Spatial Medicine

We used the term ‘Spatial Medicine’ to describe the larger realm to which Anatomy Trains is a conceptual contribution, and in which KMI, and Structural Integration in general, lives and has its being. Let’s peer into that macroscope a bit to inquire more deeply to see our place within that larger whole. We examine space first, medicine second.

Fundamental to the understanding of large, slow-moving objects in this universe (that’s us, for example, or planets, as opposed to quarks, quanta, and electrons) are the concepts of space, matter, and time. Since I am no physicist, let’s stay simple: Space seems to be this largely empty medium that goes on for billions and billions of miles all around us. Matter is stuff that takes up space, moving and changing within it. Time is the way we measure the movement of matter through space.

Scientists gather that the beginning of this space-time-matter energetic dance was about 13.7 billion years ago, when this universe flared forth into being. Tiny disturbances, or fluctuations in that Big Bang ultimately produced stars, planets, and, more recently, us. What was happening before that (if ‘before that’ has any meaning), where the perturbations came from, and what will happen at the far end of this interesting ‘gesture’, are all mysteries.

Indeed, all these concepts basic to our work and life remain fundamentally mysterious, as does ‘gravity’, a word Structural Integrators bandy about all the time. Time, except for disconcerting experiences of past lives, déjà vu, or psychic clairvoyance of things yet to come, seems to flow in one direction only. Clocks measure it in seemingly regular intervals, though our own perception of time is much more malleable. (Einstein’s Dream quote)

What space actually is likewise remains a mystery. Is it really ‘nothingness’, or is it more likely a medium – the ether, say – through which things happen, as Einstein posited? Like time, it is hard to define, but it is equally hard to imagine a world without three-dimensional space.

Even matter, the simplest of these concepts for a baby to understand - smacking a hand on the table or letting water run through your fingers, or leaning into the wind - becomes confusing when you look at it closely. The material world, when we get into its very small crevices, dances away from the easily-perceived solidity into different forms of energy and information.

We will return to this dance of energy and information later. For now, without plumbing the depths of any of these terms, all of which – Space, Time, and Matter - are awash in controversy and complexity if you look deeply (quantumly), each of these fundamental human percepts has led to its own modes of healing or self-development.

Chart 1 – 3 systems

The most accepted form of medicine in our era is linked to matter – so we could call it Material Medicine. Material Medicine looks at the interactions of matter in the body, and alters those interactions by introducing different chemical substances into the system. We started with herbs in the ‘way back when’, but have progressed through the efforts of so many dedicated physicians and researchers to the current sophistication of vaccinations and the complex molecular chemistry involved in today’s prescriptions. Whether or not you believe that we have gone a bit overboard in our reliance on these material interactions, we must admit that Material Medicine’s exploration of biochemistry and hygiene has yielded some pretty impressive and interesting results.

All the different diets, from Atkins to Zen Macrobiotic, the whole nutritional supplement boom, and even the herbal ‘simples’ and tonics are also based in Material Medicine – altering the matter and the interactions of matter in the body. Anything that uses a substance to alter our health or functioning would fall in this category.

Homoeopathy falls at an interesting edge of this designation, however, since the whole project is based on how substances affect us, but the medicines themselves have been so reduced as to probably have only traces or perhaps not even one molecule of the original substance remaining. The fact that homoeopathy works at all drives the priests of Material Medicine, the allopaths, wild, because it flies in the face of the chemical model and falls over the cliff into the realm of Energy Medicine. Same goes for acupuncture and its derivatives.

Healing based around our interaction with time, which we can call Temporal Medicine, is also in current practice, even if it is not so dominant or developed. Psychiatry and psychotherapy principally look at where we have become stuck in time, and attempt to get us unstuck. The ability to live in the ‘now’, essentially a spiritual discipline, has everyday healing applications when we start carrying around the effects of events from the past, or let worries about the future affect our current functioning.

The ability to ‘complete’ or resolve events from the past is essential to living freely in the present. When a past event still lives within you, still governing your behavior or keeping you from moving on, you are stuck in time, and you thus need Temporal Medicine. The function of psychotherapeutic intervention is to resolve these old events that control you, to have them become like other events in your memory – experiences to learn from, remember, and build upon, not shoes nailed to the floor of perception and action.

Shamanistic healing is often also based around Temporal Medicine, getting the person unstuck from inner ‘programming’ based on the past. The scope of shamanism is so wide that this definition of it may be too limiting, but in this author’s experience, the practical result is often similar to that of good psychotherapeutic intervention – the freeing of the soul and will from the tyranny of the unresolved past – even when that past extends back into past lives or the collective unconscious.

We should note that both psychiatry and shamanistic practices sometimes partake of Material Medicine. Psychiatry increasingly relies on SRI and SSRI drugs such as Prozac and its kin, along with Ritalin and lithium and all the other ‘meds’ prescribed to bring sufferers of mental disorders back to ‘normal’. Shamanism has long made use of a different class of psychoactive alkaloids, though often the intent is not to bring the ‘patient’ back to ‘normal’, but rather to use the distinctly abnormal push through mental or perceptual blocks to arrive at a new norm for consciousness.

The third instrument in this trio (perhaps we should include Energy Medicine and make it a quartet, as acupuncture clearly contributes to health but is not readily classifiable in any of these categories) is the family of healing practices associated with the changing of Space. Less explored, certainly less well documented, Spatial Medicine heals via shifting relationships within, in other words, actual structural relationships and/or their kinesthetic proprioception.

Ida Rolf’s seminal work (and its extension, KMI) remains a genuine contribution to this larger endeavor, of course, but it is not the only one. The scope of inquiry within the world of Spatial Medicine is very wide, considering issues of evolution and maturational development, authentic self-expression, the relationship between spatial arrangement and physiology, and of course the complex details of biomechanics.

Starting with this most ‘simple’ area of biomechanics, what are the elements in Spatial Medicine? One can parse this in different ways, but the basic elements are the bones, the connective tissues (of which bone and blood are both examples, but we refer here to the predominantly fibrous soft tissues that comprise the ligaments, tendons, and fasciae), the muscles, the nerves that run them, and the afferent nerves that keep the central nervous system informed about the condition of all these elements. If we change these elements, or the relationships among them, or the perception of their relationships, we are practicing Spatial Medicine.

The biomechanical tissues can be divided fairly neatly into categories, though another practitioner might see different divisions in what after all is a unitary whole. The reality in the body is a spectrum of building materials that are chemically or electrically induced according to need. The bones are one readily identifiable set. The cartilaginous end plates, discs, rib extensions, and voice box would be another. The bones are often assembled into the familiar skeeton, but one never sees ‘cartilage man’ – the entire set of cartilage seen as a system.

The joint tissues, the periosteum and articular capsules, and their thickening into specific ligaments constitute another category. The parietal fascial planes would be a third category. We would divide the muscles into the outer ‘sleeve’ muscles and inner ‘core’ muscles, though firm boundaries between the two are hard to maintain. Then there are the sacs and bags that surround the organs of the ventral cavity and tie them into the parietal structures like the spine, ribs, and diaphragm. And finally, in the dorsal cavity, the meningeal membranes are fascial sheets that surround the central nervous system.

The perceptual tissues, nerves, which participate in spatial medicine would include the muscle spindles and the many (primarily stretch) receptors in the connective tissues, as well as the efferent tracts of the alpha and gamma motor nerves, their neuro-muscular junctions, and the motor patterns within the cerebellum and basal ganglia. The autonomic system to the organs might also be included, as would all the afferent nerves that give us conscious or subconscious perception of the organs, their connective tissue attachments, allowing us to perceive the condition of the rest of the tissues listed above.

Osteopaths and chiropractors, yoga and Alexander teachers, Feldenkrais workers, Pilates and dance teachers, martial artists, somatically-oriented psychotherapists, athletic trainers and coaches, bodyworkers of all stripes, and most especially the teachers of movement to children – all these and more labor in the vineyard of “Spatial Medicine’.

All Spatial Medicine practitioners seek what we could call ‘KQ’ – increased Kinesthetic Intelligence. We are accustomed to measuring IQ, and we are warming to the idea of EQ – Emotional Intelligence. But KQ – the intelligence of the moving body – has yet to be measured or mapped, with the result that, especially in our body-alienating culture, much of our KQ is wasted.

Spatial Medicine

In Spatial Medicine, nothing is added but information; nothing is taken away but strain. We do not mean to imply that Material Medicine - nutrition or drugs - have no effect on structure – sometimes they very much can and do. And the practice of Temporal Medicine – e.g. psychotherapy – can sometimes affect posture, as when a mental or emotional burden is relieved, and the body straightens in response.

But Spatial Medicine is working from a different premise from either of the other two: get the spatial order of the elements right, and you will contribute to health. Align the bones, free the glued fabric, balance muscle tonus – and watch the changes to chemical and mental health, as well as seeing the structure and movement itself improve. All the therapists working in the fields above can attest to stacks of anecdotal evidence for the kinds of mental, spiritual, and physiological changes that proceed from interventions to the structure and movement of the client / patient.

As an example, in my years of practicing Structural Integration, I have had many clients who were taking medicine or supplements for low thyroid function. Among these, a large plurality started exhibiting exopthalmia, slight mania, and other signs of hyperthyroidism toward the end of our series of treatments. I always tell them to go have their thyroxin level checked, and invariably this function has started working better, and it is necessary to reduce or eliminate the medicine to avoid overdoing it. This is not because I worked on the thyroid gland, but simply because – for reasons that are still obscure to me – the structural improvement produced a physiological improvement.

Although massage and ‘bonesetting’ reach back into the dawn of prehistory, and we must acknowledge our predecessors in ancient times, such as Asklepios and Galen, it is only in modern times that Spatial Medicine has been delineated and formalized. Of the giants who broke new ground in creating a science of Spatial Medicine, we must recognize Andrew Taylor Still, who founded Osteopathy and F. Matthias Alexander, originator of the Alexander Technique, as the two pillars on which the ultimate field to come will rest.

Still, with his deep understanding of structural relationships, and abiding faith in the vis mediatrix naturae, set the stage for Sutherland (cranial osteopathy), Palmer (chiropractic), Rolf (Structural Integration), and Barral (Visceral Manipulation) – as well as a host of other similar approaches.

Alexander, proceeding from his original insight into the retraction in the upper neck, brought forward the idea of the ‘use of the self’, which led directly to Feldenkrais and many others of similar philosophy. Unfortunately, the proper ‘use of the self’ has yet to take root in popular culture, though echoes can be seen in Pilates and other new approaches to exercise.

A third possible pillar in the realm of Spatial Medicine, though he bridges the gap between the strictly spatial and the psychological, would be Wilhelm Reich. Reich’s focus on the body and its patterns gives him a strong placement in the firmament of Spatial Medicine, which led to Levine, Lowen, Keleman, Kurtz, and the rest of the somatically-oriented psychotherapeutic approaches.

Others will insist on the primacy of still other progenitors: this whole area can be seen as an outgrowth of dance in its largest sense, and Joseph Pilates, with his ‘Controlology’ led the way in the modern world toward a coherent therapeutic theory for proper muscle balance via exercises that were and are an extension of the dance oeuvre.

Unless you are a studied member of the profession, many of the names above are probably obscure to you, which only goes to show how Spatial Medicine has yet to take its place in the Valhalla occupied by Material Medicine (Harvey, Pasteur, Sherrington), and – somewhat less – by Freud, Jung, and the other gods of Temporal Medicine. Over the next century, advances in Spatial Medicine, which are only now being researched, will contribute to developmental issues (i.e. orthodontic braces, club foot, immaturity), diseases with a mechanotransductive element (wound healing, sclerotic diseases), as well as the more traditional problems of mechanical pain and musculo-skeletal dysfunction.

Of course these divisions among healing approaches are analytical and somewhat arbitrary, as each bleeds into the other, and all occupy the same unified body and person, but the distinction is useful nonetheless.

There are two major approaches within Spatial Medicine – the biomechanical and the perceptual. The biomechanical in turn has two major divisions: one uses leverage, usually applied with the hand or other part of the body, or (as in yoga) using the recipient’s own body to exert leverage on another part, in order to change the length or apposition of body tissues. Chiropractors and osteopaths claim to be manipulating bones, whereas in actuality HVLA thrusts change peri-articular tissues – muscles and ligaments close to the joint; the bones themselves do not change. Bones can, in fact, change their internal structure slightly, but only in response to pressures sustained over weeks and months – think of a bone break healing - usually not within the therapeutic context.

Structural Integration workers play with the guy-wires that hold the bones – lengthening and freeing the fascial planes that surround the skeleton and help determine its overall shape. It is in this context that Anatomy Trains provides a useful map, and KMI as an applied extension of that map.

Visceral Manipulation biomechanically intervenes in the strictures to movement in the fabric that holds the organs to each other and the parietal body wall, and Craniosacral therapy, or cranial osteopathy, does the same with the meninges that surround and hold the brain to the skull and spine.

Thus, a complete approach to the body’s fascial fabric, a complete approach to the biomechanical aspect of Spatial Medicine, would need to include:

the ability to read the skeleton and realign bones,
the ability to read the whole body soft-tissue patterns and resolve them systemically employing myofascial release,
the ability to sense and release visceral restrictions in the ventral cavity
the ability to sense and release cranial motion and meningeal restrictions in the dorsal cavity, and
the ability to relieve adverse tension in the peripheral neurovascular bundles.

The second major approach to Spatial Medicine involves the training of the muscles – the contractile units within these structural biomechanical tissues listed above. Correcting adverse muscle tone, and creating a balanced tonus around the skeleton and within the fascial fabric, obviously contributes to spatial health.

There are too many systems of exercise to catalogue here – from the gentle to the strenuous, and from the most generalized to the therapeutically specific. The general populace is so kinesthetically deprived that nearly any form of exercise is better than none, but different people require different applications, and who needs what is only now beginning to be studied.

Pilates, Alexander, Gyrotonics, Feldenkrais, Yoga and Yoga Therapy, Callanetics, Nautilus, Aikido, Tai Chi, karate and the rest of the martial arts – the list is endless – but all seek to balance the body in terms of muscular tone, counting on this ‘fix’ to work its magic on the other biomechanical tissues listed above. Often it works, sometimes manipulative help is needed. In any case, muscle exercise and toning has a salutary effect on physiology and mentality even if the specific biomechnical intent is not realized.

Hand in hand with the biomechanical goes the perceptual aspect of Spatial Medicine. We often mis-perceive our own bodies. We miss signals that are there; we augment signals that are relatively meaningless, we ignore signals until the body breaks down.

Neuro-Muscular Therapy (NMT) has been a very popular and widely used method of breaking perceptual cycles that cause pain. By intervening at the neuromuscular junction, it is possible to change the perception of how we are in space and get the muscle to relax, changing how we actually are in space.

Changing how we perceive movement is a science of its own, studied by Feldenkrais, Aston, Meziere, Gerda Alexander, Hubert Godard, Continuum, Body-Mind Centering, Evolutionary Movement, and a host of other approaches that transcend ‘exercise’ into a perceptual shift of the spatial self.

This aspect is explored more in the ‘KQ’ section, so we will leave it here for now, but with the admonition:

It is the responsibility of practitioners within Spatial Medicine to be at least on familiar terms with the whole field. Too many are married to their own point-de-vu, to the point of disparaging other schools of thought and approaches. Some osteopaths disparage exercise programs, there is little love lost between chiropractors and osteopaths, the various schools of Alexander are at each others’ throats, the visceral manipulators call the cranial osteopaths ‘les coiffures’ (the hairdressers), the Feldenkrais folks find Structural Integration too brutal by half – and on and on the cycle of misunderstanding goes.

Even though your work may concentrate on one aspect or another – no one can cover them all, and trying to mix too many elements together is often a recipe for dishwater, though in the hands of a few it can be a delicious soup – you need a knowledge of how other systems work, and when it might be better to refer your client for supplemental help in another part of the spectrum. To do this well, you need to both experience and understand the scope of other branches of Spatial Medicine.

Over the next century, I strongly believe that Spatial Medicine – whatever it comes to be called – will flower and bloom. As KQ grows, so will our sophistication and reliance on our balanced body. As we live longer, healthy functioning of our frame will be ever more necessary.

So I say to the new practitioner, just starting out in this field: Know thyself – there are so many ways to do it; explore as many as you can find. Those with the widest vocabulary of touch, and the widest peripheral vision on this fascinating field, will be those who advance our understanding of the humane use of human beings (and coincidentally advance themselves in the process).

Spatial Medicine involves expanding our understanding of somatic maturational development – in other words, it is an anthropological study that includes both our physical and social evolution. It is the key to a whole new field of healing and growth in the human condition. Material Medicine – allopathy, our current medical system - has made great strides, and many refinements are still to come, but its major creative period is behind it. Temporal Medicine – psychology – is temporarily a bit stalled and diverted into chemistry, but has more discoveries left in it. But Spatial Medicine is just beginning to find its feet and its voice – a toddler, in other words, compared to the others. But like most toddlers, it has great potential and a great future if it is raised up properly.

Spatial Medicine

Spatial Medicine Expanded