Bernice Landels has been in the massage therapy profession since 1990, and taught at the New Zealand College of Massage for many years. As an educator, Landels and her colleagues used case studies as one way of assessing their massage students. “I always believed that there was more to be learned by the student in the process, however,” Landels explains.

A move to the United Kingdom later in her career introduced Landels to structural integration, where she found the research limited. “Unlike the research and published case studies lying behind massage therapy, there were limited resources or evidence available,” she remembers. “Instead, structural integration relied on anecdotal evidence.”

Landels took that as her cue to start documenting the benefits she believed structural integration offers in a more evidence-based way. “I felt I had a responsibility to my profession to,” she says. “What is structural integration? The big question for me was how structural integration worked and how effective it was as a modality.”

Those bigger questions prompted Landels to enter a case study competition sponsored by the Ida P. Rolf Research Foundation, where she investigated how a more global, whole-body approach using structural integration may benefit clients managing site-specific rehabilitation goals.

See Also: Myofascial Release and Pain Management Post-Surgery and in Postpartum Depression

The Plan. “The client had fractured her ankle, was recovering from surgery, and was looking for assistance with her rehabilitation,” Landels explains. “That was her primary goal.”

Initial conversations with the client, however, uncovered that the client’s injury had left her with aches and pains in other parts of her body, too. “The client’s rehabilitation had been limited and she was discharged as being functional because she was able to walk unaided,” Landels explains. “No consideration was given to the fact that her level of function prior to injury used to be much higher.”

Together, Landels and the client developed a protocol following the Anatomy Trains Structural Integration 12 series. “This protocol focuses on approaching the whole body—a global approach—in a systematic way rather than just dealing with presenting issues,” Landels explains.

Landels and the client worked together for 12 sessions over several months. “Each session was approximately 90 minutes, and there were a couple of follow-up sessions at the end,” Landels says. “Hands-on techniques were mostly fascia-based, along the lines of myofascial release, and most of the time the client was engaged providing movement under my hands, elbows, and forearms, similar to pin and stretch, though my contact was not stationary. I glided with the movement.”

The Results. Results included a reduction in lower leg edema, increased range of motion, postural improvement, and the client’s return to sport. “I used both photographic measures and a variety of feedback tests, such as the Weight Bearing Lunge Test, Lower Extremity Functional Scale, McGill Pain Questionnaire, and the WHO Quality of Life Questionnaire,” Landels says.

The client noted a reduction in pain, and her WHO Quality of Life Questionnaire reflected overall satisfaction with the results. “She has actually been in touch with me over the last two weeks as she’s fractured her hand playing hockey and wanted to book some rehabilitation sessions with me again,” Landels adds.

See Also: Helping Massage Clients Recover from Ankle Fractures

Words of Encouragement. “While my case study was not strictly massage focused, I think the value is in the big picture,” Landels notes. “Often, clients with one major focus area will have secondary issues that they may not think are relevant. To gain a full picture of your client is important because everything is connected.”

Landels also appreciated how this case study reinforced her awareness of the foundational role a person’s feet play in wellness. “This client’s upper body complaints were directly related to how she was standing and moving,” Landels says. “Injury aside, how often do we look at someone with shoulder tension and make adjustments at the feet, through the pelvis and ribs to help the shoulders? Relationships within the body are so important. We need to stop looking at issues as presenting in isolation.”

Read the case report.

Bernice Landels is a massage therapist, speaker, and author. She won the Ida P. Rolf Research Foundation’s case report award for her “Structural Integration: A Global Intervention Challenging the Limitations of Local Rehabilitation.”