Structural Integration was never intended to be a quick fix for a bad back. Its intent is to gradually align and balance the entire body, and thus support the long-term stability of the back. But, that said, it’s unlikely a day will go by in your practice without seeing at least one client whose hips are uneven and whose back is hurting.

When we see a client whose back is hurting, we can assume that at least one hip will be locked in an elevated position and one in an anterior or posterior tipped position. That tells us that supporting the ability of the pelvis to pivot at the femoral heads and the ability of the pelvic basin to rest in a level and ‘horizontal’ position is critically important. But the means to accomplish this may not be immediately obvious.

Thus far in class, we have talked about what might be keeping the hips elevated and rotated, and how to ease these rotations and support the capacity of the pelvis to move independent from the legs. We have worked to free adhesion between the quadratus lumborum and psoas layers to ease lateral flexion of the thorax and hip rotation. And we’ve worked to release the hamstrings at the ischial tuberosities, the quadriceps from the ilia and the abductors from the inferior edges of the pubic bone to support the mobility of the pelvis and its ability to move independently from the legs.

We now shift our focus to supporting the ability of the pelvis to pivot at the femoral heads by releasing the lateral hip rotators adhered to the femoral heads and ischial rami, and creating mobility and balance between these rotators and the iliopsoas tendon.

To help conceptualize the functional interrelationship between the lateral hip rotators and the iliopsoas layers, we might imagine a Venetian blind. The iliopsoas layers would be the draw strings that raise and lower the blind, and the lateral hip rotators would be the horizontal slats that lift and drop as the psoas elongates and contracts.

But before we can free those lateral hip rotators and support the pelvis’ ability to pivot at the femoral beads, we must release and balance the tension between the rectus abdominis and iliopsoas layers. That’s because the pelvis is held in a dynamic balance between the rectus abdominis attaching to the superior margins of the pubic bone and the tendons of the iliopsoas layers attaching to the lesser trochanters of the femurs. So, we must first release adhesion of the rectus, which can lock the pelvis in a posterior tipped position, and adhesion of the iliopsoas, which can lock the pelvis into an anterior tipped position.

For the pelvis to be free to pivot at the femoral heads and for side-to-side balance between the femurs, there must be mobility and side-to-side balance between all the rotators – especially between the piriformis and obturators (both internus and externus). Easing the imbalance between these layers will help ease torsion between the ischium and sacrum, and between the sacrum and spine.

This description is, of course, overly simplified and does not address the need to create greater overall balance between the core and sleeve, and the pelvic floor and respiratory diaphragm. But even if it’s not a quick fix, this process should really help clients feel better quickly.