The Feldenkrais method
Catherine Wycoff
History of Intervention:
The Feldenkrais Method was invented by Dr Moshe Feldenkrais (1904-1984). Dr Feldenkrais was a physicist and worked as a research assistant under
Nobel laureate physicist Frederic Joliot-Curie at La Sorbonne while studying for his “Ingenieur” doctorate degree, performing some of the first experiments in
atomic research. He had practiced jiu jitsu since the early 20’s and had designed his own self defense techniques. He was the first European to receive a
black belt in Judo ( in 1936). In 1940, he escaped to England just as the Germans arrived in Paris. As a scientific officer in the British Admiralty, he
conducted anti-submarine research in Scotland. In 1942, he published a self defense manual, Practical Unarmed Combat and Judo. Soon after that, he
suffered a crippling knee injury which was the result of a series of sport-related injuries and of his work on submarines. The doctors he consulted gave him
a very bleak diagnosis, a 50 %chance that a surgery to repair his knees might be successful and a chance that he might not be able to walk ever again. He
refused the surgery and started studying neurology, anatomy, biomechanics and human movement development. Armed with his newly acquired
knowledge and his physics and martial arts background , he completely restored his ability to walk by developing a way to improve his body that was to
become the Feldenkrais method. He stayed in London, where he published in 1949, his first book on the method: “Body and Mature Behaviour”
Inspired by his thorough examination of the relationship between the nervous system and movement, Dr Feldenkrais designed hundreds of movement
lessons designed to access the motor learning centers. He started to give lectures about his new ideas, began to teach experimental classes, and work
privately with some colleagues. He also studied the work of George Gurdjieff, F.M. Alexander, William Bates and went to Switzerland to study with Heinrich
Jacoby.
In 1954, Feldenkrais moved permanently to Tel Aviv, Israel where he made his living solely by teaching his method.
In the mid 1950’s Feldenkrais presented his work in Europe and the United States. He taught his first teacher training program in San Francisco over 4
summers in 1975. He began the 235-student Amherst training in 1980, but was only able to teach the first two summers of the program. He stopped
teaching after becoming ill in the fall of 1981. He died in 1984.
Since then his students have developed standards for professional trainings and have become trainers themselves. The 4 years, 800 hours, professional
trainings are now held all over the world. Graduation from an accredited training gives students the title of certified Feldenkrais Practitioners.
Theory
The description of the Feldenkrais Guild of North America is as follows: “The Feldenkrais Method is a form of somatic education that uses gentle movement
and directed attention to improve movement and enhance human functioning. These movements result in increased range of motion, improved flexibility
and coordination, and allow the students to rediscover their innate capacity for graceful efficient movements. By expanding the self-image through
movement sequences, the method enables students to include more of themselves in their movements. They become aware of their habitual
neuromuscular patterns and rigidities, and learn to move in new ways.” 1
Feldenkrais practitioners (FP) believe that more efficient actions can emerge from guided exploration of movement that promotes improved attention and
awareness and refines the ability to detect information and make perceptual discriminations. The exploration can also be done through imagery with very
little or no active movement.
The goal of the method is to get people to become self directed learners who can then apply and expand their learning in every day life. 19
The method can be taught individually or in groups:
In Functional Integration (FI), the Feldenkrais Practitioner (FP) guides his student’s movements through gentle non-invasive touch and words. It is an
individual session.
For groups, Awareness Through Movement lessons, are taught by a FP who verbally guides the group through a sequence of structured movement
explorations aimed at discovering one’s own habitual movement patterns and learning new alternatives. Many lessons are based on developmental
movements and ordinary functional activities. Some are based on more abstract explorations of joints, muscle and postural relationships.
According to Dr. Feldenkrais2, the following elements are essential in order for learning to take place:
- the student should be allowed to perform a movement at their own rhythm,
- the movement should be repeated a number of times, so that the students can refine it each time based on their individual feedback, , but only as long as
they pay attention to them, as soon as they become mechanical in nature, the repetitions should be stopped and new variation of the movement explored.
-the student’s intent should be to make the movement better, and not right. What could be seen as mistakes in a right or wrong situation becomes learning
in a situation where betterment is the goal.
-the lesson should include many variations of all the components of the final movement, including performing the same movement in different orientations.
-the movements should be pleasant and easy in order to increase the chance that they will become habitually spontaneous. It is argued that faced with a
choice, the nervous system will favor a pleasant movement over a painful one.
-the lesson includes learning about one’s own habitual patterns of movement first, before exploring alternatives with the idea that it is only when you know
what you do that you can do what you want.
-The intention of the teacher is not to correct a wrong motor pattern but to make the student aware of their habits and then to show them other possible
ways to move, in an empowering, nonjudgmental way.
The method does not claim to be a therapy; the beneficial effects are considered to merely be a consequence of a better use of oneself. The local tissue
level is therefore never addressed directly, and when improvement at the local tissue level occurs, it is thought to be the result of a better organization of the
neuromuscular system 13.
When reading the method’s approach to learning described above, one cannot help but be reminded of the adaptive codes of motor learning described in
Lederman’s book : “The science and practice of manual Therapy” .
Cognition, described as “being aware of/attentive to the process and taking an active conscious part in it” 2, is considered to be an essential element of the
first phase of motor learning.
The need for numerous repetitions, allowing for feedback and therefore refinement of the motor program when necessary and the importance of the
student’s active participation either through active movements or through taking an active part in a passive movement through attention are also described
as important elements of motor learning.
Two other important concepts of the method are the concept of body and mind being one, and the concept of reversibility. Feldenkrais believed that body
and mind could not be separated, and that a motor pattern is linked to each emotional state and even to every thought. He believed that a thought that is
not linked to an action is not useful. 21
From his experience in martial arts and combat, he had found the ideal movement should be reversible at each moment, and could be enacted without prior
rearrangement. In combat, the time needed to shift weight or rearrange one’s posture could mean the difference between life and death. 21 All these
elements are included in the movement lessons he designed.
One last but extremely important key to the method is the need for the teacher to be him/herself aware of his habitual patterns and of as many variations of
movements as possible. The first two years of the training focus on developing the future teachers’ awareness of their own selves, so that they can better
distinguish their clients’ limitations from their own.
The evidence in the research literature for the Feldenkrais Method is encouraging, but further studies on bigger samples, and more directed toward the
principles behind the results are still needed. Below are a few of the peer reviewed studies that shed some light on the possible applications of the method
or of its principles:
A recent study in Physical Therapy 3 found ATM lessons to be the first method to increase hamstring length without stretching and found its results to be
comparable to classical stretching. Further research is needed to understand through which mechanism the lengthening happened.
Even though it not the primary goal of the method, significant decrease in chronic pain complaints have been described in 4 studies 4,5,6,7 following
Awareness through movement sessions. In one study 7 , the Feldenkrais Method(FM) was found to be a little better at improving both psycho physiological
symptoms and pain than traditional physical therapy (performed in the study’s occupational therapy center). The authors suggest that the pedagogic
method used in the FM (and described in the theory above) was responsible for the improved result.
In a study on sensory motor learning’s effect on chronic low back pain (CLBP) patients’ movement capacity 8, CLBP patients were found to have improved
their performance so much that they did no longer differ from the healthy control group. They had retained a more efficient behavior 12 month after the
intervention.
A group of 59 elderly women were found to have improve after 10 weeks of ATM lessons on ADL scores, Timed Up and Go and Berg balance assessment.
9 ATM was also found to improve balance and balance confidence in a group of people with MS. 10
The FM also uses imagery of a movement as a way to improve movement efficiency and to decrease effort. A study by Dunn, PA and Rogers, DK 15 found
that, after an ATM of imaging one half of the body being brushed by a soft bristle, there was a significant increase in forward flexion range on that side. This
correlates with a number studies on visualization described in Lederman’s book, page 134, in which visualizing a movement facilitates motor learning.
Stephens, in his article on the Feldenkrais method 17 found that the Method is an excellent approach to use in rehabilitation of people with orthopedic
physical problems.
On the psycho physiological level, several studies 11, 12, 14, 16 have found that the FM results in decreased stress, increased self confidence, a more
positive self image and an improved level of acceptance of the body. In her study of 78 patients with non specific musculoskeletal disorders, Eva Malgrem-
Olson and colleagues found self image to be a good predictor of outcome, and to be closely linked to the number of symptoms a person is experiencing.
(Ohman and Armelius, 1990). They also found the Feldenkrais method to be slightly superior to the conventional focus on just the physiological aspects of
musculoskeletal disorders.
Dr Feldenkrais said: “What I am after is to restore each person to their human dignity”. I my opinion, this approach to students-teacher interactions is a big
part of the success of the method. Feldenkrais Practitioners, in their non judgmental approach, create an environment ( which they believe to be conducive
to learning) in which the person is accepted as he/she is, and is presented with options that expand their capacities, in opposition with the medical view that
something is wrong and must be made right.
It would be interesting to further study how awareness influences self image, well being and self confidence, and how it helps decrease pain in chronic non
specific musculoskeletal pathologies
Finally, body awareness therapy was found to have positive effects in a study of patients with fibromyalgia and chronic pain 18.
As with many body mind methods, research on the Feldenkrais Methods is at its beginning and many of the studies could not be included in this paper
because of their methodological problems, low quality, and small sample size. A lot of the articles rely on case studies and cannot therefore be extrapolated
to the general population. One thing all studies agree on is the safety of the method. The movements are so small and performed so slowly that they are
less strenuous than what the person usually does on a daily basis. The emphasis put on no pain or strain of any kind also helps make this method
extremely safe.
Case presentation:
Patient is a 63 year old male office worker referred to physical therapy for constant pain in the lumbar region in standing and walking, going down both legs.
Mild lumbar pain started one year ago, when the patient moved from the US to Austria, to an office with a bad chair. Last December, he unloaded and
reloaded a truck with heavy boxes to help a friend, and felt pain in his back and down both legs that made him limp in pain.
Pt underwent quintuple bypass surgery in 1999, and must walk everyday to keep his heart in good shape. He is consulting today because his back pain has
prevented him from walking from his home to work and back (15 minutes walk) despite the use of daily pain medicine. Pt reports that he used to enjoy
walking as exercise. Patient is married with one grown daughter, works in an office in the administrative section of a big embassy. He sits in front of the
computer or in meeting 90 % of the time; his job does not entail any lifting or driving. His apartment has no stairs and his building has an elevator. He has
received 2 months ago a new ergonomic chair that fits him well. Pt wears small frame glasses which contain 3 different prescriptions.
He currently takes the following medications: Altese for his heart, Lipitor to regulate cholesterol, vitamins, Percaset for pain everyday.
Evaluation:
-Cardiovascular/pulmonary: Resting heart rate: 62, blood pressure: 122/80
-Integumentary: Pt presents with a vertical scar over his sternum, and on his right thigh. Both scars are flexible in all directions and pink.
-Neuromuscular: normal reflexes throughout.
-Communication system: Pt is alert and well oriented.
-Musculoskeletal:
Standing:
Frontal plane:
ASIS and PSIS symmetrical, right scapula slightly higher than left, no significant spinal deviation. Both legs rotated inward, feet inverted with increased
pressure on first metatarso-phalangeal joint bilaterally.
Sagittal plane:
Mild increase lumbar lordosis, thoracic kyphosis, forward head posture. Both shoulders rounded.
Gait assessment:
Good balance.
Trunk: bent forward, decreased rotation and lateral bending.
Pelvis: excess forward rotation, lacks backwards rotation
Hip: inadequate extension, internally rotated and adducted.
Knee: bilateral valgus
Ankle: inversion, medial fore foot contact
ROM:
T spine AROM and PROM decreased in rotation bilaterally and lateral bending right more than left
Decreased AROM and PROM L scapula in elevation.
Full lumbar PROM in all directions, decreased AROM in extension, and in R and L rotation with pain EOR.
SLR negative bilaterally.
Muscle strength:
Spinal extensors: 4/5, spinal flexors: 5/5, R lateral flexors 4/5, L lateral flexors 5/5, rotators: 5/5.
Hip extensors: 4/5, hip flexors 5/5
Pain:
To the touch L3-L4 and L4-L5 bilaterally,
After 3 minutes of walking,
EOR in lumbar rotation and extension.
Diagnosis:
Patient presents with impaired joint mobility, Motor function, Muscle performance and range of Motion associated with localized inflammation (4E according
to the guide to physical therapy practice) of the spine. The ICD 9 CM code associated with his pathology is 724.2 (low back pain).
Prognosis:
According to the Guide to Physical Therapy Practice, the patient should, over the course of 2 to 4 months, demonstrate optimal joint mobility, motor function,
muscle performance and ROM and the highest level of functioning in home, work, community and leisure environments. The expected number of visits
needed is between 6 and 24. Given the overall good health and high motivation of this pt, he is expected to achieve his goals after 6 to 8 visits.
Intervention:
The first lesson will be described in details to show the strategies used. It is to be assumed that the following lessons use the same principles of making the
patient aware of his habitual patterns first, and then presenting him, through gentle manual guidance with alternative options. And finally, allowing the
patient to experience the same configuration in different orientations.
In the first session, the patient was asked to lie supine on the treatment table and to pay attention to the contact of his body with the table. He was quickly
able to feel the distance between his low back and the table, therefore visualizing his lordosis. He also noticed that the back of his thighs did not touch the
table, which with the therapist guidance made him aware of the shortness of his hip flexors. His attention was then brought to the direction his big toes were
pointing, which made him aware of the IR of his legs.
Note: the supine position allows the patient to pay attention to himself without having to worry about gravity and balance.
The therapist then pushed through the foot, in the direction of the hip and asked the patient to localize his hip joints with the therapist’s help. (Where do you
feel your thigh bone meets your pelvis?). Patient repeatedly pointed to his iliac crests. After looking at a skeleton and differentiating the iliac crest from the
hip joint, patient was then asked to feel the hip joint that he had now seen on the skeleton in himself with many repetitions and the help of the feedback from
the therapist. Once the patient had localized the hip, he noticed a decrease in lumbar lordosis, and hip flexors activity as his self image started to match his
actual anatomy better, and he started to let go of unnecessary contraction of the superficial hip flexors, concentrating on the deeper hip flexors for
stabilization.
Patient was then brought back to sitting to feel his hips in sitting and then to standing, and finally to walking. These are important as each orientation feels
different to the body and requires its own learning.
The patient came for a total of 3 sessions, during which he was taught in the same manner to find all the movements of his pelvis thanks to a lesson called
the pelvic clock that guides the patient through an exploration of all possible movements in the pelvis. He was taught the effect that wearing the small frame
glasses has on his posture and his freedom of movement. He was also taught how to relax his eyes regularly, learning by contrast, first to overwork the
eyes and then to relax them.
A large amount of time was spent on exploring the ribs one by one to find again the movements that had been lost after the heart surgery. Lederman
described this in his book as “re-owning” the parts of your body that, at some point, have been ostracized by the nervous system because of pain, and have
never been claimed back.
With the help of the therapist, the patient explored scapular glides, comparing his right side with his left, in supine, side lying, prone, sitting, standing and
walking.
Finally, all this was brought together in a lesson on walking, given in side lying, where all the movements necessary for smooth walking were put together,
with involvement of the head, shoulders, ribs, arms, spine, pelvis, leg and feet, with and without glasses and with eyes open and closed. The movements
were passive, guided by the therapist while the patient paid attention at first. They were repeated many times, and then gradually actively performed by the
patient with an emphasis on making the movement easier and using a little less effort each time.
Outcome:
The patient came once a week for three weeks. At his last session, he reported that he had been walking from home to work and back without pain and was
weaning himself off of the pain medicine. He had regained full active and passive ROM of his spine without pain. His muscle strength was 5/5 throughout.
His gait still showed some internal rotation of the hip that he could control when he paid attention. It now included arm sway and upright posture. The foot
contact was still a bit inverted. He was using what he had learned in the lessons to keep his back moving when sitting for long periods of time.
Complementary Manual Therapy Interventions:
The Feldenkrais Method is only a motor learning method; several other methods will need to be used to address the local tissue level when necessary.
-Because pain is counterproductive in Feldenkrais when the therapist is trying to give the patient a pleasant experience in order to re-own a part of
themselves, iontophoresis, ice, and other anti-inflammatory treatment should be used to allow the treatment to be done without pain in cases where patient’s
motor problems have resulted in inflammation,
-If the decreased ROM is due to thickening or shortening of the connective tissue or scars, myofascial release would be helpful in freeing the restricted
joint. It would then be interesting to make the patient aware of his restrictions first, and then do the myofascial release followed by a Feldenkrais lesson.
-a home exercise program, with an emphasis on paying attention to the part of the body that has been explored in the Feldenkrais lesson, would also be
appropriate when strengthening is needed.
-Therapeutic exercises are also commonly used when strengthening is the goal.
Alternative Manual Therapy Intervention:
The Alexander Method and Body Awareness Therapy are methods based on the same principles. Any method that uses awareness, multiple repetitions,
small and slow movements, and emphasis on as little effort as possible and also the idea than rather than fixing the body, the intervention is aimed at
expanding its capacities and ranges of choice 19 might yield the same outcomes.
References:
1. Frequently asked questions, Feldenkrais Guild of North America, available at www.feldenkrais.com accessed 2/27/07
2. Lederman E. The science and Practice of Manual Therapy.2nd edition, Elsevier Churchill Livingstone 2005
3. Stephens J, Davidson J, De Rosa J, Kriz M, Saltzman N Lengthening the Hamstring Muscles Without Stretching Using “Awareness Through
Movement”, Physical therapy.2006 Dec; 86(12) :1641-1650
4. Lundblad I. Elert J. Gerdle B. Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder
complaints. [Journal Article: Clinical Trial] Journal of Occupational Rehabilitation. 1999 Sep; 9(3): 179-94. (46 ref)
5. Bearman D, Shafarman S. Feldenkrais Method in the Treatment of Chronic Pain: A Study of Efficacy and Cost Effectiveness. Am. J. Pain
Management. 9 (1): 22-27, 1999.
6. Phipps A, Lopez R, Powell R (advisor), Lundy-Ekman L (advisor), Maebori D (CFP). A Functional Outcome Study on the Use of Movement Re-
Education in Chronic Pain Management. Masters Thesis at Pacific University, School of Physical Therapy, Forest Grove, Oregon, May 1997.
7. Malmgren-Olsson E. Armelius B. Armelius K. A comparative outcome study of body awareness therapy, Feldenkrais , and conventional physiotherapy
for patients with nonspecific musculoskeletal disorders: changes in psychological symptoms, pain, and self-image. [Journal Article: Research, Tables/Charts]
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optoelectronic movement analysis. SPINE, 30(17), E509-E516.
9. Hall SE, Criddle A, Ring A, Bladen C, Tapper J, Yin R, Cosgrove A, Hu Yu-Li. Study of the effects of various forms of exercise on balance in older
women. Unpublished Manuscript Healthway Starter Grant, File #7672, Dept of Rehabilitation, Sir Charles Gardner Hospital, Nedlands, Western Australia,
1999.
10. Stephens J. DuShuttle D. Hatcher C. Shmunes J. Slaninka C. Use of awareness through movement improves balance and balance confidence in
people with multiple sclerosis: a randomized controlled study. [Journal Article, Clinical Trial, Research, Tables/Charts] Neurology Report. 2001 Jun; 25(2):
39-49. (33 ref).
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Complementary Medicine 5(3): 237-43, 1999.
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14. Lowe, B., Breining, K., Wilke, S., Wellmann, R., Zipfel, S., & Eich, W. (2002). Quantitative and qualitative effects of Feldenkrais, progressive muscle
relaxation, and standard medical treatment in patients after acute myocardial infarction. PSYCHOTHERAPY RESEARCH, 12(2), 179-191.
15. Dunn PA and Rogers DK. Feldenkrais Sensory Imagery and Forward Reach. Perceptual and Motor Skills. 91:755-57, 2000.
16. Netz, Y., & Lidor, R. (2003). Mood alterations in mindful versus aerobic exercise modes. Journal of Psychology, 137(5), 405-419.
17. Stephens J. Feldenkrais method: background, research, and orthopaedic case studies. Orthopaedic Physical Therapy Clinics of North America.
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21. Feldenkrais M. Body and mature Behavior, 1981, Harpers