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 Feldenkrais Method: Clinical Applications (physical therapy)

 

By Frank Wildman, Ph.D.

Many physical therapists are now familiar with the Feldenkrais® Method. Yet, there remains some uncertainty about the place of this controversial method in physical therapy due to a lack of familiarity about what the method involves. What is the Feldenkrais Method® and what are some of the major differences and similarities with techniques already familiar to physical therapists?

The Feldenkrais Method® is an approach to improve peoples' ability to learn and to function through simulating the exploratory style of learning natural to infants. At its heart is the overwhelming need for learning in human development and the equally enormous capacity for learning throughout life. A major concern of the Feldenkrais Method® is to enable the person to include body parts never before considered in one's image of movement and to experience how the whole body cooperates in any motion. In this way, people can learn new patterns of movement specifically designed to expand body awareness and to enhance the neuromuscular self-image through more efficient and comfortable movement.

The Method accomplishes these goals through two parallel techniques:

Awareness Through Movement® (ATM) lessons consist of verbally directed movement sequences presented primarily to groups. The lessons, which last up to an hour, are not "exercises" but, rather, highly structured movement explorations. Many are based on developmental movements and functional activities as well as on more abstract explorations of joint, muscle, and postural relationships. The lessons begin with comfortable, easy movements that gradually evolve into movements of greater range and complexity. The inhibition of habitual neuromuscular rigidities and the expansion of motor options increases sensitivity and reduces muscular stress so as to improve sensory motor learning and increase efficiency. There are hundreds of ATM lessons to choose from in the Feldenkrais Method, from ones simple for the disabled to perform to difficult lessons that would be reserved for those who already have superior movement abilities.

Functional Integration® (FI) is an intensive, hands-on technique used for individuals requiring more specific attention. The practitioner promotes and communicates changes in a patient/student's body organization, enhancing muscular efficiency, coordination and ease. This is done by touching or moving the patient/student in ways that hint at new functional motor patterns.

The patient/student then assembles a more complete image of movement, mostly at a subcortical level, which can be translated into new achievements. (The image to which I refer is kinesthetic, visual and neurophysiological. It is similar to Dr. Karl Pribram's image of achievement.)

Whether the practitioner uses ATM, FI, or both depends upon the needs and aspirations of the patient/student. In serious neurological and orthopedic disorders, FI might at first be the exclusive modality, until the patient/student is better able to direct his own movement.

The Method is commonly used by people with all types of clinical disorders, from hemiplegia and cerebral palsy to acute or chronic back and other pain problems. Interestingly, it is also used by superior athletes, dancers, and musicians who have recurring injuries or stress symptoms and by their coaches and physical education teachers needing more refinements in movement analysis and teaching technique. Other major areas of application include elderly citizens with motor limitations, people with breathing disorders, and those suffering from chronic anxiety and psychosomatic disorders. The method has been dramatically successful in those shadowy medical areas where both diagnosis and/or treatment are difficult or where there is little hope for further improvement.

One of the most striking aspects of the Feldenkrais Method® is that functional limitations are not corrected or treated. In Functional Integration, for example, the practitioner's touch is instructive, not corrective. The Method engages the patient/student in a learning environment custom-made in each treatment/lesson to the unique configuration of that particular person at that moment. Through kinesthetic rapport, the practitioner conveys the experience of comfort, pleasure and ease in movement while the patient/student learns how to reorganize his body, including his limitations, in new and more effective ways. The patient/student experiences the practitioner not as someone trying to shape him to a concept of normalcy, but rather as someone who understands him deeply and feeds that back to him as useful information. The areas in which he operates effectively and comfortably then begin to expand into other functions not previously achievable. Never does the patient experience himself as a trained animal drilling to become "normal."

A simple example is a woman with difficulties in the head, neck and shoulder region. Rather than working exclusively on the problem area as though it were a mechanical entity operating independently of her whole functioning, a Feldenkrais practitioner would look comprehensively at how she arranges her body in movement and in rest. She will have a very specific gait, balance and joint motion in her hips, knees and ankles, as well as a characteristic distribution of tone in her feet and hip adductors. She may also have an overactive sympathetic neural charge that makes it hard for her to relax, normalize her tone or engage in a learning process. The Feldenkrais® practitioner would tailor a Functional Integration lesson to help her become aware of how her overall, fixed patterns of movement are stressing the particular area with which she is preoccupied. A Functional Integration lesson for this woman would require a keen analysis of her unique arrangement of self-limiting patterns of movement. In addition, the practitioner must recognize how she obtains information about her body and how she organizes this information, so if a joint is mobilized it is experienced as part of a whole pattern that changes with the new joint position.

If one has little awareness of the lower back's relationship to the forward movement of the head upon getting out of a chair and does not understand how that affects hip and knee extension at exact moments, a person who suffers damage from any source may find rising to standing a difficult or impossible feat. Likewise, an athlete who uses weights and continuous repetition to try jumping higher may be unaware of similar spatial and temporal relationships and therefore may never be able to become a superior athlete. People like this usually blame their difficulty on lack of strength or talent rather than on kinesthetic misunderstanding and an incomplete body image.

How much of ourselves can we bring to the image of an action we want to achieve? This is the important question to ask about anyone's ability to function effectively in the world. The more limited a person becomes through accident, stress or badly learned, fixed habits of behavior, the less he can bring to the image of an action. Each person needs to become aware of exactly what is missing in his or her internal representation of what is needed to act.

Most people limit their self-image by learning only what they absolutely need to know about their bodies and in a disorganized way at that. In addition, the individual must conform to patterns of action that are socially imposed. These actions are then generalized to any situation, which does not necessarily serve the person well in life. One of the major effects of the Feldenkrais Method is enhanced ability to learn, not just movement skills, but the process of learning itself. Learning to dissolve rigid, habitual patterns of action and behavior linked to ordinary motor skills serves the interests of occupational therapists, educators, and learning theorists working with the mentally handicapped as well as with superior achievers.

The more we learn to recognize sensations that correspond to increased ability and comfort, the less we need to repeat the same movement lessons and the more we can internalize and recreate those sensations. Once a lesson is clearly represented internally, then the practitioner and patient/pupil move on to expand other parts of the self-image.

One of the most exciting things about working in this way is that one begins truly to work with the whole person. Someone coming for Functional Integration lessons does not experience him or herself as a "hemi" or as someone needing his back put in place. Instead, he begins to understand his own dynamic organization within the context of the unique learning environment created by the practitioner.

Many occupational and physical therapists enjoy studying and applying the Method not only because of its effectiveness but because it allows them open-ended creativity in their work. Many feel they are able to involve their patients in the excitement of discovering something entirely new each session rather than re-applying known procedures with occasional variations.

Another difference between this and other approaches involves the training of a Feldenkrais® practitioner. Studying the Method requires considerable self-development and experiential understanding on the part of the therapist. Achieving kinesthetic rapport and feeling the complex involvement of another person's system demand that the therapist's sensory capacities be greatly heightened along with his ability to integrate and organize his own movements. (Functional Integration refers to the functioning of two systems as one cybernetic whole.) Awareness Through Movement retrains the therapist's sensory-motor system to enable him to use FI as more than a set of clever tools or techniques. Without this improvement of the therapist's system well beyond what could have been learned from previous academic or clinical studies, many of the procedures in FI will not work. They are dependent upon subtle and discrete changes which many experienced therapists cannot at first sense and therefore cannot feed back to the patient.

Some therapists have asked for research supporting the Feldenkrais Method®. Research which supports any effective treatment modality also supports much of the Feldenkrais Method. However, a technique that is pushing back the envelope of possibilities cannot be explained or even described accurately until such time as research catches up with the clinical experimentation that the Method is currently offering. This has been true for every method new to the profession. So far, the effectiveness of the work has greatly surprised many skilled physical therapists, occupational therapists and physicians, not to mention their patients. By the time we all think we know why it works, I hope it will have developed into something better yet.

For those interested in background material, I would suggest a careful reading of the works of Nobel laureate Dr. Gerald Edelman, in particular his notions of coordinative structures. The most useful material lies in the realm of learning theory and cybernetics. Drs. Humberto Maturana and Francisco Varella's notions of self-organization and cognition in biological systems is excellent for establishing an appropriate context for understanding the Feldenkrais Method®. These ideas allow for a more complete notion of the therapist, the environment, and the patient's internal character structure as they are involved in learning and improving function.

Note: Dr. Wildman developed a Feldenkrais® audio cassette series originally to serve as an introduction to the method and as an adjunct to clinical application seminars designed for occupational and physical therapists. Remastered as CDs, the course is available through the Feldenkrais Movement Institute by clicking here.

©1988 Dr. Frank Wildman
as published in Physical Therapy Forum
Volume VII, No. 6, February 8, 1988

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