The Rolfing® Skillful Touch Handbook by Dr. Ida Rolf Institute

FIRST EDITION 2022 FOREWORD

Robert Schleip

Neal Anderson Bethany Ward Lu Mueller-Kaul Faculty Contributors Ellen Freed Larry Koliha Nobuko Muth Russell Stolzoff Marius Strydom

FIRST EDITION 2022 FIRST EDITION 2022FOREWORD

Robert Schleip

Neal Anderson Bethany Ward Lu Mueller-Kaul Faculty Contributors Ellen Freed Larry Koliha Nobuko Muth Russell Stolzoff Marius Strydom

Skillful Touch Manual

about the book

Learn fundamental skills for effective manual therapy.

“The Rolfing Skillful Touch Handbook is a wonderful resource for any manual therapist looking to escape a rote repetitive routine, reach a new level of skill, and affect real lasting change in the body. The exceptional photos and precise, clear explanations of techniques will help structural integrators, massage therapists and physical therapists advance their theoretical understanding of the goals that achieve balance in structure. I so wish I’d had this information in the early days of my own bodywork career; it would have saved me many years in my learning of effective therapeutic techniques fortified by informed, powerful, and pleasant touch.” — Art Riggs: Author of Deep Tissue Massage: A Visual Guide to Techniques; Certified Advanced Rolfer; massage therapist; and international bodywork instructor “The Rolfing Skillful Touch Handbook supports practitioners in living into the positional strategies and grounded embodiment necessary for meaningful client education and therapeutic touch.” — Caryn McHose: Co-author of How Life Moves; Certified Advanced Rolfer; Registered Somatic Movement Educator; and international bodywork instructor “Touch is a dialogue between the practitioner’s hands and the client’s tissues — this handbook is an excellent guide for developing that therapeutic conversation. Filled with clear instructions supported by photographs, it illustrates a multitude of robust strategies and techniques. Students will undoubtedly find this resource useful for years beyond their basic training.” — Kevin McCoy, PT: Rolfing Faculty; Board Member, Ida P. Rolf Research Foundation; and Past Board Chair, Dr. Ida Rolf Institute Board of Directors “This handbook provided a systematic approach to learning Skillful Touch techniques. It empowered me to better understand my client’s anatomy and taught me how to adapt my own body positioning for improved contact. A musthave for all students of Structural Integration!” — Sarah Habbe: Certified Rolfer, 2021 “The Skillful Touch Handbook quickly became an essential resource throughout my studies at the Dr. Ida Rolf Institute®. It contains many thoughtful details that help the student develop a comprehensive understanding of how to provide therapeutic manual touch with confidence.” — Kenji Sugawara: Certified Rolfer, 2021

Neal Anderson

Certified Advanced Rolfer® and Rolf Movement® Practitioner Board Certified Structural Integrator Chair, Faculty Executive Education Committee, Dr. Ida Rolf Institute® of Structural Integration Co-Chair, Phase 1 Faculty, Dr. Ida Rolf Institute® of Structural Integration

Bethany Ward, MBA

Rolfing Faculty and Rolf Movement Faculty (Co-Chair), Dr. Ida Rolf Institute

credentials

AUTHORS

Leadership Council, International Somatic Movement Education and Therapy Association Board Certified Structural Integrator Past-president, Ida P. Rolf Research Foundation

Lu Mueller-Kaul

Certified Advanced Rolfer® and Rolf Movement® Practitioner Faculty, Dr. Ida Rolf Institute® of Structural Integration Licensed Naturopathic Physician, Germany Co-Chair, Phase 1 Faculty, Dr. Ida Rolf Institute® of Structural Integration

FOREWORD Robert Schleip MA, PhD

Director, Fascia Research Project (Ulm University & Technical University Munich, Germany) Research Director, European Rolfing® Association e.V. Visiting Professor (IUCS Barcelo)

Skillful Touch Manual

The Rolfing® Skillful Touch Handbook

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Published by The Rolf Institute of Structural Integration d/b/a Dr. Ida Rolf Institute 5055 Chaparral Court, Suite 103, Boulder, CO 80301 www.rolf.org Cover and book design by Pepita Martins, Orange Identity LLC (sayoi.com) ISBN: 978-1-7332838-8-5 The Rolf Institute of Structural Integration owns the following trademarks and registered trademarks in the United States and other countries: Rolfing; The Rolf Institute of Structural Integration; Rolf Institute; Dr. Ida Rolf Institute; Little Boy Logo; Little Boy Animation Mark; Rolf Movement; Rolf Movement Integration; Rolf Movement Practitioner; Rolfer; Certified Rolfer, Certified Advanced Rolfer. Disclaimer: This publication is designed to be used for instruction in the Rolf Institute® classroom under the supervision of qualified instructors. It is meant to provide accurate and authoritative information regarding the subject matter covered. It is distributed with the understanding that the authors, editors, and publisher are not engaged in rendering medical, psychological, or other professional services. Care has been taken to confirm the accuracy of the information presented and describe generally accepted practices. Neither the authors, editors, nor the publisher shall be liable for any loss or damage of any nature occasioned to or suffered by any person acting or refraining from acting as a result of reliance on the material contained in this publication.

dedication

To Dr. Ida Rolf who gave us meaningful work.

Skillful Touch Manual

foreword

What a joy this is! When I entered the world of structural integration in the late 1970s as one of the first European Rolfing Structural Integration students, my adventurous and rather chaotic personal learning curve could have benefited greatly from a well-structured and easyto-understand textbook such as this one. My countless doubts—“Will I ever be able to learn this difficult craft? How can I understand the often-mysterious concepts behind its method?”—would have been reduced to a pleasurable minimum. I envy those who will get to study this powerful method today with the support of this excellent textbook. This book is a brilliantly designed manual that will make learning the hands-on details of this work an easier and more joyful task. The Rolfing Skillful Touch Handbook is the result of collaboration among several passionate instructors at the Dr. Ida Rolf Institute of Structural Integration. In it, these seasoned teachers bring together novel insights and state-of-the art illustrations to create this milestone contribution to the international field of structural integration education. Having first been an anatomy teacher and, later, a Basic Rolfing Instructor in many European and international trainings, I gradually turned towards academic fascia research. What started as a new obsession eventually developed into a new profession. Today, I spend far more time in laboratories and establishing international scientific research collaborations than I do working with clients. While my current professional focus continues to be very exciting—new research insights are retrospectively supporting many of the visionary concepts of Dr. Ida Rolf—I do miss the deeply meaningful sense of connection and nourishing presence that goes along with a regular clinical hands-on practice. Leafing through the pages of this text, with its excellent descriptions of what happens in the therapeutic hands-on exchange, inspires me to contemplate returning to a full-time clinical practice in the future, if my current scientific quest ever reaches a point of plateau or relative frustration. Yes, personal learning in direct contact with a master—or, even better, from several masters—cannot be replaced by any other medium, whether a book or a video recording. But in this case, several masters have come together to create a written text that supports the in-person learning process of their students. The result is a fantastic contribution—a well-done instruction manual for all those who want to become more skillful in practicing the powerful work of structural integration, as developed by the visionary biochemical scientist, Dr. Ida Rolf.

Robert Schleip Munich, Germany December 2021

Two people were instrumental in the creation of this book. Lu Mueller-Kaul heard my question and took up the challenge to change how we teach Skillful Touch. She worked with me to convert our oral and demonstrative teaching into written techniques. Bethany Ward spent many hours on formatting, layout, copy editing, photo layout, and design. Together, we created this handbook.

preface

“Why are we writing this down over and over for every Phase I class?” This was the question behind what you are now holding in your hands. Historically, every Skillful Touch instructor would write instructions on the whiteboard each time they taught the class. Some students copied the instructions in their notebooks and, later, others took pictures with their phones. As a result, there wasn’t always a consistent transmission of the material and students often missed table demonstrations because they were taking notes. My motivation for this book was to provide students with a clear and easily understandable primer to accompany the hands-on training provided by their teachers.

After assembling a first draft, a diverse group of faculty members—Ellen Freed, Russell Stolzoff, Marius Strydom, and Bethany Ward—stepped forward to thoroughly review and edit what had been generated. We spent many months in video calls every two weeks discussing how best to teach fundamental touch knowledge and skills that would be useful throughout a Rolfing student’s training and subsequent practice. This team not only edited what had been written, but also generated valuable original content specifically in the fundamentals, analysis, and integration sections. Written instructions are important, but accompanying images provide clarity and context to the descriptions. Many thanks to our photographer, Nic Daughtry and his assistant Zach Joing; the practitioner models, Larry Koliha, Nobuko Muth, and Bethany Ward; the client models, Tanya Coyote, Nipun Fantoni, Mary Ashleigh Hardiman, Kenji Suguwara, and Lindsey Watson; and the assistant photo shoot director, Nobuko Muth. This book looks fantastic and that is thanks to the superb design and layout skills of Pepita Martins, Senior Designer, and the team at Orange Identity. There’s an old adage that when you’re almost done writing a book, you’re only halfway through. As we edited the manuscript, we realized that it would benefit from an additional set of eyes. Sandy Horn, a professional editor and Rolfing devotee and John Schewe, Rolfing Faculty and one of the editors for our professional journal, agreed to edit the final version. Both generously contributed their time and energy to make this a textbook of which the school can be proud. Many faculty members have taught fundamental touch skills throughout the years and created earlier written material. I thank my initial teachers in Phase I, Jon Martine and Juan David Velez, as well as those with whom I did not have the privilege of studying: Til Luchau, Suzanne Picard, Michael Polon, John Schewe, and many others. I also thank the Phase I colleagues who welcomed me into their ranks and taught me how they teach: Meg Maurer, Adam Mentzell, Nikki Olsen, and Michael Polon.

Skillful Touch Manual

The purpose of this handbook is to teach fundamental touch knowledge and skills to Rolfing students. Over the past couple of years, many students were recipients of portions of this handbook and provided meaningful feedback for improvements. We’re grateful for their willing participation. Teaching at the Dr. Ida Rolf Institute cannot happen without a dedicated school administration and board of directors. Thank you to the staff, executive director Christina Howe, and board chair Libby Eason for their significant support of this project. Without Christina’s encouragement and DIRI’s financial commitment, this project would have remained a collection of unillustrated handouts. And now we have written it down. It’s been a labor of love and I’ve had a lot of help. I love teaching and I’m looking forward to finally getting to use this handbook!

Neal Anderson Loveland, Colorado December 2021

Skillful Touch is not Rolfing SI. Skillful Touch is a non-specific manual therapy predominantly composed of myofascial manipulation techniques. All of the skills and techniques you learn here can be used throughout your Rolfing SI training and career. This handbook does not cover the Rolfing Ten-Series. Instead, you will learn how to contact clients using a Rolfing touch and approach. This text also introduces some basic skills and concepts from Rolf Movement® Integration. Practicing these techniques inside and outside the classroom will help you develop a skill set for working with clients. You are beginning your journey to becoming a Rolfer®. We have arranged this book for easy use with color-coded sections: ■ The first section, Skillful Touch Fundamentals, describes terms and body positions referred to throughout the book. This section also lays out preparing your space, developing a session plan, and suggestions for closing a session. ■ The second section, Analysis: Body Reading, shows a variety of structural and functional assessments that will help you decide where to work. ■ The following three sections present 64 techniques: the Upper Body section covers the thorax and shoulder girdle; the Middle Body section covers the pelvis and thigh; and the Lower Body section covers the leg and foot. In general, the large photographs show how to position yourself with the table and client for effective work. Smaller detail photographs highlight different options for hand and body use. Each of the techniques has seven headings: • Purpose/Intention – When and why to use the technique • Client position - How your client is positioned as described in Chapter 1 • Practitioner body position - How to position yourself to work effectively • Practitioner hand position - How to contact the client as described in Chapter 1 • Instructions - A step-by-step outline of the technique • Anatomy - Structures impacted by the technique • Potential Client Movement and Cues - Passive or active client movements to increase the impact of your contact, as well as sample language cues to elicit these movements ■ The sixth section, Integration: How to End a Session, covers four important approaches for global integration. ■ The final section, Session Outlines, presents three Rolfing Skillful Touch session protocols.

introduction

Rolfing® Structural Integration (SI) students and practitioners use skillful and intelligent touch to facilitate change with clients. This handbook lays out the basic concepts and techniques of Rolfing Skillful Touch, a method developed and utilized at the Dr. Ida Rolf Institute® of Structural Integration for teaching foundational manual therapy skills.

This handbook is meant to be a resource throughout your training as a student and as a practitioner. With that in mind, we designed this book with an area on each page for writing your own notes and observations. The more ways you interact with this material (visually, auditorily, tactilely), the better your ability to make it your own. Thank you for choosing the Dr. Ida Rolf Institute to learn Rolfing Structural Integration. Now let’s get to work!

Skillful Touch Manual

table of contents

Foreword...........................................................................................................................................6 Preface................................................................................................................................................7 Introduction......................................................................................................................................9 Table of Contents....................................................................................................................... 10

SKILLFUL TOUCH FUNDAMENTALS...................................................15

Skillful Touch Fundamentals.................................................................................................17 Practitioner Hand Positions and Use...............................................................................18 Fingers Spread...................................................................................................................18 Fingers Together...............................................................................................................18 Fingers Flexed.....................................................................................................................18 Knuckles.................................................................................................................................18 Soft Fist...................................................................................................................................19 Forearm...................................................................................................................................19 Elbow........................................................................................................................................19 Practitioner Hand Use....................................................................................................19 Quality and Quantity of Touch........................................................................................... 20 Terms.................................................................................................................................................21 Client Position on Table..........................................................................................................22 Supine.....................................................................................................................................22 Side-lying..............................................................................................................................23 Prone.......................................................................................................................................24 Working in Sensitive Areas...................................................................................................25 Preparing a Therapeutic Space........................................................................................26 Designing a Session.................................................................................................................27

II. ANALYSIS: BODY READING.........................................................................29 Analysis: Body Reading...........................................................................................................31 Standing..........................................................................................................................................32 Arm Arcs.........................................................................................................................................33 Knee Bends...................................................................................................................................34 Walking.............................................................................................................................................35 On-table Analytic Tests......................................................................................................... 36 Analytic Tests in Supine............................................................................................... 36 Analytic Tests in Side-lying.........................................................................................37 10

Anterior Thorax.................................................................................................................42

2. Clavicle Shear.....................................................................................................................44 3. Shoulder Girdle – Abduction..................................................................................... 46 4. Shoulder Girdle – Overhead Reach...................................................................... 48 5. Posterior Thorax – Supine.......................................................................................... 50 6. Scapula – Supine..............................................................................................................52 7.

Scapula Depression.......................................................................................................54

Anterior Axilla.....................................................................................................................56

9. Posterior Axilla...................................................................................................................58 10. Lateral Axilla....................................................................................................................... 60 11. Arm into Axilla.....................................................................................................................62 12. Glenohumeral Joint........................................................................................................ 64 13. Lateral Shoulder to Arm............................................................................................... 66 14. Arm Compartments....................................................................................................... 68

table of contents

III. UPPER BODY – THORAX AND SHOULDER GIRDLE TECHNIQUES..............................................................................................................39

15. Forearm Twist.....................................................................................................................70 16. Forearm Extensor Compartment...........................................................................72 17. Forearm Flexor Compartment.................................................................................. 74 18. Forearm – Squeezing.....................................................................................................76 19. Forearm – Stacking.........................................................................................................78 20. Forearm – Pressing........................................................................................................ 80 21. Distal Radioulnar Joint...................................................................................................82 22. Carpal Tunnel..................................................................................................................... 84 23. Palmar Fascia..................................................................................................................... 86 24. Axilla – Side-lying............................................................................................................. 88 25. Lateral Thorax................................................................................................................... 90 26. Posterior Thorax – Side-lying....................................................................................92 27. Spinal Groove.................................................................................................................... 94 28. Upper Posterior Thorax – Prone............................................................................. 96 29. Lower Posterior Thorax – Prone............................................................................. 98 30. Scapula – Prone............................................................................................................. 100

Skillful Touch Manual

table of contents

IV. MIDDLE BODY – PELVIS AND THIGH TECHNIQUES........ 103 31. Iliotibial Band – Supine................................................................................................ 106 32. Rectus Femoris Shearing......................................................................................... 108 33. Anterior Hip Flexors.......................................................................................................110 34. Lateral Hip Crease.........................................................................................................112 35. Medial Hip Crease...........................................................................................................114 36. Hamstrings – Supine A.................................................................................................116 37. Hamstrings – Supine B.................................................................................................118 38. Hamstrings – Supine C............................................................................................... 120 39. Ischial Tuberosity – Supine.......................................................................................122 40. Thigh Pull.............................................................................................................................124 41. Iliacus.....................................................................................................................................126 42. Distal Iliotibial Band – Side-lying.............................................................................128 43. Proximal Iliotibial Band – Side-lying..................................................................... 130 44. Distal Hamstrings – Side-lying................................................................................132 45. Proximal Hamstrings – Side-lying.........................................................................134 46. Trochanter Shear...........................................................................................................136 47. Trochanter to Crest.......................................................................................................138 48. Trochanter to Sacrum................................................................................................. 140 49. Deep Lateral Rotators.................................................................................................142 50. Hamstrings – Prone.......................................................................................................144 51. Ischial Tuberosity – Prone..........................................................................................146

V. LOWER BODY – LEG AND FOOT TECHNIQUES.................... 149 52. Ankle Retinacula.............................................................................................................152 53. Dorsal Fascia....................................................................................................................154 54. Plantar Fascia...................................................................................................................156 55. Talar Glide...........................................................................................................................158 56. Subtalar Joint................................................................................................................... 160 57. Anterior Leg – Gliding...................................................................................................162 58. Anterior Leg – Pressing...............................................................................................164 59. Lateral Leg..........................................................................................................................166 60. Posterior Leg – Supine................................................................................................168

62. Eye of the Foot..................................................................................................................172 63. Posterior Leg – Prone................................................................................................... 174 64. Lower Limb Traction.....................................................................................................176

VI. INTEGRATION: HOW TO END A SESSION..................................179 Integration: How to End a Session..................................................................................181 Neck Work...................................................................................................................................182 Head Cradle.......................................................................................................................183 Neck Work A......................................................................................................................184 Neck Work B......................................................................................................................185 Neck Work C.....................................................................................................................186 Pelvic Lift.......................................................................................................................................187 Back Work................................................................................................................................... 190 Supported Sitting............................................................................................................191 Neck to Shoulder Work...............................................................................................192

table of contents

61. Calf Shear...........................................................................................................................170

Roll-down............................................................................................................................193 Back Work with Roll-down........................................................................................194 Back Work with Extension........................................................................................195 Sit to Stand.........................................................................................................................196 Tracking.........................................................................................................................................197 Ankle Tracking..................................................................................................................198 Knee Tracking.................................................................................................................200 Head Tracking..................................................................................................................201

VII. SESSION OUTLINES........................................................................................ 203 Session Outlines................................................................................................................... 205 Outline for Upper Session................................................................................................. 206 Outline for Lower Session................................................................................................ 208 Outline for Connecting Session..................................................................................... 210 Notes...............................................................................................................................................212 About the Authors................................................................................................................. 220

Skillful Touch Manual

NOTES

SKILLFUL TOUCH FUNDAMENTALS Skillful Touch Manual

Skillful Touch Fundamentals When Dr. Rolf started teaching Rolfing® Structural Integration, she wanted students whose bodies and hands were large enough to manage what she considered a very physical discipline. Along with height and weight, prospective students had to submit a photograph of their open hands with a US quarter coin in each palm. As a result, most of Dr. Rolf’s early students and teachers were men since they more often fulfilled her criteria. While this is an interesting part of our history, it is far from how we view the work now. With appropriate body use and intention, hand and body size have little bearing on the effectiveness of the practitioner. At the Dr. Ida Rolf Institute®, we believe that the practitioner’s body mechanics and awareness are essential to skillful and transformative work. You will learn how to use your hands and body for effective contact, to sense what is happening under your hands, and to stay present with your client and yourself simultaneously.

Skillful Touch Manual

Practitioner Hand Positions & Use The following are seven common ways you will use your hands and arms to contact the client. Some instructors use the term tools to refer to these hand positions. In the descriptions, we refer to push to describe moving tissue away from your body and pull to describe moving tissue towards your body. Your intention is never one of pushing or pulling on the tissue or client. These terms describe the direction of your contact force, and do not imply an insensitivity in your contact.

Fingers Spread Contact with the full surface of fingers and palm. Used to push or pull.

Fingers Together Fingers together and slightly flexed. Contact with fingertips. Avoid loading with extension into the interphalangeal joint ligaments. Used to push or pull.

Fingers Flexed Fingers together and flexed to about 90°. Contact with finger pads or fingertips. Used to pull.

Knuckles Fingers together and curled and thumb relaxed. Contact with second knuckles and middle phalangeal segments. Used to push.

Practitioner Hand Use With respect to hand use, we commonly refer to the following: Hand – The hand that is actively • Working working. Hand – • Listening attentively resting Soft Fist Fingers curled into a lightly held fist. Contact with first knuckles and proximal phalangeal segments. Align the metacarpal bones with the carpal and forearm bones. Avoid tucking the thumb between the fingers and palm or actively flexing the distal phalanges against the palm. Used to push.

Elbow Elbow flexed. Contact with tip of elbow for detailed direct pressure. Contact can be modified in the same ways as the Forearm. Used to push.

The hand that is on the client. It provides additional connection with the client and feedback to the practitioner.

Hand – This hand may • Non-Working help guide a client into a position or complete a movement cue but is not the major focus of the technique. A non-working hand often finishes its positioning job and then transitions to being a working or listening hand. Working and Listening hands can • The swap roles during some techniques without breaking contact with the client.

Forearm Elbow flexed. Contact with proximal end of forearm. There are several ways to modify your contact: 1) rotating at the shoulder joint; 2) flexing/extending the elbow; and/or 3) pronating/supinating the forearm. Used to push or pull. Ulnar Blade: Sometimes instructions refer to using the ulnar blade of the forearm. In these cases, use the edge of your ulnar bone. This is in contrast to using a broad area of the forearm to manipulate superficial layers or a flat area of the forearm for compression.

Skillful Touch Manual

Quality and Quantity of Touch In Rolfing and Skillful Touch, we use quality to describe the essential nature of your touch and quantity to describe measurable aspects of that touch. Quality of touch can refer to, among other things, a direct or indirect intervention or working with a gamma touch (dividing your attention equally between yourself and the client). Quantity of touch includes depth, direction, and duration of your touch. When you first contact your client, resist the temptation to move right away. The impulse to “do something” is a strong one. Instead, allow time for the contact between you and the client to inform how and where, and even if, you should move. Is your contact at the appropriate depth? Are your hands pointing in the best direction? What is the optimal duration of your intervention? Is your body in a connected and grounded position to easily transmit therapeutic force? Vector is a concept in Euclidean geometry that has both direction and magnitude. In Skillful Touch, a vector describes the direction of your contact and the amount of force you apply in that direction. Keep in mind that the angle of contact affects the depth and direction of your input. In general, a steep vector of touch (more perpendicular to the working surface) has a compact and deep effect, while a shallow vector of touch (more parallel to the working surface) has a broad and superficial effect. To experience this, imagine making contact with your hand and arm perpendicular to your client’s thigh as they lie supine on the table. Feel how you can work very deeply, affecting a concentrated area. In contrast, imagine stepping further away from the table and allowing your hand and arm to be at a significantly shallower angle to the client’s thigh. In this case, you can easily contact more superficial layers and feel your effects more broadly. In addition to thinking about vectors with respect to transmitting forces through physical tissue, you will also use this concept to work with client perception and coordination. In functional interventions, a vector refers to sensing direction and magnitude of movement in one’s own body as well as in the environment. A simple example of working with vectors would be to ask your client to dorsiflex their ankle, cueing them, “Reach through your heel.” The term layer of availability is one you will hear throughout your training. In a touch sense, this is the point at which the client’s body responds positively to the quality and quantity of your input: Is your contact engaging enough to facilitate change, yet secure enough to not overwhelm? Layer of availability also applies in the psychobiosocial realm: Are you working at the client’s learning edge, while providing enough support for them to explore the unfamiliar? It is at this balance point—between challenge and safety—that transformative change occurs.

Terms The following is a list of terms you will encounter throughout the book, your training, and the wider bodywork and healthcare community. Although you may not use all of these terms with every instructor, you should be familiar with them to communicate accurately with other bodywork practitioners and healthcare professionals. Use the following terms when describing location with respect to the body and anatomical position:

Superior — above Inferior — below Anterior — toward the front Posterior — toward the back Medial — toward the midline Lateral — away from the midline Superficial — closer to the surface Deep — further from the surface Proximal — situated nearer to the point of attachment of an extremity Distal — situated away from the point of attachment of an extremity Caudal — downward, or toward the tail Cephalad — upward, or toward the head Ventral — on the front Dorsal — on the back Additionally, we use the following terms to describe an intervention approach:

Direct — touch that challenges a pattern of restriction; working in the direction of tissue resistance or strain Indirect — touch that facilitates release by increasing a pattern of restriction; working in the direction of tissue receptivity or ease Many of the techniques in this book can be used in either a direct or indirect way.

Skillful Touch Manual

Client Position on Table The position of the client, also referred to as positional strategy, is an important part of your overall session strategy. How the client lies on the table greatly affects your ability to work effectively towards the goals of the session. The following are three basic positional strategies you will use throughout your career.

SUPINE Common Uses Supine position is good for working on all aspects (front, sides, and back) of the client.

Client Position The client is lying on their back, face up. Unless otherwise noted, the client is in the anatomical position. Any variations in limb position are outlined in the techniques.

Bolstering Some clients require bolstering to comfortably remain in this position. The most typical modification is to bolster under the knees, which slightly flexes the hips and eases the lumbar spine. Another common adaptation is to bolster under the head, so the head and neck are not overly extended.

Keep in Mind Avoid reflexively providing bolstering in response to client comments or your own projection of client comfort. Strain patterns in the supine body are often visible to you (and are often felt by the client) and can present good indications of where to work. In general, bolster no more than needed.

SIDE-LYING

Client Position The client is lying on their right or left side. Unless otherwise noted, the client has their head and neck aligned with the thoracic spine, with hips flexed 30-60° and knees flexed 60-90°. Unless otherwise noted, ankles, knees, pelvis, thorax, and shoulders are stacked vertically over their counterparts. Any variations in limb position are outlined in the techniques.

Bolstering Provide bolstering under the head to limit lateral flexion of the cervical spine. It is important to keep the pelvis stacked vertically. There can be a tendency for the top hip to lean forward or backward toward the table, so bolster between stacked knees and ankles. When a lower limb is extended for inner leg and thigh work, place a bolster under the other flexed thigh and leg.

Common Uses Side-lying position allows you to work on the lateral aspect of the body, to differentiate the front and back of the body, and to address relationships between the appendicular girdles and the axial complex. Side-lying is also a useful alternative for clients who are unable to be in supine or prone positions. These clients might include individuals who are pregnant, who have surgical or morphological limitations, or who are having an emotional response Keep in Mind Bolstering in side-lying facilitates client comfort and allows you to see structural patterns without the strain imposed by the position itself. In other words, an unbolstered client would exhibit torsional or positional strain unrelated to their structural patterns. With appropriate bolstering, the strain patterns that remain visible to you (and are often felt by the client) can present good indications of where to work.

in another position.

Skillful Touch Manual

PRONE Common Uses Prone position is useful for general and detailed work along the dorsal aspect of the body, including the thorax, spine, pelvis, sacrum, thighs, legs, and feet.

Client Position The client is lying face down with their feet past the bottom end of the table and arms resting by their sides. They will typically turn their head to one side or the other. If they are able, remind them to turn their head to the other side occasionally throughout the session.

Keep in Mind While the prone position can be extremely comfortable for many clients, it can be quite challenging for others. This is often the case for those with limited head and neck rotation or low back pain. In these cases, even if you successfully help them find a comfortable position with bolstering, it is important to occasionally ask the client if the position is still appropriate.

Bolstering Many clients require bolstering to remain in this position comfortably. Provide bolstering under the torso (not under the head) to facilitate less strain in the cervical spine. A good practice is to align the top edge of the bolster with the top of the client’s shoulders. This also provides bolstering under the abdomen, easing hyperlordosis of the lumbar spine. An alternative to having the client’s feet past the end of the table is to provide bolstering under the client’s ankles. With this positional strategy, the client can use a face cradle to eliminate neck and head rotation. Provide bolstering under the torso if needed.

Working in Sensitive Areas Work around the breasts, groin, pelvic diaphragm, and abdomen must be approached with care. Always ask for permission before beginning work in these sensitive areas. It is important to communicate clearly to the client what you will be doing and why, and give time for their consideration and questions before proceeding. Additionally, using neutral language while maintaining a professional demeanor is critical for an effective working relationship. Never force or coerce a client to receive work that they do not want or do not feel comfortable receiving, and don’t do work that you are not comfortable providing. Keep in mind that the client may not tell you, or even be aware, that an intervention is not appropriate or welcome until you have started working in a sensitive area. Remember to continually track your client’s subtle responses to the work. If you, as a practitioner, sense any conflict or resistance in your client’s system or your own, stop working and consider alternative interventions. Also, be aware that a client may have sensitivity anywhere in their body outside of these specific areas of consideration. When working in the anterior chest, the musculoskeletal structures that you need to address are deep to breast tissue. As you work around the margins of breast tissue, keep in mind that this territory is highly vascularized and innervated. There are also lymph nodes on the lateral and superolateral borders of the breast, so work sensitively in the axilla. For all clients, nipples are sensitive so avoid direct work in this area. Additionally, breasts and the anterior chest may have an emotional charge that must be considered by the practitioner and the client.

When working with a client with breast tissue (i.e., women as well as many trans and non-binary clients), if their clothing does not provide adequate coverage in supine or side-lying, offer a draping option and work through the fabric. When working in the supine position, depending on the client and your comfort level, it might be acceptable to ask them to use their own hand to hold their breast away from the axillary region. This allows you to access the area safely and appropriately. You may also use the back of your nonworking hand to shift the lateral margin of the breast before placing your working hand in the axilla. These precautions may also apply to larger clients with adipose tissue. Remember that all of these hand placements are options only after you’ve asked for and received permission to work in this territory. When working in the pelvis, the musculo– skeletal structures that you need to address are outside the urogenital triangle. You should use the bony structures of the pelvis as landmarks to assure yourself, and your client, that you have palpatory certainty in this sensitive area. Keep in mind that this territory is highly vascularized and innervated. There are also lymph nodes posterior to the inguinal ligament, around the femoral neurovascular bundle, and within the abdomen, so use care when working in the hip crease. For some clients, work around the groin, pelvic diaphragm, and pelvis can be triggering or challenging, so this area needs to be addressed with care. Being specific with your language and touch creates a sense of therapeutic safety. Be aware that clients may not share their history of trauma with you. You must be prepared and willing to stop work if you sense any conflict or resistance in your client’s system or your own.

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When working with a client with external genitalia (i.e., most men as well as some trans and non-binary clients), if their clothing does not provide adequate coverage, offer a draping option, and work though the fabric. When working around the pelvis in supine or side-lying positions, depending on the client and your comfort level, it might be acceptable to ask them to use their own hand to adjust the external genitalia away from where you will be working. This allows you to access that territory safely and appropriately. Once again, make sure you ask for and receive permission before shifting any clothing or initiating contact in this area. The techniques in this book assume that you will adjust for the many variations of bodies and clothing that you encounter. It would be onerous to include written accommodations for sensitive areas in every technique. Instead, we’ve assumed that, based on this section, you will adapt your approach to meet the needs of each client.

Remember the governing rule: Never force or coerce a client to receive work that they do not want or do not feel comfortable receiving, and don’t do work that you are not comfortable providing.

Preparing a Therapeutic Space Your working surface as a practitioner, almost always a massage table, is an important consideration. It should be a firm, yet comfortable, surface for the duration of the session. In general, set the table height so that when you stand next to the table, the first knuckles of your lightly held fist graze the surface. This height will be comfortable and effective for the supine and prone positional strategies. If your client will be in the side-lying position for much of the session, adjust your table to a lower position because the territory of the client will be higher above the surface of the table. Most clients have greater dimension from left to right than from back to front. Make appropriate adjustments for larger clients. We recommend that you acquire a motorized table as soon as you are able because it will allow you to make table height adjustments in real time throughout the session. This one piece of equipment will significantly improve your longevity as a practitioner. When using a static table, in general, err on setting the table height a little lower than you might initially think. It is easier to adjust your body use to a lower table because it facilitates getting behind or over your work. This helps you find grounded and engaged positions in your own body that enable you to utilize your body weight rather than phasic muscle activity. Ultimately, efficient body use improves the quality of touch you deliver as well as the quality of feedback you receive. When preparing your space, make sure you have all of the following available:

• Table, appropriately adjusted • Two sheets (one on table, one for client coverage) • Three pillows in pillowcases • Blanket • Rolfing bench • Practitioner stool/chair • Client chair (can be the bench or table) • View of a clock • Knowledge of and compliance with the school’s draping and clothing policy.

Designing a Session How you begin and end your session is as important as any technique you use within the session. The way you design the entire client experience—understanding their goals, communicating what you’re doing and why, and incorporating integrative work—is essential to meaningful strategy. A successful session relies on a good relationship between the practitioner and client. Communication is key. Begin by asking your client about their goals for the session. Then explain how your pre- and post-session analysis is relevant to those goals. After the analysis, discuss where and how you plan to work. Explain how your strategy addresses the client’s goals. Ask if your plan makes sense to them and if they have questions. This provides an opportunity for the client to be an active partner in your work together.

Effectively ending a session increases the likelihood that your client will continue to embody the changes that occurred during the session. Integration—unifying parts into a functional whole—is an important objective throughout the entire session but comes to the forefront at the end of your time together. Rolfers historically use neck work, pelvic lift, and back work to close their sessions. You will use these same three techniques at the end of a Skillful Touch session. Tracking is another important integrative approach for educating and orienting the client into verticality and movement. Additionally, if a client feels a little spacey or ungrounded upon standing up from the table, tracking is an excellent intervention to help them feel more connected and supported.

One of the most important things that you can do to facilitate closure is to leave enough time for it. It’s our goal to leave clients as integrated as possible at the end of every session.

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Ankle Retinacula

PURPOSE/INTENTION CLIENT POSITION

Differentiation of superficial ankle structures. Supine

PRACTITIONER BODY POSITION

Standing or sitting at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Fingers Spread, Soft Fist, Forearm

INSTRUCTIONS

•Cue the client to have both heels off of the table. •Start at the interphalangeal joints inferior to the retinacula and work tissue superficially and in a superior direction.

•Alternatively, you can position one foot against your thigh or chest (or place a pillow between your chest and the client’s foot). This position increases foot stability and makes it possible to use the foot as a lever for introducing passive dorsiflexion and plantarflexion as you work.

ANATOMY

POTENTIAL CLIENT MOVEMENT AND CUES

Extensor retinacula, anterior and lateral compartment tendons (tibialis anterior, extensor digitorum longus, extensor hallucis longus, peroneus longus, peroneus brevis)

•Client is passive.

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Dorsal Fascia

PURPOSE/INTENTION CLIENT POSITION

Differentiation of dorsal foot structures. Supine

PRACTITIONER BODY POSITION

Standing or sitting at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Fingers Together, Knuckles

INSTRUCTIONS

• Work on the dorsal surface over the tarsals and metatarsals. • Hold the superficial fascia laterally or medially while moving the forefoot into eversion and inversion.

• Alternatively, you can position their foot against your thigh. This position increases foot stability while you take the foot into eversion and inversion.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Dorsal fascia, extensor digitorum longus, extensor hallucis longus

• Client is passive.

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Plantar Fascia

PURPOSE/INTENTION CLIENT POSITION

Differentiation of plantar foot structures. Supine

PRACTITIONER BODY POSITION

Sitting at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Knuckles, Soft Fist

INSTRUCTIONS

• Position client’s heels and ankles off the table and grasp the toes or dorsal surface of the client’s foot with your listening hand.

• With a straight working arm, address the plantar surface of the foot. • Work from the ball of the foot towards the heel, covering both lateral and medial arches.

• To add more differentiation of the toe flexor tendons, lightly extend the client’s toes using your listening hand.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Plantar fascia, flexor digitorum longus, flexor hallucis longus

• Client is passive.

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Talar Glide

PURPOSE/INTENTION CLIENT POSITION

Differentiation of tibiotalar joint. Supine

PRACTITIONER BODY POSITION

Standing at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Thumbs, Fingers Together

INSTRUCTIONS

• With your fingers on the plantar surface of the foot, place both thumbs in the crease anterior to the tibiotalar joint.

• Using the support of your thigh, take the client’s ankle into passive dorsiflexion and plantarflexion.

• Your thumbs should slide posteriorly and almost under the tibia in dorsiflexion. • Use fingertips to access the anterior ankle ligaments and space between the malleoli and talus.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Foot to leg connections

• Client is passive.

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Subtalar Joint

PURPOSE/INTENTION CLIENT POSITION

Differentiation of subtalar joint. Supine

PRACTITIONER BODY POSITION

Standing at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Fingers Spread

INSTRUCTIONS

• Firmly hold the heel in one hand and broadly grasp the forefoot with the other hand.

• With both hands working in unison, move the foot into eversion and inversion • ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

focusing on any limitations of rotational capacity in the subtalar joint. Swap hands as needed, keeping in mind that inversion usually has greater range of motion than eversion. Additionally, you can stabilize the heel and move the distal foot into pronation and supination.

Bony and myofascial structures of the foot

• Client is passive.

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Anterior Leg – Gliding

PURPOSE/INTENTION CLIENT POSITION

Differentiation of anterior leg. Supine

PRACTITIONER BODY POSITION

Standing at the end of the table, facing client’s head, or sitting at the side of the table, facing client’s knee.

PRACTITIONER HAND POSITION

Soft Fist, Forearm

INSTRUCTIONS

• When standing, place the client’s foot against your thigh or chest and work the •

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

anterior compartment in a superior direction. Be sure to stay lateral to the tibial shaft. Passively take the foot into dorsiflexion and plantarflexion. When sitting, cradle the leg for support and use your ulnar blade to slowly glide superiorly.

Anterior compartment of leg, lateral compartment of leg

• Dorsiflexion and plantarflexion to engage and release the muscles of the leg.

“Bring your toes up, foot up… take your toes down, foot down.” Ankle rotation. “Make a small circle with your foot… now take it the other way.”

•

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Anterior Leg – Pressing

PURPOSE/INTENTION CLIENT POSITION

Differentiation of leg compartments and deeper leg structures. Supine

PRACTITIONER BODY POSITION

Standing at the side of the table, facing client’s leg.

PRACTITIONER HAND POSITION

Soft Fist

INSTRUCTIONS

• Locate the lateral edge of the tibial shaft. • Place the knuckles of both soft fists on the anterior edge of the tibia and draw • •

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

the superficial tissue laterally until you can compress the anterior compartment posteriorly. The backs of your knuckles will be against the lateral side of the tibial shaft. With arms stacked over hands, press firmly into the table and cue the client for movement. Relocate as needed along the entire anterior leg.

All four compartments of leg, deeper structures of leg including interosseous membrane

• Dorsiflexion and plantarflexion to engage and release the muscles of the leg. “Bring your toes up, foot up… now take your toes down, foot down.”

• Ankle rotation. “Slowly draw a small circle with your foot… now take it the other way.”

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Lateral Leg

PURPOSE/INTENTION CLIENT POSITION

Differentiation of lateral leg. Supine

PRACTITIONER BODY POSITION

Sitting next to client’s leg, facing their head.

PRACTITIONER HAND POSITION

Knuckles, Soft Fist, Forearm

INSTRUCTIONS

• Cradling the heel or leg to prevent rotation, work the lateral side of leg superficial to the fibula.

• If using a Soft Fist, the ulnar side of your arm and hand will slide on the table while knuckles contact the lateral compartment.

• If using a Forearm, your hand will point toward the ceiling to provide a broad working surface moving perpendicularly to the leg.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Lateral compartment of leg

• Invert and evert foot. “Angle the sole of your foot toward the other foot... now angle it away.”

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Posterior Leg – Supine

PURPOSE/INTENTION CLIENT POSITION

Differentiation of superficial compartment of leg. Supine

PRACTITIONER BODY POSITION

Sitting at the end of the table, facing client’s head.

PRACTITIONER HAND POSITION

Fingers Together, Fingers Flexed

INSTRUCTIONS

• Cradle the back of the client’s leg below the knee. Your fingers will meet between • •

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

the bellies of the gastrocnemius with your thumbs resting on the lateral and medial sides of the leg. Work the myofascial structures from the superior attachments at the knee to the distal attachments at the calcaneus. Use the weight of the client’s leg to modulate depth and pressure.

Gastrocnemius, soleus

• Dorsiflexion and plantarflexion to engage and release the muscles of the leg. “Bring your toes up, foot up... now take your toes down, foot down.”

• Ankle rotation. “Slowly draw a small circle with your foot… now take it the other way.”

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Calf Shear

PURPOSE/INTENTION CLIENT POSITION

Differentiation of posterior compartments of leg. Supine, hip and knee flexed, foot stabilized on table

PRACTITIONER BODY POSITION

Sitting on the table, next to client’s foot.

PRACTITIONER HAND POSITION

Fingers Spread

INSTRUCTIONS

• Wrap your hand around the lateral leg, placing your fingertips at the edge of the posterior compartment on the medial side.

• Grasp the posterior leg compartments and shear laterally by leaning back. • Repeat from the other side: Wrap your hand around the medial leg, placing your fingertips at the edge of the posterior compartment on the lateral side.

• Grasp the posterior leg compartments and shear medially by leaning back. • The listening hand stabilizes the leg by pressing against the tibia below the knee. Shift the hand as needed for optimal stability.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Superficial and deep compartments of the leg

• Toe flexion facilitates differentiation by activating the deep posterior compartment without activating the superficial posterior compartment. “Scrunch up the sheet with your toes… now release.”

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Eye of the Foot

PURPOSE/INTENTION CLIENT POSITION

Differentiation of plantar surface of foot; release of deep leg structures. Prone

PRACTITIONER BODY POSITION

Standing at the side or the foot of the table.

PRACTITIONER HAND POSITION

Elbow

INSTRUCTIONS

• Keeping the knee on the table, lift the leg and locate the eye of the foot. • This spot is directly inferior to the tibiotalar and subtalar joints. When contacted • • • •

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

firmly, this is the spot on the sole where the foot neither dorsiflexes nor plantarflexes. Place your elbow there. Line up your humerus with the client’s leg so the force of your contact transmits through the center of the leg and into the knee. It is important to have your arm and their leg aligned for a clear transmission of force. You’re contacting the eye of the foot when you feel continuity between the foot and the leg. Maintain steady contact to induce release deep in the leg. When the table is low enough, you can work with the client’s leg perpendicular to the table. If the table is higher, extend the client’s knee until you can align your arm with their leg.

Entire foot and leg

• Client is passive.

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Posterior Leg – Prone

PURPOSE/INTENTION CLIENT POSITION

Differentiation of posterior compartments of leg. Prone with feet off the end of the table

PRACTITIONER BODY POSITION

Standing at the foot of the table, facing client’s head.

PRACTITIONER HAND POSITION

Soft Fist, Forearm, Elbow

INSTRUCTIONS

•Support the client’s foot with your thigh, so when you bend your knee it dorsiflexes the client’s ankle.

•Place a listening hand under the shin. •Work the medial and lateral bellies of gastrocnemius as you move their foot to tauten and slacken the myofascial structures.

•Alternatively, you can work with the foot unsupported. Place your elbow in the

junction between the distal gastrocnemius bellies and the tendinous surface of the deeper soleus and cue for foot movement.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Gastrocnemius, soleus

•If the foot is supported, the client is passive. •If the foot is unsupported, the client can make small circles with the foot or move only the toes.

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Lower Limb Traction

PURPOSE/INTENTION CLIENT POSITION

Continuity of lower limbs, can be used for integration. Supine

PRACTITIONER BODY POSITION

Standing at the end of the table, facing client’s head.

PRACTITIONER HAND POSITION

Firm grasp with hands

INSTRUCTIONS

• Cup each heel with your hand so your thumb and index finger are on either side of the ankle.

• Standing with long arms, lean backwards to provide traction through the client’s whole body.

• This can be used as an integrative technique at the end of a session if the client is uncomfortable with a pelvic lift.

ANATOMY POTENTIAL CLIENT MOVEMENT AND CUES

Lower limbs

• Client is passive.

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