Postural Reeducation Therapies
Three prominent therapies in the United States use as their approach the reeducation of the body through movement and physical touch. In all three systems--Alexander, Feldenkrais, and Trager--patients are taught how to retrain their bodies to come into alignment to release and change postural faults, to improve coordination and balance, and to relieve structural and functional stress. A major principle underlying the three methods is that awareness has to be experienced rather than taught verbally. The awareness may then lead to more effective use of one's whole self. Alexander technique. The Alexander method is a system of body dynamics, especially in respect to the head, neck, and shoulders. The technique was developed by the actor F.M. Alexander, who created the method after concluding that bad posture was responsible for his chronic periods of voice loss (Maisel, 1989). The technique includes simple movements that improve balance, posture, and coordination and relieve pain. During a session the client typically goes through a series of standing and seated exercises while the practitioner applies ~light pressure to points of contraction in the body. These pressures are intended to awaken kinesthetic response (sensitivity to motion by the muscles) and retrain the kinesthetic organs in the joints to their proper spatial relationship. The process is taught in many drama schools and is popular with performers. The techniques help clients learn how to use their bodies with less tension and more awareness and efficiency. Alexander practitioners report success with neck and back pain, postural disorders, whiplash injury, breathing problems, myalgia, rheumatica, repetitive strain injury, hypertension, anxiety, stress, and other chronic conditions. Feldenkrais method. The Feldenkrais method was developed by Moshe Feldenkrais, a Russian-born Israeli physicist, who turned his attention to the study of human functioning. His work integrated an understanding of the physics of the body's movement patterns with an awareness of the way people learn to move, behave, and interact (Feldenkrais, 1949, 1972, 1981, 1985). He began teaching his method in North America in the early 1970s. The Feldenkrais method consists of two branches--"awareness through movement" and ~"functional integration." • Awareness through movement. This verbally directed form of the Feldenkrais method consists of gentle exploratory movement sequences organized around a specific human function (such as reaching, bending, or walking) with the intention of increasing awareness of multiple possibilities of action. A group of students may be standing, sitting, or lying on the floor. Thinking, sensory perception, and imagery are also involved in examining each function. • Functional integration. This method involves the practitioner's use of words and gentle, noninvasive touch to guide an individual student to an awareness of existing and alternative movement patterns. The teacher communicates to the student--who may be lying, sitting, standing, kneeling, or in motion--how she or he organizes herself or himself and suggests additional choices for functional movement patterns. The use of touch is for communication, not correction, and there are no special techniques of pressing or stroking. Any changes in functioning result from the student's actions.~Practitioners report success with a variety of postural and functional disorders in such diverse applications as sports performance, equine training, physiotherapeutics, zoo animal rehabilitation, the performing arts, neurological and orthopedic physical therapy practice, pain management, and habilitation of developmentally impaired children. Currently, the North American Feldenkrais Guild has approximately 1,000 members. As of January 1994, 31 training programs lasting 3 to 4 years were available around the world for Feldenkrais practitioners. The method is a synthesis of modern ideas and basic research findings in perception, motor learning, neural plasticity, and sensory integration (Edelman, 1987; Georgopolus, 1986; Jacobson, 1964; Jenkins and Merzenic, 1987; Jenkins et al., 1990; Kaas, 1991; Kandel and Hawkins, 1992; Seitz and Wilson, 1987; and Sweigard, 1974). Only limited clinical research studies have been conducted to document the Feldenkrais method. Clinical successes have been cited in several review articles and clinical guidelines for physical therapy and pain management (DeRosa and Porterfield, 1992; Jackson, 1991; Lake, 1985; ~and Shenkman and Butler, 1989) and have included reports on exercise for the elderly and for persons recovering from spinal injury (Ginsberg, 1986; Gutman, 1977). In one research study, Jackson-Wyatt and colleagues (1992) used video analysis to measure the kinetics of the change in motor ability in a vertical jump test in a subject who completed eight 5-day weeks of 6-hour training days in a Feldenkrais practitioner training program. Dramatic improvement in power, velocity, and movement efficiency were demonstrated. Narula (1993) similarly examined the sit-to-stand movement, walking speed, and grip strength of four subjects with class 2 rheumatoid arthritis. After attending a twice-weekly 75-minute class for 6 weeks, all subjects showed decreased pain, improved walking performance, and improved kinetics of the sit-to-stand movement, but no improvement in grip strength. The results suggest that lessons in awareness through movement could be used by individuals to improve their functions despite long-term disabling medical conditions. ~Ruth and Kegerries (1992) used a 25-minute, four-step process to test the flexion range of neck motion in college students before and after half the group received a 15-minute sequence from the awareness through movement methods. Compared with the control group, students experiencing this sequence showed measurably improved neck flexion motion and a decrease in the perceived effort to accomplish this motion. Since Feldenkrais's functional integration method involves a highly individual interaction between practitioner and client, outcomes research should be long-term, using both subjective and objective measures. Such studies could establish whether various applications of the Feldenkrais method are useful both for medical care and in educational systems. Trager psychophysical integration. The Trager method uses light, rhythmic rocking and shaking movements that loosen joints, ease movement, and release chronic patterns of tension. This method was developed by a Hawaiian physician, Milton Trager, on the basis of his experience as a trainer for the sport of boxing. The Trager practitioner uses his or her hands with the aim of influencing deep-seated psychophysiological patterns in the client's ~mind and interrupting the projection of those patterns into body tissues. This method of movement reeducation is distinguished by compressions, elongations, and light bounces as well as rocking motions. These actions cause patients or clients to begin to experience freedom of movement of their body parts. Since practitioners believe they are affecting the inhibiting patterns at their source, it is expected that clients can experience long-lasting gains. The goal of Trager work is general functional improvement, partly by creating a feeling of pleasure in being able to move body parts more freely. The process incorporates a meditative state called "hookup," which is intended to enhance sensory, kinesthetic, and other pleasurable experiences for the client. Several case histories describe long-term improvement in movement function for persons with multiple sclerosis; in chest mobility with lung disease (Witt and MacKinnon, 1986); and in trunk mobility with childhood cerebral palsy (Witt and Parr, 1986). Other reports suggest ~success in treating chronic pain of various sorts, headaches, muscular dystrophy, muscle spasms, temporomandibular joint pain, recovery from stroke, spinal cord injuries, and polio. The Trager method also includes Trager "mentastics," a system of mentally directed physical movements developed to maintain and enhance a sense of lightness, freedom, and flexibility. Mentastics is used by Trager practitioners and is taught to clients to enhance results. There are now more than 800 certified Trager practitioners around the world. Training is available in the United States and several other countries.

 

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