Fibromyalgia syndrome treated with the structural integration Rolfing ® method

Abstract

BACKGROUND AND OBJECTIVES:
Rolfing method is a procedure to integrate human body structure, which considers people’s physical and emotional aspects. It consists in 10 deep manual interventions (myofascial release) applied to the elastic structure of the loose connective tissue (myofascial) and in reeducation of movements. This study aimed at checking the effectiveness of the method to treat fibromyalgia patients in relieving pain and states of anxiety and depression.

METHODS:
Participated in the study thirty patients of the Pain Center, Neurological Clinic, Clinicas Hospital, School of Medicine, University of São Paulo, who were submitted to 10 Rolfing sessions and have maintained their routine outpatient treatment. All patients were evaluated by the pain verbal numeric analog scale and by Beck’s Depression and Anxiety Inventory, applied during initial interview, in the last session and three months after treatment completion.

RESULTS:
Treatment was effective and has shown statistically significant difference in evaluated items.

CONCLUSION:
Patients’ improvement was correlated to Rolfing method intervention.

Full text

248
Rev Dor. São Paulo, 2014 oct-dec;15(4):248-52
ABSTRACT
BACKGROUND AND OBJECTIVES: Rolng method is a
procedure to integrate human body structure, which considers
people’s physical and emotional aspects. It consists in 10 deep
manual interventions (myofascial release) applied to the elastic
structure of the loose connective tissue (myofascial) and in re-
education of movements. is study aimed at checking the eec-
tiveness of the method to treat bromyalgia patients in relieving
pain and states of anxiety and depression.
METHODS: Participated in the study thirty patients of the Pain
Center, Neurological Clinic, Clinicas Hospital, School of Medi-
cine, University of São Paulo, who were submitted to 10 Rolng
sessions and have maintained their routine outpatient treatment.
All patients were evaluated by the pain verbal numeric analog
scale and by Beck’s Depression and Anxiety Inventory, applied
during initial interview, in the last session and three months after
treatment completion.
RESULTS: Treatment was eective and has shown statistically
signicant dierence in evaluated items.
CONCLUSION: Patients’ improvement was correlated to Rolf-
ing method intervention.
Keywords: Chronic pain, Complementary therapies, Fibromy-
algia, Quality of life.
Fibromyalgia syndrome treated with the structural integration Rolfing®
method*
Síndrome fibromiálgica tratada com o método Rolfing® de integração estrutural
Paula Stall1, Manoel Jacobsen Teixeira1
*Received from the Pain Center, Neurologic Clinic, Clinicas Hospital, School of Medicine, University of São Paulo São Paulo, SP, Brazil.
1. University of São Paulo, School of Medicine, Department of Neurology, São Paulo, SP,
Brazil.
Submitted in May 23, 2014.
Accepted for publication in September 18, 2014.
Conict of interests: none.
Correspondence to:
Paula Stall
Rua Eneas de Carvalho Aguiar, 255 – Cerqueira César
Instituto Central 5º andar
05403-900 São Paulo, SP, Brasil.
E-mail: paulastall@hotmail.com
© Sociedade Brasileira para o Estudo da Dor
RESUMO
JUSTIFICATIVA E OBJETIVOS: O método Rolng é pro-
cedimento de integração da estrutura corporal humana, que
considera os aspectos físicos e emocionais do indivíduo. Con-
siste em 10 intervenções manuais profundas (liberação miofas-
cial) aplicadas na estrutura elástica do tecido conjuntivo frouxo
(miofáscia) e em reeducação dos movimentos. O objetivo deste
estudo foi vericar a ecácia do método no tratamento de paci-
entes bromiálgicos no alívio da dor e nos estados de ansiedade
e de depressão.
MÉTODOS: Trinta pacientes do Centro de Dor da Clínica
Neurológica do Hospital das Clínicas da Faculdade de Medicina
da Universidade de São Paulo foram submetidos a 10 sessões de
Rolng e mantiveram o tratamento ambulatorial de rotina. To-
dos foram avaliados de acordo com a escala analógica numérica
verbal de dor e com o Inventário de Depressão e de Ansiedade
Beck, aplicados durante a entrevista inicial, na última sessão e
três meses após o término da aplicação do tratamento.
RESULTADOS: O tratamento foi ecaz e apresentou diferença
estatisticamente signicativa nos quesitos avaliados.
CONCLUSÃO: Os pacientes tratados apresentaram melhora
que se correlacionou com a intervenção do método Rolng.
Descritores: Dor Crônica, Fibromialgia, Qualidade de vida, Te-
rapias complementares.
INTRODUCTION
Fibromyalgia syndrome (FMS) is currently considered syn-
drome with generalized decrease in pain tolerance. era-
peutic interventions recognized as most eective are antide-
pressants and analgesics, rest, relaxation, heat and massage1.
Massage is useful to treat bromyalgia patients because it im-
proves sleep disorders, psychic symptoms such as anxiety and
depression, and pain intensity2. FMS pain may trigger reex
protective muscle spasm, which causes further pain and re-
sults in progressive movement limitation, stiness and adop-
tion of inadequate posture3.
In general, bromyalgia patients have amplied body sensa-
tions and relationship of dependence on relatives and pro-
fessionals. ey report mood changes, non-restorative sleep
and disproportional fatigue to the developed eort4. Conicts
trigger and worsen FMS1. As consequence, there is further
ORIGINAL ARTICLE
DOI 10.5935/1806-0013.20140053

249
Fibromyalgia syndrome treated with the
structural integration Rolng® method
Rev Dor. São Paulo, 2014 oct-dec;15(4):248-52
distress and decreased quality of life5. Symptoms may be
caused, worsened or maintained by emotional inuence.
Rolng is the method developed by North-American bio-
chemist Ida Pauline Rolf during the 1960s in California
(USA). It aims at balance and human postural alignment
quality by means of manipulation and movements’ orienta-
tion and enhancing. e method aims at improving body
functions, organizing its structure and showing that it is pos-
sible to overcome pain.
Ida Rolf has considered that fascial adaptation mechanism
acts by contraction: muscle tissue under tension shortens,
thickens, stiens and links to neighbor structures; bone con-
nected to it is pulled and its natural balance point is changed.
Since we move as a whole, each restriction aects the totality.
So, movements become ineective, there is excessive energy
consumption and adjacent muscle groups are activated in-
stead of remaining at rest6.
She noticed that when muscle tissue tone is balanced, the set
presents less resistance as a consequence of connective tis-
sue elasticity and plasticity. However, it is necessary to un-
derstand how each person moves and misaligns his/her own
body from verticality to improve joint bones relations and
musculoskeletal disorders.
According to Rolf’s expectations6, when changing gestures,
thoughts and ways to deal with daily life, bromyalgia pa-
tients, subjects of this study, may develop mechanisms to
control their symptoms, to adopt more positive posture with
regard to the disease, thus not allowing pain to master their
lives, this way recovering quality of life and conquering better
social adjustment.
Ida Rolf believed that a balanced body makes human be-
ings better. e belief that it is possible to overcome pain by
adopting a new posture with regard to the disease has justi-
ed this study which aimed at evaluating the eect of Rolng
method on pain intensity and anxiety and depression status
presented by bromyalgia patients.
e Rolng method, internationally recognized as complemen-
tary therapy, does not replace conventional therapies, but may
be part of the multidisciplinary approach often indicated for
chronic pain patients. It is worth highlighting that this method
may be useful to treat other diagnoses and symptoms; however
evaluation and approach should be carried out by specialists.
METHODS
Participated in the study 30 female of age patients, diag-
nosed by neurologist according to medical criteria proposed
by the American College of Rheumatology as having FMS,
who were individually submitted to 10 Rolng sessions at
CDCN-HCFMUSP. All patients were randomly selected and
evaluated in the beginning, at the end and three months after
proposed treatment, and have maintained routine treatment
previously prescribed by this outpatient setting.
Inclusion criteria were bromyalgia patients able to under-
stand and answer with autonomy to proposed tests and who
had never received Rolng treatment. Exclusion criteria were
severe psychic changes or illiteracy. All patients were under
conventional outpatient treatment for at least one year and
had not shown expected improvement. Because pain is a sub-
jective symptom and patients were already been treated, the
group itself was considered control. We decided to compare
the group to it, where patients were the evaluators of their
pain before and after application.
All patients were assisted by a psychologist, specialist in this
method, were volunteers for the study, have signed the Free
and Informed Consent Term (FICT) and have met research
protocol.
Evaluation tools
• Pain Verbal Numeric Analog Scale (PVNA);
• Beck Depression Inventory (BDI);
• Beck Anxiety Inventory (BAI).
PVNA has measured pain in a scale from zero to 10: patients
were oriented to verbalize the point corresponding to the
magnitude of their pain between the edges zero, that is, ‘no
pain’ and 10, that is, ‘unbearable pain’.
BDI and BAI have measured depression and anxiety intensity
by means of self-applied questionnaire. ese tests consider
the subjective aspect of analyzed items and patients have eval-
uated their pain as well as emotional symptoms.
e Rolng method is characterized by working with myofas-
cial release in parts of the body and with movements’ re-educa-
tion, because each session has specic biomechanical goals. e
process was completed in stages, during 10 individual sessions,
once a week, lasting 30 minutes. In this process, the therapist,
by means of tissue manipulation, has stimulated diaphragm re-
spiratory freedom indicating relaxation and tensions relief. e
therapist has pointed that the vertical axis had two directions
(head rostrally and feet caudally) and that knees exibility and
balance come from the contact of feet with the ground.
en, contralateral movements were improved to help align-
ing pelvis to the chest. Myofascial release concentrated on
scapular and pelvic girdles, and movement on arms and legs
motor coordination.
en ischiotibial and paravertebral muscles were exercised,
where focus was to make patients aware of their spinal ex-
ibility, the stretching of posterior muscle chain and ground
contact via legs and feet. Finally, the therapist has encouraged
head balance with regard to neck and the axis as a whole. For
such, manipulation aimed at dierentiating head from neck,
improving spatial orientation by means of new movements.
Free movement was always reinforced so that patients could
nd what is most comfortable inside of them. e objective
was to create conditions for them to adopt new posture and
gestures and to incorporate them to their daily life. ere has
been no report of adverse eects.
Statistical analysis
Non parametric Friedman test7 was used. All variables were
descriptively evaluated and quantitative variables related to
minimum and maximum value, means and standard devia-
tions were calculated to obtain treatment results.

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Stall P and Teixeira MJ
Rev Dor. São Paulo, 2014 oct-dec;15(4):248-52
is study was approved by the Ethics Committee for the
Analysis of Research Projects, Clinical Board, HCFMUSP,
under number 305/2004.
RESULTS
Sample characteristics are shown in table 1. Symptoms im-
provement was maintained from treatment completion until
at least three months after its suspension. ere has been sta-
tistically signicant dierence at the rst evaluation moment
in all evaluated items; there has been no dierence in the sec-
ond moment, showing that the result was maintained, except
for anxiety which continued improving even after treatment
suspension (Tables 2 to 6).
Table 5. Changes in pain intensity, depression and anxiety
Variables Moments Mean SD Median Minimum Maximum n p
Pain Beginning 9.07 1.14 10.0 7 10 30 <0.001
Treatment completion 2.80 1.79 3.0 0 5 30
Three months later 3.07 2.02 3.0 0 9 30
Depression Beginning 29.80 11.41 30.5 10 53 30 <0.001
Treatment completion 11.43 9.27 8.5 0 31 30
Three months later 8.13 6.43 8.0 0 27 30
Anxiety Beginning 37.30 12.75 36.5 13 58 30 <0.001
Treatment completion 13.87 10.01 11.5 1 53 30
Three months later 10.53 9.58 7.0 0 44 30
Table 1. Sample characteristics
Variables n %
Marital status
Single 8 26.7
Married 16 53.3
Divorced 3 10.0
Widow 3 10.0
Skin color
White 23 76.7
Pardo 7 23.3
Education (years)
Elementary (up to 8) 20 66.7
High school (up to 11) 5 16.7
College (more than 11) 5 16.7
Table 2. Pain intensity according to verbal numeric analog scale
Pain intensity Before treatment At treatment completion Three months after treatment completion
n % n % n %
No pain 0 0 5 16.7 4 13.3
Mild 0 0 6 20 8 26.7
Moderate 0 0 13 43.3 13 43.3
Severe 4 13.3 6 20 4 13.3
Unbearable 26 86.7 0 0 1 3.3
Table 3. Anxiety level according to Beck Anxiety Inventory
Anxiety level Before treatment At treatment completion Three months after treatment completion
n % n % n %
Minimum 0 0 12 40 21 70
Mild 2 6.7 12 40 5 16.7
Moderate 8 26.7 5 16.7 3 10
Severe 20 66.7 1 3.3 1 3.3
Table 4. Depression level according to Beck Depression Inventory
Depression level Before treatment At treatment completion Three months after treatment completion
n % n % n %
Minimum 3 10 17 56.7 23 76.7
Mild 4 13.3 6 20 5 16.7
Moderate 14 46.7 7 23.3 2 6.7
Severe 9 30 0 0 0 0

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Fibromyalgia syndrome treated with the
structural integration Rolng® method
Rev Dor. São Paulo, 2014 oct-dec;15(4):248-52
DISCUSSION
is study has indicated that treatment has contributed to the
recovery of bromyalgia patients. Rolng method’s proposal
is to improve communication of musculoskeletal structures
with the nervous system6. Ida Rolf has concluded that what
prevented ideally free and natural movement was related to
myofascial tissue, perception, neuromotor coordination and/
or emotional meaning.
e Rolng method is based on general organism response
(homeostasis) and contemplates connective tissue continu-
ity, thus treating individuals as a whole rather than treating
symptoms alone. Its objective is that, via punctual interven-
tion, tissue manipulation reaches the whole body, so as to re-
cover balance also in regions distant from those manipulated.
So, function and biomechanical stability may be enhanced
by fascial manipulation and by sensory-motor education by
reaching minimum stress and overload and maximum daily
movements’ eectiveness.
By relieving tensions, stimulating new body perception and
the development of functional resources, the therapist teaches
patients to cultivate the ability to separate established and
already incorporated habits from new movement patterns
causing less biomechanical tension8. Patients are active par-
ticipants of the process so that one works with patients and
not on patients.
e Rolng method aims at patients improving their biome-
chanical action by learning more eective movements as a
consequence of postural alignment8, thus nding new inter-
ests in themselves and the environment where they live, and
learning new ways to move and to cope with pain. Body bal-
ance is also part of the well-being scenario6,9. It oers quality
in spatial orientation and helps dealing with movement-in-
duced instability. Even if symptoms were not totally resolved,
patients were able to conquer new skills, which is an initial
healing possibility. Jacobson10, in his review, reports ndings
of chronic pain improvement in patients treated with Rolng.
Touching may intensify therapeutic skills and patients’ recov-
ery. When regaining freedom of movements, they nd their
way to relax, to move and to cope with their own conicts. So,
this technique may help rening stress coping mechanisms
and the resolution of problems generated by the chronic na-
ture of the disease4.
Life strength motivating and mobilizing healthy individuals
to pleasurable face their lives is in general absent in bromy-
algia patients. FMS is like the end of a process where patients
see no chance of recovery. e contact with themselves is
made through pain. Without resources to deal with this, they
are depressed, imprisoned in their own pain. In this stage,
chronic disease does not tend to self-healing, but rather in-
creasingly to worsening.
Depressed patients have fear of changes, with pain, they para-
lyze inside themselves and loose creativity, that is, the human
ability to create something new. Patients treated with the Rolf-
ing method could get something new in the perception of
them, as well as in pain perception and have acquired the possi-
bility of daily life transformation and action. rough touching
and new movements, they were awakened for a new awareness
and reality of themselves. Patients were strengthened and new
conquers have inuenced also the emotional eld.
Ida Rolf shared the ideas of Wilhelm Reich and also believed
that chronic tension determining muscle pattern restricts
movement and postural alignment, which may contain and
be related to emotional and behavioral issues, in addition to
stress10. Although ndings related to psychological benets
have still not been suciently investigated, there are reports
on decreased levels of anxiety and depression after Rolng
treatment10. However, clinical ecacy evidence is still very
limited due to the scarcity of studies.
For the study group, treatment has provided improvement of
analyzed symptoms and has shown that it is able to mobilize
bromyalgia patients when they understand that pain may
mean a concrete reality of their self and body ‘obstacles’ over-
coming. It is certain that antidepressants and analgesics help
treating FMS1
. However, future studies are recommended to
evaluate the eectiveness of the association of dierent drugs
to the Rolng method to see whether there is possibility of
decreasing quantity and maintenance duration of such drugs,
as well as to validate the hypothesis that this method may
improve sensory processing and contribute to individuals’
psychological health10.
CONCLUSION
Treatment had positive, statistically signicant eect on pain
intensity, anxiety and depression. Patients presented changes
Table 6. Multiple comparisons to evaluate differences among values observed for pain intensity, depression and anxiety
Variables Comparison Z value p
Pain Begining versus treatment completion 8.03 <0.001
Beginning versus three months later 8.12 <0.001
Treatment completion versus three months later 0.09 0.927
Depression Begining versus treatment completion 7.30 <0.001
Beginning versus three months later 8.85 <0.001
Treatment completion versus three months later 1.55 0.121
Anxiety Begining versus treatment completion 7.12 <0.001
Beginning versus three months later 9.31 <0.001
Treatment completion versus three months later 2.19 0.028

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Stall P and Teixeira MJ
Rev Dor. São Paulo, 2014 oct-dec;15(4):248-52
in initial condition which were correlated to Rolng method
intervention. However, the relationship between pain de-
crease and psychological benets shall be further investigated.
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