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Back Pain

Low back dysfunction is  a common cause of pain and disability. Though its mechanism is often unclear, evidence suggests several factors as possible contributors, including unhealed soft tissue injury, pressure on nerves, chronic muscle tension or insufficient muscle tone, insufficient circulation and fluid movement, and even emotional stress and hostility. And, outcomes of treatment – be it medication, physical therapy, exercise, chiropractic or massage – are often unsatisfactory.

Those dissatisfied with other back pain treatments often consult a Rolfer™, whose unique premises and methods are often effective in reducing pain and dysfunction when other approaches have failed. A Rolfer believes that many musculoskeletal problems can be mitigated or resolved by balancing the length and tone of soft tissues throughout the entire body. This view is crystallized in Dr. Rolf’s admonition, “Where you think it is – it ain’t”; in other words, the place where it hurts is not necessarily the source of the problem.

A Rolfer evaluates the client’s entire body structure, considering not only the low back as the locus of the symptoms, but also the quality of support available to the low back from the pelvis, hips, legs and feet, as well as the mobility of the body segments above. Do the middle and upper back, shoulders, neck and head engage each other with well-coordinated grace?  A Rolfer works with the connective tissue, which not only surrounds every muscle, joint and organ, but also functions as the body’s organ of support, to balance the span and tone of the connective tissue network as a whole.

Though recipients of Rolfing® Structural Integration often report mitigation of low back pain and dysfunction, scientific research concerning its effects is just beginning. Several promising hypotheses of how the Rolfer’s methods might alleviate chronic musculoskeletal pain merit investigation, including:

  1. Balanced length and tone throughout the body, including improved support from the pelvis, hips, legs and feet, and improved coordination in the mid and upper back, shoulders, neck and head, might lessen the strain the low back bears in daily activities. Perhaps reduced strain allows injured tissues to heal and reduces the odds of re-injury, which would mitigate chronic pain.
  2. Increased pliability of the connective tissues might enhance circulation and fluid flow in regions where nociceptive amplifiers – substances that heighten and/or accelerate the brain’s perception of pain – have previously accumulated.
  3. More balanced span and tone throughout the connective tissue network might relieve nerve compression and irritation through improved alignment of joints and/or increased pliability of scar tissues that have entrapped nerves.
  4. Greater mobility and reduced tension in the soft tissues of the low back and sacrum might facilitate relaxation, as well as reduce the intensity of negative emotions that can exacerbate the symptoms.

At this point in time, these are only theories. Good scientific research needs to be done before we know which of these effects, if any, actually do contribute to the alleviation of chronic pain.  Any of these hypotheses might also account in part for the therapeutic effects of chiropractic, osteopathy, massage or acupuncture. What sets Rolfing Structural Integration apart from these other disciplines is:

(a) its emphasis on balancing span, tone and mobility throughout the entire body,
(b) its method of working extensively and deeply within the connective tissues to produce long-lasting improvements, and
(c) its design as a limited intervention.

For further reading about hypothesized mechanisms for the effects of Rolfing Structural Integration on chronic musculoskeletal pain, see the following articles:

Burns JW, Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients.  Emotion 6(2):309-19

Cottingham JT, Porges SW, Lyon T.  Effects of soft tissue mobilization (Rolfing pelvic lift) on parasympathetic tone in two age groups. Journal of American Physical Therapy  1988;  68(3):352-56

Cottingham JT, Porges SW, Richmond K. Shifts in pelvic inclination angle and parasympathetic tone produced by Rolfing soft tissue manipulation. Physical Therapy 1988; 68(9):1364-70.}

Deutsch J, Derr LL, Judd P, Reuven B. Treatment of chronic pain through the use of Structural Integration (Rolfing). Orthopedic Physical Therapy Clinics of North America 2000; 9(3):411-27

Larsson R, Oberg PA, Larsson S-V, Changes in trapezius muscle blood flow and electromyography in chronic neck pain due to trapezius myalgia. Pain  199; 79:45-50.

Panjabi MM. A hypothesis of chronic back pain: ligament sub-failure injuries lead to muscle control dysfunction. European Spine Journal 2006; 15(5);668-676.

Pool-Goudzwaard AL, Vleeming A, Stoeckart R, Snijders CJ, Mens JM.  Insufficient lumbopelvic stability: a clinical, anatomical and biomechanical approach to “a-specific” low back pain. Manual Therapies 1998; 3(1):12-20.

Schleip R, Vleeming A, Lehmann-Horn F, Klinger W.  Letter to the editor concerning “A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction” (M. Panjabi). European Spine Journal 2007; 16(10):1733-35.

Shah, JP, Phillips T, Danoff JV, Gerber LH.  An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. Journal of Applied Physiology 2005; 99(5):1877-84.

Solomonow M, Zhou B-H, Harris M, Lu Y, Brata R. The ligamento-muscular stabilizing system of the spine. Spine 1998; 23(23):2552-62