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more on movement: problem = difficulties.

March 4, 2012

Just after I hit the “publish” button on the previous post, I recalled having already written on a similar topic. After a quick hunt, I found this post from two and a half years ago. I haven’t changed position on what I wrote then, but I do think it’s worth fleshing out, as the issue is currently ‘hot’ again and I think it’s high time we moved on to a better framing for the role of a Feldenkrais Practitioner.

So just to recap, Feldenkrais Practitioners work with movement problems; most often those problems present in the form of difficulties; those difficulties arise from either pathology or pain.

Hopefully the diagram below helps elucidate.

If you’re jumping up and down right now saying “There are more bases to movement problems than either pathology or pain! What about…?” you’re correct. I just probably classified the problem you’re thinking of as a puzzle, not a difficulty. We haven’t detailed the right side of the diagram yet, and probably won’t in this post, but soon, I promise, soon…

One of the reasons I want to examine the left side in more detail is, oddly enough, health insurance. Quite a few health insurers in Australia rebate visits to Feldenkrais Practitioners. Mind you, they also rebate – amongst a plethora of other things – for aromatherapy and medically prescribed yoga(!). But anyway, there it is, Feldenkrais Method, invariably listed under (shudder) alternative therapies. More grist to the misrepresentation mill, but that’s another rant. Earlier this year, a group, Friends of Science in Medicine (FSM), launched a campaign to remove the teaching of alt med and alt therapies in Australian universities. They also push for removing alternative therapies from health insurance. You can read about it in this article from the SMH, or this article in The Atlantic . Two things: first, the Feldenkrais Method is not mentioned as far as I know and second, I should declare my support here and now for FSM. Nevertheless, there are stirrings of anxiety roundabouts that Feldenkrais Practitioners might lose access to hard-fought rebates. It’s a tricky issue.

On the one hand, there are practitioners like me whose students rarely, if ever, consider health insurance rebates as a criterion for deciding whether or not to come to a class or lesson. That’s not because they’re rich, but because they simply don’t see it as ‘therapy’. (They’re problem = puzzle folk, bless’em!)

On the other hand, there are plenty of Feldenkrais Practitioners who work in rehabilitation, or in hospitals or adjunct to them, or with chronic pain sufferers, for whose students health rebates are enormously important. And furthermore, beyond the health rebates issue, could there be a place for these practitioners within the FSM model? I think there could be, particularly where there is increasing evidence that medications and/or surgery are no longer appropriate interventions in certain situations. This is especially the case for pain-based movement problems: pain science has pretty comprehensively shown that there is no 1:1:1 direct or linear relationship between tissue damage, nocioception, and the experience of pain. For the most elegantly simple and concrete demonstration of this, read Damage does not ’cause’ pain by BBoy Science.  Aphorism-ised, “pain is in the brain” – and there are a growing number of therapists who are researching, teaching, and innovating in their clinical practice around this understanding. In Australia, Body in Mind and NOIgroup are just two examples; from Canada, there’s the marvellous Humanantigravitysuit blog detailing goings-on North of the equator. In my opinion, Feldenkrais Practitioners have a lot to offer to this research and practice, particularly as it edges toward education as an effective intervention. Learning, particularly embodied learning, is our specialty. And there is precedence for educators (i.e. not therapists) within the medical structure: dietitians are but one example (and their services are rebated by health insurers too). But two things need to happen, I think, for Feldenkrais Practitioners to participate more effectively within science based medicine.

First and foremost, we need to stop allowing ourselves to be called therapists – alternative, complementary, or otherwise. It positions the profession on sides of fences which are simply not in our neighborhood. Learning may benefit a person, but that does not make it a therapy (unless you loosen the definition of therapy so much it’s almost meaningless, as in ‘retail therapy’). It also profoundly limits the public perception of Feldenkrais Practitioners. By way of analogy: while there are dance teachers who claim there are both mental and physical benefits from doing dance classes, people generally enroll in those classes because they think it will be fun, or pleasurable, and not because it might be theraputic.

Second, we need to interact with research and the building of an evidence base in new ways. Based on the Research links page on the International Feldenkrais Federation website, much of the research into the Feldenkrais Method took place between 1990 and 2005 (it seems to have petered off since then). More relevant to this post, much of it attempted to demonstrate the efficacy of the Feldenkrais Method for specific pathology or pain conditions. This is the sort of research you do if you carry the mindset that the Method is, or is equivalent to, a therapy. As a profession, we are always going to struggle with getting the large enough sample sizes, sufficiently well constructed experiments, robust research methodologies, and sufficient distance from cognitive bias, if we continue to persist with this approach. Advances in scientific technology mean that it is now much more possible to investigate the evidence (for and against) on the tenets of the Method: do humans learn the way we (Feldenkrais Practitioners) think they learn? Are the conditions of learning we hold important valid? Does the kind of learning we advocate actually “stick” and if so, how? What really happens in an Awareness Through Movement lesson? If we can’t answer these with any degree of certainty then science based medical folk have every right to dismiss the Method as “interesting but unproven”.

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