Neuromuscular Integration and Structural Alignment (NISA)
by Margaret Colborne

What does a massage therapist with chronic pain in the left shoulder do? How does she continue her practice when each day the pain gets worse? That was my situation in 1987.

Having tried all the different therapies available without relief, I was beginning to think I'd have to change careers when an associate at my clinic offered her help. "This is what's called Neuromuscular Integration and Structural Alignment(NISA)" she said "and I've just completed the first Toronto workshop." After her treatment, I became free of pain for the first time in years and developed a passion for NISA.
 
In order to see the development of NISA we have to go back to the mid 80s and a Florida LMT, Jean Loving, owner of Seminar Network International, the massage school in west Palm Beach, Florida. Jean Loving developed this technique from SOMA bodywork, a soft version of Rolfing. NISA differs from Rolfling/SOMA by taking a little longer (12 sessions instead of 10) and approaching the body somewhat more gently to accomplish the same goal of structural alignment.

My own experience of receiving NISA led me to the next workshop Jean Loving taught in Toronto, Canada, and to a long and valued association with her. I now teach workshops across Canada and the wonderful feedback from participants is a constant inspiration to me.

In order to understand NISA, it is necessary to know the major anatomical structure that NISA affects. The NISA technique is designed to affect the fascia, which is a system of broad, web like sheets, envelopes and bands of fibrous tissue found everywhere in the body. The fascia envelops every muscle and connects muscle cells to each other. It lies underneath the skin and wraps around organs and bones.

The strong collagenous fibers of the sheets of fascia are multi-directional, forming web like cocoons. They provide a framework and give shape to the body. According to Leon E. Page, D.O., "If it were possible to remove all the tissue elements of the body with the exception of the connective tissue, the superficial appearance of the body would not be greatly altered."

Fascia is categorized in several ways: superficial (the first layer under the dermis); deep or investing (the layer that wraps itself around muscle groups, individual muscles and muscle fibers); serous (the layer that surrounds the organs). In addition, there are areas where fascia thickens to form bands and provide extra support in various crucial places, for example, the retinaculum at the ankles and wrists (see fig. 1).

Fascia serves many functions. The first and most important function is that of connection. Fascia interconnects throughout the body, forms a framework holding and shaping cells, muscles, organs, vessels and nerves and, as well, wraps around the bones as periosteum. Fascia also has a viscous quality that allows structures to glide over one another. This is, of course, crucial because it enables muscles and other soft tissue to act independently. We all have experience of what happens if the opposite occurs, when restriction in some area inhibits normal movement. A few years ago, I treated an elderly man who had a chronically poor range of motion in his neck. This lack of mobility was seriously impeding his lifestyle, particularly his ability to drive. In just a few NISA sessions, I managed to separate the adhered layers of fascia which were holding the upper back and neck in a hard and frozen state. He regained the lost mobility and, more importantly, has it to this day.

In an ideal well-aligned body, the tissue is soft and pliable. However, life happens and bodies struggle with gravity. Poor posture, physical or emotional trauma and disease take their toll. The fascia contracts, the layers adhere and become congested. Blood flow, energy, range of motion and independent function of muscles are reduced. Pain and a chronic holding pattern results.
A direct fascial technique, such as NISA, addresses these problems by separating and stretching. The NISA technique uses a shallow angle of entry, some lotion for lubrication and a "spreading" of tissue. The latter technique addresses the multidirectional nature of fascia. All three aspects of the technique reduce the pain normally associated with structural bodywork.
One of the most exciting aspects of this work is the visual difference that a NISA treatment makes. This measurable difference reinforces both the effectiveness of the therapist's work and the improvement of the client. I begin with a body reading of the client, not only looking at how the bones line up on a plumb line but also observing bulges and creases in the soft tissue that indicate compression. These restrictions in the fascia are often a more accurate guide to the source of the pain than a client's own report. After treatment, I take another body reading and can see changes in the alignment. Perhaps a shoulder has dropped and the head has found a better position over the spine. Creases and bulges may have disappeared and clients generally report feeling lighter and looser. In fact measurement with an arthrodial protractor will prove this to be so.

A frequent appreciation from clients is the long-lasting effects of this type of treatment. Often pain is completely relieved after only one session. However, it may be necessary to take the client through the entire structural alignment series to get lasting improvement. For example, if the head is leading due to severe kyphosis and lordosis (see fig. 2) and the whole structure is out of alignment, the series of 12 sessions will shift postural patterns towards a better relationship with gravity.

The series works systematically through the whole body, bringing it into harmony. Weekly treatments maintain the momentum of change and yet allow time for integration. Clients become involved in the process by setting their own goals. They are invited to include a goal that is more internal in nature (spiritual, psychological, behavioral) along with a physical one. This internal goal may or may not be shared with the therapist. Such connections between the body, mind and spirit are addressed in various books, including Anatomy of the Spirit by Caroline Myss and Women's Bodies, Women's Wisdom by Christiane Northrop.

The initial session consists of the body reading (mentioned above). I take Polaroid photographs and measure body height and neck range of motion. I look for any creases, bulges, fascial pulls, torques, or postural deviations from the plumb line. I also note whether the body appears to be in balance. For example, does the upper body look like it belongs to the lower body, does the left side fit with the right? I'm also looking for a centre line: is the navel centered over the pubis, the sternum over the navel and do the chin and nose line up?

I also look for potential emotional messages of the body. For example, might those drooping shoulders indicate sadness, vulnerability, defeat or a sense of being overburdened? In other words, it is important to be aware of the underlying emotional climate in order to be able to treat the whole person. As Jean Loving explains, "If our attention is on the client and we are listening with our whole being, observation will be an outside and inside connection to our clients. Some call it hard-seeing and soft-seeing. Develop an eye for soft-seeing."

If we look at the client in figure 2, we can see restrictions in the anterior chest area. Since session five addresses the anterior chest and self-identity issues, the therapist might therefore anticipate some reaction during or after this session and be accepting and supportive should the client share their experience. For example, after session five, this client had feelings of vulnerability surface (see fig. 3). It would be appropriate to reassure the client that feelings of this type frequently arise from this session.

After the initial body reading assessment, the first session addresses the superficial fascia in a generalized treatment. The next eight sessions address adhesions and restrictions in the deep layers, starting with the feet and working through the entire body. Although sequential, sessions overlap and difficult areas of the body are revisited. The last three sessions are integrative in nature. In other words, as a simplification, nine sessions consist of taking the body apart and the last three sessions put it back together again. At the end of session 12 the assessment process is repeated.
 
Therapists wanting to learn this technique, can contact Seminar Network International in Florida 1-800-882-0903. The first part of the training, consisting of the Basic NISA four-day workshop, can be made available through local Massage Associations and schools. This diploma course is also taught regularly at Seminar Network International in Florida and Sutherland Chan School in Toronto. The Basic gives grounding in fascial anatomy and techniques, and an introduction to postural work. Because the workshop is predominantly hands-on, it enables the therapist to immediately incorporate the new technique into their practice.
 
The Basic enhances any practice, but therapists wishing to expand into full postural alignment with the holistic approach, can take the Certification course of four workshops, over the course of four months. These four-day workshops enable 3 sessions, of the 12 in the series, to be taught each month. This very intense process involves the participants observing a model receiving 1 of the series of 12 from one of the instructors. After observing, the participants then exchange sessions with each other. As well, each participant takes 2 clients through the sessions in a supervised clinic. We teach the Basic with 1 instructor for every 12 participants, and the Certification course with 2 instructors for 6 to 12 participants. Candidates for any of the workshops must already have massage or related training.

Anyone participating in these courses can identify with Still's observation: "We can see all the beauties of life on exhibition by that great power with which fascia is endowed. The soul of man with all the streams of pure living water seems to dwell in the fascia of his body" (A.T. Still, developer of osteopathy in Philosophy of Osteopathy, 1899).
 

Margaret Colborne of Colborne Therapy Centre has happily retired as of August 2009. We at Massage.ca wish her well in all her endeavours.

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