By Frank Wildman,
In examining the field of physical therapy
today, I am reminded of the situation of the pre-evolutionists who began
investigating biology, geology, paleontology, and other natural sciences
in the 19th century. Their situation was remarkably similar. There was
a wealth of newly observed phenomena, and a profusion of methods to observe
more. But there was a conceptual void that made it impossible to account
for the many contradictions and inconsistencies in the observed data.
That there was a progression in the hierarchy
of fossils and life forms was observed time and again, but no one could
propose a theory that could account for all the data, and explain how
life began or how and why life moved in time toward ever greater complexity.
To explain all these myriad observations, and to try to integrate all
the catalogued information of the natural world, scientists proposed
incredible theories, like the spontaneous generation of life; the theory
of acquired characteristics; the theory of the diluvianists, who believed
the world had been destroyed by periodic great floods; the theory of
the vulcanists, who believed the world had been repeatedly inundated
It is important for physical therapists to
realize that each of these theories were founded on large amounts of
scientific research and had great numbers of scientists supporting each
of them, while often ridiculing the others. Some tried to find a way
to synthesize bits of all of them into some eclectic world view. Eventually
many scientists began suspecting that something was missing in all of
these theories and that there was a need to find something completely
different, something outside of any particular hypothesis but yet able
to contain or link all of the data in one over-arching, integrated view
Today, there are a large variety of techniques
available in physical therapy and many diverse schools of thought brought
to bear upon the patient population. However, the many theoretical and
clinical inconsistencies and occasional discrepancies between techniques
point up a lack of agreement as to what basic principles of human functioning
underlie effective treatment. I observe an unfortunate lack of any integrated,
comprehensive theory pertaining to the function of brain and body that
could include all modalities of patient care.
Many therapists resolve this dilemma by using
an eclectic approach. They might problem solve a particular neurological
case by using some N.D.T. here and a little P.N.F. there, depending on
the type of condition or sometimes according to what seems to work best
at the moment. This can create problems, since assumptions underlying
the operational models of P.N.F. about how the brain actually functions
are quite different from the models used for N.D.T. It is as though there
are two different brains with mutually exclusive principles of operation
in the same patient's head. This leads to occasional disagreements with
therapists from the other school of thought as to what is an appropriate
or good treatment plan. And although many therapists have studied and
use both, there are also many strict adherents to one or the other, because
they feel "the other" is not well thought out enough, or less workable.
Therapists working in the orthopedic area
who use joint mobilization procedures have blended another eclectic variety
of techniques derived from Maitland, Caltenborn, and several others.
The work of Cyriax, the Norwegian muscle energy techniques, and cranial-sacral
work are often added to the list after the therapist has been exposed
to them in continuing education courses. That some of these methods contradict
each other, both in application and in functional principles, often leads
to a "do whatever works best" approach.
The critical impasse that affected all the
sciences about 100 years ago was overcome by Darwin's theory of the evolution
of life by natural selection. It was the most creative, important and
far-reaching perception of life that Western civilization had developed
for a millennia. Darwin's theory quickened the thought of the world,
tied together many confusing and fragmentary loose ends in all fields
of science, and changed our view of life and our place in it forever.
Darwin's insight enabled the emergence of a truly scientific world view.
It was the missing link for all natural and biological sciences.
It is my opinion that physical therapy is
at a critical juncture not dissimilar in kind from that facing those
pre-evolutionary scientists. What is needed today is an encompassing
model that links together all of the disparate practices and hypotheses
currently operating in the physical therapy profession--one especially
that dissolves the historical division between mind and body and thereby
fully links together psychological as well as physical healing arts.
In order to develop a conceptual framework
to integrate the current procedures in Physical Therapy, a model must
be developed that would include all aspects of human functioning from
motion to emotion. As is the current focus in physics, there is a need
to discover a unified "field theory" to encompass all the types of clinical
cases that are worked with piecemeal in the hospital and clinic today.
At the heart of this more potent conceptual
framework for physical therapy should lie the recognition of not only
the enormous capacity for learning that exists in the human being but
also the overwhelming need for it. The reason an increasing number of
neuroscientists and researchers are becoming interested in the Feldenkrais® Method
is because the method not only speaks to this need to learn but has developed
clinical skills that consistently use the singular aspects of human learning
ability in application to everything from serious orthopedic problems,
to chronic pain patients, to infantile neurological disorders, to the
training of superior athletes, to the field of geriatrics. It is especially
interesting that this is done using one consistent conceptual framework
and set of practices.
Models of human learning sophisticated enough
to handle the immense task of conceptually integrating all of the biosciences
have already been developed by such prominent biologists and neuroscientists
as Humberto Maturana ( Ph.D., Neuro-biology, Harvard University) and
Karl Pribram (M.D. Ph.D., Stanford University Neuro-Psychiatry Lab and
President of the Feldenkrais Foundation), and other scientists involved
in the exploding field of cognitive studies. What interests them is that
the clinical applications of these models are already being utilized
in the sensory-motor learning approach of the Feldenkrais Method.
Of course, there are already numerous models
of sensory motor learning based on developmental sequencing in use by
many Physical Therapists. However, most of what is meant by learning
in currently utilized models such as P.N.F., N.D.T., sensory motor integration,
etc., is really conditioning. A great confusion exists in differentiating
between the type of learning that takes place in conditioned responses
and the learning process based upon self-awareness of which only a human
being is capable.
In current physical therapy curricula there
is a healthy tendency to want to become more "scientific" in the approach
to patient care. This is necessary; however, there is a proclivity among
many people to try to explain all aspects of human ability from the lowest
level of organization possible for example, the naive belief that if
we could only understand physics and biochemistry in relation to neurology
we would come to a scientific understanding of the human mind. Therefore
nothing is considered valid unless it can be referred back to the basest
level of understanding. This is not scientific but rather a misapprehension
of the nature of science.
To describe the functional capacity of a patient
in terms of the most fundamental levels of operation in an attempt to
be more scientific is like defining a dog as a barking cabbage. From
this perspective, human learning does indeed look like nothing more than
an elaborate pattern of conditioned reflexes, all of which rest upon
lower levels of biological processes at the foundation. However, the
human capacity for self-awareness is very difficult to explain in a linear
and hierarchical manner, and such materialistic scientism refuses to
admit that humans have completely unique attributes that cannot be understood
in terms of components.
Part of the reason the Feldenkrais Method
is able to utilize the capacities of human cognition even with head injury
patients with short-term memory loss or infants with cerebral palsy is
because the Method develops attention both in selecting the patient's
field of attention as well as expanding their ability to attend to themselves.
The Method is able to improve people's ability to learn-not only to teach
them skills. This is accomplished by working with the patient in an instructional
manner, rather than attempting to correct them. The patient improves
overall cognitive abilities and self-awareness by improving their capacity
to make distinctions.
The capacity to make distinctions is the basis
of human awareness. If we do not know one thing from another, if we cannot
feel one state from another, we are left with no choice but to repeat
the same pattern of dysfunctional movements again and again. Without
improving the sensitivity of the patient to themselves and increasing
their self-awareness, they behave like a trained animal and bypass the
use of the human brain. The patient can accomplish far more by improving
their ability to make sensory distinctions that are correlated to improved
motor ability. In this way the patient's own nervous system is able to
find the best way possible to function. Otherwise, the patient simply
receives an imposed system of usage without any felt understanding. Every
patient is therefore viewed as a pupil to a Feldenkrais practitioner.
A feeling expressed by physical therapists
who have taken courses in clinical applications of the Feldenkrais Method
is that they no longer look at the patient only in terms of primary symptoms.
Instead they understand how to explore the patient's learning style.
They become excited about working with the whole person. It has been
pointed out to me over the years by many Physical Therapists that most
of what they were doing in working with patients was trying to correct
impaired individuals by finding whatever procedure from whatever school
of thought seemed to enable some improvement in function.
For example, when a therapist mobilizes a
patient's spine, far more occurs than the simple movement of a joint.
That patient's nervous system responds to the touch and to the movement
and records it as a piece of potentially useful information. After taking
courses in the Feldenkrais Method, orthopedic therapists realize that
a measurable effect of their work is in the neurological area. And more
than that, they learn how to use the contact, the directions of the movements
and the pressure of the touch to teach the patient how they need to rearrange
their body to avoid locking the joint or how to stabilize a hypermobile
joint in extraordinarily precise ways. What a powerful thing it is for
a therapist to know how to utilize this capacity of the nervous system
to change and to learn, rather than treating the patient like an object
that needs something to be pushed into place.
After studying the Feldenkrais Method, therapists
working with neurological patients have expressed relief in finding a
theory and set of practices that is inclusive of several contradictory
theories and sets of practices they have previously learned. Many physical
therapists who have taken training programs in the Feldenkrais Method
have revealed to me that the Method provides the synthetic key in their
own educations and practices. This seems to be especially true for more
experienced therapists who "have done it all".
As progress continues in physical therapy
there will someday be a link established among the many diverse practices
and approaches involved in working with the human body and mind. As evolutionary
theory provides the missing link that enables all biological sciences
to proceed, the Feldenkrais Method offers the theoretical and technical
bases to do this for physical therapy.
© 1988 Dr. Frank Wildman
as published in Physical Therapy Forum
Volume VII, No. 6, February 8, 1988