The natural state of the human body is to be in motion.
biomechanics를 바탕으로 한 human body movement, pathology, treatment stratiges가 더 필요하다.
하지만 그 끝에는 인간의 마음과 연결된 치료법이 있다.
![](https://t1.daumcdn.net/cfile/cafe/190B124D4F6E434A31)
The natural state of the human body is to be in motion. This motion includes dynamic movements, such as running or jumping; subtle fine movements, such as writing; or omnipresent movements, such as breathing.
- 신체의 자연스러운 상태는 be in motion(움직임에 머무름)에 있다. 달리기, 점핑 등 큰 동작뿐 아니라 글쓰기, 숨쉬기까지
Most people do not focus on the quality of movement, but rather take movement for granted. It is not until people become injured or begin to perfect their movement for a specific activity that they may become more aware of these activities. Heightening the awareness of one’s own movements can be traced back more than 1000 years. The importance of being fully attentive to the state of all one’s muscles, including the muscles involved in the act of breathing, can be found in references to meditation and yoga found in the Yogasutra by Pathanjali dating back to 200 A.D.
- 사람들은 움직임의 질(quality)에 주목하지 않음.
- 1천년전 자신의 움직임에 주목(자신의 근육상태, 호흡상태)한 것은 요가와 명상에서 발견할 수 있음.
Applying this same awareness to the body in motion, rather than at rest, is the primary focus of modern movement re-education techniques. Two of these techniques are the Alexander technique and the Feldenkrais method.
- 이러한 신체움직임 인식에 적용한 modern movement reeducation 테크닉 두가지가 알렉산더 테크닉과 펠덴크라이스 치료법.
The Alexander technique and Feldenkrais method are somatic education techniques designed to establish a heightened awareness of movements. The desired outcome is to become more functional and aware of one’s movements spatially (or, more accurately, kinesthetically) throughout everyday routine activity.
- 알렉산더 테크닉과 펠덴크라이스 치료법은 자신의 움직임 인식을 완성하기 위해 고안된 somatic education technique
- 테크닉을 통해 얻고 싶은 목적은 "more functional"임. 일상생활을 통해 좀더 정확하게 자신의 움직임을 공간에서 인식하여
The Alexander technique and Feldenkrais method, in contrast to other forms of alternative therapies, are relatively new and not as widely understood by society. Although each method has its own history and accepted approach, both also have many parallels and similarities. Both techniques use the student/teacher paradigm rather than patient/therapist paradigm.
- 알렉산더 테크닉과 펠덴크라이스 법은 다른 전통적인 치료법과 달리 새롭고 덜 이해되고 있음. 두가지 방법은 역사와 접근방법이 다르지만 유사성을 가지고 있는데, patient/therapist패러다임에서 student/teacher 패러다임으로의 변화를 사용하는 것임
The teacher’s role can be compared with that of a sports or musical instructor, such as a golf instructor or piano teacher. Movement awareness taught by a practitioner helps the student to move more fluently and as a result may aid in pain, muscular imbalances, performance difficulties, movement disorders, and many other ailments, such as overuse injuries.
Throughout the entire process of learning these techniques, the student ideally alters habitual movement patterns, which are viewed as limiting, to become more aware kinesthetically of the functional movements that are a part of everyday life.
- 선생님의 역할은 음악, 골프, 피아노 선생님에 비유될 수 있음. 전문가에 의해 교육된 movement awareness(움직임 인식)은 학생으로 하여금 좀더 유창하게 움직이게 할 수 있고, 과사용과 같은 손상으로 발생하는 통증, 근육불균형, 수행어려움, 움직임 disorder, 부정열 등에 도움을 줄 수 있음.
- 이러한 테크닉 배움과정을 통해 학생은 이상적으로 자신의 습관적인 움직임패턴을 수정함.
This article develops an overall better understanding of the Alexander technique and Feldenkrais method. Initially, a brief history is provided to lay the groundwork for the development of these techniques. A description of the techniques, training requirements, and mechanism of action follows. Indications, contraindications, and patient selection are discussed. This article reviews and identifies what research has been completed and what areas need further investigation. Overall, the goal is to establish a guide to aid in determining who may benefit from these techniques and outcomes to expect when using these techniques [1,2].
History
Fredrick Matthias Alexander, founder of the Alexander technique, was an actor and teacher born in 1869 in Australia. Although gifted in his chosen profession, he developed voice problems while reciting. Frustrated with the chronicity of his problem, he visited many professionals, including physicians and voice specialists, who offered him many of the same treatment recommendations without improvement. Resting his voice resulted in recovery from his hoarseness. He did not lose his voice with everyday speaking, yet during the course of a performance he ultimately would become hoarse and unable to complete the performance.
- 프레드릭 마티아스 알렉산더는 알렉산더 테크닉을 만듬. 그는 배우이자 선생님, 1869년 오스트레일리아 태생.
- voice problems의 반복으로 쉰목소리. 아무리 치료를 받아도 만성화, 결국 쉰목소리
This situation led him to self investigations eventually resulting in what is known today as the Alexander technique. While experimenting with head and neck positioning, Alexander became aware of habitual movements that were hindering his expression and quality of voice. Over his lifetime, he further developed the technique to assist and aid others, primarily individuals in the performing arts, to overcome their own dysfunction and use their bodies better as a whole. Alexander continued his teachings throughout his life eventually training others in the art of the technique until his death in 1955 [3].
- 알렉산더는 스스로 연구를 시작, head and neck 위치에 따른 습관적인 움직임이 목소리의 질에 변화를 주는 것을 발견, 적용
- 결국 자신의 기능부전을 극복하고, 더 나은 몸의 사용법을 체계화함.
- 1995년 사망할때까지 알렉산더 테므닉의 교육법과 트레이닝방법을 개발함.
Moshe Feldenkrais was born in Russia in 1904 and lived until 1984. An electrical engineer and physicist, he possessed a sharp intellect and athletic physique. His interest in athletics, including soccer and judo, resulted in multiple knee injuries, which eventually left him crippled in his ability to walk. Unsatisfied with the treatment options offered by medical professionals, he began researching other mechanisms to overcome his injury. Similar to Alexander, through his own investigation, Feldenkrais believed habitual movements predisposed injury. While developing the method, Feldenkrais
researched and experienced many different treatments. All of his experiences helped to shape what is known today as the Feldenkrais method.
- 모쉬 펠덴크라이스는 1904년 러시아에서 태어나 1984년에 사망. 전기 엔지니어, 물리학자였던 그는 축구, 유도를 하다가 multiple knee injury를 입고 걷기 장애를 당함. 기존의 어떤 치료에도 만족스러운 결과를 얻지 못한 그는 스스로 탐구하여 걷기장애를 극복함.
- 펠덴크라이스는 습관적인 움직임이 손상을 만들어 낸다는 것을 알아냄. 그리고 펠덴크라이스 법을 창안함.
Feldenkrais experimented by performing minute variations in his movements to become more aware of his own body mechanisms as a whole. Eventually through self experimentation and variation of movement, he overcame his disability,
improved his gait, decreased his pain, enhanced his functional level, and avoided surgery [4,5]. He too found that his discoveries were equally helpful to others, and after many years of teaching, he began to train others to become teachers of his method.
- 펠덴크라이스는 다양한 작은 움직임, 자신의 움직임을 인식하는 전체를 바라보는 메카니즘을 통해 disablilty를 극복하고, gait를 개선하고 통증을 감소시고 기능을 개선시켜 수술을 피하는 회복에 도달시킴.
Training
Alexander and Feldenkrais went on to teach their individual techniques to others interested in the methods for various reasons. Over time, these practitioners have established themselves via their respective organizations. The most recognized bodies governing the Alexander technique and Feldenkrais method in the United States are the American Society of the Alexander Technique (AmSAT) and the Feldenkrais Guild of North America.
In the United States, there are more than 20 schools certified to teach the Alexander technique. After completing these programs, graduates are eligible to become certified practitioners by the AmSAT. Depending on the program, courses and training usually span 3 to 4 years, and students must complete approximately 1600 hours [6]. This training usually incorporates an understanding of the Alexander technique and a basic understanding of anatomy. The primary focus is, however, on hands-on training. The schooling that practitioners undergo allows them to experience and embrace the Alexander technique. Prerequisites are minimal and do not require a specific educational background but may require that a person has experienced the technique personally briefly over a few sessions before acceptance into the school.
- 미국에서 알렉산더 테크닉은 20개 학교에서 certified. 프로그램을 통한 course and training기간은 짧아도 3-4년 소요. 1600시간
- 이 테크닉의 primary focus는 hand-on training, 자신이 체험하면서 이 테크닉을 체득하는 과정.
- 이 테크닉을 배우기 위한 전제조건은 단순함, 학력은 필요치 않음. 하지만 배우려는 수강생은 학교에 입학하기 전에 자신이 직접 이 테크닉을 체험해야 함.
Similar to the AmSAT, the Feldenkrais Guild of North America governs the Feldenkrais method in the United States. When a person completes the course work at 1 of the more than 20 US accredited training programs, he or she is eligible to be certified as a Feldenkrais practitioner. Feldenkrais training requires approximately 1200 hours of training that occurs over 3 to 4 years [7]. The educational training consists of lectures and readings specifically on the Feldenkrais method and complementary knowledge and teaching a basic understanding of anatomy and biomechanics. Classes also may address communication techniques and developing relationships through the art of interviewing.
- 펠덴크라이스 트레이닝을 위해서는 1200시간, 3-4년의 기간이 소요.
- basic understanding of anatomy and biomechanics를 공부
Overall the program emphasizes a hands-on experience of the method that allows each student to practice the technique fully. A significant aspect of the preparation is that the practitioner-in-training experiences the technique as if he or she were the student. The individual also observes the methods performed on others to gain a better understanding and prepare them further as a teacher. In choosing a practitioner for either the Feldenkrais method or the Alexander technique, it is important to look at the practitioner’s educational background, experience with the technique, and specific area of interest. The most important factor in choosing a teacher is, however, the interaction between student and practitioner and that a comfortable relationship is formed.
- 치료프로그램은 도제식 교육(hand-on experience), 환자와의 관계는 선생님과 학생의 관계로 바꾸는 치료의 패러다임 변화.
Mechanism of action
The mechanisms by which somatic movement re-education techniques achieve their effect are unknown. Theories exist as to the mechanism by which each technique obtains its desired effect, and as expected, the originator of each technique theorized why his treatment worked. The Alexander technique and Feldenkrais method theorize that movement is a function not only of the body, but also the mind, and the two should not be viewed separately but as a whole. Few research attempts have been made to evaluate the mechanism by which these techniques achieve their effect, and that type of research at a physiologic level would be difficult to conduct.
- 두가지 테크닉은 그 기전이 명확하지 않지만 somatic movement re-education 테크닉임
- 알렉산더 테크닉과 펠덴크라이스 법은 movement는 몸의 기능만이 아니라 마음까지 이어지고, 그 몸과 마음을 둘로 나누어서는 안되고 전체의 하나로 보아야 한다는 것.
Jones, in the 1950s and 1960s [8–10], performed experiments attempting to document physical improvement in quality of movement of the head and neck in subjects using the Alexander technique. The process by which these techniques achieve their effect is likely multifactorial, however. One hypothesis on a physiologic level is that these techniques change the muscle spindle set points to a new resting length or change the gamma neuron system set points [5,11].
치료기전의 첫번째 가설
- 이 테크닉은 change the muscle spindle set points to a new resting length or change the gamma neuron system set points
Another concept may be that the engrams of habitual movements are effectively altered or replaced by more functional and efficient movement patterns. The techniques could be compared with osteopathic, muscle energy techniques in how they derive their effect. The hands-on aspect of these treatment interventions (although primarily intended to be instructional) may elicit effects similar to massage by activation of peripheral sensory receptors, a mechanical release of neurohumeral factors, or direct stimulation of Golgi tendon organs. The psychological component of the Alexander technique plays a large role in movement because the method educates the student on how to control physical movement in the time between deciding to move and the actual movement itself.
치료기전의 다른 가설
- 좀더 기능적이고, 좀더 효과적인 움직임 패턴으로 변화시킨 습관적인 움직임의 기억(engram of habitual movement)
- hands-on aspect of these treatment 개입은 연부조직 마사지가 끌어내는 효과( activation of peripheral sensory receptors, a mechanical release of neurohumeral factors, or direct stimulation of Golgi tendon organs)와 유사한 치료적 결과를 도출해냄.
- 알렉산더 테크닉의 정신적인 측면은 움직임에 큰 역할을 함. 왜냐하면 the method educates the student on how to control physical movement in the time between deciding to move and the actual movement itself
Techniques
The Alexander technique and Feldenkrais method have many similarities; however, each method also has a unique philosophy that makes it distinctive. Both techniques postulate that habitual movements lead to movement problems, pain, or overall patterns of dysfunction. Through changing these patterns, the entire system or body functions better. The Alexander technique and Feldenkrais method suggest that the process by which these patterns are changed is a learning process.
- 알렉산더, 펠덴크라이스 법은 많은 유사성이 있음. 하지만 각각의 치료법은 독특한 철학이 있고 차이점이 있음.
- 두가지 치료법은 habitual movement가 movement problem을 야기하고, 통증을 일으키면서 기능부전의 패턴을 만들어낸다고 가정함. 움직임의 패턴 변화를 통해 전체적인 시스템과 신체기능이 호전됨. 이러한 움직임 패턴의 변화는 learning process임.
The techniques have been used extensively for decades by performing artists and professional athletes and more recently by low-level functional performers to help improve their performance. Whether the goal is for a person to be able to roll from back to side in bed; reach for, grasp, and drink out of a cup; or perform a triple somersault, the learning process is essentially the same. Over time, the student begins to delineate and differentiate subtle nuances of intention and allow for a greater awareness of performance. Throughout this process, the student continually closes the gap between what he or she wants to do and what he or she actually achieves. Overall, by becoming more aware of one’s actions kinesthetically, one functions at a higher level.
- 이 테크닉은 음악가, 육상선수의 수행을 통해 10년넘게 광범위하게 시행되어 최근에는 low-level functional performers에 의해서 환자의 수행능력 증진을 도움.
- 침대에서 back to side로부터 구르는 동작을 수행하게 하는 것으로부터 시작하여 grasp, drink에 도달하고, triple somersault를 수행하게 하는 단계로 진행함. 이러한 learning process는 기본적으로 두 테크닉이 동일함.
- 시간이 지나면 학생(환자)는 의도(intention)의 미묘한 뉘앙스를 구별하고 묘사하기 시작하고 큰동작의 인식이 가능해짐.
- 이러한 과정을 통해 학생(환자)는 그 자신이 원하는 동작과 실제로 할 수 있는 동작의 갭(GAP)에 가까워짐.
- 점차로 환자 자신의 움직임, 기능을 몸전체의 사슬관계을 알아차리고 점차 높은 단계의 수준으로 시행하게 됨.
Alexander stressed the importance of inhibition to alter routine movement. He postulated that by stopping a movement from occurring, one could reset the action and redirect motion to function more naturally. Over time, these movements become second nature. The result may include an array of different results, including improvement of movement, posture, or voice
quality, and even a decrease of pain. Alexander believed the dynamic relationship between the head, neck, and spine was crucial to a person’s overall well-being. He referred to this as the primary control. The upper and lower extremities were secondary to the head, neck, and spine. Alexander set precise standards that he applied to every type of movement. He stressed the importance in positioning of the primary control and believed that no movement would be adequate if it did not to some degree follow his format. Alexander’s problems involved his voice, and he worked primarily on repositioning the head and neck; this may explain why he emphasized the importance of head, neck, and spine positioning.
- 알렉산더는 routine movement의 변화를 위해 제한의 중요성(importance of inhibition)에 중점을 둠
- 그는 stopping a movement에 의해 환자는 action을 reset할 수 있고, 좀더 자연스러운 기능을 위한 움직임을 redirect할 수 있다고 가정함.
- 이러한 치료를 반복함에 따라 이러한 동작들은 second nature가 되어감.
- 치료 결과는 array of different results, improvement of movement, posture, or voice quality, and even a decrease of pain
- 알렉산더는 환자의 총체적인 well-being에 head, neck, spine의 dynamic relationship은 매우 중요한 역할을 한다고 믿음
- 그는 이것을 primary control로 간주함.
- 상지와 하지는 head, neck, spine의 이차적인 관계라고 인식함.
- 알렉산더는 type of movement을 적용시켜 정확한 표준을 세팅시킴.
- 그는 primary control의 positioning 중요성에 중점을 두고, no movement는 적합하지 않다고 믿음.
- 알렉산더의 문제는 그의 voice를 포함했고, 그래서 그는 head and neck의 positioning에 중점을 두고 테크닉을 만듬. 이것은 왜 알렉산더가 head, neck and spine positioning의 중요성을 강조했는지를 설명해주고 있음.
An initial session of the Alexander technique usually focuses on chair work and table work (Figs. 1 and 2). Alexander worked with his students in front of a mirror. He and the student would go through the motions of sitting, standing, and lying while maintaining appropriate head positioning and body lengthening (see Fig. 2). The focus of the pupil is to lengthen and widen while maintaining the upright central positioning of the head, neck, and spine. The student is encouraged to use visual cues to maintain positioning rather than just proprioception. The student does not rely solely
on misleading proprioceptive feedback. This also allows the student to become an active participant in the session rather than a passive observer.
- 알렉산더 테크닉의 초기 session은 아래 그림과 같이 chair work and table work에 초점이 맞추어져 있음. 그는 학생(환자)와 함께 거울앞에서 치료작업을 많이 시행함. 그는 학생(환자)와 함께 motions of sitting, standing, and lying while maintaining appropriate head positioning and body lengthening을 시행함.
- 학생(환자)의 초점은 head, neck, spine의 upright central 자세를 유지하는 것
- 학생(환자)는 visual cue를 사용하여 고유수용감각을 넘어서 자세를 유지하기 위해 encourage 해야 함.
- 학생(환자)는 고유수용감각 피드백을 잘못 유도하면 안됨. 그리고 수동적인 관찰자보다는 적극적인 참여자가 되어야 함.
The Alexander technique focuses on the direct hands-on methodology from the practitioner to help define movements objectively and reposition the student (Fig. 3). The technique sometimes is taught in a group setting, but it is preferably taught one on one.
- 알렉산더 테크닉은 아래 그림과 같이 hand-on 방법으로 전문가가 정확한 동작으로 학생(환자)의 reposition을 도움. 테크닉은 때로 그룹 세팅으로 교육하지만 일대일 교육이 적합함.
![](https://t1.daumcdn.net/cfile/cafe/1931394E4F6F977327)
The Feldenkrais method, although similar to the Alexander technique, varies in its fundamentals, teaching mechanisms, and philosophy. Feldenkrais often said his goal was to produce ‘‘flexible minds, not just flexible bodies.’’ This technique usually is taught in positions that eliminate gravity, such as lying down (Fig. 4). He used developmental movements, such as rolling and crawling. The Feldenkrais method typically does not address posture directly, whereas the Alexander technique focuses on dynamic posture. In the Alexander technique, the teacher provides more clear direction to the student, whereas in the Feldenkrais method, the teacher makes a point of not directing toward a specific outcome.
- 펠덴크라이스 법은 알렉산더 테므닉과 유사하지만 fundamentals, teaching mechanisms, and philosophy이 다름. 펠덴크라이스 목표는 ‘flexible minds, not just flexible bodies"라고 말해짐. 이 테크닉은 주로 중력을 제거하는 아래 그림과 같은 lying 자세에서 시행됨.
- 펠덴크라이스는 주로 rolling, crawling과 같은 발달자세 움직임(developmental movement)를 주요 이용
- 펠덴크라이스 방법은 직접적으로 자세를 address하지 않고, 알렉산더 테크닉은 dynamic posture에 초점을 둠.
- 알렉산더 테크닉은 학생(환자)에게 분명한 동작의 direction을 제공하는데 반해, 펠덴크라이스 방법은 선생(치료사)가 특별한 결과를 유도하는 방향을 지시하지 않는게 핵심임.
![](https://t1.daumcdn.net/cfile/cafe/143578484F6F977F01)
Feldenkrais coined the terms(새로운 용어를 만들어냄) awareness through movement and functional integration to define the teaching techniques of his method. Although the goals behind each method are similar, the instruction and philosophy behind each differ considerably. During an awareness through movement session, the instructor verbally guides a group or individual through a series of movements to explore systematically the relationship of body position and space (Fig. 5). In this setting, the student is encouraged to experiment individually and freely. Ideally the student becomes more aware of his or her movements independently without the practitioner directing the experience.
- 펠덴크라이스는 그의 치료방법 가르침을 정의하기 위해 "움직임과 기능적 통합(movement and functional integration)"을 통해 "알아차림"이라는 용어를 만들어냄.
- movement session을 통한 알아차림 동안, 치료사는 언어로 body position 과 space의 관계를 시스템적으로 적용하기 위한 동작의 series를 안내해야 함.
- 이 과정동안 학생(환자)는 동기부여 됨. 이상적으로는 학생(환자)는 좀더 그의 동작을 선생(치료사)의 지시없이 독립적으로 좀더 잘 알아차릴 수 있음.
![](https://t1.daumcdn.net/cfile/cafe/183E7C4D4F6F97C72A)
One key difference between functional integration and awareness through movement is that awareness through movement consists primarily of verbal cues, whereas functional integration mainly incorporates touch to facilitate movement and awareness (Fig. 6). The use of touch and direction creates subtle sensations that result in new experiences for the student. In the Alexander technique, the objective is controlled, elegant, functional movement, whereas in the Feldenkrais method, the desire is spontaneous, elegant, functional movement.
- 움직임 과정에서 기능적 통합과 알아차림의 중요한 차이는 다음과 같음. awareness through movement은 주로 verbal cue로 구성되고, 기능적 통합(functional integration)은 주로 움직임과 알아차림을 촉진하기 위한 touch를 통합하는 것임.
- touch와 direction의 사용은 미묘한 감각을 창조하고 학생(환자)에게 새로운 경험을 야기함. 알렉산더 테크닉에서 목표는 controlled, elegant, functional movement이고, 펠덴크라이스 방법의 목표는 spontaneous, elegant, functional movement임.
![](https://t1.daumcdn.net/cfile/cafe/2040F54D4F6F97C728)
Research
A review of the literature on the Alexander technique and Feldenkrais method reveals that there are few well-designed, blinded, and controlled studies with objective or standardized outcome measures published in peerreviewed journals. Much of the literature and printed material on these techniques include case studies and testimonials on the effectiveness of the technique. Although these testimonials are passionate in their description of course and outcome, they do not carry sufficient scientific weight to carry the impact that may be intended.
- 알렉산더 테크닉과 펠덴크라이스 법에 관한 잘 디자인된 blind된 논문은 드뭄.
Multiple difficulties exist in being able to design and implement good clinical research using these techniques. Difficulties in study design include the expense and time of the practitioner, the prolonged length of time needed to conduct the studies, the difficulty in establishing a control group that meets regularly and receives placebo or sham treatment sessions, the difficulty in having a blinded treatment protocol with hands-on treatment, obtaining a large sample size that is randomized, controlling for variability in technique among practitioners, and using objective standardized outcome
measures.
- hand-on treatment이기 때문에 blind study를 하기 어려움.
An analysis of important factors to consider when designing effective studies of patients with chronic pain is found in an article by Harden and Brucehl [12]. The available published research, although limited in quantity, covers a variety of conditions and is reviewed subsequently. A study by Dennis [13] assessed the effect of learning the Alexander technique on balance by using functional reach as a clinical measure of balance. Understanding and improving body mechanics and body awareness is a proposed benefit of learning the Alexander technique; this may improve balance and reduce falls in the elderly. In this study, the experimental group received group sessions of Alexander technique instruction for 1 hour twice a week for 8 weeks, and the control group underwent the pretesting and posttesting only.
There was a small improvement in functional reach in the Alexander technique group compared with their pretest scores and compared with the control group. Subjective improvements in balance, posture, ease of movement, body awareness, and self-confidence also were noted. Weaknesses of the study included the small nonrandomized sample size, lack of any sham treatment control group, lack of standardized questionnaires assessing subjective gains, and concerns of test/retest reliability in assessing functional reach. Nonetheless, this study suggests clinical gains in functional reach using a limited number of Alexander technique training sessions in a group setting.
It has been proposed that the Alexander technique affects the pulmonary system and is used to improve breath and voice control. A study by Austin and Ausubel [14] evaluated the use of Alexander technique and pulmonary function. In this study, 10 healthy volunteers performed pulmonary function tests before and after a total of 20 weekly sessions of Alexander technique lasting 35 to 45 minutes each, taught by eight different Alexander technique practitioners. Results were compared with a matched control group of 10 healthy volunteers who did not undergo Alexander technique training or any structured exercise routine. Statistically significant increases were noted in peak expiratory flow and maximal inspiratory and expiratory mouth pressures.
No significant changes were noted in other tested areas, and no significant changes were noted in the control group. The use of multiple practitioners in teaching the technique supports the notion that the results are more likely from care elements in the technique itself rather than secondary to the unique skills of a particular practitioner. Postulated reasons
for the improvement in pulmonary function included increased length of muscles of the torso derived from ‘‘inhibiting’’ slumping patterns in posture and increased strength or endurance in abdominal muscles from improved posture. The Cochrane group performed a review of the literature and found no studies of sufficient rigor evaluating Alexander technique and asthma management.
The review mentioned anecdotal reports from practitioners of the technique and performers who have experienced improvement with their asthma symptoms and less dependence on medications. No significant evidence in the literature supports this conclusion at this time, however [15]. The effects of Alexander technique and Feldenkrais method treatments in various neurologic and musculoskeletal conditions have been examined. A randomized controlled study published evaluated the Alexander technique versus massage and a control group in treating 93 patients with idiopathic
Parkinson’s disease [16]. One group received 24 sessions of the Alexander technique, another group received 24 sessions of massage, and the third control group received no treatment. Findings included improvements in the Alexander technique group in the Self-Assessment Parkinson’s Disease Disability Scale at the best and worst of times during the day and improvements in the Beck Depression Inventory following the course of treatment.
Sustained benefits were noted in these measures at 6-month follow-up. A Swedish study of 78 patients compared the effect of body awareness therapy, Feldenkrais method, and conventional physical therapy on changes in health-related quality of life, self-efficacy, and sense of coherence in patients with nonspecific musculoskeletal complaints [16].
Questionnaires and standardized assessment tools were used. Results were not specifically significant but suggested that body awareness therapy and Feldenkrais method may have some relative greater benefit over conventional therapy in
improving health-related quality of life and self-efficacy of pain. An evaluation of the effect of Feldenkrais awareness through movement on hamstring length was investigated in 48 healthy undergraduate students. Four treatment sessions were conducted with no significant difference noted in hamstring length between the Feldenkrais group, relaxation group, and control group [17]. Valid concerns about study design include the short course of treatment and the validity of the outcome measure.
Another study compared the effectiveness of 8 weeks of Feldenkrais method versus sham treatment in 20 patients with multiple sclerosis [18]. Assessment tools used included the Nine-hole Pegboard Test of Hand Dexterity, Hospital Anxiety and Depression Scale, Multiple Sclerosis Selfefficacy Scale, Multiple Sclerosis Symptom Inventory, Multiple Sclerosis
Performance Scale, and Perceived Stress Scale. The patients were randomly assigned, and a crossover design was used. The treatment group showed no objective improvement in any of the noted measures except for improvement
in perceived stress and lowered anxiety.
An article published in the German literature suggested that the use of the Feldenkrais method in a multimodal treatment program for patients with various eating disorders may result in an improved perception and acceptance of their body. A 9-hour treatment course in the Feldenkrais method was used in this study.
The use of the Alexander technique in a multidisciplinary pain treatment program was evaluated in an article by Fischer. Feedback from participants indicated a higher degree of satisfaction persisting more than 1 year after treatment with the Alexander technique compared with the other interventions used. Although these results were not statistically significant, trends were noted indicating the relative perceived benefit.
Contraindications
Every form of treatment currently available has relative risks and benefits. Whether the treatment is medication, physical therapy, or a form of alternative therapy, the relative risks and benefits should be identified before treatment. Relatively speaking, the Alexander technique and Feldenkrais method are benign in practice and have no strict contraindications. In any therapy, however, it is imperative the patient and the health care provider address certain issues. Initially, if the patient has a complaint, a diagnosis should be ascertained, and serious pathologies should be excluded before considering either movement technique. After the workup is complete and the patient and the health care provider are comfortable with the results, it is important to address other treatment options that exist and the relative anticipated risks and benefits of each. If a person has a rotator cuff tear, and he or she is experiencing a significant amount of pain, it is important that all
treatment options, including surgery and physical therapy, are considered. If a patient has exhausted other appropriate resources or wishes to pursue a movement re-education technique, it may be reasonable to try either the Feldenkrais method or the Alexander technique.
Indications
Each patient is an individual, and every course of treatment should be distinct and specific to a patient’s particular needs. It sometimes is difficult to know which patients would respond to alternative types of treatment. The Alexander technique and Feldenkrais method require highly motivated students who are willing to put forth time and effort to see if the techniques are beneficial. As with many forms of treatment, an individual is not cured overnight. Both techniques are not intended to solve specific problems, but by learning the technique individuals may have improvement in their complaints.
Individuals who may benefit from these techniques fall into four general groups. The first group includes patients with specific complaints or chronic pain. The second group consists of high-performing individuals, including athletes, artists, actors, musicians, dancers, martial arts participants, singers, computer operators, and equestrian riders. A third group that may benefit from these techniques are individuals with specific conditions, such as learning disabilities, movement disorders such as Parkinson’s disease, cerebral palsy, stroke, and autism. Finally, the fourth group comprises individuals interested in improving their particular state or seeking personal enlightenment.
Patient selection
Selecting individuals for various alternative medicine treatments is not an exact science. It is impossible to know who will succeed with their treatment and who will not. The overall goal of the Feldenkrais method and Alexander technique differs from most medical or even alternative treatments in that these methods are not trying to fix a problem or cure an ailment. Rather, the goal of these movement techniques is to teach the student to become more aware of his or her own movements functionally and kinesthetically. The result may be an improvement, however, of posture or liberation of muscle tension. Others may have an improvement of voice projection or quality. Additionally, for some, the techniques may improve chronic pain, balance, coordination, or flexibility. The techniques also may improve breathing patterns and an overall fluidity of movement. Overall, the techniques primarily teach students a general awareness of movement, and all else is added benefit.
The length of time needed to achieve this overall awareness varies widely but mainly depends on the student and the teacher. Patient factors include their goals, progress, and financial backing. The student and what he or she hopes to achieve determine how long he or she needs to invest in learning the technique. Highly functioning individuals already may be at a superior level functionally, and they may need only a few sessions to fine tune or reiterate what they already are aware of. Other individuals may have experienced many years of dysfunction secondarily to muscle imbalances or movement disorders, and they may require much more time to work fully through the different levels and complexity of issues. Similarly, the progress that one makes during the sessions may affect the length of time it takes one to reach
the desired outcome. The movements and adjustments made are small in both techniques. Learning, processing, and using this information vary widely depending on the individual and significantly influence the length of time the individual continues with classes.
Financial concerns also may affect the number of sessions the student pursues. Most insurance companies at this time do not cover the Alexander technique or Feldenkrais method. Exceptions occasionally include worker’s compensation cases, automobile insurance cases, or cases in which the practitioner teaching the technique also is a physical therapist. The average cost of a 30-minute session usually ranges from $30 to $50; costs in metropolitan areas range from $50 to $100. The cost in general limits not only who can afford to learn the technique, but also the number of sessions the person can afford to undergo. The philosophy and routine of the practitioner also affects the number of sessions administered. Some salaried certified practitioners of the Alexander Technique and Feldenkrais method, such as a physical therapist working within the constraints of insurance reimbursement, may incorporate these techniques into their overall treatment
program. Only a few sessions may be devoted primarily to these techniques with a strong emphasis on teaching the pupil to incorporated learned strategies independently into their routine. Typically, courses of treatment from independent practitioners range from 20 to 60 sessions.
Summary
Knowing how the body moves and responds seems simplistic. Being truly aware and attentive to the subtleties of that movement is a learned skill, however, that requires a concerted effort. Conventional physical therapy, biofeedback, yoga, meditation, and martial arts training are examples of activities that incorporate this awareness. The Alexander technique and Feldenkrais method focus on developing one’s awareness of movement and provide the student the ability to improve that movement. The philosophy and method each technique uses to achieve that common goal differs. For motivated individuals, both techniques provide tools to improve functional quality of movement and improve quality of life. Each technique has been practiced for more than 50 years, in many countries, by thousands of students and teachers. Strong anecdotal experience supports its use and growing popularity. The core principle of improving awareness of one’s
movements resonates as a useful tool in improving dysfunction of movement.
Current research-based evidence cannot guide clinicians, however, in determining the effectiveness of these techniques, the length of treatment needed, or for which patients it would be most effective. Prospective clinical studies with standardized outcome assessment tools would provide more objective evidence to support the utility of these techniques. Keeping an open mind, being motivated, and having a clear goal allow an individual to benefit from these techniques, while still remaining a critical consumer of health care options.
Acknowledgments
The authors thank Rose Bronec, the Alexander teacher who assisted us. Further information
American Society for Alexander Technique (AmSAT), PO Box 60,008 Florence, MA 01062, USA; e-mail: alexandertech@earthlink.net; phone: 1-800-473-0620. Feldenkrais Guild of North America, 3611 SW Hood Avenue, Suite 100 Portland, OR 97201, USA; e-mail: info@feldenkraisguild.com; phone: 1-800-775-2118.
References
[1] Davis CM, Barnes JF, Berger D, et al. The Alexander technique. In: Davis CM, editor. Complementary therapies in rehabilitation: holistic approaches for prevention and wellness. Thorofare (NJ): Slack Inc; 1997. p. 161–82.
[2] Brennan R. The Alexander technique: a practical introduction. Shaftesbury: Element; 1998.
[3] Alexander FM. The use of the self. California: Centerline Press; 1984.
[4] Feldenkrais M. Awareness through movement. New York: Harper & Row; 1977.
[5] Feldenkrais M. Body and mature behavior: a study of anxiety, sex, gravitation, and learning. New York: International University Press; 1988.
[6] American Society for Alexander Technique. Available at http://www.amsat.ws/. Accessed May 24, 2004.
[7] Feldenkrais Guild of North America website. Available at: http://www.feldenkrais.com/ faq.html.
[8] Jones FP. Freedom to change: the development and science of the Alexander technique. London: Mouritz; 1997.
[9] Jones FP. Collected writings on the Alexander technique. Cambridge (MA): Alexander Techniques Archives; 1998.
[10] Jones FP. Method for changing stereotyped response patterns by the inhibition of certain postural sets. Psychol Rev 1965;72:196–214.
[11] Cranz G, Collin B, Bluethenthal A, et al. Foreword. In: Sontag J, editor. Curiosity recaptured: exploring ways we think and move. San Francisco: Mornum Time Press; 1996.
[12] Harden RN, Brucehl S. Conducting clinical trials to establish drug efficacy in chronic pain. Am J Physical Med Rehabil 2001;80:547–57.
[13] Dennis RJ. Functional reach improvement in normal older women after Alexander technique instruction. J Gerontol Med Sci 1999;54a:M8–11.
[14] Austin JH, Ausubel P. Enhanced respiratory muscular function in normal adults after lesions in proprioceptive musculoskeletal education without exercises. Chest 1992;102: 486–90.
[15] Cates DJ. Alexander technique for chronic asthma. The Cochrane Database of Systematic Reviews. Chichester (UK): John Wiley & Sons, Ltd; 1999.
[16] Stallibrass C, Sissons P, Chalmers C. Randomized controlled trial of the Alexander technique for idiopathic Parkinson’s disease. Clin Rehabil 2002;16:695–708.
[17] Malmgren-Olsson EB, Branholm IB. A comparison between three physiotherapy approaches with regard to health-related factors in patients with non-specific musculoskeletal disorders. Disabil Rehabil 2002;24:308–17.
[18] James M, Kolt G, McConville J, Bate P. The effects of a Feldenkrais program and relaxation procedures on hamstring length. Aust J Physiother 1998;44:49–54.
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