on her left foot. But – after the Padovan-style oral work, she came to sense in walking the heel strike and toe (especially halux) push-off. She also sensed transmission of weight through more of each foot, and came to use all her toes more in the push-off when she had a greater sense of her fifth toe beforehand.
In the third, fourth, and fifth sessions, we practiced the exercise of pushing toward the wall from her feet, and using the support of her back to avoid straining her knees. What also helped in various sessions was the suggestion of seeking the horizontal line with the mandible and the peripheral vision together, while at the same time releasing the back of the neck – as if to release the neck with the aid of vision and gravity.
She arrived for the fourth session by herself – and had put her own socks and shoes on beforehand. During the fifth session, she felt the presence of backs of her knees: “They grow!” she observed. As I worked with the multifidus in the sixth hour, pulling the tissue on the left side, her left hand fell asleep and her right femur ached because it was unwinding. With aligned knee bends, we tracked between the ischial tuberosities and the arches of the feet. We also used a movement technique that works with tennis balls on the soles feet, with the goal of releasing the head, neck, mandible and tongue.
The work followed Jan Sultan’s ideas – freeing the sacrum, upper ribs, triceps of the right arm and biceps of the left arm, and the scoliosis (lumbars rotated to the left, and thoracics to the right.) Pulling the tissue. The cervicals are still buried in the flesh of the neck; the mandible pulls to the right to counteract a rotation to the left.
Next, with the use of Lael Keen’s functional techniques, the neck began to lengthen. When we arrived at Ida Rolf’s structural Seventh Hour, Judith had already gained contralaterality through the liberation of the girdles.
Eventually, we stabilized the sacrum, pelvis, legs and feet, as well as the contralaterality Judith had achieved, using the foot-to-head movements in a way that includes all the joints, including the TMJ, and also using Thera-Bands and unstable standing surfaces such as wobble boards. We used lots of accessories: balls and foam rollers to diminish the sense of weight, and breathing to allow a felt sense of expansion. Most of all, we harnessed the capacity to project imaginary vectors; something she could not yet do, she could imagine herself doing.
Judith had her surgery January 27, 2010. It went well, and she has already lost eight kilograms. “As soon as I began to walk, it was lighter, different. All my clothes are loose, and my self-esteem is still improving. I consider it a victory, and bless you for your part in the effort. But now there are other parts of my body I want to change… My breasts are too large, and my legs are really gross! I still do the oral exercises with the sipping straw, and the pacifier – and another one the doctor gave me with a tube and three little balls to increase my respiratory capacity. Once my work with you at NAPER is finished, I’ll need some guidance to work on better movement on my own.” I suggested to her that for the time being, she use the vectors of weight and direction in space to imagine herself doing whatever movements she wants to do.
Ana Maria: The Stomatognathic System as a Gateway to Autonomic Re-regulation
Practitioner: Beatriz Pacheco, Certified Advanced Rolfer, Rolf Movement Practitioner
Ana, age forty-nine, a chemical engineer who also owns a fashion clothing business, arrived with cervical pain and a sense that her left arm lacked support. She said she couldn’t sleep, nor could she walk for more than a few minutes. She had already gone to medical doctors, who had diagnosed bursitis; however, she did not want to take anti-inflammatory drugs any longer.
I could see that her left side was shorter than the right, and that there was a counterclockwise torsion to the left in her spine. I could also see a difference between the two sides of her face, the right side of which appeared larger.
The first session began with work in the neck for the cranial and temporal fascia of the left side, which produced pain in Ana’s left arm. As I differentiated the bones of the wrist and opened the carpal tunnel area, Ana felt a small tremor through her arm. I asked her to wave “bye-bye” with her hand, and waited a few minutes for the tremor to pass. I explained to Ana that the tremor was most likely a beneficial discharge of the autonomic nervous system (ANS), and that she should not be alarmed by it. Opening the interosseus membrane of the forearm produced more ANS discharge, as did work in the temporals, as did work at the left trochanter and in the left hamstrings. We allowed all of these discharges complete themselves. After the first session, Ana’s pain was reduced for a few days, but returned.
At the second session, I asked her to bring an oral kit (a small kit containing tools for oral exercises, such as a whistle and a pacifier). I find these offered for purchase at speech therapy clinics where they give classes in the oral exercises. Ana did not bring one until the fourth session. To be clear, I present the oral function work to the client as a method perfected over thirty years by experts in speech therapy and dentistry. I explain why I believe that certain exercises will be beneficial in the client’s particular case. If the client agrees to do the exercises, I send the client to Beatriz Padovan’s clinic to purchase the kit and other necessary materials.
I began the core opening and introduced unilateral chewing exercises. The following week, the pain did not return until the day before Ana’s next session – but she arrived in considerable pain. That day, we began with exercises to help Ana feel the power of her connection to the ground. The pains departed and returned, but were not as bad.
Ana continued the chewing exercises; and the whole-body exercises were made more challenging with the sense of moving both homolaterally and contralaterally to induce communication between the two asymmetrical sides of the body. Throughout the process, the intensity of Ana’s pain diminished considerably, and after seventeen sessions, the pain was finally banished through the structural order that had been established. In this case, mobilization of the TMJs and strengthening of the muscles of mastication on the weaker side equalized the pressure the TMJ exerted upon the cervical spine. Reducing the tension in the muscles of mastication and corresponding corporal musculature (pelvic and respiratory diaphragms and the lateral line) rendered the muscles of mastication more available to receive the work. I believe it was the ANS discharge via the tremors through the left arm during various maneuvers that relieved the strain.
I always contextualize the oral function work with the use of the feet: the feet push and the mouth reaches. It is this dynamic of opposing forces that establishes the functional axial organization of the vertebrates.
Maria Fernanda: Letting Go . . .
Practitioner: Maria Beatriz Whitaker, Certified Advanced Rolfer, Rolf Movement Practitioner
Maria Fernanda, a young woman of twenty-one, was reluctant to complete her Rolfing series, to disengage. She received twenty-three sessions. Only after we attended to the TMJ did she feel ready to end her treatment.
The Power of Working in the Stomatognathic System[:]