Originally published in Massage & Bodywork magazine, April/May 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.


The essence of Structural Integration is the dynamic tonal balance between the surface of the body and the body's core. The nature and location of "core," however, has long been debated among Structural Integrators. Herein, let's explore several avenues of thought about core and synthesize them into a practical whole, citing research that is opening new vistas to understanding the mechanism of Structural Integration and related disciplines.

Structural Integration (SI) is distinguished from other disciplines by its primary attention to gravity. Other bodywork systems seek tonal balance, energy balance and emotional balance. While SI attends to all of these, its primary goal is to alter the structure of the human body so that instead of fighting gravity, one can use it as an energy source. After a complete series of 10 SI sessions, clients look taller and more balanced, and report they not only feel lighter, but also physically uplifted. This lift is due to the client's new relationship to gravity. Once this has been felt, no other state will do.

While the results of SI are long-lasting, injury or illness can reduce the lift originally achieved. Such a reduction can change one from feeling like a soaring bird into Jabba the Hutt. Tune-up sessions, either after stressful events or at six- to 24-month intervals as preventive therapy, maintain that graceful and balanced dance with gravity.


Some Principals of SI
Structural Integration works with the continuity and plasticity of connective tissue. The human body has only one piece of connective tissue - all fasciae, periostia, ligaments, tendons, etc. are continuous. Collectively, these tissues make up 20% of human body weight and form the element of support that maintains spatial relationships amongst organs, bones, muscles and all other tissues. Structural Integrators know the map of this connective tissue. With that in mind, they apply analytical skills to choose where to make the most meaningful interventions to restore damaged or habit-worn tissues. The greatest challenge when studying SI is to learn these analytical skills. In classic Rolfing, most of the information is gathered visually.

In order to integrate the human structure into the gravitational field, several tonal balances must be considered. Left and right sides of the body must have similar tone and span in each segment, from toe to scalp (Fig. 1). Similarly, the tone and span of the posterior aspect of the body must balance the front of the body at each level. It is also customary to consider upper-body, lower-body balance.

As the reference to "each level" indicates, balance above and below the waistline must be extended to balance between all segments of the body. For example, the tone in the feet must match that in the leg, that in the thigh, and so on. If each of these three dimensions of balance is improved in a series of sessions, the result will be a good level of Structural Integration.

In addition to these three dimensions of balance, there is a fourth, which if achieved, will bring integration a quantum level higher. This dimension, called core-sleeve balance, occurs when surface tone balances core tone and is less often achieved. It is difficult because, as mentioned before, the exact location and nature of core continues to be obscure. Let's take a closer look at core.


Defining Core
The definition of core has been debated in SI circles for at least the last 50 years. Functionally, Structural Integrators can recognize when a person has core-sleeve balance. A person living in such balance quickly learns to recognize it, too. Movement can be initiated in any direction with equal ease. "Effortless" is the usual description, like a sailboat with all the sails trimmed just right and singing together.

Naming the structures that are core and teaching another to produce this balance comes much harder than recognition of the balanced state.

Surface is easier to describe than core. The superficial fascia is a discreet unit, enveloping the whole body. Deeper fasciae, such as intermuscular septa, connect to the superficial fascia. Any consideration of layered myofascial relationships deeper than the superficial fascia is open to interpretation. Deeper layers overlap and interpenetrate.

The extrinsic muscles lie nearer the surface of the body and tend to move the body quickly and strongly, but somewhat imprecisely. Intrinsic muscles lie generally deeper in the body and move more slowly and more precisely. When these two are functionally balanced, the body can move with strength and precision.

The extrinsic musculature is one definition of sleeve, but exactly where does extrinsic end and intrinsic begin? The spinal rotatores muscles are clearly intrinsic because they are the deepest muscle in that area. The soleus lies deep to the gastrocnemius and is challenging to directly contact. Yet functionally, the soleus is extrinsic, a prime extensor of the ankle. Although structurally deep, lying next to bones, under a large muscle, the soleus is functionally not as intrinsic as the pedal lumbrical muscles. Yet, penetrating through certain portions of the distal plantar aspect of the foot, the lumbricals are the first muscle layer encountered.

So far we have considered core-sleeve relationships with respect to muscles and myofascial structures. But there are more ways to describe core:
- Ida P. Rolf described core in several ways, including "everything you can't live without." This is an intriguing statement, but far from clear in its application to Structural Integration.

- The bones. We think of them as deep structures, but in some places, such as the shin, they immediately underlie the superficial fascia. In the human body, bones serve as spacers in a tensional matrix similar to Buckminster Fuller's tensegrity structures. In this model, the surface-core relationship is translated into balance between the thrust of the bones and the tension in the fascial planes enveloping and connecting them. The internal structure and tensions of the bones can be quickly modified by manual means, producing prompt improvement in the overlying soft tissue tone. Craniosacral therapy (CST) and visceral manipulation (VM) are among the therapies that work with the internal structure of the bones.

- Jan Henry Sultan and other Rolfing instructors use "the visceral space" as core. By this they mean not the viscera themselves, but the container of the viscera and the pressure system inherent in the visceral space and its container. Management of these pressure relationships is essential to Structural Integration, and yet this is not the whole story of core.


New Ways of Defining Core
Certain concepts developed in other disciplines are now giving Structural Integrators new and highly useful ways of defining core. Although craniosacral therapists do not focus on core-sleeve relationships in the way structural integrators do, from the viewpoint of Structural Integrators, CST practitioners treat the dural membranes as core. Certainly the dura are deep in the body, lying inside the skull and within the spinal vertebrae. Cranial manipulation and its descendant, craniosacral therapy, ably demonstrate that altering the tone and span of the dural membranes produces profound and immediate change in tone of body tissues at any distance from the dura. These changes may be either highly tissue-specific or quite general. If the dura is ignored, core sleeve balance is incomplete.

Dural restrictions affect other tissues in three or more ways.
1. A severe dural restriction may put direct pressure on the central nervous system (CNS). Even slightly impaired CNS will result in skewed monitoring and control of body processes.

2. The spinal dural must have flexibility to accommodate spinal movement. The spinal cord must lengthen by several centimeters to accommodate full extension and flexion of the spine. If the dural tube lacks this flexibility, the spinal musculature will reflexively stiffen to protect the spinal cord.

3. Autonomic reflexes will create localized areas of tissue tension at any distance from the spinal cord in seemingly quirky patterns.


CST, VM Inform the Structural Integration Core Search
In the classic 10-session SI recipe, work proceeds, session by session, from surface to center. The CST recipe taught to beginners starts at intermediate depth within the horizontal diaphragms of the body and proceeds deep to the dural core. Advanced CST practitioners may begin on some clients with the dura itself.

It is important to remember that the name craniosacral therapy represents the historical origins of this discipline. Today, craniosacral therapists apply techniques developed in working with the dura to tissues at any depth in any part of the body.

For Jean Pierre Barral, creator of visceral manipulation, the pleura, pericardium, peritoneum and other membranes and ligaments which support the viscera are core. In visceral manipulation, the work usually proceeds from the core out. When the viscera are released, related musculature will automatically release in response. The most effective way to free spinal restrictions is often to work on the connective tissue suspending the viscera. If a visceral structure is tense, associated myofascial structures will tighten to protect it. Specific stretches or other types of release for the visceral support system will result in prompt and lasting release of the myofascia. Here are two examples:

Roots of mysentery.
Structure: The 30 feet of small intestine are anchored by a set of membranes called the mesenteries. All the planes of the mesenteries collect into a line running from the ileocecal valve in the lower right quadrant of the abdomen to the duodeno-jejunal junction in the upper left quadrant of the abdomen.

This line, called the root of the mesentery (see Fig. 5), is anchored to the back wall of the abdomen, crossing the lumbar spine on a diagonal line from upper left to lower right.

Dysfunction: Because of the diagonal attachment of their root, any tension in the mesenteries will rotate the lumbar spine. By this mechanism, either a stomach flu or an emotional experience that ties our guts up in knots can result in lumbar dysfunction and pain.

Long Chains of Visceral Connective Tissue
Structure: Consider this strong and continuous line of connective tissue (see Fig. 6):
a. Body of the sphenoid bone
b. Anterior longitudinal ligament
of the spine
c. The continuous skein of ligament attaching the posterior aspect of the pericardium to the anterior surface of the bodies of all of the vertebrae C4-T4
d. The pericardium
e. Round ligament of the liver
f. The falciform ligament
g. The umbilicus
h. The urachus
i. The anterior bladder support ligaments
j. The wall of the bladder
k. The posterior bladder support ligaments

Dysfunction: Bladder support ligament tension can show up symptomatically as a dowagers hump and/or by way of the brachial plexus as arm pain. Conversely, a whiplash injury affecting the base of the neck can produce pathological changes in bladder function. Because it can also displace and or distort the sphenoid, which contains the pituitary gland, a whiplash can also produce endocrine dysfunction.

The last two examples cited describe mechanical means by which restriction at one area can cause dysfunction in a distant area. Conversely, Structural Integrators and other bodyworkers have long observed how manual therapy in one area can produce change far away in areas without obvious mechanical linkage. A second mechanism for change at a distance is autonomic mediation.

J. Staubesand of the University of Leipzig provided us with groundbreaking research on the structure of connective tissue that describes a physiologic mechanism whereby the autonomic nervous system may refer structural change at any distance in the body.

Staubesand created electron micrographs of sections of human crural fascia. He found this fascia contains smooth muscle cells scattered through it, each with autonomic nervous system innervation. This is intriguing news. Up until now we knew the fascia had some contractility, but did not know how. We eagerly await follow-up studies looking for the same arrangement in other fasciae.

If this arrangement is found in fascia throughout the body, it provides a key to exactly how freeing an organ or the dura frees a muscle. Such release could be quickly mediated through the autonomic nervous system. Recall that smooth muscle cells do not fatigue in the same way striated skeletal muscle does. Given reasonable nutrition, smooth muscle can contract indefinitely. This allows a muscle to stay tense for decades and then release in seconds with appropriate manipulation of dural or visceral tissue. (Note: To view Staubesand's photomicrographs of crural fascia and read an English-language interview with him, see Robert Schleip's Web site at www.somatics.de.)

We do know if an area of the dura or a membrane supporting an organ has reduced elasticity, then associated muscles will tighten, limiting range of motion to protect that membrane from further injury. In CST and VM, we routinely observe that releasing deep restriction will immediately release the associated musculature. Through Staubesand's discovery, we now have a physiological mechanism to describe this referred change.

FIG. 6

Interdisciplinary Integration of the Core Concept
To our core-sleeve model we must add another element. There are actually two cores, the anterior (or visceral) compartment, and the posterior (or dural) compartment. Tensional forces must be balanced within and between these two cores, along with all the other balances mentioned above.
Contrary to the classic SI recipe which proceeds from surface to center, the experience of Structural Integrators who are also trained in CST and VM is that approaching these core compartments first is often the most effective and efficient approach to integrating the human structure with respect to the gravitational field.

However, this does not end the discussion of core and sleeve. There are, after all, more candidates for core. What this writing provides is practical steps toward more effective and efficient Structural Integration.


Methods, an Introduction
Some practitioners of CST and VM will wonder why bring in the SI perspective at all, since, on their own, CST and VM greatly increase order in the body. To answer this question, we must return to gravity. Gravity is a large force we are subject to all the time. One way to appreciate the strength of gravity's force is to weigh yourself, then pick up the scales and hold it against the wall at chest level. Then with your hands on the scale try to push your own body weight. Most people can only push about half their weight. Yet, in standing we balance our weight against gravity with little effort. In CST and VM classrooms, gravity is rarely, if ever, mentioned. Balances are established between tissues in the body, but the body is treated as if it were an open, kinetic chain. The closed kinetic chain balance within the gravitational field is a powerful fact largely (or entirely) overlooked. SI brings in this vitally important perspective on gravitational relationship.

Arcing, a primary CST assessment method, is usually done with the client supine. "Listening" (actually very sophisticated palpation), the primary assessment method of VM, is usually done with the client standing for the posterior compartment and supine for the anterior compartment. From the SI perspective, it is important to do all of these assessments with the client standing. It may also be useful to do them with the client supine or even side-lying, but the standing closed, kinetic chain relationship must be included, otherwise body parts will be related to each other, and not to the earth's gravitational field. In addition to assessing the standing body, it is frequently advisable to work on the standing or sitting client. In his recent book, Cranial Sutures, Analysis, Morphology and Manipulating Strategies, Mark Pick describes compelling reasons for working on the cranium with the client seated.

Visceral listening provides a particularly valuable method to assess balance between the cores. One part of visceral listening is selective inhibition, whereby tissues are induced to temporarily forget their compensations. This allows a pair-wise comparison of bodily restrictions to determine which dysfunction should be manipulated first to produce the greatest positive change for the whole body.

Using listening with inhibition, the cores and the sleeve can be brought into better balance within themselves and between each other. A VM strategy called stacking-a-line-of-tension (SALT) can be employed to bring the level of order even higher. In this paradoxical method, two related areas are manipulated concurrently, one with each hand. Once the two areas are located with listening and selective inhibition, each one is mobility tested in three planes. One hand is placed on each structure. Then each structure is moved into its directions of ease in three planes, until a first barrier is reached. The therapist waits until that barrier is felt to ease. Each structure is again mobility-tested to assess how much its previously poor directions of movement have been improved. The procedure is repeated as necessary. SALT can potentially be used to improve the tonal relationship of any two structures. Applying SALT to the relationship between the two cores, as well as between the cores and the sleeve, leads to great improvement in integration of the structure, particularly if the pre-test and post-test assessment are done with the client standing in the gravitational field.


Perspective
Bringing CST and VM perspectives to Structural Integration might appear to lengthen the session, because there are naturally more things to do. SI practitioners who incorporate one or both of these other perspectives find, however, that with a broader selection of skills, sessions are shorter and require less effort, while producing better results for the client. SI, CST and VM are all descended from early osteopathic manipulation. The reunion of these separate lines of development is a fortuitous marriage of cousins.

Jeffrey P. Burch, MS, BA, studied biology at the University of Oregon before becoming a Certified Rolferâ„¢ at the Rolf Institute of Structural Integration in 1977. He practiced in London and Honolulu before earning his Advanced Rolfing Certification in 1989. Burch served as a diplomat of the American Psychotherapy Association, was a member of the Rolf Institute ethics committee and continues as a member of both the Rolf Institute research committee and the executive committee of the board of directors. For more information, visit darkwood@rio.com, or call 541/689-1515.

Author's Note: I am very grateful to Siana Goodwin, Ellyn Lindquist, Aria Seligman, John Schewe and Catherine Vandertuin for their generous assistance in preparing this article.


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