By Christoph Sommer, H.P., Certified Advanced Rolfer™,Rolfing~ Instructor

Practical Considerations forStructural Integration, Biased

by the Nervous System

of connectedness and differentiation thatresembles our nervous system.

In the following pages I want to emphasizethe value of certain selected peripheralnerves in relation to the Rolfing Ten

Look at the jellyfish, floating in itsnourishing environment - the sea - its finetentacles united at the upper pole and webbedinto the space it encompasses. Contemplatingit may give you a floating sensation, a sense

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CONSIDERING NERVES AND THE COLD LASER

The intercranial membranes may be compared toa perforated three-dimensional trampoline whichoverhangs the posterior cerebral fossa.

The entire device in place. The hats are onthe trampoline. the foot passes through theperforation (homologous with the free edge of thetentorium cerebelli). Every mechanical stress onthe foot of the mushroom involves the foot-hatjuncture. the hats themselves. and the entiresystem of intracranial suspension and cushioning.

The neuraxis can be compared to a "bicephalic"mushroom: the foot represents the Pons-SpinalCord Tract and the two hats represent thecerebral hemispheres.

Figures 4: The three-dimensionaltrampoline.

Together all these systems are sustained byintraneuronal pressure and distal tension.

Imagine our jellyfish tentacles pressurizedfrom inside and able to resist externalcompression along their pathways withinthe body.

The distal tension of the peripheral nervesand the vertical tension of the CNS results ina well-cushioned floating of the pons - spinalcord tract, our internal jellyfish suspendedin space and giving buoyancy to the system,which we SI practitioners recognize as liftand vitality (see Figures 3 & 4).

rc

~s

~J T

1

: ~ L

Perineurium

Total force concentrated on the upper part of thePCT results from the individual forces caused byeach nerve root during flexion of the trunk.

Figures 3: Traction forces on thespinal cord.

• The epineurium internum ensuresthe movement of the individual nervefascicles while adjusting to the movementof the extremities.

• Nerves consist of 50%-90% connectivetissue, depending on their location, andcan elongate 8%- 20%.

Figure 2: The nerve connective-tissuefibers.

• Most peripheral nerves consist of sometype of myelin sheath encapsulatingthe nerve, and are then surrounded byconnective-tissue sheaths (endo-, peri-,epi-, and mesoneurium).

• Within the epineurium we find bloodvessels (vasa nervorum) supplying theneeds of the nerve's metabolism.

• Within the epi-, peri-, and endoneuriumwe find nerve fibers (nervi nervorum),consisting of sensory and sympatheticnerves perceiving and regulating the localnerve environment (see Figures 1 and 2).

'---.."

Nerve fiber bundle.

• The central and peripheral nervoussystems (CNS, PNS) are composed of 14billion nerve cells (14,000,000,000) with1412 interconnections - numbers I amunable to comprehend ....

• A peripheral nerve consists of the cellbody of the neuron, the dendrites, andthe long axons. Motor and sensory fibersare differentiated. The sympatheticganglia of the sympathetic trunk alsocontain neurovisceral fibers.

Figure 1: The nerve with itsvascularization and the nervi nervorum.

Series so that we can avoid unrewardingresponses in our structural integration (SI)work. Differentiating our palpatory skillsand therefore directly addressing nervoustissue is a valuable and recommendedenterprise for your continuing education.

I want to preface this article with some basicfacts that will help you to comprehend thebiased point of view I wish to develop:

• The peripheral nerves approximate alength of 100,000 km.

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CONSIDERING NERVES AND THE COLD LASER

Figure 7: The axillary nerveinnervating the posterior shoulderjoint capsule and the deltoid muscle.

The axillary nerve originates at the spinalnerve roots of CS/C6 and is a mixedmotor and sensory nerve. It innervates theposterior aspect of the shoulder joint, thedeltoid and teres muscles, and the skin ofthe shoulder (see Figure 7).

Practical Recommendations: When workingwith a client in a sidelying position to accessthe posterior aspect of the shoulder, considerthe inferior border of the teres minor muscleto be a possible entrapment site for theaxillary nerve. Working the tissues in thedirection of a medially rotated humerus willhelp to free a possible nerve entrapment.

The Third Session - The Axillaryand Radial Nerve

The obturator nerve originates at L2-L4.The nerve's anterior branch travels in themedial aspect of the psoas major muscle,surfaces at the level of the promontory andtraverses the small pelvis. It exits throughthe obturator foramen and innervates theadductors (motor), the anterior hip joint,.the posteromedial knee joint and the skinon the lower medial thigh (sensory) .

The saphenous branch of the femoralnerve also originates from L2-L4, travelsthrough the central part of psoas majorand surfaces on the lateral side wherethe iliacus and psoas muscles meet. Itexits the pelvis next to the femoral artery,under the inguinal ligament, to traveldistally within the intermuscular septum

Nerve of the teres" minor muscle

Vessel branch(nerve)

...-Vesselbranch(artery)

The Fourth and Fifth Sessions -The Saphenousand Obturator Nerves

Axillary artery 'Teres minor -

muscle

Teres majormuscle

Triceps --brachiimuscle

long head

Tibialnerve

Nerve toabductor

digiti minimimuscle

Lateral _'_calcanealbranch of

sural nerve

Proper plantardigital nerves ,

I"~~ L~''( .....---~.o .:...-,rn "

Figure 5: The medial and lateralplantar nerve innervating the plantarsurface with about 8,000 nerveendings.

tibio-talar glide, and differentiation betweenthe short and long flexors of the toes.

The medial and lateral plantar nerve (seeFigures 5 and 6) and sections of the tibialnerve (a split of the sciatic nerve) are wellcovered by the plantar aponeurosis and them. flexor digitorum brevis.

Practical Recommendations: When workingthe plantar fascia, focus on the medial aspect,while considering the medial to lateraldirection to which the nerves orient.

Figure 6: Work on the plantar fasciaand the medial and lateral plantarnerve. You work distally and can useactive or passive toe extension.

Deepbranch to /-

interosseousmuscles

Superficialbranch to

interosseous .e;:.muscles

Each sole of the foot contains about 8,000peripheral (sensory and motor) nerveendings with the function to perceivethe "ground" and inform our "Triangleof Perception" about where we stand. Astructural aim within the second session isa competent foot with balanced arches, good

PracticalApplications for 51

Let me take you through some generalconsiderations for myofascial interventionsbefore offering a few examples of "howto" work structurally utilizing the primaryimportance of the nervous system inregulating the body.

Peripheral nerves are everywhere we touch- the main branches are located in well-protected inter- and intra-muscular septa.Nerves do not like compression! Always workin oblique angles (as we were all taught)and do not compress tissues onto the bone.

When working in the area of the largeperipheral nerve branches, work in thedistal direction, not proximally. Keep inmind that your strokes should follow thetissues and meander around a chosenanatomically meaningful direction, notfollow straight lines. When working nearnerves, make sure that you use finger pads(not fingernails) or other soft surface tools. Ifyou find highly sensitive places in the body(possibly caused by nerve irritation and theinflammatory processes involved), workproximal and distal to the "sensitive spot"in a light and slow viscoelastic manner untilthe "spot" diminishes in intensity.

In the following, I will relate some localgoals within the structural series to theperipheral nerves that may be involved.These treatment ideas are based on theteachings of Jean-Pierre Barral, D.O. andAlain Croibier, and their books (Trauma,Manual Therapy for the Peripheral Nerves,and Manual T11erapy for the Cranial Nerves,all published by Churchill Livingstone -Elsevier) and more than thirteen years ofmy personal experience with these tissues.The following examples are meant toawaken your curiosity for further studiesin the realm of manual therapy for nerves.Just as the Rolf Institu te@is regarded as theleader in the field of structural integration,the Barral Institute is recommended forfurther differentiated studies in the realmof manual therapy for the nerves.

The Second Session - the Medialand Lateral Plantar Nerves

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CONSIDERING NERVES AND THE COLD LASER

Figure 8: The best access to thenervus saphenus above the knee.

Practical Recommenda tions: Workingbelow the inguinal ligament, slowly contactthe tissues with your finger pads and inducethe tissue changes in a distal direction (seeFigures 9, 10 and 11).

Working at the level of the adductor canal,make sure you contact the canal four tofive fingers above the knee joint on themedial aspect of the vastus medialis, deepto the sartorius. Slacken the muscle toneby flexing the knee and stay light-handedwhen working on the medial condyles ofthe tibia and femur. Working on the psoasmajor and iliacus, remember that the majornerves of the lumbar plexus run withinor on the anterior surface of the musclebelly. After having considered all otherprecautions, work in a distal direction usingsoft finger pads.

The Seventh Session - BrachialPlexus and Phrenic Nerve

In this article, I am not going to highlightany of the cranial nerves that are withinthe territory of the neurocranium orviscerocranium. I want to focus instead onthe anterior and medial scalenes, whichsurround the proximal section of the brachialplexus. In addition, the medial part of theanterior scalene is traversed by the phrenicnerve, which innervates the diaphragm.

Figure 11: While working in theconnective tissue between the psoasand iliacus muscle, maintain contactwith your cranial thumb and workrespectfully in a distal direction withthe inferior hand. This may affect thelumbar plexus nerves.

Profunda-femoralarteryFemoralveinFemoralartery

' Adductorlongus muscle

Extemal Iliacus vein

Psoas mucle,'.

Figure 10: The femoral nervebetween the fascia of psoas andiliacus muscle as well as in the spacecovered by the sartorius.

Figure 9: In the fifth session, workingthe intermuscular septum under thesartorius in a distal direction you willhave an effect on the femoral nerve.

Rectusfemoris \ ~\\muscle

(quadripcepsmuscle)

Sartoriusmuscle

Branchesto therectus

femoris- 'muscle

Branchesto the \~

vastus-- -mediaismuscle " ., 'i I

Vastusmediaismuscle

of the quadriceps femoris and the adductorcompartment, which is covered by thesartorius. The sensory and vasomotorsaphenous nerve innervates the medialaspect of the knee joint and has anastomosiswith the obturator nerve at the level of theadductor canal (see Figure 8).

Anrenor .- .-'~ . - .-

Mediat.. ····l ····Lateral /~'.,".iii"'II!l'"Posterior / ......

Vastus medialis ,/ /1Nerve of the mUSclE;" / ,.•...-~.,,-~

vastus medialis ' ,/muscle ::J....

Sartorius i 1f.J.J,.>-C.muscle t-~~ J

Saphenous ' c -muscle ,;

Femoral /"artery .

. ' ,0

Saphenous j / ~~~vein .

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CONSIDERING NERVES AND THE COLD LASER

Note: Illustrations courtesy of ChurchillLivingstone - Elsevier, Barral Institute USA;photos courtesy of the author.

to regain some distal gliding. The scalenewill readjust its tone once the plexusis freely gliding under the clavicle andpectoralis minor.

Conclusion

These are just a few practical suggestions ofhow to enhance results in structural work byincluding manual perception of the peripheralnerves. There are many more details to learn,as there are many compression sites fornerve tissue that lead to different structuraland symptomatic phenomena. Studying thenerves and the best entries for treatmentis a worthwhile enterprise. By doing so, itwill help to differentiate and evolve yourpalpatory skills and allow yet another levelof manual communication between you andyour client.

Christoph Sommer, Heilpraktiker (H.P.), ison the Rolf Institute faculty, teaching ill theEuropean Rolfing Association 's ModularTraining. He is also 011 the faculty of the BarralInstitute.

Between the anterior and medial scalenes,the superior part of the brachial plexus isgirded and can be entrapped, affecting allthe brachial nerves and causing the arm andcervical spine to go into compensationalpatterns. When working with the scalenes,pay attention to the embedded brachialplexus, contact it with a light touch withyour finger pads, and help the nerve plexus

n. UUl \ V " Ganglia stellate

s:::::::::f~~\. Vagus nerve~\~" (recurrent rami)

Subclavian artery

Vagus nerve jttm~VI~

Anterior scalenemuscle "- -JJ:i /11 ./

Verterbral artery

Practical Recommendations: When workingthe anterior scalenes, keep in mind that thephrenic nerve travels on the anterior surfacefrom the cranial to caudal aspect and fromlateral to medial (see Figure 12). If you canadjust to these angles while working and usesoft, melting finger pads, you will be ableto influence the effects of the phrenic nerveand see a change in your client's breathing.

Figure 12: When working on the scalenius anterior consider the phrenicnerve. When working on the brachial plexus (superior part) consider possibleentrapments between anterior and medial scalene muscles.