This week, in hot UK Rolfing news, we received unexpected airtime on the Jeremy Vine Show on BBC Radio 2, and a ringing endorsement from a lady called Avril, from Aberdeen. (The whole show, discussing sciatica, was available through the ‘listen again’ facility until 9 September, 2015; I’ve saved the relevant 2-minute clip here.)
During their discussion of sciatica (on Monday 10 August), the painful condition that stems from a trapped or compressed sciatic nerve, Avril called the show to say that she had received Rolfing sessions and was now completely sciatica-free. “I had serious sciatica for two and a half months where I didn’t sleep, I couldn’t eat, and I was in agonising pain constantly. All the doctors I saw, they just gave me painkillers non-stop, said there was nothing else they could do. Luckily I found a guy that did a technique called Rolfing, or structural integration. And I’m totally sciatica-free now.” She went on to say that her son had experienced a herniated (‘slipped’) disc, and had also benefited from Rolfing.
On behalf of everyone in the UK Rolfing community: thank you, Avril.
The response to Avril’s comments unfolded in an interesting way. While the show’s on-air doctor, GP Sarah Jarvis, was pleased to hear that Avril was no longer in pain, she was understandably reluctant to endorse a treatment that isn’t yet available on the NHS (though she conceded that doctors aren’t entirely consistent about this, as they do recommend Pilates). I also suspect that she hadn’t of Rolfing before, and nor had Jeremy Vine, who immediately made that joke about rolling-on-the-floor-laughing.
But she also said something that I found quite surprising: she said that she was “struggling to see how pulling on the fascia could cure a slipped disc”. Let’s take two aspects of that line in turn.
I must say that I’m struggling a little to understand Sarah Jarvis’ struggle, given the increasing prominence of medical fascial research as well as the notable buzz around all things ‘myofascial’ in the world of fitness and physiotherapy. But since we do understand that conditions such as lower back pain and herniated vertebrae can be the result of abnormal loading (either a one-off event, such as picking up heaving furniture, or everyday postural issues, such as an overly tucked (posteriorly tilted) pelvis), it is no struggle to imagine that fascia, as a supporting and structuring spacer between muscles and bones, could be implicated.
I also slightly wince at the phrase ‘pulling on the fascia’ (and I think that’s what she said; it’s a little unclear from the audio), since it’s a particularly unsophisticated way to describe the effect of indirect palpation of such a complex and pervasive anatomical tissue, rich in proprioceptive receptors that deliver information to our central nervous system about the position, loading and perceived ‘safety’ of parts of the body and thereby contribute to the setting of standing tone of the many muscles involved in maintaining posture.
Rolfers do not make strong and specific claims for the effect of Rolfing touch on these complex features of fascia, but we do look to the work of researchers such as Dr Robert Schleip (himself a Rolfer), Dr Jaap van der Wal, and Dr Carla Stecco, to deepen our theoretical understanding of the properties of connective tissue. Quoting Dr Stecco et al. (2014) in Surgical and Radiologic Anatomy, ‘it is now evident that fascia is a dynamic tissue with complex vasculature and innervation’. Van der Wal (2009) has described the architecture of connective tissue as ‘more important for understanding functional meaning than [..] more traditional anatomy, whose anatomical dissection method neglects and denies the continuity of the connective tissue as integrating matrix of the body’; and Schleip (2004) has spoken of his research ‘shifting the traditional concept of fascia as a passive tension transmitter to a new picture of fascia as a dynamically adaptable organ’.
While the detail we now have is new, the intuition is not. As far back as 1899, the founder of osteopathy, Andrew T. Still, went so far as to describe fascia as the ‘probable matrix of life an death’, and Ida Rolf looked both to fascia’s elasticity (that is, its ability to respond to changes in load) and plasticity (its ability to be moulded) as keys to understanding the ways in which the shape of our body bears the imprint of the loads we place upon it.
None of this is to say that Rolfing has been ‘proven’ as a therapy by the gold standard of the large-scale, randomised controlled (or comparative) trial, but the theoretical basis for Rolfing is unarguably compelling (and so are the testimonials of Rolfing clients).
Mainstream medical science, meanwhile, has been slower to focus on fascia’s role, and there’s a very good historical reason for that. Advances in anatomical understanding in the 18th and 19th centuries proceeded primarily from the dissection of cadavers and the identification of muscles, bones and organs conceived of as discrete parts of the body. Although tendons and ligaments were dissected and labelled, the fascia as a whole, and comprising different kinds of connective tissue, was largely overlooked, and seen as packing material rather than as a pervasive and connected tissue system. Fascia – of different kinds: the superficial fascia which lies just beneath the adipose layer, the deep investing fascial sheaths wrapping muscles and organs – was what was cut into or cut away in order to isolate specific, nameable structures of the body. This very act of cutting made it harder to see the fascial interconnectedness of the body.
Recent contributors such as Joanne Avison go further than this to suggest that, in effect, early anatomists effectively ‘carved out’ the discrete structures we think we know as muscles and organs (prioritising the apparent visual unity of an organ over its functional connectedness). Modern neurologists also say something similar, noting that, while we may consciously conceive of, say, a bicep as the motor agent of a particular movement, the unconscious mind does not. Rather, the brain will activate muscle fibres along a particular pathway in order to achieve a functional end, recruiting whichever muscles are required to do so.
It is understandable, but frustrating, that medical doctors in the UK continue to hold unusual-sounding physical therapies such as Rolfing at arm’s length while continuing to look to painkillers to manage common pain conditions with limited success. Physiotherapy, which is available on the NHS, is undoubtedly helpful, but it is not geared to the whole-person exploration of embodiment and proprioception that is such a feature of Rolfing, and tends to offer local solutions to fix or stabilise specific areas of the body. While hip rotator and hamstring stretches can help to decompress the sciatic nerve, for instance, they won’t address the reasons why parts of the body were tight in the first place.
In the UK, the Rolfing community currently stands at around 30 practitioners, but we are growing both in numbers and confidence. (To that small number we can also add our close friends from the Guild of Structural Integration and related schools of structural integration.) In 2010, the British Academy of Rolfing Structural Integration opened its doors to the first cohort of UK-trained Rolfers, and a second training group is now underway. For the foreseeable future, we are unlikely to be able to exert the kind of lobbying power and research funding that is enjoyed by other contributors to public health. And while we remain unable to commission large-scale trials of Rolfing’s effectiveness, we look to the States where – slowly – research evidence is emerging to support the claims of the Rolf Institute.
In September, I will have the great pleasure of attending the Fourth International Annual Fascia Research Congress in Washington D.C., on a scholarship from the Ida P. Rolf Foundation. The Fascia Research Congress brings together somatic practitioners with medical experts and researchers in the fascial research field. I shall report back here on my return.