Chapter on Structural Integration from "Fascia, Function, and Medical Applications"
Updated: Jan 4, 2021
The publisher describes Fascia, Function, and Medical Applications as "essential reading for medical and allied health practitioners." Michael Polon and I were invited to co-author Chapter 13, an overview of Structural Integration. We present the work as an interactive approach to manual and movement therapy that emphasizes embodiment education. Thanks to David Lesondak, Angeli Maun Akey, and Michael Polon for the opportunity to collaborate on this project.
You can order the book from CRC Press.
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Polon, M., & Akins, D. (2020). Structural Integration. In D. Lesondak & A. Maun Akey (Eds.), Fascia, Function, and Medical Applications (pp. 177–183). CRC Press, Taylor & Francis Group.
Chapter 13: Structural Integration
Michael Polon and Daniel Akins
Structural Integration (SI) is an interactive approach to manual and movement therapy that emphasizes embodiment education. Since gaining popularity in the U.S. in the 1960s, people around the world have sought out structural integration for help with relieving pain and discomfort, improving posture and movement, and to enhance overall well-being. Structural Integrators help their clients explore ways of experiencing their bodies with greater ease, comfort, and efficiency. Over the course of a series of sessions, usually 10-12, SI’s wholistic approach is designed to address body-wide posture, movement, and pain patterns that have become habituated due to injury, stress, trauma, repetitive motion, or personality expression.
Graduates of basic programs recognized by the International Association of Structural Integrators (IASI) are trained in anatomy, physiology, kinesiology, therapeutic relationship, clinical assessment, and manual therapy application. Graduates of IASI-recognized programs are eligible to sit for an exam administered by the Certification Board for Structural Integration. Passing this exam earns the practitioner the right to refer to themselves as a Board Certified Structural Integrator (BCSI).
Ida P. Rolf, PhD, a biochemist, began developing her work of Structural Integration in the 1940s and founded her original school about 30 years later in Boulder, Colorado, where it still operates today.(1) There are currently 22 IASI-recognized SI training programs being offered across the U.S., Australia, Europe, India, Brazil, and Japan.(2) Graduates of these programs sometimes identify with brand names associated with their respective schools, including Rolfing, Anatomy Trains, and Hellerwork Structural Integration. The term “Rolfing” was originally a nickname given to the work by Rolf’s early students, but today the term is exclusively available to graduates of the Dr. Ida Rolf Institute.
Rolf synthesized concepts from the fields of osteopathy, hatha yoga, biomechanics, various posture and movement awareness therapies, the science and philosophy of consciousness, and somatic psychology.(1) She observed that the way a person carried their body was related to a wide range of factors including muscular tone, strength, balance, previous injury history, and learned patterns of movement. Furthermore, she maintained that these patterns could be related to deeply held mind-body relationships with emotionally-driven factors like body image, self-concept, and personality expression. Through this awareness, Rolf developed a 10-session process of manual therapy and somatic education that paved the way for many, if not all, of the myofascial/structural bodywork modalities that evolved since her passing in 1979. The art, science, and application of SI has since been developed into a principles-driven approach that still utilizes aspects and variations of Rolf’s 10-session series. While the SI schools each present their own take on that series, the differences between their interpretations are considered relatively marginal.(3)
Structural Integration in Theory
While common use of the term structure tends to emphasize the physical structure of the body, modern perspectives favor more wholistic definitions that are consistent with current understandings of the body as a complex biological event. Structure, when considered as any “slow pattern of long duration”(4), may include our soft tissues as well as our established neural patterns represented by our habits of posture, movement, language, and ascribed meaning.(5) Structure is both a medium and result of function(6) that might be described as “how the system predictably behaves as a response to specific conditions.”(5) This definition is consistent with Rolf’s view that “structure is behavior.”(7)
Psychiatrist and neuroscience author Dan Siegel defines integration as “the linkage of differentiated components of a system, integration is viewed as the core mechanism in the cultivation of well-being… These integrated linkages enable more intricate functions to emerge.”(8) Siegel describes an integrated brain as being flexible, adaptive, coherent, energized, and stable.(9) These same integrative qualities could be applied more broadly to include our physical experience. By paying attention to one’s present moment, felt sense experience, the perceptive domains of interoception, exteroception, and proprioception may be integrated, resulting in an overall sense of mind-body coherence and well-being.
Structural Integration in Practice
It is appropriate to consider SI as an approach to manual and movement therapy and embodiment education, as opposed to a protocol or set of techniques. A typical SI session begins with client and practitioner consulting about any changes in awareness or physical state since the previous session, and the goals and intentions for the current session. At this point, the client usually dresses down to athletic wear and the session proceeds to a physical assessment of the client, including visual and palpatory assessment of posture and movement as relevant to client concerns. The practitioner proposes a strategy for the session, and with the client’s consent the session proceeds to the therapy table where the manual and movement work will take place.
Practitioners may choose from a variety of hands-on techniques, with pressure ranging from firm to gentle in accordance with client preferences. Many SI sessions also feature movement interventions, which may include passive as well as active client movements like those seen in stretching, yoga, or coordinative movement approaches like the Feldenkrais Method. Another powerful aspect of the SI approach comes through the real-time interaction between practitioner and client. During the session, the structural integrator typically engages the client in dialogue about the client's felt sense, images, and thoughts that accompany receiving touch, performing movements, or standing or lying still. Through exploring the client’s subjective experience of the session, the client can integrate and embody the work in ways that are often missed with passive modalities.
By combining these three main interventions of touch, movement and embodiment exploration, SI addresses deeply held patterns that may show up as postural strain, movement or activity limitations, plateaued injury recovery, and persistent pain. Through a series of sessions designed to systematically address the body’s habituated sensorimotor patterns, SI aims to help people with how they stand, sit, breathe, and move. These changes ultimately help clients live with a feeling of freedom in their body while having less pain, recovering lost abilities after accidents or injuries, and feeling more potential for pursuing meaningful activities. SI is commonly sought by high-level to recreational athletes, performance to casual dancers, office or desk workers, manual laborers, musicians and artists, busy parents and their children, as well as aging folks looking to feel younger and more resilient. SI may be pursued as either part of an individual’s wellness plan or as a component of rehabilitation and integrative medicine approaches like physical therapy, chiropractic, acupuncture, or fitness training.
While there are often noticeable changes to postural alignment, muscle tone, and range of motion immediately following SI sessions, another aspect of SI’s effectiveness arises from the client re-orienting to their felt sense. Through touch, movement, and embodiment exploration, the work helps to introduce new possibilities of how one’s body feels and functions. The goal of these interventions is to offer novel sensory input to help interrupt patterns of conditioned behavior. This helps facilitate the emergence of new options for movement, posture, and self-regulatory capacity in dealing with physical or psychological pain and stress.(10)
The Three Main Interventions of SI: Physiological Mechanisms
Since its inception, the theory and practice of SI has had a strong emphasis on the manipulation and remodeling of fascial structures and behaviors. Research developments continue to point to a model where the effects of modalities like SI take place across multiple systems including the nervous, immune, and endocrine systems as well as the fasciae.(11) The changes created by SI sessions are often immediate, indicating a neuroplastic learning component, which is consistent with Rolf’s original idea that SI was primarily an educational process.(12) In light of recent scientific findings in the fields of manual therapy, movement, pain, and touch-related affective neuroscience, this chapter will take a biopsychosocial view of how SI affects health outcomes.
In an SI setting, slow, respectful, and specific manual therapy is applied to different anatomical regions based upon client needs and mutually-determined goals for the session. Using fingers, knuckles, hands, forearms, and/or elbows, a Structural Integrator may apply manual stretching of affected tissue layers, temporarily changing the position and forces on the related areas. These temporary positional changes communicate a cascade of information to the client’s central nervous system, beginning at the nerve endings which terminate in the outer layers of the body, including skin, superficial fascia, and muscle.(13,14) While the use of manual therapy may create changes in hydration or pliability to the tissue to which it is applied(15), changes that occur in the nervous system’s feedback loops of sensitivity and response cycles are often immediate and profound.(16)
As the nervous system is provided with information from the various receptors in the addressed body tissues, there are a series of responses that may contribute toward a shift in the perception of and behavioral expression in that part of the body. Sensitive nerve endings can become less reactive, muscles can lower their tone, and the central nervous system can decrease its level of excitability, providing a local and generalized feeling of calming down.(17) These combined effects often result in lower pain sensitivity and the client becoming aware of and releasing previously unconscious patterns of tension. In this less reactive somatic climate, new options for posture, range of motion, and embodiment can emerge. These effects usually leave the client feeling taller, lighter, more spacious, balanced, stable, stronger, better coordinated, and with a sense of new possibilities.
Movement interventions can also be applied to interrupt patterns of postural, movement, and behavioral fixation. Both passive and active client movement may be standalone features of some sessions or may be done simultaneously with hands-on work. In many cases, the ways in which the various joints move are determined less by limitations of the client’s anatomy and more by their habituated patterns of body use.
Guidance and support from the practitioner can help the client feel safe enough to allow their body to be taken gently through joint ranges that are difficult to achieve on their own. As joints are moved safely through new angles and dimensions, the sensory receptors around the joint tissues supply the central nervous system with novel information about what movement is safe and possible, reducing both conscious and unconscious fear-avoidant movement behaviors. With an updated movement blueprint, the body can make significant changes to complex patterns like breathing mechanics, gait, and posture which are often observed by the practitioner and perceived by the client.
Another way movement is utilized throughout SI sessions is in the form of active participation from the client while the practitioner performs hands-on techniques. For example, the client may slowly flex and extend their knee while the practitioner treats the quadriceps group. This combination of externally and internally generated forces affords the client’s nervous system the opportunity to integrate their exteroceptive, proprioceptive, and interoceptive experience. Recruiting active client movement concurrently with manual therapy techniques can be especially beneficial in pain-sensitive regions or where a client has become fearful, guarded, or avoidant of movement in general.18 Beneficial outcomes of active movement performed with manual therapy may also include reduced muscle tone, increased tissue extensibility, an overall sense of bodily calm, and enhanced somatosensory awareness and self-efficacy.(16,19)
There can be clear value in changing posture or movement patterns in the presence of injury, pain, or in performance settings like fitness or sport. While SI traditionally focused on the alignment of the body to postural ideals, it is now understood that “normal” movement/posture varies tremendously across individuals. (20, 21, 22) Normal movement and posture can encompass a wide diversity due to: anatomical variations; adaptations to personal illness, injury, and pain history; influences from repetitive sports or work-related motions; learned familial and cultural gestures; gender norms; current mood and long-term emotional tendencies; general personality expression; and any history of impactful events or trauma. SI is less about teaching “proper” posture or movement patterns but more about helping clients embody safer, more capable, and more confident options for approaching the same functional tasks.
Schwartz and Maiberger define embodiment as “the combined experiences of sensations, emotions, and movement impulses in the present moment… at its most basic level, embodiment is an integration of three sensory feedback systems: exteroception, interoception, and proprioception.”(23) The way individuals experience their emotional and physical reality is driven by interoception, the body’s collection of processes that gives rise to how we feel about what is happening in our bodies.(10)
The various body tissues routinely targeted by manual therapy, including SI, have a large density of sensory nerve endings that directly inform the interoceptive parts of the central nervous system. In addition to scanning for data about depth, direction, pressure, and stretch, the interoceptive aspect of the sensory nervous system is especially aware of the emotional quality of what receiving touch from this person, in this body region, in this context is like. SI’s combination of slow, respectful touch, novel movement interventions, and interactive dialogue facilitates change in the body’s interoceptive signaling.(13) This can help affect change in autonomic functions like heart rate, respiratory rate, stress-related inflammatory responses, and spinal cord-driven muscle hypertonicity.(16) Other wide-ranging nervous system responses could include changes in motivation, memory, emotion, pain, and self-awareness. The client’s engagement with the caring and thorough manual and movement work of SI can help update the lived experience of one’s body in part or in whole, while facilitating global changes in somatic awareness, agency, autonomic self-regulation, and body-mind integration.
The interactive nature of SI, as delivered over a series of sessions combining the therapeutic use of touch, movement, and embodiment exploration, can be highly effective for achieving various client goals. By addressing the body systematically and tailoring the pace, style, and purpose to the individual, it is an effective modality for people who are seeking help with postural improvement, movement function, recovery from accidents or injuries, or relief from stress, tension, or persistent pain. Sometimes the benefits experienced are immediate, and sometimes they emerge more slowly over time. Clients commonly report positive change in how they feel and move in both their normal activities and in the occupations most meaningful to them, enhancing feelings of self-efficacy and possibility in life. Recent research findings have shown SI to be effective as an adjunct to outpatient rehabilitation for chronic non-specific low back pain.(24) Given the highly customizable nature of a series of SI sessions and the client’s unique medical history, specific results will often vary between individuals.
Thomas W Myers, “Structural Integration: Developments in Ida Rolf’s ‘Recipe’—Part 2,” Journal of Bodywork and Movement Therapies 8, no. 3 (July 2004): 189–98, https://doi.org/10.1016/s1360-8592(03)00103-7.
L Van Bertalanffy, Problems of Life: An Evaluation of Modern Biological Thought (Mansfield, CT: Martino Publishing, 1952), 134.
Kevin Frank and Ray McCall, “Integration: How Do We Define It? How Do We Assess It? Where Do We Place It in the Ten Series?,” Structural Integration (September 2016): 5–10.
Daniel Akins, “Integrating the Structure of Structural Integration: A Visual Model for Professional, Conceptual, and Biopsychosocial Coherence,” IASI Yearbook of Structural Integration 15 (2018): 25–39.
Ida P Rolf, Rolfing: The Integration of Human Structures (New York: Harper & Row, 1997), 31.
Cynthia J. Price and Carole Hooven, “Interoceptive Awareness Skills for Emotion Regulation: Theory and Approach of Mindful Awareness in Body-Oriented Therapy (MABT),” Frontiers in Psychology 9 (May 28, 2018), https://doi.org/10.3389/fpsyg.2018.00798.
Giandomenico D’Alessandro, Francesco Cerritelli, and Pietro Cortelli, “Sensitization and Interoception as Key Neurological Concepts in Osteopathy and Other Manual Medicines,” Frontiers in Neuroscience 10 (March 10, 2016), https://doi.org/10.3389/fnins.2016.00100.
Rosemary Feitis, Rolfing and Physical Reality (Rochester, VT: Healing Arts Press, 1990), 40.
Joeri Calsius et al., “Touching the Lived Body in Patients with Medically Unexplained Symptoms. How an Integration of Hands-on Bodywork and Body Awareness in Psychotherapy May Help People with Alexithymia,” Frontiers in Psychology 7 (February 29, 2016), https://doi.org/10.3389/fpsyg.2016.00253.
Gary Fryer, “Integrating Osteopathic Approaches Based on Biopsychosocial Therapeutic Mechanisms. Part 1: The Mechanisms,” International Journal of Osteopathic Medicine 25 (September 2017): 30–41, https://doi.org/10.1016/j.ijosm.2017.05.002.
Carla Stecco and Julie Ann Day, “The Fascial Manipulation Technique and Its Biomedical Model: A Guide to the Human Fascial System,” International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice 3, no. 1 (March 17, 2010), https://doi.org/10.3822/ijtmb.v3i1.78.
Joel E Bialosky et al., “Unraveling the Mechanisms of Manual Therapy: Modeling an Approach,” The Journal of Orthopaedic and Sports Physical Therapy 48, no. 1 (2018): 8–18, https://doi.org/10.2519/jospt.2018.7476.
Robert Schleip, “Fascial Plasticity – a New Neurobiological Explanation: Part 1,” Journal of Bodywork and Movement Therapies 7, no. 1 (January 2003): 11–19, https://doi.org/10.1016/s1360-8592(02)00067-0.
Lennard Voogt et al., “Analgesic Effects of Manual Therapy in Patients with Musculoskeletal Pain: A Systematic Review,” Manual Therapy 20, no. 2 (April 2015): 250–56, https://doi.org/10.1016/j.math.2014.09.001.
Dan-Mikael Ellingsen et al., “The Neurobiology Shaping Affective Touch: Expectation, Motivation, and Meaning in the Multisensory Context,” Frontiers in Psychology 6 (January 6, 2016), https://doi.org/10.3389/fpsyg.2015.01986.
François Hug et al., “Individuals Have Unique Muscle Activation Signatures as Revealed during Gait and Pedaling,” Journal of Applied Physiology 127, no. 4 (October 1, 2019): 1165–74, https://doi.org/10.1152/japplphysiol.01101.2018.
Stephen J. Preece et al., “Variation in Pelvic Morphology May Prevent the Identification of Anterior Pelvic Tilt,” Journal of Manual & Manipulative Therapy 16, no. 2 (April 2008): 113–17, https://doi.org/10.1179/106698108790818459.
Hendrik Schmidt et al., “How Do We Stand? Variations during Repeated Standing Phases of Asymptomatic Subjects and Low Back Pain Patients,” Journal of Biomechanics 70 (March 2018): 67–76, https://doi.org/10.1016/j.jbiomech.2017.06.016.
Arielle Schwartz and Barb Maiberger, EMDR Therapy and Somatic Psychology : Interventions to Enhance Embodiment in Trauma Treatment (New York: W.W. Norton & Company, 2018).
Eric E. Jacobson et al., “Structural Integration as an Adjunct to Outpatient Rehabilitation for Chronic Nonspecific Low Back Pain: A Randomized Pilot Clinical Trial,” Evidence-Based Complementary and Alternative Medicine 2015 (2015): 1–19, https://doi.org/10.1155/2015/813418.