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Therapies

Rolfing - Structural Integration

What Is It?
How Does It Work?
What You Can Expect

Health Benefits

How To Choose a Practitioner

Cautions

References

Evidence Based Rating Scale

 What Is It?

Rolfing is a form of deep-tissue, structurally-oriented Bodywork created in the 1930s by Ida P. Rolf, Ph.D., a Columbia University trained biochemist. When she developed this therapy, Dr. Rolf was influenced by her knowledge of Hatha yoga, the Alexander technique, osteopathy, and homeopathy. She called her own approach Structural Integration because it dealt with the way the body's structure affects its function. It didn't take long, however, for the public to start calling it Rolfing--and the nickname stuck. In 1971, Dr. Rolf established the Rolf Institute of Structural Integration, now located in Boulder, Colorado, with adjunct institutes in Munich, Germany, and Sao Paolo, Brazil to oversee the standardization of the Rolfing method and the training of their practitioners, known as Rolfers. Today the term Structural Integration is in more general use due to other programs that teach the approach and the "Rolfing" name remains associated with the Rolf Institute itself.

Today, Structural Integration is employed primarily to help reduce stress and ease mobility, address posture problems and to reduce back and musculoskeletal pains, particularly those that result from repetitive use injuries. Sufferers who may benefit range from musicians to construction workers. Proponents suggest that it can relieve a variety of other ailments as well.

How Does It Work?

Structural Integration is based on the premise that physical and emotional stress--as well as gravity--can throw the body out of vertical alignment and cause muscles and the connective tissue known as fascia to become rigid and inflexible. (Fascia encases muscle and connects muscle to bone.) These problems can then lead to more stress, illness, and a loss of comfort and general well-being.

Structural Integration aims to realign the body by using intense pressure and stroking to stretch shortened and tightened fascia back into shape. The goal is to make the fascia softer and more flexible, and to restore the natural balance of muscles, tendons, and bones.

Practitioners manipulate the fascia rather than the muscles themselves. Pressure from the practitioner's knuckles, knees, elbows, or fingers on this connective tissue is said to release deeply-held tension and stress, as well as emotional memories that can sometimes be stored in the body’s tissues known as “cellular memory”. Rolfing results in ease of movement, improved posture, and overall emotional and physical health.

Because Dr. Rolf was influenced by her knowledge of other therapies, Structural Integration closely resembles several other therapeutic modalities. Some components of Rolfing are similar to myofascial release therapy, which also uses stretching and massage to ease pressure in the fascia; and to osteopathic manipulative therapy that may include soft-tissue manipulation, along with muscle energy and painless high-velocity thrusts that help to establish realignment and remove impingements on nerves and on blood and lymphatic vessels. However, Structural Integration practitioners claim that its attention to the balance of the body in gravity sets the practice apart from other manual therapies. (For more information on related therapies, see their individual entries in the WholeHealthMD Reference Library.)

What You Can Expect

Treatment with a Rolfer or Structural Integration practitioner generally begins with a discussion of the patient’s medical history, including any former injuries, such as sprains and broken bones. The conversation may also include such topics as how the patient totes items like shoulder bags and where the patient "carries” stress.  During a working session, the patient usually lies on a massage table and receives deep tissue pressure along with being guided through specific movements.  The treatments may begin with the practitioner manipulating the upper half of the body to free any restrictions around the rib cage. This helps the patient breathe more easily, which will set the tone for the next sessions.

Typically, a full Structural Integration or Rolfing series involves 10 sessions of 60 to 90 minutes each. Sessions one through three, known as the "sleeve" sessions, usually focus on the surface layers of the fascia. These layers are associated with the muscles that are near the surface of the body. Sessions four through seven involve the deeper fascia and muscles and are called the "core" sessions. Sessions eight through ten are the "integrative" sessions. They aim to synthesize the work of the earlier sessions. As the sessions progress, the course of treatment will involve an increasing amount of pressure on the fascia. Because the practitioner is working so deeply, the treatment can be painful rather than relaxing, but it should never be unbearable. And a patient should feel energized after each session.

In recent years, advanced pracititioners of Rolfing and Structural Integration have been exposed to an updated curriculum that puts less emphasis on the 10-session model. The updated curriculum addresses a wider variety of manual therapies, including cranial, visceral and joint manipulation. And interest from the scientific community on the function of fascia is burgeoning—the first international conference on fascia was held at Harvard in 2007 funded in part by the National Center for Complementary and Alternative Medicine at NIH.

Health Benefits

There are few controlled studies of Rolfing that compare it with other therapies or with no treatment at all. Proponents, however, firmly contend that Rolfing can increase mobility, ease breathing, relieve stress, increase energy, and generally improve a person's well-being.

Many patients find that Structural Integration aids in easing chronic back, neck, shoulder, and joint pain, as well as in relieving repetitive stress injuries and headaches. Because of its clear focus on muscular problems, the therapy is often included in sports medicine treatment programs.

Specifically, Rolfing- Structural Integration may help to:

  • Relieve stress and improve well-being. Massage, in general, has been shown to increase the body’s production of pain-killing endorphins and the mood-altering Hormone Serotonin. It may also decrease the release of the stress hormone cortisol. The Rolfing method of bodywork, is often prescribed as an adjunctive therapy for people whose immune systems are compromised by stress. However, scientific research in this area is limited. A 1979 study evaluated the effects of Rolfing on 48 patients with anxiety. After five weeks of treatment, patients who received Rolfing therapy experienced a greater decrease in anxiety than those in a control group as measured with questionnaires administered to all of the subjects before and after the five-week study, which focused on release of emotional tension stored in muscles. (1) A 1988 study compared 16 healthy young men who received a 45 minute Rolfing session focused on pelvic tilt with a control group of 16 who received a 45 minute session with no mobilization. Cardiac vagal tone, a measure of autonomic nervous system relaxation, was significantly increased immediately after the session and 24 hours later. (2)

    Further studies focus mostly on a combination of massage techniques. In 1993, a small study examined the effects of therapeutic massage (including myofascial trigger point therapy) on pain perception, anxiety and relaxation levels in nine hospitalized men experiencing cancer related pain. The men received 30 minutes of massage on two consecutive nights, recording self-reports of pain, relaxation and anxiety before and after treatment. Massage therapy significantly reduced the subjects’ level of pain perception and anxiety, while enhancing their feelings of relaxation by an average of 58 percent. Additionally, physiological measures (heart rate, respiratory rate and blood pressure), which were recorded before and after treatment, tended to decrease from baseline, further indicating relaxation. (3) And in a 2007 randomized pilot study, 54 adults ages 60 and older received either 50 minutes of bodywork therapy (including Swedish, neuromuscular, and myofascial techniques) or guided relaxation sessions twice a week for a month. Patients in the massage therapy group demonstrated significant improvements in anxiety, depression, vitality, general health, and positive well-being compared to those in the guided relaxation group. The massage therapy group also noted reduced stress after treatment. (4) More research is needed to confirm these preliminary results.

  • Improve mobility and pain in the back, neck and shoulder, and joints. By making the fascia softer and more flexible, Rolfing may improve ease of movement and reduce pain in the back, neck and shoulder, and joints. However, scientific evidence regarding specific Rolfing treatment is limited. A preliminary case series specific to cerebral palsy, found that side effects of Rolfing treatment may outweigh the benefits in some patients. In this 1981 study, 10 patients with mild, moderate or severe cerebral palsy underwent Rolfing treatment. Mildly impaired patients made gains in velocity, stride length and cadence; the moderately impaired group made only minor gains in velocity; and the severely impaired did not improve by any of the criteria used in the study. Muscle strength and electromyography did not change in any of the patients. While mildly impaired individuals benefited from an increased range of motion/tissue mobility, in moderately or severely impaired patients, some resultant increase in muscle tightness in the hips, knees and feet may have outweighed the benefit from the Rolfing therapy. (5) In a 1997 case study of one young adult with lower back pain, a three-paradigm model of treatment included relaxation, manual therapy including Rolfing, and an integrative paradigm using guided movement/mobilization techniques to improve overall posture and movement. The subject first underwent six sessions of relaxation then manual therapy but did not exhibit sustained improvement in pain and movement until the third paradigm – guided movement/mobilization techniques – was implemented. This case study suggests Rolfing may improve low back pain and mobility when used in conjunction with guided movement/mobilization techniques. (6) More evidence is needed to assess the efficacy of Rolfing for improving mobility and pain in larger populations.

    In related trials, in a 2000 study by the Texas Woman’s University School of Physical Therapy, 40 adults (17 male, 23 female) ages 23 to 58 with one or more myofascial trigger points in the neck and upper back were divided into two groups to participate in a five-day home program of either ischemic pressure (heavy pressure on trigger points) followed by stretching or a control treatment of active range of motion. The ischemic pressure and sustained stretching group reduced trigger point sensitivity and pain intensity better than placebo. However, no difference was reported between the two groups regarding the percentage of time patients were in pain during a 24-hour period. (7) A 2007 Finnish study of 125 women with chronic neck pain also focused on manual therapy and stretching treatment. The women either received manual therapy followed by stretching exercises or first performed stretching exercises followed by manual therapy. Both groups had improved mobility and reduced spontaneous and strain-evoked pain: the order of treatment was not significant. (8)

    Manipulating the soft-tissues of the body with techniques like Structural Integration may also help to relieve stress injuries, such as sports injuries, which are caused by repeated use or stress on a particular joint. However, scientific research in this area is lacking. Several studies have determined the efficacy of massage on pre- and post-exercise massage, but the studies have not specifically examined use of the techniques of Structural Integration to treat these injuries.

  • Relieve headaches. Because the use of Structural Integration methods can help to release tension and improve circulation, it may be of importance to those with chronic muscle tension headaches. While anecdotal evidence is favorable, scientific research is limited. And although some studies evaluating the use of massage techniques have shown no efficacy in treating headaches. A 2006 Cochrane Database Review of studies evaluating the efficacy of manual therapies in reducing pain from tension-type headache (TTH) found two trials involving connective tissue manipulation and one trial using soft-tissue massage. These techniques showed limited evidence of effectiveness in reducing pain from TTH. (9) However, Rolfers would argue that these techniques were not sufficiently similar to the ones they use. More research is needed.

How To Choose a Practitioner

The Rolf Institute of Structural Integration  maintains a list of certified practitioners certified by their proprietary institute (www.rolf.org). The basic training and certification program for Rolfers takes a minimum of one to two years, with additional training available for those interested in advanced certification. The work of Dr. Rolf has however led to the formation by her personally trained students of many other programs teaching forms of Structural Integration. The International Association of Structural Integrators (IASI)was formed to provide fellowship and cross-pollination among the various practitioners and approaches dedicated to the work of Dr. Rolf. (www.theiasi.org) The IASI supports the definition of Structural Integration as a professional discipline and offers Continuing Education featuring teachers from a variety of different Structural Integration schools. The IASI, which is a non-profit umbrella organization, is fostering an independent certification program and reviews the credentials of practitioners who apply for membership. If you are considering consulting a Structural Integration practitioner, ask if they are certified by the Rolf Institute or if they are a Professional Structural Integrator member of the IASI, which recognizes 12 additional training schools based on Dr. Rolf's work.

If Rolfing -Structural Integration is performed by a practitioner who is also a licensed massage therapist,  physical therapist, or chiropractor, or if your primary-care physician recommends Structural Integration or Rolfing, some health plans may provide coverage. Call your insurance company about its policy.

Cautions

 It is important to note that although professional Structural Integrators seek to help release stress and tension, they are not psychotherapists and should not be sought to treat deep-seated emotional problems.

Women who are more than three months pregnant, should work only with a senior practitioner who has the experience to modify the usual Structural Integration techniques for safety and comfort in pregnancy.

 References

1. Weinberg RS, Hunt VV. Effects of structural integration on state-trait anxiety. J Clin Psychol. 1979 Apr;35(2):319-22.
2. . Cottingham J, Shifts in pelvic inclination angle and parasympathetic tone produced by Rolfing soft tissue manipulation. Physical Therapy, 1988 68:1364-1370.
3. Ferrell-Torry AT, Glick OJ. The use of therapeutic massage as a nursing intervention to modify anxiety and the perception of cancer pain. Cancer Nurs. 1993 Apr;16(2):93-101.
4. Sharpe PA, Williams HG, Granner ML, Hussey JR. A randomized study of the effects of massage therapy compared to guided relaxation on well-being and stress perception among older adults. Complement Ther Med. 2007 Sep;15(3):157-63.
5. Perry J, Jones MH, Thomas L. Functional evaluation of Rolfing in cerebral palsy. Dev Med Child Neurol. 1981 Dec;23(6):717-29.
6. Cottingham JT, Maitland J. A three-paradigm treatment model using soft-tissue mobilization and guided movement-awareness techniques for a patient with chronic low back pain: a case study. J Orthop Sports Phys Ther. 1997 Sep;26(3):155-67.
7. Hanten WP, Olson SL, Butts NL, Nowicki AL. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Phys Ther. 2000 Oct;80(10):997-1003.
8. Hakkinen A, Salo P, Tarvainen U, Wirén K, Ylinen J. Effect of manual therapy and stretching on neck muscle strength and mobility in chronic neck pain. J Rehabil Med. 2007 Sep;39(7):575-9.
9. Fernandez-de-Las-Peñas C, Alonso-Blanco C, Cuadrado ML, et al. Are manual therapies effective in reducing pain from tension-type headache?: a systematic review. Clin J Pain. 2006 Mar-Apr;22(3):278-85.

Evidence Based Rating Scale  

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

 

 

 

 

 

 

Headache

 

 

 

 

 

 

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Research in this area is limited. Studies involving similar techniques indicate no efficacy, but individual headache sufferers report relief. More research is needed.

 


Date Published: 04/19/2005
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