Deborah Bowes, DPT, GCFT on Feldenkrais for Back Pain

Deborah Bowes, DPT, GCFT on Feldenkrais for Back Pain


BETH DARNALL: She is trained
as a physical therapist. She trained at
Columbia University and later earned a doctorate
in physical therapy. She continued her self-education
with complementary medicine approaches, including Tai Chi,
martial arts, yoga, dance, and meditation. She’s a certified trainer
in the Feldenkrais Method and teaches internationally,
training new practitioners. Last year, she was
a keynote speaker at the International
Congress of Physiotherapists in Bogota, Colombia, presenting
on the topic of Feldenkrais and chronic pain. She works at Stanford in
the coordinated care clinic, and since 1988, has
maintained a private practice at the Feldenkrais Center
for Movement and Awareness in San Francisco. Please join me in giving a
warm welcome to Dr. Bowes. DEBORAH BOWES: OK, so I’m
just super happy to be here and to have this
opportunity to talk with you and share an approach for
improving function and reducing pain, called the
Feldenkrais Method. So as Dr. Darnall
said, for 30 years I’ve been studying alternative
and complementary medicine, and that includes all kinds
of mind-body approaches that use awareness
or mindfulness in a way of thinking about and
working with the whole person. So it’s very exciting
to be included in a program like this. When I first started
I was more relegated to the quack category. So it’s nice to see that
the world of medicine has come along. So I’m going to talk
about Feldenkrais Method, and how it helps with back pain. So first, I’ll
describe the method, because probably many of you
have no idea what this word is or what it is about. I’ll go over some
principles and ways that you can apply
them in your life, and then, we’ll have some time
for an experiential exercise too. So the Feldenkrais Method
is a learning model. It kind of fits in
with what everyone’s been saying this morning, and
it’s a biopsychosocial model of working with yourself. So biopsychosocial
models of medicine means that there are multiple
and complex factors that interact and affect your health. So that also means that
there’s multiple ways of changing and influencing
how you can improve. So you can’t really think
of just one cause and one solution, and that works really
well if you have a broken bone. The bone has to heal, but in
chronic pain or back pain, we know that there’s
a lot of elements that contribute to either
making you feel better or making you feel worse. So how you think, how you
move, how you sense yourself, how you feel, your habits, your
attitudes, all of these things are part of the pain pattern. And they are going to
affect your experience with pain or any health
condition that you have. So Feldenkrais Method
could be described really as learning for health. In the Feldenkrais Method, you
explore your movement options or possibilities. You want to develop
greater awareness about your habits of
movement and posture, breathing, and even how
the attitudes that you have towards your body
affect the pain and affect the total
experience of yourself. Whoops. So this quote is from
Moshe Feldenkrais. “Movement is life. Life is a process. Improve the quality
of the process, and you improve the
quality of life itself.” So Feldenkrais is
not a rote training. No one’s going to tell you,
oh, this is how you sit. This is how you
arrange everything. People aren’t going to say,
you must do these exercises. It’s more, as Dr. Cooley
was talking about, finding what works for you. Feldenkrais is a
training so that you can improve the way that
you sense and feel yourself, and then, according to that
feeling and that sensation, you can adjust
what you do, based on the quality of
that experience. So there are principles
of good movement, and I’d like to talk to you
a little bit about that. So with back pain, your
movement is altered. Right? You move differently
once you have back pain, and the way that you move
then is part of the problem. So these altered
movement patterns are that you’ve adjusted
how you do something. It’s a normal response to
having pain or an injury, and in the ideal
situation, it would just be a temporary adjustment. But what happens, the
way the brain works, that temporary change then
becomes a permanent habit, and they start to
cause other problems. So some of the things
that you might do is maybe you use
too much effort. Maybe your breathing
is restricted, or you don’t feel how the
skeleton supports you. You overuse some parts of the
spine, and don’t use others. So for example, I
would say just about everybody I work,
with low back pain, has very little movement in the
thoracic spine in the rib cage. So to explain that, if you
think of your lumbar spine, the lumbar vertebrates,
five vertebra, and it takes up about this
much space of your spine. Right? So it’s at the lower part of
the spine, that much space. On top of that is the
thoracic vertebra. There’s 12 of
them, and they will have ribs attached to them, and
they take up this much space. So if you can learn to sense
this much of your spine, the thoracic spine, you
can reduce the strain on the lumbar spine. Each part of the
spine is designed to do a different
kind of movement. So the lumbar spine, the
way the facet joints, the way it’s made, is made
to do flexion and extension. So that’s like–
you can’t see me, because I’m behind the podium– but it means you kind of
stick your butt out and tuck your butt. Right? So you’re rocking. I’m going to step to the side. So flexion and extension, right? Babies do it. It’s one of the first
movements we do. Thoracic movement,
the thoracic spine is built to do so many
other kinds of movements, twisting, side bending,
a little bit of arching, a little bit of flexing. If you’re not using the
thoracic spine movement, then all of that
kind of movement is going to the lumbar spine. It’s why people who have
back pain are often told don’t twist, but it really
should be, no, twist with the rest of your spine
that’s made for twisting. So that’s the kind
of thing that I teach people that are
based on these principles of good movement. So I have written
down here, the sense of lengthening of the spine. So what does that mean? So the sense of
lengthening of the spine, meaning that your spine is long,
that you’re not compressing it. So you can compress
your spine many ways, but one way people
often do it is they compress their spine by
kind of flexing and shortening. And the length
we’re talking about is from the back of the head
to the back of your sacrum. So you want that line
long, so that there’s space between the disks,
that there’s space in the first facet joints. So by learning these
principles of good movement, through exploration
and practice, it’s not just
thinking about them. It’s called embodied
learning, and then you can use that in
your everyday life. So Moshe Feldenkrais, the man
who put this method together, he was an Israeli
scientist who combined various of his knowledge
and skills and studies from the sciences of physics,
engineering, psychology, with judo, and
child development. And he put together
this method or a process that uses learning,
a particular kind of learning with directed
attention and movement patterns to improve function. So the method has
two modalities. So one is called awareness
through movement, and awareness through
movement lessons are led and guided by a teacher. There’s no demonstration. So the teacher, she’ll
give verbal directions and suggestions that have
a particular sequence. It’s a structured sequence
to explore some function, like bending or
breathing or reaching. And so in this photo, these
students are on the floor, and the teacher, who is
me in my younger days, is guiding the
students to explore the relationship between
breathing and the pelvic floor. And that is one of the areas
that gets affected also with back pain. So here, the woman
on the left is learning how to roll with
the whole body, exploring how to turn the spine,
how to turn the ribs, how to sense herself
as she’s doing that. And the group on the right
is sitting and exploring how to find an easier and
more comfortable way to sit. So each person is asked to move
according to their own ability, and there’s no ideal posture. There’s these principles
of good movement to follow, not that you want to match
someone else’s movement, but to find your
own way through it. And you’re looking
for a way that’s easy and doesn’t increase pain
or reduces the unpleasantness of the movement. There’s also what we call
functional integration, which is the hands-on work. We use the same principles,
and the main difference is that the practitioner is
touching you, very sensitively. It’s the kind of
touch you would use if you were like, oh, guiding
a small child through a dance. Right? You’re going to be very lightly
touching them and guiding them, not grabbing them or
forcing them to do anything. So this kind of touch stimulates
the brain’s natural ability to notice differences, make
distinctions, and then change. And in this functional
integration, I guess, treatment,
the person can feel where they’re
holding tension, where they’re afraid
to move, and then they can learn how to
change this pattern. So curiosity is a basic
function of the brain and nervous system. Curiosity motivates
us to find solutions, answers to questions. If you strengthen
your curiosity, you can discover many
ways to move better. And curiosity is one of
our fundamental tools in Feldenkrais. So this– what’s
up on the slide– is a simple model of what
the nervous system does. So Moshe Feldenkrais was fond of
saying that the nervous system has three important functions. One, it gives us
information about our body. Two, it gives us information
about the environment. And three, it provides the
curiosity to do the first two. In my work with people with all
kinds of pain and back pain, I found that there’s definite
problems in these functions. So number one, the information
about the body may be limited. The person may be only sensing,
does it hurt or not hurt. That the ability
to sense of some of the other human
sensations that we have, like ease and
comfort and pleasure, or the sense of length or
the sense of getting wider. Those sensations are put
down, and the more unpleasant sensations speak louder. In relationship to the
environment, people with pain have told me, when the
pain is very strong, it’s very hard to sense
where they are in space. People have trouble
crossing the street, trying to judge how fast
the cars are coming. They may bump into
things, and often feel vulnerable out in
public or in crowds. And curiosity, for me
curiosity is the big one. Curiosity is often
diminished, and this could be because the person
hasn’t had any success yet in finding what
they need to learn how to improve their function. And hopelessness might set in. So the kind of exploration
process we use in Feldenkrais helps to really
use your curiosity, and we ask questions. And we ask questions
to get your attention. So some of the
questions might be, how are you doing a movement. Where do you put your attention? How could you make it easier? How could you do less? So this is the process,
and you can learn. Once you have that
kind of process, you can apply it in many,
many parts of your life. Another quote from
Moshe Feldenkrais is that, we do not achieve by
repetition, muscle exercising, by increasing speed and force,
but by widening and refining the cerebral control
of the muscle range. So in plain speak, right,
that means, in order to improve movement, you have
to use the coordinating role of the brain. And learning to move with less
pain, is a skillful activity. You learn to inhibit
the strain that you’re putting into the system. So you can use the brain’s
ability at any age. It will change no matter
where you are in the spectrum. That’s what learning is. And this capacity for
learning and the capacity for the brain to change
is called neuroplasticity. And I’m sure you’ve
read a lot about that. It’s all in the news now. So now, what we can do a
little bit of experiential to try to make concrete
what I’m talking about. Right? Words are just words,
but it’s the experience that’s really important. So we’re going to do
something in sitting first. So if you have
stuff on your lap, maybe you could just
put it to the side, or put it on the floor. And just allow yourself to
sit comfortably in the chair, and what you think
is comfortable. And now, bring your attention
to the quality of your sitting. And if you had to sit
like this for a long time, are there any places that
you would feel uncomfortable? Right? Where does that
strain come for you? Where do you feel the
support for your body? What parts of you are
touching the chair? Do you have any sense of the
skeleton, the bones inside you, supporting you? What’s happening
with your breathing? Do you feel any movement of
your body with your breath? How are your legs arranged? Are the legs together? Are they apart? Where are the feet
touching the floor? Now slowly, if it’s
comfortable for you, without causing any
pain to yourself, slowly come to standing. So how did you do that? Did you use your
arms on the chair? Did you feel your
feet push the floor? The big one, did you
hold your breath? And if you didn’t
hold your breath, when you came up to
standing, did you do it on an inhale or an exhale? What were you thinking? So you might think,
yeah finally, I get to get up a little bit, or
you’re thinking like, oh no. Right? All of these elements affect
the quality of your movement. So now, you know the chair is
still behind you, so slowly return to sitting. How did you do that? Did you use your arms? When you went down to sit, did
your feet stay on the floor, or did the toes come up? Did you inhale as you sat? Exhale? Hold your breath? And if you held your breath, did
you hold it after you inhaled or after you exhaled? There’s so many details
that we can pay attention to in our movement that we’re
completely unaware of. But when someone asks
you the question, your curiosity,
right, is stimulated. And then, you start to seek,
well, how did I do that, and have I made the
choices in my movement that actually are helpful. So now, in the chair,
sit and arrange yourself as if you were going to stand. So knowing that
you’re going to stand, how do you arrange yourself? Right, so some people
scoot a little bit, some people put their
arms on the chair. Do you have your
feet in a place where you don’t have to move
them in order to stand up? So generally, it would be useful
if you are a little bit more to the front of the chair. Right? So that you don’t have to haul
your heaviest part of the body from the back of the chair. Now, start to sway your body. So start to just sway
a little bit forward, a little bit backward. It’s so fun to do this teaching
and see everybody start moving. Right? So you’re just swaying a
little bit forward and back. Now, you’re swaying
on the hip joints. So to be able to feel
that, place your hands on the hip joints. So your hip joints, they’re
not like on the side. On the flank, right here,
it’s where you bend. So somewhere in here. And now start to sway, and
feel how your hands get kind of squeezed
in there, right, but you’re bending
at the hip joints. So this is where
the movement first takes place to come to stand. Why? So the spine can stay long. So now, sense the
length of your spine, from the back of your
head to the sacrum. And notice if you change that
line as you just sway forward. OK? Good. Now, take both hands and just
feel the back of your neck. And now, sway forward
and back, and see, so you’re actually on
the muscles of your neck. Right? You are using your hands
as listeners, as feelers. So as you sway forward
and back, sense and feel, are you contracting your neck. Can your neck stay very relaxed? So you come forward
and back, because you don’t need to use your
neck muscles to stand up. It happens in the
legs and the hips. OK, now take one hand
and put it on your chest and your breastbone,
and then the other hand can either go on your belly,
below your belly button, or behind your back,
on your sacrum. So you put the back of
your hand on the sacrum, and now again, sway a
little bit forward and back. And can the hands stay at
the same distance apart? So you’re not flexing or
extending as you move. The hands you can
feel like, uh-oh, I’m really flexing as I come
forward or I’m extending. How can you just
feel for yourself? And are you breathing? So now, as you go forward and
back, when do you breathe out, and when do you breathe in? There’s many ways, but could
you now match your breathing to your movement. That when you come forward, you
exhale, and when you go back, you inhale. So you’re kind of breathing
with the whole body, breathing out as you go forward
and in as you come back. OK, great. Take your hands
off, pause a moment. So now, place your
hands on the chair, as if they were
going to help you. You may not need to use
your hands to come up, but just we have a
big room and want to make sure everyone
is comfortable. And have your
pelvis, we talk a lot about the pelvis in Feldenkrais,
because the pelvis is really the power seat that
initiates movement. So bring your pelvis now
to the edge of your chair. So you’re really at the
forward edge of the chair. Your hands are gently
touching the chair. And start to sway forward,
using everything we know, keeping the spine long. When do the feet get heavier? When does the weight
go more onto the feet? Because that’s what you’ve got
to do in order to stand up. Can you feel that? Can you sense that? Everyone’s at a different
place for sensing. For some, this
might be something you need to practice later. OK? Now, when you feel the
weight come onto the feet, start to stand by pushing
into the feet to come up. So feel the weight on the feet. Push, use your hands as you
need to, and then come up. Did you hold your breath? You can ask yourself that
almost any time of day. Whenever you think
something’s hard or effortful, you hold your breath,
and then, that makes it hard and effortful. All right, so now sensing
the weight on your feet, notice your toes. and as you go to sit, keep
the weight on the whole foot, so your legs lower you, and
you’re not using your back. So slowly lower yourself,
bending the hips the knees. Keep the weight in the
feet, and slowly sit. Very nice. And that’s just sense the
way you feel in sitting. Do you have any more
idea of the support that you have from the chair or
the internal support that you have from your skeleton? We can all regain. These sensations are
there, and they’re there in a snap, if you direct your
attention in a particular way to your movement. So it takes more than
alignment or flexibility. So some people think
back pain solution it’s all about alignment. It’s all about posture. Others say, no, no, it’s
all about flexibility, and other people say,
no, no, it’s strength. You have to do strength. Especially in
America, the paradigm is that whatever you
got wrong with you, you got to get stronger. That’s not it. It’s how you use yourself. So if we look here at the
Eiffel Tower and the wicker man, what’s the difference? The Eiffel Tower,
perfect alignment, recognized around the world,
but it is not going anywhere. Now, if you look
at the wicker man, there’s a potential for
so much movement there, but the wicker man
can’t do anything unless there’s a system to
coordinate all that movement. So from research, we know
that more of the brain is devoted to movement
than any other aspect. We have a big problem
dealing with gravity. You fall down, you had
a unsuccessful encounter with gravity. Right? And each moment, the brain
and the nervous system is receiving all of this
complex sensory information from your touch, from
sight, from hearing, and in movement the
most important system is the kinesthetic system. So the kinesthetic system is
the sensation of movement. It tells you, like right
now, your kinesthetic system tells you where your
joints are in space. You know where your arms are. You don’t have to look for them. The kinesthetic system
gives you information about how much effort
you’re using in your joints, and when you have back
pain, the kinesthetic system is severely affected. So a lot of training
in Feldenkrais is to train the kinesthetic
system, to learn how to notice yourself. So we always start each
class lying on the back and doing a body scan. One minute? Seriously? OK, I’m going to speed up. So you have to learn how to
sense yourself by sensing and feeling where you are. And we begin with scanning
different parts of the body and breathing, so that you
have a comparator later on. We use small
movements to activate the spinal stabilization system
and avoid setting off pain. You can find out how you move
the easiest and gain control, so you can do bigger things. You want to reduce the
effort in movement, so you can feel more
of what you’re doing, have less compression
in your joints, and greater sensitivity. And you want to do
whole body movements, because the solution
for your pain is not necessarily
where you feel the pain. If you involve other
parts in the movement, you can take the strain off
the injured or painful part. As Corinne said, muscles
do not work alone. They work in
synergistic patterns. And then you want to attend
to the qualities of movement and breathing, like ease
or comfort or smoothness. This organizes and creates
new and pleasurable patterns of movement. Movement can be
pleasurable, even with pain, you try to have the
least amount of pain. And the results are that you
overcome the fear of moving. You can experience yourself
as I can, rather than I can’t. You can trust your
body again, and you solve movement
problems that help you solve other kinds of problems. You develop a sense of agency,
and you rediscover pleasure in movement. So to end, I would
like to leave you with one last small, short
experience in sitting. There are some
parts of the brain that are more important to
relax, or become aware of. Because more of the innervation,
or more of the real estate, of that body part in
the brain, it’s bigger. So like your hands, your
feet, your eyes, breathing, and balance. If you can pay attention
to those five parts– I call it the five
questions– you can really have a big effect on
relaxing the whole body. So right now, pay
attention to your hands. Place your hands on your lap. Whatever is comfortable,
touching each other or not, and just now soften your hands. So make your hands very relaxed,
softened, easier to move, not clenching. Think of the spaces
between your fingers. And now, bring your
attention to your feet, and even though
you have shoes on, think of the feet and the
softness in your toes. Are you clenching the toes? The softness in
the arches, maybe move the feet a little
bit within your shoes. And now, your eyes, the
eyes are little brain buds. With your eyes, just gently
shift where you’re looking. When you have pain,
the eyes become fixed. You can tell people are hurting. You say, wow, I see
it in your eyes. So just by shifting your eyes,
and looking left and right or looking far into the
distance and then close, can change and
interrupt the pattern. That’s including the eyes. And now, sense your support. How are you supported? Where in the chair
and your pelvis? The support of
your feet and legs? And what’s going on
with your breathing? So for one breath
cycle, pay attention to breathing in
and breathing out. So these five questions
can be used to practice. And the way I use them is
I encourage my patients. I just say, what am I doing
with my eyes, my hands, my feet, breathing, and
where is my support. So I’ll end by
saying, there’s a lot of Feldenkrais research, both
qualitative and quantitative. There’s more that
needs to be done, but there’s a very good showing
that, if this is an option and appeals to the
way that you would like to work with yourself,
Feldenkrais Method is a very good option for
helping you learn how to have less pain and more function. And I’d like to thank my
colleague and collaborator, Cliff Smyths, also my husband. And I work at Coordinated
Care, and the people that I work with their everyday
teach me more and more how to help people with back pain. So thank you very much.

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