Editor’s Note: The gathering of the selections that follow, as well as their development, organization, and translation from the Portuguese, is the joint effort of Heidi Massa and Pedro Prado.
Including the Stomatognathic System in Rolfing SI
A Collaborative Experiment in Broadening Our Scope
Introduction
The structural and functional importance of oral reflex functions and their relationship to Rolfing Structural Integration (SI), both conceptually and practically, has been calling the attention of practitioners in Brazil. Rolf Institute® Faculty member Monica Caspari has done extensive research related to the jaw, tongue, and teeth, and has developed structural and movement protocols to address them. At the same time, several NAPER participants have been exploring this territory in their clinical practices. NAPER(1) is an organization of Brazilian Rolfers operating out of the Brazilain Rolfing Association’s Sao Paulo headquarters, the mission of which includes clinical work, public outreach, mentoring, continuing education and research.
Beatriz Pacheco (author of “Including Functional Exercises in the Seventh Hour”), who had studied with speech therapist Beatriz Padovan and MD physiologist Carlos Douglas, experimented with oral exercises in her NAPER Rolfing practice. When she shared the results with other NAPER members, they were also inspired to include the oral reflex functions in their thinking and practice, and began to observe in their clients’ processes remarkable changes in structure, function, and quality of life.
Over the years, NAPER has built a set of clinical practice and research protocols, and has organized a data bank, which now includes outcome information on the processes of more than 1000 clients. The prospect of gathering empirical data on the use of exercises based on the oral reflex functions in the Rolfing context is exciting, indeed!
In this collection, we share Beatriz Pacheco’s summary of the oral reflex functions and their anatomy and physiology; case studies and observations by Pacheco and her fellow NAPER practitioners Rosângela Maria Baía, Yahra Silveira Perdomo and Maria Beatriz Whitaker; and Monica Caspari’s “Movement Strategies for the Stomatognathic System.” We hope it will inspire and encourage the international community of Rolfers to include this dimension in their view of our work.
Pedro Prado
Certified Advanced Rolfer
Rolf Movement Practitioner
Advanced Rolfing Instructor
Research Coordinator, NAPER, Sao Paulo, Brazil
Heidi Massa
Certified Advanced Rolfer
Rolf Movement Practitioner
Endnotes
Including Functional Exercises in the Seventh Hour
By Beatriz Pacheco, Certified Rolfer, Rolf Movement Practitioner
This article(1) highlights the four vegetative oral reflex functions – chewing, sucking, breathing and swallowing – as avenues of approach to the work of the Seventh Hour. An understanding of the movements, bones, joints, and muscles employed in these functions provides both a reference and an orientation to the structural work of the Seventh Hour. I also seek to bring a vision of bodily organization that enhances our sense of the involvement of these functions, and also to show that working functionally provides a resource preparatory to core opening, maintains the gains of the structural work, and allows us to organize the cervical and atlantooccipital regions – all of this besides reducing our clients’ discomforts.
I will not explain the particulars of oral exercises, but will highlight what they can achieve. The information contained herein is from notes of classes conducted in 2006 and 2007, and from interviews with oral health specialists Beatriz Padovan and Carlos Douglas.
Introduction
To think about oral functions, we must go back to the origins of animal structural organization. Unlike plants, which developed photosynthesis as their means of nourishment, animals developed nervous systems, which brought the possibility of voluntary movement in pursuit of food. In other words, feeding is the motive of locomotion.
Following this idea, when we consider the dichotomy of form and function, we discover that each vertebrate animal has an axis, one extremity of which is the entry point for food, and the other of which is the exit point for that which the body does not assimilate. Therefore, the mouth, which is one extremity of the axis, is a reference not only for locomotion but also for vertebrate morphology generally. In fish, amphibians, reptiles, and quadrupeds, where the axis is aligned horizontally in relation to the center of gravity, we see the mouth in front with respect to locomotion.
Thus, we have hind legs (or fins, in the case of fish) posterior to the axis to push the body forward (rear drive), at the same time the mouth provides another force in the opposite direction (front drive). These forces combine to generate a sense of push-pull – a functional opposition shared throughout the vertebrate animal family. In humans, however, there are other possibilities; we can move to wherever our faces are directed.
Based on these facts, as well as other mechanical and neurological observations, oral health professionals such as orthodontists, phonoaudiologists, bucomaxillary specialists, and others have a vision of bodily organization based not on the support of the structure, as is Rolfing, but rather on the reference point of the mouth (the stomatognathic system). This concept of bodily organization is important because it is the reference of many health professionals, including the followers of Sigmund Freud. In his theory of the development of psychic structures, Freud considered the “oral” stage to be the beginning of human psychic existence; at that stage, we begin to move and to perceive ourselves and the world through the mouth. Besides, this view of bodily organization enhances, reinforces and complements our own as Rolfers. The typology of the oral health professions is well known to us, as if they have arrived at the same place via a different route.
For me on my path, this idea greatly enhances comprehension of how the axis functions and the question of communication among the diaphragms. And, above all, it leads to a reassessment of the importance of the muscles of mastication, the temporomandibular joint (TMJ) and the tongue – all of which are explored but little in Rolfing – for proper posture and structural function. We should also keep in mind the importance of the study of function to the understanding of form, as well as its importance as a reference for structural work.
Views of 7th Hour Work
We come to the Seventh Hour with the objective of finding a position of equilibrium for the head. This is a daunting task, as we are seeking equilibrium over the vertebral column for the cranial mass, which weighs over five kilograms. For something this heavy, we seek equilibrium of the occiput over the condyles of the atlas, which surround the dens of the axis. It is no accident that we have a veritable forest of muscles that connect, stabilize, extend, rotate and flex the head over the neck.
So, let’s consider the mobility of the head. It is stimulated by the sense organs: the eyes, nose, mouth, ears, and skin. Embryologically, the mouth is the first of these organs to form. Once the entry point for food and the exit point for unassimilated byproducts forms the axis around which human structure is organized, we observe in the embryological development that the gastrulation of the morula forms the digestive tube, already rendering the mouth both the superior reference of the axis and the starting point for the embryological differentiation of the endoderm, ectoderm, and mesoderm. Shortly after the digestive tube is formed, nerve tissue starts to form at its inferior portion and migrate toward the mouth, where the central nervous system will develop.
In humans, motor control begins at the mouth through sucking. The very first voluntary human movement is to suck the thumb, which activity begins in utero, at the fourth month of gestation. This thumb sucking is timed to the mother’s heartbeat and coordinates the function of the fetus’ hyoid muscles, which the newborn will need in order to suck at the breast. Intrauterine thumb sucking also allows the fetus to ingest amniotic fluid, which contains substances necessary for the maturation of its digestive and respiratory tracts. Because thumb sucking has a formative function, all fetuses exhibit this behavior in utero.
We must also keep in mind the percentage of the motor homunculus devoted to the mouth: the mouth occupies 20% of the primary motor cortex. Let’s list some of the mouth’s functions:
So, we return to the question of proper placement of the head over the spinal column. We learn from the oral health profession that the position of the mandible determines the position of the head. The three main muscle groups governing mandibular position are:
These muscle groups effect a dynamic in which the muscles of mastication act as antagonists to the hyoid muscles. In the taxonomy of Tom Myers, the latter are part of the deep anterior line, which penetrates the thorax through the mediastinal fascia. Their participation in the deep anterior line makes them functional antagonists to the powerful muscles of mastication.
The muscles of mastication belong to the erector group. In other words, they are antigravity muscles, and are among the strongest in the entire body. No wonder, in an evolutionary sense, we see that in most non-human vertebrate species they are the principal mechanism of attack and defense.
Accordingly:
Of course, as with any typology, we encounter various combinations in between the pure types. We must also remember that the position of the mandible is determined by genetics, by the positions of the teeth, and by the way the person performs the various oral functions.
The mandible is controlled by the TMJ, which is a very special joint. It is the only synovial joint of the face; it allows motion along three vectors; and is one of the most highly innervated joints in the body. As noted above, the TMJ receives proprioceptive signals regarding bodily positions and movements so that the position of the head may adjust appropriately. Because it is a paired joint, the TMJ also registers any difference in the horizontal level of one condyle from that of the other, and transmits this information to the brain so that the body may adapt to support the head. In addition to postural information, the TMJ registers periodontal information concerning the consistency of food, which indicates how much force is needed to chew it and when to stop chewing – or whether the food contains a bone or small stone harder than the teeth themselves.
But in my opinion, the most important point for structural integrators is the TMJ’s intimate association with the thalamus gland, which is the center of the limbic system. The limbic system coordinates affects connected to the basic survival mechanism of “fight or flight”. Whenever the sympathetic branch of the autonomic nervous system is activated, the trigeminal nerve is also activated to prepare the mandibular system for attack or defense.
Thus, the entire mandibular system (nerves, bone, muscles. and teeth) is activated involuntarily. As I see it, this is the principal justification for functional work with the four oral reflex functions (sucking, chewing, breathing, and swallowing): in our society, we are exposed to sympathetic activation many times each day, which powerfully reinforces existing neuromotor patterns affecting the cervical region, head and throat.
Working with the Four Oral Reflex Functions
All four oral reflex functions employ the same neuromuscular equipment. Because the functions are so interconnected, if we find a dysfunction in one, we may be sure to find altered function in the others, as well. For this reason, Padovan cautions against working with any one function in isolation from the others.
Chewing
Chewing combines mandibular movements in three dimensions – front-to-back, side-to-side, and top-to-bottom – resulting in a helical motion. This happens so that both sides of the array may work equally. Chewing begins with a bite, after which the teeth chop and tear the food to the consistency of the alimentary bolus. At any moment, one side is working, and the other is poised to work. On the working side, the teeth are in contact with the food, while on the other side they are not, and there is space between the teeth. The two sides alternate their functions as the tongue transports the alimentary bolus from one side to the other. If for some reason one of the two sides works more than the other (unilateral mastication), over time the mandible will develop a rotational pattern resulting in a fixation in the direction of the harder-working side.
The main muscle group for chewing comprises the muscles of mastication: temporalis, medial and lateral pterygoids, and masseter. The initial bite is effected by the temporalis, masseter, and pterygoids. The masseter maintains the mandible in the closed position. The lateral pterygoid effects the side-to-side component of chewing.
These days, because our food is so soft, we chew ten times less than humans did at the start of the twentieth century. As we chew, we induce parasympathetic activation, and discharge and inhibit the activation of the trigeminal nerve. As the mandible alternates between opening and closing, the sides of the mouth alternate between working (biting) and balancing the jaw. This activity equalizes the tonus of antagonist muscles. But we can also achieve comparable equalization of muscle tonus through exercises designed for that purpose.
Masticatory Disturbances
According to Padovan, a child’s baby teeth begin to imprint the helical chewing pattern when the child is about three years old. This is the same time at which the child begins to display contralateral motion. It is also the time when the child begins to use the first-person pronoun, “I”: “I want to eat,” instead of “want to eat.” Thus we see the structural, functional, and psychobiological realms flowering simultaneously!
Sucking
Working with sucking is essential because sucking is the most comprehensive of the reflexive/vegetative oral functions. The pressure of the tongue against the palate, along with nasal breathing, sustains the upright posture. A chronically resting tongue begets hypotonic muscles of mastication and hypertonic hyoids, which bring the head forward and cause the thorax to collapse over the abdomen.
The main sucking muscles are the infrahyoids and suprahyoids and the extrinsic muscles of the tongue, the intrinsic muscles of the tongue being more important for swallowing and speaking.
The intrinsics of the tongue are:
The extrinsics of the tongue are:
The base of the tongue is formed by extrinsics – the geinoglossus, palatoglossus, hyloglussus, and chondroglossus, which inset into the hyoid bone. In sucking, the tongue undulates upon, puts pressure against, and opens the anterior portion of the palate. The tongue is raised by the styloglossus, which brings the tongue toward the palate at the same time it brings the hyoid bone superior in order to close the larynx so that food and saliva may descend through the pharynx. For this function, the suprahyoids and infrahyoids act as antagonists, raising and lowering the hyoid bone. Working with sucking, we can bring the tonus of these muscles into equilibrium.
Seeking and finding the breast, which precede sucking, initiates and stimulates an unwinding of the fetal position and brings a tendency to lift up the superior portion of the thorax. This is true in adults and the elderly, as well as in infants. The search stimulates the achievement, the same as when the infant seeks its mother’s breast. And, because there is no achievement without a “pull” in its direction, we see the dynamic of the opposing forces that organize the axis, which begin to show themselves in the earliest infancy.
Among adults and the elderly, practicing sucking recovers and organizes this action/attitude, which is effectuated through the deep musculature and not through the fascia. The action of the tongue pressing upon the palate generates an impulse in humans equivalent to the heliotropic tendency in plants, and develops the sense of spatial orientation emphasized by the work of Hubert Godard.
Sucking brings about nasal breathing. The combination of sucking and nasal breathing allows the infant to support its head and establish motor control of its neck. They also permit the infant a greater experience of motor coordination. Could it be that the coordination of sucking, swallowing, and breathing, in their three different rhythms, is the cradle of motor coordination? (See the thesis of Manoel SouzaCunha at www.fmh.utl.pt/mestradodc/a succao.doc.)
Sucking protrudes the mandible, which is retracted in the fetal position. This movement also disengages the sympathetic activation of the muscles of mastication. The rhythmic movement that sucking produces in the pharynx, which is connected to the cervical column at approximately C4, generates a vibration (like a cat’s purr) that can either relax or tonify the cervical region.
Sucking produces endorphins and engages the hippocampus to produce the proteins BDNF (brain-derived neurotrophic factor) and GDNF (glial cell-derived neurotrophic factor), which increase cerebral activity and enhance the neural plasticity of the hippocampus in functions such as memory and imagination. Sucking is, therefore, highly recommended for the elderly. Sucking also stimulates the peristaltic activity of the digestive tract.
In balancing the tonus of the hyoids, it is worth emphasizing the role of the digastrics, which originate at the occiput and insert into the mandible. The posterior belly of the digastric functions like reins on a horse and has considerable influence on head position. We should also emphasize the importance of the omohyoid, which originates at the hyoid bone and inserts into the shoulder blade. Contraction of the omohyoid narrows the thoracic inlet and the superior portion of the thorax itself.
Sucking Disturbances
Respiration
Respiration begins at birth. If all goes well, the baby begins to breathe through the nose and activate the musculature of the diaphragm. Because the mechanisms of respiration are well known among Rolfers, I will not describe in detail the muscles involved, the phases of respiration, or the basic respiratory dysfunctions (inspiration fix and expiration fix) and their postural and muscular characteristics.
But I would like to highlight the importance of nose breathing, in which the nose filters, humidifies, and warms the air so that it reaches the lungs at 38ºC (the air temperature determines the flow of blood in the lungs). Having entered through the nose, the air passes under the sphenoid, which is warmed by the heat cerebral activity produces. Thus, as the air passes from the nose into the nasopharynx, a heat exchange takes place in which the air is warmed and the brain is cooled. Inadequate cooling of the brain (having a “hot head”) can be responsible for hyperactivity, deficits in attention and concentration, and emotional lability.
Without nose breathing, the cold and unfiltered air that reaches the lungs creates an opening for respiratory disease. The mucosa of the nose contains 20% of the autonomic nervous system’s pathogen detection receptors. Finally, pheromones, which stimulate sexual behavior, are registered by the osmaceptors near the vomer.
Mouth breathing generally arises from difficulties at the time of breast-feeding, as it is during this time that nose breathing should be established. Oral health professionals have observed that many problems accompany mouth breathing. Health problems include:
Disturbances from Mouth Breathing
Mouth breathing can also induce emotional and behavior problems, such as:
Finally, aesthetic and functional changes from mouth breathing include:
Swallowing
We swallow between 500 and 1500 times each day. Saliva, besides dissolving food, protects the esophagus from the gastric juices produced by the stomach. Swallowing takes place in four phases:
The main structures involved in swallowing are:
o styloglossus, which raises and cups the tongue
o hyoglossus, which depresses the tongue
o genioglossus, which projects the tongue forward
Swallowing Disturbances
Conclusion
Working with the four vegetative oral reflex functions has greatly enhanced my own comprehension of the structural, functional, and psychobiological dimensions of bodily organization, as well as the interplay among those dimensions. Perceiving the effects of the TMJ on the lateral line, diaphragms, shoulder girdle, thoracic inlet and spine has given me a better understanding of the dysfunctions that can happen in those areas. It seems to me that Rolfers often underestimate the enormous strength and reactive capacity of the muscles of mastication in all dimensions of being.
Understanding how the musculature of the stomatognathic system is involved in posture makes possible different approaches, from specialized touches to differentiate these various muscles and other structures to oral exercises. Approaches may be directed to primary mechanical patterns that have not fully matured, or to dysfunctional patterns resulting from the mechanical activation of the limbic system. (Dysfunctions arising from genetics or misaligned teeth are beyond the scope of these approaches.) The results of the manipulation, amplified by the oral exercises, made it possible for me to give clients tools that both allow them to discharge the limbic activation and reeducate their systems.
Seeing how opposing forces organize the axial complex is reinforced by an understanding of the tongue’s role in this dynamic. It is very difficult for a mouth-breather to maintain an erect posture because keeping the tongue on the floor of the mouth to permit airflow creates excess tension in the infrahyoids. Studies by phonoaudiologists and biomechanical engineers concerning the axial forces imposed by the tongue in mouth breathing versus nose breathing, in premature infants, and in persons with Down’s syndrome and cerebral palsy. Given the need to objectively evaluate the power of the tongue, the Biomechanical Engineering Group at the Federal University of Minas Gerais (State of Minas Gerais, Brazil) has devised an apparatus to measure the axial forces produced by the tongue.
But, do the oral exercises allow us to make changes in well-established patterns? It depends on the client’s age, as well as on how regularly the client practices the exercises. And, more important than achieving specific changes is the capacity of the functional tools to bring about maturation of the vegetative oral reflex functions, as well as the client’s cognizance of them. And, according to both the work cited above and my own experience, the changes we can effect are significant.
I could tell you about many clients who, after practicing the oral exercises, feel better contact of their feet with the ground, have longer necks, sense the mobility of the spine s contralateral movement manifests itself,[??] etc. Some day I will prepare an article just to tell you about my clients’ responses.
I want to be clear that the objective of my work with the four vegetative oral reflex functions is the fundamental one of integration of the body in gravity. I do not pretend that this work is a substitute for the work of oral therapists. My intention is to cooperate with them to open a new area of work for us. Actually, I believe there are many things for us to discover through these ideas. That is why I wanted to present them to you: so that we can enrich our practices and the possibilities of helping our clients.
Endnotes
The Power of Working in the Stomatognathic System
NAPER Case Reports
By Yahra Silveira Perdomo, Beatriz Pacheco, Rosângela Maria Baía, Maria Beatriz Whitaker
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.
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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.
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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.
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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.
<img src=’https://novo.pedroprado.com.br/imgs/2010/1096-7.jpg’> <img src=’https://novo.pedroprado.com.br/imgs/2010/1096-8.jpg’>
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.
Endnotes
Movement Strategies for the Stomatognathic System
By Monica Caspari, Certified Advanced Rolfer, Rolf Movement Practitioner, Rolfing and Rolf Movement Instructor
Introduction
As the Rolf Institute’s Little Boy Logo shows, structuralists tend to emphasize the role of the pelvis in postural organization. Yet infants initiate the organization of verticality from G-prime (G`) – the upper center of gravity – first by following caretakers with the eyes, and then by raising the head and chest with the help of the hands and arms. It seems that the impetus for verticality starts at the mouth, which is far more important for the organization of posture and movement patterns and the dynamics of reaching than we have recognized.
We have long known that balance is organized through the feet, eyes and vestibular system. Both tonic and phasic muscles, the tonus of which continually adjusts to keep us erect, are regulated by the vestibular apparatus and eyes, while the feet influence the body’s organization in the sagittal plane. However, we now know that the mandible, TMJ and the four oral reflex functions (sucking, mastication, breathing, and swallowing) are essential to the organization of our balance and posture.
The TMJ, one of the body’s most innervated joints and the only moving joint of the face, acts in three planes. The TMJ registers information about body position and movement in space, and its own position adjusts accordingly. Conversely, because the receptors in the mandibular fossa of the TMJ register the position of the condyles of the mandible, it is sensitive to whether the plane on which they lie is other than horizontal; if so, afferent signals from the TMJ signal the body to adapt in order to create support for the head. Basically, the jaw affects the spine and the spine affects the TMJ.
The four oral reflex functions and the position of the mandible (relative to the rest of the standing posture) are interdependent and influence each other. The oral reflex functions also influence the tonus of the tongue and performance of various other oral functions, such as speaking. Because all four oral reflex functions employ some of the same neuromotor components, a problem in any one of them manifests in the others.
Taken together, the TMJ, the mouth, and those parts of the head, neck, and upper thorax (muscles, bones, ligaments, fascia, and nerves) that control sucking, biting, chewing, swallowing, are called the stomatognathic system.
Human Verticality Starts at the Mouth
Classically, the Seventh Hour is about putting the head on or finding the skyhook. While in structural terms it concerns the suboccipitals, in functional terms it concerns the senses – finding directions in space, and reaching to do so. In that respect, the impetus for our verticality starts in utero, at the same time human motor control starts with the mouth. In the fourth month of gestation, the human fetus performs its first voluntary movement: sucking the thumb and consequently swallowing amniotic fluid. This activity cause ingestion of substances essential to the maturation of the digestive tube and lungs, and also prepares the hyoid muscles for sucking at the breast, which, in turn, rehearses the verticality to come. In putting the head on, we implicate primal developmental events and engage the enormous portion of the motor and sensory homunculi devoted to the mouth.
Exploration: Suck your thumb and notice how it awakens the neck muscles and evokes the up direction. To experience the baby’s complex coordination among sucking, swallowing, and breathing, get two feet of IV tubing and place one end in a cup of water. Suck the water through the other end and breathe through your nose in the intervals. Notice how this action evokes the up direction.
TMJ: The Fourth Balance Factor
“When you work in the neck your fingers will be as close as possible to the control structures of the body than at any other moment.”(Ida Rolf)
The front of the head is heavier than the back. For that reason alone, balancing the head on the neck is complex. But, because the postural mechanism of the head and the movements of the mandible are intertwined, whatever influences the latter (e.g., cavities, missing teeth, misaligned teeth) will affect the balance of the head on the neck. In that sense, the masticatory system is part of the postural system:
In any event, whether the masticatory system is a regulator or a perturbator of the tonic postural system, we do know that imbalances in one affect the other.
Experiencing the Jaw in the Context of the Ten Series
Though the jaw is addressed specifically in the Seventh Hour, we influence the jaw in each session.
In the First Hour, when we enhance the orientation to space by differentiating the arms and neck from the thorax and freeing the breathing, already we‘re affecting the jaw. Exploration: Sitting as before, try rotating your arms medially and laterally, and notice how the rotations affect your breathing and the sensations in your jaw. Next – in the millisecond before you want to inhale – think, just think, that your jaw is seeking a direction in space (as if it were a drawer opening), and notice how it feels to breathe like this. Then try the opposite: think, just think, that your jaw wants to go back, towards your throat, and feel what happens to your breathing and the connection of the feet to the ground. Perhaps just imagining to project your jaw forward encouraged inhalation, while the opposite encouraged exhalation. In fact, we can encourage a client to inhale or exhale simply by slightly extending or flexing the client’s head.
The Second Hour’s work at the ligamentous level of the feet and lower legs reaches up to the cranium, and thus affect the jaw. Exploration: Assume your habitual standing posture and notice how your jaw is, how it feels. Then release into your inner arches, maybe even collapsing them, and feel the effect on your throat, jaw, tongue and neck. Next, observe the effect of resting into your lateral arches. See how the neck and jaw feel when you either hyperextend the knees or never really straighten them. What happens to the jaw when you activate the extensor digitorum muscle or shorten the low back?
In the Third Hour, we influence the TMJ through our organization of the G`/G relationship, as well as the lateral neck work. Exploration: Assume your habitual standing posture and notice how your jaw and neck feel. Then change the relative position of G` and G, taking G` way behind or way forward of G and feel what happens.
As we open the mid-line of the legs in the Fourth Hour, we affect the jaw via the pelvic floor, respiratory diaphragm, and thoracic inlet. Exploration: Standing or sitting, notice what you feel in your jaw. Then tighten the pelvic floor and notice what happens. Next, reverse the sequence: clench your teeth and notice what happens in your pelvic floor.
In the Fifth Hour, as we organize the legs with the pelvis, and through the pelvis to the visceral space, the affect on the core influences the jaw. Exploration: From your habitual standing posture, rotate the femurs medially and laterally and feel what happens to both the pelvic tilt and the jaw. And, as we organize the core by organizing the abdominal wall, we affect the jaw and TMJ via the abdominal, thoracic and cranial cavities. Exploration: Notice how your jaw feels when you are in your habitual standing posture. Completely release your abdominal wall and feel what happens. From there, activate your transversus abdominus (TA) and feel. Next, release the TA, activate rectus abdominus (RA), and feel the changes in the TMJ/jaw. The exploration around the TA and RA becomes clearer with sit-ups: without activating the TA, you’ll notice the strong shortening of the neck. But if you first activate the TA and only then the RA, the neck will remain movable and relatively free, and so will the jaw.
As we organize the whole back of the body in the Sixth Hour, our work on the spine as a whole influences the jaw. Exploration: Shorten your spinal erectors and feel what happens in the jaw; next, see what happens when you lengthen the front of your neck and throat. Exploration: Stand, one leg in front of the other, (let’s say the right leg in front), feet pointing straight ahead, the right arm bent at your back over the upper lumbars, and the left arm along the body. Reaching with the left arm down and then to the front and then up, while your feet make the best possible contact with the floor, ask then the ischial tuberosities to widen, and lower the torso toward the floor by flexing at the hip hinge (not at the lumbars), reaching with the extended arm as far down as you can, feeling the jaw, and reaching towards the floor with the forefoot of the front foot and with the heel of the back foot. To come back up, draw the ischial tuberosities closer together and still reaching with the arm allow your body to come to standing while you take your awareness to your jaw and notice what happens there. Explore the same sequence again – but without activating the contact of the feet with the floor, or reaching with the arm/hand, or widening or narrowing of the ischial tuberosities – and feel what happens to the jaw.
Finally, in the Seventh Hour, if we consider the functional goals as well as the structural goals, we will influence the TMJ by taking the arms and hands to a higher level of integration. The functional goals include:
Explore the following arm/hand movements, and notice what happens in the TMJ:
As Ida Rolf said, if the client is adequately prepared, the mouth will not be vulnerable; but if the client is not prepared, the mouth will be quite vulnerable, indeed. Therefore, if the arms, hands and shoulders have not yet been adequately differentiated, they should be addressed before proceeding to the classical territory of the Seventh Hour.
Jaw Movements Influence the Postural Mechanism of the Head
The position of the mandible affects not just of the head, but the whole person. Changing the position of the mandible changes the whole line, as well as how the person relates to the environment. The next exploration uses movements of the mandible to help the client become aware of head and neck position.
Exploration: Stand, connect your feet to the ground, and find the up direction and your Line. Notice your breathing and where your body weight rests in your feet. Leaving your cranium where it is, project your chin forward.
After returning to neutral, leave your cranium where it is and pull your chin toward you. Ask the same questions.
Finally, in the seated position, place a thumb under your chin, its tip touching the throat, to hold the chin steady. Keeping the chin in place, first project the neck forward and feel what happens to the lumbars, the sternum, and the breathing. Second, take the neck back as if you wanted to make it a straight continuation of the spine, and feel what happens to the spine, the distribution of weight in the feet, and the breathing.
To balance the action of the posterior erector muscles with that of the hyoids, it helps to imagine that the face to belongs to the sternum, while the cranium belongs to the spine. Let’s work first with the whole head, and then with the jaw specifically.
Exploration: Sit slightly forward of your ischial tuberosities, feet connected to the ground, head suspended in space by the dynamics of the senses, and the weight of your head balanced between front and back in such a way that the cranium rests on the spine and the face on the sternum. Now, allow your whole neck and head to go forward and recheck all the landmarks: what happened to the connection of your feet with the floor, your up direction, your down direction, your breathing? Return to neutral, imagining your head suspended from or reaching toward the ceiling. Without moving the neck or head, imagine the cranium staying with the spine as the jaw goes forward. This overactivates longus colli and the hyoids, yielding considerable throat tension that makes it hard to swallow.
Psychobiology: The Jaw in the Expression of Emotions
“Smile from your cervicals.” (Vivian Jaye)
Hubert Godard teaches that our spine gives us the sense of self. Hugh Milne, however, teaches that the mandible is the bone most associated with the person’s sense of who he is. Because so much of our self-expression happens through the face, the jaw helps display many feelings. When we feel:
Communicating through the jaw as much as we do, we develop movement patterns that can contribute to TMJ dysfunction and temporal region tension headaches, which have repercussions throughout the body. Fortunately, movement patterns of the jaw can be addressed through Rolf Movement education. Jaw tension is hard to control, but the first step is to help the client recognize the context in which the TMJ/ temporalis tension arises. Next, encourage the client to acknowledge any feelings associated with the situation or events. Finally, identify the manner and sequence in which client builds the tension pattern.
Sitting quietly for ten or fifteen minutes before bed time, contemplating the day and releasing the tension generated by the day’s stress, allows us gradually to release accumulated jaw tension. While sitting in the meditative attitude, the client can place a pencil as a brace between the upper and lower molars to encourage the jaw muscles to relax. As the muscles lengthen over time, the client can use two pencils taped together. Take care to increase the size of the brace gradually, and to respect the average limit of how far the mouth can open (forty to sixty millimeters).
Functional Interventions
“The face is just the other side of the neck.” (Ida Rolf)
To embody Dr. Rolf’s observation, sit slightly forward of your ischial tuberosities, with “footy feet” on the floor and “handy hands” in your lap. Turn your head to either side and notice the quality of movement. Next, instead of turning the head from the face (or the nose in front), turn it from an imaginary nose in back. Notice that in the first action, when you turn to the left, it seems to turn from an imaginary axis close to the left sternocleidomastoid (SCM), and when you turn to the right, it seems to turn from an imaginary axis close to the right SCM; but, in the second action, the whole head seems to turn on a single axis that lines up with the cervical spine, which is what we want to evoke. Notice also that here a perceptual shift improves the coordination. Perception is also key to the functional interventions described below.
Rolf Movement Integration is helpful for stomatognathic system and TMJ problems only if the client has the discipline to work with it daily. First, teach the client to keep the upper and lower teeth separated, even as the lips are softly closed. Next, the tip of the tongue should rest on the palate, just behind the upper front teeth. This positioning alone is often enough to reduce TMJ tension by opening some space at the condyles. Persons with TMJ problems should be educated not to chew gum or eat hard things like beef jerky. The client should be educated to avoid collapsed standing postures and poor sitting habits that throw the head forward, as well as carrying heavy handbags on one shoulder and chewing on one side only.
Exploratory repatterning exercises for the jaw:
For each of the following exercises, sit slightly forward of the ischial tuberosities, feet on the floor, finding the down direction with the ischial tuberosities and the up direction with the top of the head. The back of the spine looks back and opens graciously towards the wall, even as its front remains open.
For the Lateral Pterygoids
Before a mirror, if possible, cradle the mandible in the crescent of the thumb and index/second fingers. With teeth resting apart, translate the jaw from one side of the crescent to the other, the cradling hand neither encouraging nor inhibiting the translation of the mandible. Are you moving the lips more than the mandible? Explore this movement daily, starting with one minute, and increasing the daily duration by one minute each week until you reach the three to five minutes. If the jaw translates asymmetrically, have a competent dentist evaluate it.
For the depressors of the mandible:
The depressors of the mandible open and retract the mandible. Included in this group are the lateral pterygoid (also an auxiliary of mastication) and the suprahyoids (digastrics, stylohyoid, mylohyoid, and geniohyoid).
Before opening the mouth, stroke the mandible with the thumb, from the mastoid process to the tip of the chin, inviting something there to let go before opening the mouth. Or, cradle the mandible in the crescent of the thumb and index/second fingers and invite the mandible to rest in your hand before opening the mouth. Both touches give support for the temporalis to release and the suprahyoids to work more freely.
For Flexibility and Strength of the Jaw
Work gently with isometric exercises. First, place three fingers of each hand along the sides of the mandible to offer a bit of resistance to its reaching side-to-side movements. Next, place the fingers under the chin and let the mandible reach through the fingers as the mouth opens. Start with one minute per day and gradually increase to three minutes.
For the Temporals-Masseters-Chin
Cradle the mandible to guide its movement gently forward, so that the lower teeth go anterior to the upper teeth. Start with one minute per day, and gradually work up to three minutes. Take it easy: Overdoing this exercise might leave you with a sore temporalis!
For increasing the TMJ Range of Motion
Slightly open the mouth, and place a thumb under the upper front teeth and two fingers of the other hand over the lower front teeth. Invite the jaw to remain passive as you gently open the mouth. Take care not to put too much pressure on the teeth: the more gentle you are, the better and more quickly this works. This is good for clients whose mouths barely open. Start with one minute per day and gradually work up to three minutes.
For Coordinating the Three Planes of Movement of the TMJs
Draw imaginary figure eights with the tip of your chin. For this you’ll have to open and close the mouth, and take it side-to-side. Draw two equal figures, one to each side of the mouth, taking care not to cut any curve. Start with one minute to one direction and another minute in the reverse direction. Gradually increase to two minutes each side.
Conclusion
Better understanding of the stomatognathic system as a whole, and of the jaw in particular, offers a new and broader perspective on the Seventh Hour. It enhances our ability to help our clients by facilitating their awareness of existing patterns, and by giving them self-help movement tools. It also opens the door for us to work cooperatively with holistically oriented dentists and speech therapists.
Including the Stomatognathic System in Rolfing SI[:]
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