There are substantial differences between structural integration (SI) and massage in rationale, technique and training,” says Eric Jacobson, Ph.D., MPH, president of the Ida P. Rolf Research Foundation and lecturer of Global Health & Social Medicine at Harvard Medical School. “It is a different way of looking at the body.” Developed by biochemist Ida P. Rolf in the 1940s, SI is a form of massage therapy that treats the body as a holistic system, with a particular focus on fascia, a connective tissue that surrounds the body’s muscles, blood vessels, organs and nerves.1
SI is based on a thorough understanding of the body’s fascial anatomy and applying very specific hands-on techniques to integrate the structures of the body into a more organized whole,” say Ann and Lynn Teachworth, co-founders of Trunamics in Orlando, Florida. “Most pain and tension in the body result from structural imbalances due to chronically shortened or lengthened tissue. So, in SI, instead of chasing pain, we seek to address its causative factors.”
The Mystery of Fascia
Jacobson describes fascia as “a gelatin with lots of protein fibers—it’s like a biological fabric.” But that said, he stresses that “very little is known about fascia,” particularly how it functions on an everyday level in living people.
Organizations such as the Fascia Research Society2 hope to support and encourage more research to better understand fascia. A 2020 workshop sponsored by the National Institutes of Health HEAL Initiative focused on myofascial pain, identifying new directions where research might go. These include using up-to-date imaging techniques to understand the complex interactions between muscles and fascia.3
The fascial system is an amazingly designed web that transfers, converts and absorbs force,” says Ann Teachworth, LMT, “and where we find a lot of our proprioceptors,” which provide our sense of where our body is in space. According to a 2018 article in the Journal of Bodywork and Movement Therapies, “a high density of nerves is found in fascial tissue.”4
Jacobson emphasizes the need for more research to establish SI as a reliable and acceptable pain intervention in clinical settings. “It’s important to establish the mechanism of how it works,” he says. “If you have a credible mechanism, you are taken seriously, and if you don’t, you are not.” Acupuncture, he says, has a proven mechanism that allowed researchers to conclude it helps with pain. As a result, acupuncture is now generally accepted in clinical settings.
A 2020 study in Front Physiology assessed the effectiveness of 10 sessions of SI on the fascial tissue of 13 women.5 The researchers found that the SI interventions “demonstrated positive effects on increasing superficial blood perfusion, contributed to a decrease in FT [fascial tissue] stiffness and an increase in elasticity properties in the dominant upper limb.” According to Jacobson, there is more research in the pipeline. “We need two things: clinical trials and case series. We need to know how SI has its effect, and we need to show it has a good clinical effect.”
SI in Practice
Typically, SI protocols are 10 or 12 sessions, each with a “specific targeted goal,” says Elizabeth Scupham, LMT, a practitioner at Anatomy Trains in Dunwoody, Georgia. “The series is designed to take the person through their entire connective tissue network systematically, hour by hour.” Alternately, a session may be built around one targeted area. After the first round of sessions, people may continue to come in for “tuneups.”6
Rolf believed that gravity was a significant factor in how we hold ourselves. “Her observation was that we live our entire existence in gravity,” says Jacobson. He adds, “She talked about grace in movement—that the joints should be free to move in a balanced way, flexors should flex and extensors should extend.” SI practitioners will frequently position clients in different postures to understand where tense and painful areas are located. Daniel Tsukayama, LMT, says his sessions begin with a “viewing” of the client’s body, both standing and in motion. He says he is “particularly interested in the position of the client’s pelvis and how other structures above or below the pelvis respond to its alignment.”
“A common pattern you see is due to our flexion-based lifestyle (sitting often)—the quadriceps, hip flexors, adductors and abdominals aren’t able to eccentrically load, restricting overall function,” says Ann Teachworth. “In that case, a client’s pain will often occur in the neck and upper back.” However, Lynn Teachworth points out, “If you loosen those posterior muscles that hurt (rhomboids, trapezius, levator scapulae) without getting into the hip flexors, quadriceps, abdominals, pectoralis and anterior neck muscles, you will make a client feel better for a few hours, but you’re actually driving them further into dysfunction.”
SI views the body as a system and, as such, seemingly local pain may originate from more global issues. Ann Teachworth uses lower back pain as another example. “What are the relationships in the body that are causing structures in the lower back to manage forces or movements that are beyond their capacity?” she asks. Many people sit at computers all day and lack thoracic extension or mobility; the lumbar spine may be forced to compensate by absorbing or transferring more force than it should because of lack of motion elsewhere. “If relationships aren’t properly balanced, an area [of the body] is just not going to function optimally.”
Finding the Line SI may have an undeserved reputation for being painful. As Tsukayama observes, “While there is often an intensity that accompanies this work, sustained discomfort or pain during a session should not. Throughout my sessions, I closely monitor my client’s comfort levels via verbal feedback, breathing patterns and other nonverbal cues.”
Scupham says she takes a “significant” client history that includes accidents, illnesses, surgeries and traumas. If fascia is injured, it will form adhesions or scar tissue as part of the healing process. Ann Teachworth compares it to sewing torn fabric. “You have to lay down more thread, which makes it denser,” she says. When healing, “there will be a similarly dense reorganization of fibers within fascia.” “When therapists do hands-on work [on fascia], they often say they are ‘releasing’ it,” Ann Teachworth says, “but fascia is very strong, especially when we talk about deep fascia that is relatively fibrous and dense.” When working with scar tissue, SI sessions may be particularly intense. “When we work with an area of densification, there may be more pain,” she adds. “But people want SI because they want a more specific type of work to address unhealthy patterns, and overcome pain and limitations.”
Jacobson cites the results of a 2015 study that he led on the feasibility, effectiveness and discomfort after treatment of SI when compared with outpatient rehabilitation (OR) for 46 patients with chronic nonspecific low back pain. He says they found “no greater incidents of moderate pain following treatment in the SI plus OR group than in the group receiving OR alone.” The researchers write, “Compliance with SI treatment was high, suggesting that any discomfort associated with it did not dissuade the majority of participants … from attending.”7
Scupham thinks client engagement is essential. “I stress that we are working together and that their participation in the session has a powerful effect,” she says. “It’s the interactive nature of the work that makes the change, more than a stroke or a technique.” She has clients perform small movement patterns, such as joint flossing, flexion extension and range of motion, “while I am either deepening the movement of my hands, resisting the movement or extending the range or depth involved.” She also will use a bench, with the client seated. “There may be some restriction in the muscle layers, fascial layers or both, and as we repeat movements, I’m able to assist the client to sense and feel areas of restriction, so that together we are able to get a fluid expression of the movement pattern.”
Practitioners often choose to study SI after they have experienced it themselves. “When I got off that table,” Lynn Teachworth, LMT, remembers, “I knew right there that if I didn’t learn it, I would be limiting my potential impact for clients. It was such a profound change in my body.”
I find that athletes, performers, actors and dancers are great candidates for SI because they are people who are constantly looking for ways to enhance performance,” Scupham says. “And the demands of performance often leave a history of injuries and strain in the structure, which SI can significantly alleviate.”
While becoming a certified SI practitioner is a substantial commitment involving hours of training, Tsukayama, who practices at Structural Bodywork Hawai’i, feels all therapists could benefit from learning about it. “I believe that employing just a few basic SI ideas and protocols will undoubtedly increase the efficiency and confidence in therapists’ practices and will be hugely impactful for their clients.”
“SI is both a science and an art,” says Scupham. “It is lifelong learning [and] a commitment to improving the skills necessary to engage a person’s body and mind. It makes every session an exciting adventure.”
Massage Therapy Journal
Research: Myofascial Techniques & Immune Function
1. New to Structural Integration? (2020)
3. Workshop Synopsis. HEAL Workshop on Myofascial Pain (9/16– 17/2020), National Institutes of Health.
4. Gonzalez CAA, Driscoll M, Schleip R, Jacobson E, Findley T, Klinger W. "Frontiers in fascia research." Journal of Bodywork and Movement Therapies, Sept. 13, 2018.
5. Jedrzejewski G, Kasper-Jedrzejewski M, Dolibog P, Szygula R, Schleip R, and Halski T. "The Rolf Method of Structural Integration on fascial tissue stiffness, elasticity, and superficial blood perfusion in healthy individuals: The prospective, interventional study." Front Physiol., 2020; 11:1062.
6. Structural Integration: The architecture of health. International Association of Structural Integration (n.d.). Retrieved from https:// iasi.memberclicks.net/assets/images/iasi-brochureproof.pdf.
7. Jacobson EE, Meleger AL, Bonato P, Wayne PM, Langevin HM, Kaptchuk TJ, and Davis RB. "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.