The first research study involving Feldenkrais
Method® (FM) was published in 1977 with several more appearing in the next
decade. Since 1988 there has been an increasing amount of research done and recently
this has been increasing each year. Because FM has such a wide range of effects,
a wide range of outcomes has been looked at and reported. Most of the clinical
studies to date have involved a very small number of subjects (6 or fewer). Some
are larger, using control group designs. The areas of outcome break down into the
following four general themes:
PAIN MANAGEMENT: Case studies
describing the resolution of chronic back pain following the failure of other
methods to ameliorate the problems have been published by Lake (1) and Panarello-Black
(2). A retrospective study of 34 patients using FM as an adjunct to treatment
in a chronic pain management clinic showed that FM helped to reduce the pain
and improve function and still was used independently by patients two years
postdischarge (3). Dennenberg (4) showed decreased pain and increased functional
mobility using FM as a component of treatment for 15 pain patients. The primary
result of this study was to show that there were changes in the pattern of
health locus of control in patients participating in FM. A study using a
group ATM intervention with five fibromyalgia patients showed significant
decrease in pain and improved posture, gait, sleep, and body awareness (5).
Lake (6) showed changes in posture in patients with chronic back pain following
FM. Chinn et al (7) showed improvements in functional reach in symptomatic
subjects. Idebergs (8) showed significant changes in pelvic rotation and
pelvic obliquity during rapid walking in 10 patients with back pain compared
to normal controls, following a series of Functional Integration lessons.
Narula showed decreased pain and improved function, including improved biomechanic
efficiency, measured by motion analysis, in a sit-to-stand transfer from
a chair, in several people with rheumatoid arthritis following six weeks
of ATM lessons (9).
PERFORMANCE AND MOTOR CONTROL: Function is a result of movement. Changes
in the process of control of movement therefore influence function. As
noted above in relation to pain patients, there were changes in movement
pattern leading to reduction of pain. These were patterns involved in the
activities of walking (8), transfers (9) (10) posture, reaching, and general
activities of daily living (11) (12).
As well as with orthopedic pain patients, functional improvements
have been described in people with neurologic diagnoses. Although there was
no formal quantitative assessment of balance, four women with multiple sclerosis
reported improvements in balance in daily activities and improved walking and
transfers, as assessed by video motion analysis. (13)
Shenkman described improvements in posture in individuals
with Parkinson'S disease using FM as part of the intervention strategy (14).
Shelhav-Siiberbush has reported case studies of two children with cerebral
palsy who made major functional gains during several years of FM work (15).
Ginsburg has anecdotally described functional and motor control improvements
in young people with spinal cord injuries who were involved in the "Shake a
Leg" program (16). Gilman has reported improved control of stuttering in two
As well as improving function in people with impairments,
FM also is used to improve athletic function. At this time the evidence for
this is mostly anecdotal for skiing (17) and kayaking. Jackson-Wyatt's has
reported a case study of improved jumping following a Feldenkrais intervention.
There is also interest in athletic injury prevention using
ATM to improve flexibility and control. An initial study published in this
area showed no increase in hamstring length following a single ATM lesson (19).
However, this study has several important design problems and further work
is underway as follow-up.
- PSYCHOLOGIC EFFECTS: Feldenkrais'
initial intentions in the application of his work were to improve a person's
awareness of the body in action (Awareness Through Movement), improving
the integration of functions (Functional Integration) and thereby effect a
process of change leading to greater emotional maturity (20). This has been
studied very little. Dennenberg (4) has noted changes in health locus of control.
Self-efficacy has been shown to be a significant correlate of successful rehabilitation,
but there have been no studies published on this to date. Several studies are
under way with patients with diagnoses of multiple sclerosis and fibromyalgia.
In an interesting study using analysis of clay figures, Deig
described expansion in the detail and form of body image after a series of
ATM lessons (22). Shelhav-Silberbush has shown improvements in mobility skills,
social function and IQ scores in a class of learning impaired children (23).
Recently, in a matched control group study of 30 children with eating disorders,
Laumer concluded that a course of ATM facilitated an acceptance of the body
and self, decreased feelings of helplessness and dependence, increased self-confidence
and a general process of maturation of the whole personality (24).
- QUALITY OF LIFE: Quality of
life and its associated measures of perceived health status is becoming an
increasingly important and widely used construct in assessing the overall outcome
of a process of rehabilitation. In a problematic study that showed no significant
functional or physiologic changes, Gutman (25) showed a trend toward improvement
in overall perception of health status in a healthy older adult population.
This finding has been corroborated in a similar population by improvements
in vitality and mental health as measured by the SF-36 (26) and in a group
of women with multiple sclerosis using the Index of Well-Being (13) (27).
Theory underlying the Feldenkrais Method® assumes a process of learning
that is based in hard changes in the nervous system. Through this process an
image of the body is constructed that corresponds to movement. In movement, a
person then interacts with the environment in a loop of perception and action
that further refines movement and the sensory-perceptual processes. Dynamic systems
theory as described by Thelen (28) and Kelso (29) best fits the observed processes
of the Feldenkrais Method. This theory accounts for the process of skill acquisition,
functional development, and organization change resulting from changes in posture
and coordination (30) and relies on an understanding of the body as having a
modifiable internal representation of body scheme (31) that includes the shape
of the body surface, limb length, sequence of linkage, and position in space
(32). The process of skill acquisition, coordination change, or functional or
motor development is driven by a process of active exploration involving awareness
Over the last 15 years, research in the area of neuroplasticity
has built a solid foundation for the concept that interaction with the environment
and changes in the structure of the body are represented by measurable changes
in the process of representation in the cortex (34) (35). These changes may underlie
and be related to basic processes of learning (36) (37). This plasticity of the
central nervous system may be both the source of chronic functional problems
and the means to recovery from them (38) (39).
Although none of the research on Feldenkrais Method® addresses
this basic level of physiologic function, physiologic changes do occur that fit
within this theoretic framework. Some functional changes have been mentioned
in the previous section. Others include changes in function of trunk and cervical
muscles reflected by changes in EMG activity (41) (41), changes in muscle function
and posture related to improvements in abdominal breathing (42), and changes
in body image or scheme (21) (23). Narula (43) also has reported increases in
EMG activity in cases of low back pain where it appears that painful muscles
had become inactive. It may be that reintegration of these muscles into normal
movement patterns stimulates blood flow and thus a normal healing process.
Risk and Safety
There is very little risk involved in the use of this method. It is
both conservative and safe. People are instructed to stay generally within the
bounds of pain-free ranges of motion and use as little effort as possible to
perform a movement. Comfort and ease and the explicit guides are understood to
be part of the optimal conditions for learning. It is still possible for a person
who has fibromyalgia or adhesive capsulitis to do too much and have pain as a
result. However, if this should occur, limits are learned that then can be applied
to future sessions. This kind of outcome happens infrequently and most often
in home sessions not supervised by a practitioner, in which the student reverts
back to a "more is better" philosophy so common in our culture. Often as a result
of a slow and comfortable approach, people learn that they can do much more with
much greater safety and comfort than they had imagined possible.
Generally, no statistics are known or published on the efficacy of this
method. All conclusions about this are based on hearsay and general impressions.
One of the authors (JS) takes the liberty here to report on the efficacy of using
Feldenkrais Method® as part of a rehabilitation process with 166 patients
over the last five years in his private practice. Outcome has been judged on
percentage of the original goals established at the initial visit that were achieved
by the time of discharge. Four levels of outcome were used: 1) 100% achieved;
2) 75% to 90% achieved; 3) 50% to 75% achieved; and 4) less than 50% achieved.
Orthopedic cases made up 84% and neurologic cases made up 16%
of the population. Age range was from 8 to 84 years, with most people being between
30 and 60 years. In thirty-five cases of back pain, 77% reached level 1 outcome
and 91% reached a level 1 or 2. Of twenty cases of osteoarthritis, 80% reached
level 1 and 95% reached level 1 or 2. 76% of seventeen people with a primary
diagnosis of neck pain reached level 1 and 88% reached at least level 2. In thirteen
shoulder diagnoses, 69% achieved level 1 and 92% reached at least level 2. Of
six people with fibromyalgia, 83% reached level 1 and all reached at least level
2. Of fourteen people with tendonitis or bursitis or other hip and knee problems,
85% reached level 1, an additional 7% reached level 2, and another 7% reached
level 3. Of eight people with back and leg pain from spinal stenosis of spondylolisthesis,
63% achieved level 1, an additional 12% reached level 2, and 25% achieved level
3 or 4. Of three TMJ cases, 2 reached level 1 and the other reached level 2.
And of five people with scoliosis, 80% reached level 1 and 20% reached el 3.
Reaching level 1 does not mean that the scoliosis was reversed. It means that
pain was significantly reduced and function improved with long-term success.
Of the twenty-seven neurologic cases, 60% were people with
multiple sclerosis or stroke. Of the people with stroke, 50% achieved level
1 and 50% achieved level 2. Of the multiple sclerosis cases, 50% reached level
1 and only 17% were discharged below level 2.
Overall, out of one hundred sixty-six patients, 70% reached
level 1, 22% reached level 2, 6.6% reached level 3, and 1.2% were at level
4 at discharge.
Ongoing and Future Research
As we stated at the beginning of this section, research on the Feldenkrais
Method has just started in the last ten years. Several studies are now in progress
related to balance and self-efficacy in people with multiple sclerosis; function
and length of the hamstrings; pain, function, and self-efficacy in people with
fibromyalgia; the efficacy of ATM as an adjunct to cardiac rehabilitation; and,
back pain related to postural and motor control variables. The Feldenkrais Guild
also is in the process of establishing a procedure for systematic collection
of outcome data by all practitioners across the U.S. who want to participate
in a multisite outcome study.
Other areas for future research include: injury prevention
and performance enhancement in athletes, dancers, and musicians; controlled outcome
studies with people who have had strokes, head injuries, and cerebral palsy;
introduction of ATM into elementary schools to enhance self image, attention
capacity, and learning; study of other psychologic dimensions, such as body scheme,
self-esteem, self-efficacy, anxiety, and learning; and inquiry into physiologic
mechanisms of action, including balance and postural control, proprioception,
and timing and sequencing on muscle activity in movements.