Structural Integration and Rolfing: What It Is, Claims and Evidence

What It Is

Structural integration is a form of hands-on bodywork aimed at posture, movement and the connective tissue called fascia. Rolfing is the best-known version. The Dr. Ida Rolf Institute describes Rolfing Structural Integration as a type of hands-on bodywork developed by Dr. Ida Rolf more than fifty years ago, working with the connective tissues, or fascia, around muscles, bones, nerves and organs. [4] The Institute writes Rolfing, Rolfer and Rolf Movement with registered-mark symbols and says it is the school that certifies Rolfers. [5] Other schools teach other structural integration protocols; one case report, for example, used a 12-series protocol from a different school. [6]

How a Series Is Described

The Institute describes a "Ten-Series" of sessions, in three stages. [4] The first sessions are described as working on surface layers of connective tissue, with attention to breathing and balance. The middle sessions are described as addressing the core and deeper tissues, and the last sessions as integrating the earlier work into whole-body movement. [4] This is the Institute's own description of its method, not an independent finding.

How It Is Proposed to Work

A 2011 review in a complementary-medicine journal says SI aims to improve overall biomechanical function by moving toward ideals of posture and movement, rather than treating one symptom. [2] Suggested mechanisms in that review include increased tissue pliability, release of adhesions, and changes in sensory processing and vagal tone. [2] These are proposed mechanisms. The same review concluded that evidence for effectiveness and for these mechanisms is severely limited by small samples and a lack of control groups. [2] Our page on muscles, fascia and connective tissue explains why claims about changing fascia by hand are still debated.

What Research Shows

Evidence label overall: insufficient evidence. A 2004 review said only a few clinical trials had looked at Rolfing and that outcomes such as pain and function had not been looked at specifically in trials. [7]

1. Chronic non-specific low back pain

   Promising but limited; pilot size

   A pilot randomized trial of 46 people compared SI plus outpatient rehabilitation with rehabilitation alone. The pain difference was not statistically significant (P = 0.075), while a disability score was (P = 0.007). [8]

2. Young children with cerebral palsy

   Insufficient evidence

   A randomized trial of 29 children (treatment vs waitlist) found no group difference in the main motor outcome. Gait quality was associated with improvement. [9]

3. Range of motion

   Weak design; cannot show cause

   Retrospective record reviews of people who completed 10 sessions reported improved shoulder and hip motion (383 people) and lower-limb mobility (563 people), with no comparison group. [10] [11]

4. Neck pain and motion

   Weak design

   A retrospective review of 31 people reported less pain and more motion after 10 sessions. [12]

5. Pelvic floor muscle activity

   Preclinical-type measure in healthy people

   A randomized study of 33 healthy women found changes in some muscle-activity readings after 10 sessions. [13]

6. Fibromyalgia

   Not assessed

   Proper evidence not found. The Institute's research page mentions a clinical trial, but we did not find it in PubMed. [14]

Two limits apply. Hands-on therapy cannot be hidden from the person receiving it, so expectation and attention may contribute to improvements. Retrospective reviews of a practice's own records cannot show that SI caused the changes.

The Institute's research page summarizes the low back pain trial as suggesting that adding Rolfing to standard rehab may improve pain relief and patient satisfaction. [14] The trial abstract itself reported that the pain difference was not significant and concluded that SI was not likely to provide additional pain reduction. [8] Read practitioner-body summaries with that gap in mind. The Institute also says Rolfing is safe for children; [4] we did not find independent safety data in the sources we read.

Where It Fits

Related approaches are covered in myofascial release and massage types. Do not use bodywork to postpone seeing a clinician about a medical problem. [1]