The Mini-BESTest outcome provided detail about the degree that various biological systems were affected by the RMSI series. Though the subsections are the convergence of more than one aspect of balance, each of the four categories provides a particular focus.(3)
The first section measured the subject’s ability to anticipate postural adjustments. This subscore increased the least post-intervention because the client was lacking the strength needed to accomplish the tasks of rising onto toes and standing on one leg.(3) Corrective exercise would improve performance of these tasks,(25) although home exercises were outside the scope of the RMSI intervention. The second section shed light on the subject’s ability to recover equilibrium with a fast step in the direction required to bring her feet under her center of mass.(3) Improvements in these tasks signify an improvement in proprioceptive feedback and rapid motor response.(3) The third section, sensory orientation, tested the client’s vestibular system as well as sensory integration when standing on varied surfaces with her eyes open and closed.(3) Again, there was an improvement in these tasks post-intervention, particularly in standing with feet together and eyes closed on a foam surface. The subject was unable to balance for more than one second before the RMSI series, and post-intervention was able to balance more than 30 seconds. This improvement is likely due in part to the emphasis the Rolf Method puts on improving the client’s sense of herself in space. Calm awareness and confidence are brought to posture and movement during each session. The client is taught to appreciate and perceive the relationship between movement and posture and emotional states that support or detract from her balance and function. This enhancement in self-awareness in turn affects the frame of reference the vestibular system has for spatial orientation.(28) In the last subcategory, dynamic balance during gait, improvements were recorded in the walking over obstacle task and walking to a pivot turn task. There was no improvement in a task that required attention split between walking and a cognitive task, nor walking with a head turn. This subsection tested sensorimotor programs related to posture and gait as the client managed walking with various challenges.(3)
These improvements in score may be due to a recalibration of sensory organs found within the fascia. The nervous system receives the greatest amount of sensory information from myofascial tissue,(15) therefore manipulation of this tissue can alter sensory feedback. Histological findings have discovered contractile cells, free nerve endings, and mechanoreceptors within the fascia, most abundantly in the superficial fascia.(16,18,20) Aponeurotic fascia, such as the thoracolumbar fascia and fascia lata, function to transmit tension between adjacent joints, and between synergistic muscle groups, which creates an anatomical continuity.(18) Furthermore, these mechanoreceptors in these fascial sheets can perceive the stretch of underlying muscles via myotendinous junctions.(15,18) At a more local level, mechanoreceptors in epimysial fascia associate with individual muscle fibers are stimulated to correspond with the particular muscular contraction.(18,26) A distal muscle perceives the state of contraction of a proximal muscle through fascial connections. Furthermore, the transmission of stretched fascia can stimulate muscle spindle cells, thus influencing muscle contraction.(18) The neurological communication through connective tissue may be how a global approach to manual therapy such as RMSI could have significant effects.
These findings lend to the conception that the RMSI series may have removed distortions in the fascia, which had the effect of improving the communication between sensory organs in fascia and muscle and also force transmission through segments of the body. As a result, there may have been some improvement in the transmission of force through kinetic chains, proprioceptive feedback, spatial awareness, and neuromuscular coordination. This is what the fascial researcher Robert Schleip termed “sensory refinement”.(15)
There is some research to corroborate the far-reaching role of fascia in muscle function, proprioception, and transmission of tension.(6,7,11,20) Most notably, a study of thirty-three healthy men recorded electrical and mechanical vibration response of muscles remote to a muscle being massaged. Electromyogram/mechanomyogram (EMG/MMG) hybrid probes detected signals from the middle deltoid and tensor fascia lata (TFL) before and after manual therapy to the brachioradialis and peroneal muscles, respectively. EMG amplitude increased in the TFL only, and MMG increased in TFL and deltoid(7) showing continuity between remote structures via fascia. Another study found proprioceptive acuity in the ankle joint measured by dual inclinometer was significantly greater in a massage-treated gastrocnemius with exercise-induced muscle damage as compared to a control.(17)
Through the course of the series intervention, the client reported her surprise when she tripped over an obstacle in a parking lot and caught her balance. She experienced less knee pain going up and downstairs, particularly following the 5th session, which included the myofascial release of the quadriceps. She also was pleased with a newfound ability to sit cross-legged in the car, representative of improved hip and lower extremity flexibility gained during the RMSI series.
The outcome measure of this study offers insights to help physical therapists treat patients with balance disorders, however, it does not preclude the need for further diagnosis to determine the most accurate cause of balance loss. The change in objective measure reported herein could be further analyzed by other tests to clarify the nature of the constraints of the subject. Secondly, the validity of the outcome measure could be strengthened by having a formally trained physical therapist administer the Mini-BESTest. Research has demonstrated that inexperienced raters, without physical therapy experience were able to learn and score the BESTest with good accuracy, however, a therapist with expertise in the nuances of testing may have provided more accuracy.(3) Last, each SI practitioner brings different levels of experience and education to the process, which could make the reproduction of the results difficult. Additionally, more research is needed to observe whether several subjects experience a similar level of improvement before broader conclusions can be drawn about the efficacy of RMSI as a therapy to prevent falls among elderly people.