While physical therapists are known as hands-on, movement specialists, evidence is beginning to suggest their ability to teach can improve outcomes and reduce health care costs as well.
A recent study published in the journal Spine (Preoperative pain neuroscience education for lumbar radiculopathy – August 15, 2014), followed a group of individuals who were undergoing surgery of the lumbar spine. Prior to surgery, half of the participants received the typical pre-surgical care. The other half received specialized education from a physical therapist on the neuroscience of pain. The researchers followed up with the participants 1 year after surgery and found the group who received a single, educational session from a physical therapist, viewed their surgical experience much more favorably, and utilized 45% less health care expenditure following surgery.
What does this mean to me?
Physical therapists are experts in developing strategies to help you better understand and manage pain. Growing research, such as this, is indicating education, focusing on the reconceptualization of pain, can lead to improved function, range of motion and decreased pain. As little as one session with a physical therapist, can result in improved long-term outcomes and lower health care expenditure costs.
The Effectiveness of the Feldenkrais Method: A Systematic Review of the Evidence
By Susan Hillier and Anthea Worley
This review aimed to update the evidence for the benefits of FM, and for which populations. The Feldenkrais Method (FM) has broad application in populations interested in improving awareness, health, and ease of function. The Feldenkrais Method (FM) was developed over a period of decades in the last century by Dr. Moshe Feldenkrais. He claimed the basis of the approach was founded in the human potential for learning how to learn. This review showed 7 studies finding in favor of the FM for improving balance in ageing populations Single studies reported significant positive effects for reduced perceived effort and increased comfort, body image perception, and dexterity. Considered as a body of evidence, effects seem to be generic, supporting the proposal that FM works on a learning paradigm rather than disease-based mechanisms. Clinicians and professionals are encouraged to promote the use of FM in populations interested in efficient physical performance and self-efficacy.
One reason the Feldenkrais method is effective:
Movements are performed very slowly in order to you to learn at your own rate of understanding and doing.
Time is the most important means of learning.
To enable everybody to learn, there should be plenty of time for everybody to assimilate the idea of the movement as well as the leisure to get used to the novelty of the situation.
There should be sufficient time to perceive, and organize oneself. No one can learn when hurried and hustled.
Each movement is, therefore, allotted sufficient time for repeating it a number of times.
Thus, you will repeat the movement as many times as it suits you during the span of time allotted.
When one becomes familiar with an act, speed increases spontaneously, and so does power. This is not so obvious as it is correct.
Efficient movement or performance of any sort is achieved by weeding out, and eliminating, parasitic superfluous exertion. The superfluous is as bad as the insufficient, only it costs more.
No one can learn to ride a bicycle or swim without allowing the time necessary to assimilate the essential, and to reject the unintended and unnecessary efforts that the beginner performs in his ambition not to feel or appear inadequate to himself.
Fast action at the beginning of learning is synonymous with strain and confusion which, together, make learning an unpleasant exertion.
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So, prompt #1 has wholly to do with time; and touches on the role of the teacher, and the role of human insecurity as they pertain to learning.
And the approach to time within a Feldenkrais lesson has to be framed anew for beginners (and reiterated for more familiar folks) because it is so drastically different from everything we have ever been taught about time. If you are someone who grew up in an industrialized society, and attended school, etc. then the way you came to understand the link between learning and time is that you learn x within y minutes. If you don’t do it—or can’t do it— you get an F.
And within this standardized process in which most of our developing minds were ensconced, there is a teacher monitoring your capacity—the person dolling out the F, or the A, or what have you.
And, in a master move, that might easily be missed, Feldenkrais opens this first instruction (urging a reconsideration of time) with a recusal of his own role as the teacher.
He writes,
I do not intend to “teach” you, but to enable you to learn at your own rate of understanding and doing.
He is refusing to be seen as a traditional teacher. Instead he considers himself (or the practitioner at work) someone who is creating a set of environmental conditions IN WHICH a particular kind of learning is likely to happen. In fact, here, the main component of being a teacher that he is refusing is the teacher’s strict control of time, and how fast learning must happen given a particular time constraint.
He even declares that,
No one can learn when hurried and hustled.
Therefore learning cannot even happen when a time constraint is applying pressure on the learning process. The primary goal in a lesson is that a person establishes “his own rate of understanding and doing.”
The challenge here is that a Feldenkrais lesson may be the first context in which a person has ever been given this opportunity. Some may find this liberating, a joy. Others may find it anxiety-producing, boring, or in some other way frustrating. They may not appreciate being asked to have an entirely new concept of themselves and their experience in relation to time. We have mostly all been habituated to the rate of learning prescribed for us in childhood by schools, busy parents, etc. Some may have a more difficult time detaching from that habit and reimagining the possibilities.
Feldenkrais even goes so far as to say that,
No one can learn to ride a bicycle or swim without allowing the time necessary to assimilate the essential, and to reject the unintended and unnecessary efforts that the beginner performs in his ambition not to feel or appear inadequate to himself.
He’s biting off a whole other facet of human experience here. He is acknowledging that we all have an instinct to do well, and perhaps an even stronger instinct to be perceived as doing well.
Therefore when learning a new thing, for example swimming, you can imagine a 4 or 5 year old child flailing her limbs about in the water because she feels herself to be imitating her older sister who can swim. But the younger sister cannot swim yet. However, given her desire to learn, and given an entire summer, or several summers, she will have the time to choose only what is effective and functional movement, and let go of unnecessary efforts that don’t actually help her float or move in a particular direction of her choosing.
He ends with,
Fast action at the beginning of learning is synonymous with strain and confusion which, together, make learning an unpleasant exertion.
Which brings us back to one of the main tenets of the Method, which is that learning should be a pleasant experience. And, in fact, that if the process isn’t pleasant, the learning won’t happen. Step 1: Do things very slowly, especially at the beginning.
1. Pain is output from the brain. While we used to believe that pain originated within the tissues of our body, we now understand that pain does not exist until the brain determines it does. The brain uses a virtual “road map” to direct an output of pain to tissues that it suspects may be in danger. This process acts as a means of communication between the brain and the tissues of the body, to serve as a defense against possible injury or disease.
2. The degree of injury does not always equal the degree of pain. Research has demonstrated that we all experience pain in individual ways. While some of us experience major injuries with little pain, others experience minor injuries with a lot of pain (think of a paper cut).
3. Despite what diagnostic imaging (MRIs, x-rays, CT scans) shows us, the finding may not be the cause of your pain. A study performed on individuals 60 years or older who had no symptoms of low back pain found that 36% had a herniated disc, 21% had spinal stenosis, and more than 90% had a degenerated or bulging disc, upon diagnostic imaging.
4. Psychological factors, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different factors, such as psychological conditions. A recent study in the Journal of Pain showed that psychological variables that existed prior to a total knee replacement were related to a patient's experience of long-term pain following the operation.
5. Your social environment may influence your perception of pain. Many patients state their pain increases when they are at work or in a stressful situation. Pain messages can be generated when an individual is in an environment or situation that the brain interprets as unsafe. It is a fundamental form of self-protection.
6. Understanding pain through education may reduce your need for care. A large study conducted with military personnel demonstrated that those who were given a 45-minute educational session about pain sought care for low back pain less than their counterparts.
7. Our brains can be tricked into developing pain in prosthetic limbs. Studies have shown that our brains can be tricked into developing a "referred" sensation in a limb that has been amputated, causing a feeling of pain that seems to come from the prosthetic limb – or from the "phantom" limb. The sensation is generated by the association of the brain's perception of what the body is from birth (whole and complete) and what it currently is (post-amputation).
8. The ability to determine left from right may be altered when you experience pain. Networks within the brain that assist you in determining left from right can be affected when you experience severe pain. If you have been experiencing pain, and have noticed your sense of direction is a bit off, it may be because a "roadmap" within the brain that details a path to each part of the body may be a bit "smudged." (This is a term we use to describe a part of the brain's virtual roadmap that isn’t clear. Imagine spilling ink onto part of a roadmap and then trying to use that map to get to your destination.)
9. There is no way of knowing whether you have a high tolerance for pain or not. Science has yet to determine whether we all experience pain in the same way. While some people claim to have a "high tolerance" for pain, there is no accurate way to measure or compare pain tolerance among individuals. While some tools exist to measure how much force you can resist before experiencing pain, it can’t be determined what your pain "feels like."
Whole-body vibration exercise may reduce pain symptoms and improve aspects of quality of life in individuals diagnosed with fibromyalgia, research shows. Whole-body vibration exercise involves standing, sitting or lying on a machine with a vibrating platform that causes muscles to contract and relax as the machine vibrates. The machines primarily are used by researchers but have begun appearing in fitness centers and are sold commercially.
A study by Indiana University researchers found that whole-body vibration exercise may reduce pain symptoms and improve aspects of quality of life in individuals diagnosed with fibromyalgia.
Regular exercise participation is one of the best known therapies for patients with fibromyalgia, a disorder characterized by widespread musculoskeletal pain and fatigue. Many patients, however, are averse to participating over fears of pain that may be associated with increased physical activity. As a result many patients continue to spiral downward, further exacerbating a sedentary lifestyle that often leads to a worsening of symptoms.
However, some forms of yoga and Feldenkrais use Rhythmic Oscillations that are self-induced without a machine. Such movements can be a moving meditation by shaking your head and vibrating your body. This will bring you relaxation and healing energy. To begin with you just need to close your eyes and turn your head right and left, right and left, focusing on the center of your brain and keeping a rhythm. You proceed with shaking, tapping and bouncing of other body parts. Afterward an hour session you feel very rejuvenated!
This week, two brilliant doctors separately told me they are not good at yoga because they are too stiff. I frequently hear this assumption from patients. Yoga is defined as the union of the mind and body to become enlightened or to better contribute to the happiness and freedom of others. That being clarified, stiffness should not prevent one from the practice of yoga. The classic 84 yoga poses or asana where thought to be originally created so that one can learn to sit firm and comfortably in order meditate at ease. Hey, how many of us would like to learn to sit comfortably aligned for a full day at our workstation?
Yoga will give you any result you intend if you do it long enough. What you are thinking about when you perform an action will determine the result of that action. You become what you contemplate. If you want yoga (the practice) to bring you to Yoga (the goal—enlightenment), then the intention underlying your practice must be Yoga. You are not going to achieve Yoga as your goal accidentally—you must desire it with your whole being. Those who are stiff will become less stiff. With more practice they will no longer be stiff. Continued practice will make them loose. Even more training will change the poses from difficult to easy, from shallow to deeper.
Suggestion: You may attend a class with the one intention of learning or growing loose. A “stiff” may aim to become less stiff or loose. This goal will not be achieved after the first session. Think that you will become loose after weeks, months or even years.
Yard by yard, life is hard. Inch by inch, life is a cinch. You should not attempt to actually perform any pose perfectly. You should perform the pose within your own comfort zone using props for support when necessary. You want to respect your restrictions and honor your limitations. By forcing the pose deeper one may stay stiff or even become stiffer. When moving within the comfort zone, the pose eventually becomes easier over time and even later on, elegant. Challenge yourself to be patient and you will grow. One day in the future IT will dawn upon you that used to be stiff. That is learning.
Yoga can be easier than you think with greater results than you can imagine.
The American Physical Therapy Association has published nine tips to help educate the public about common age-related conditions—including chronic pain, frailty, falls, heart disease, osteoporosis and Alzheimer's disease—that effect millions of Americans but that scientific studies show can be prevented or delayed with appropriate physical activity and other healthy behaviors. 1. Chronic pain doesn't have to be the boss of you. Each year 116 million Americans experience chronic pain from arthritis or other conditions, costing billions of dollars in medical treatment, lost work time, and lost wages. Proper exercise, mobility, and pain management techniques can ease pain while moving and at rest, improving your overall quality of life. 2. You can get stronger when you're older. Research shows that improvements in strength and physical function are possible in your 60s, 70s, and even 80s and older with an appropriate exercise program. Progressive resistance training, in which muscles are exercised against resistance that gets more difficult as strength improves, has been shown to prevent frailty. 3. You may not need surgery or drugs for low back pain. Low back pain is often over-treated with surgery and drugs despite a wealth of scientific evidence demonstrating that physical therapy can be an effective alternative—and with much less risk than surgery and long-term use of prescription medications. 4. You can lower your risk of diabetes with exercise. One in four Americans over the age of 60 has diabetes. Obesity and physical inactivity can put you at risk for this disease. But a regular, appropriate physical activity routine is one of the best ways to prevent—and manage—type 1 and type 2 diabetes. 5. Exercise can help you avoid falls—and keep your independence. About one in three U.S. adults age 65 or older falls each year. More than half of adults over 65 report problems with movement, including walking 1/4 mile, stooping and standing. Group-based exercises led by a physical therapist can improve movement and balance and reduce your risk of falls. It can also reduce your risk of hip fractures (95 percent of which are caused by falls). 6. Your bones want you to exercise. Osteoporosis or weak bones affects more than half of Americans over the age of 54. Exercises that keep you on your feet, like walking, jogging, or dancing, and exercises using resistance, such as weightlifting, can improve bone strength or reduce bone loss. 7. Your heart wants you to exercise. Heart disease is the No. 1 cause of death in the US. One of the top ways of preventing it and other cardiovascular diseases? Exercise! Research shows that if you already have heart disease, appropriate exercise can improve your health. 8. Your brain wants you to exercise. People who are physically active—even later in life—are less likely to develop memory problems or Alzheimer's disease, a condition which affects more than 40% of people over the age of 85. 9. You don't "just have to live with" bladder leakage. More than 13 million women and men in the US have bladder leakage. Don't spend years relying on pads or rushing to the bathroom. Seek help from Central Park Physical Therapy 212-765-4800.
A majority of American adults expect to be living independently at age 80, and yet roughly half expect to lose strength and flexibility with age, according to a survey conducted by the American Physical Therapy Association (APTA). Americans are conflicted on aging Survey respondents seemed to be resigned to physical decline (51 percent expect to lose strength and 49 percent expect to lose flexibility as they age despite optimism about their future mobility and independence (68 percent expect they will still be able to engage in the same type of physical activities at 65 and older, and 59 percent expect to be living independently at home at age 80). Americans are also conflicted about when the effects of aging begin, with younger respondents expecting to see signs begin when people reach their 40s and 50s, while 53 percent of all respondents believe people start to notice signs of aging in their 60s or older. Aging effects can be slowed Experiencing some effects of aging is inevitable, but physical therapists want people to know that many of the symptoms and conditions associated with aging are not always a matter of bad luck, and improvements can be made even at an advanced age. "Many patients come to physical therapy believing they have no option—that they have arthritis and will have to learn to live with it," said Central Park Physical Therapist and Feldenkrais Practitioner Rik Misiura, PT, GCFP , "these patients are truly appreciative and amazed to realize conditions like low back pain, arthritis, diabetes and even bladder leakage—can be managed or even reversed with physical therapist treatment." Patients consistently report that they are pain free, regain some lost height, stand taller and brag about increased function in their activities of daily living. Central Park Physical Therapy (CPPT) can help Physical therapists, who are movement system experts, help adults stay strong and remain independent, enabling the kind of lifestyle survey respondents hope for, despite widespread beliefs that the negative effects of aging are unavoidable. For instance, research shows that an appropriate exercise program can improve muscle strength and physical function in one's 60s, 70s, and even 80s and older. CPPT employs Therapeutic Exercise, The Feldenkrais Method and Yoga to help adults achieve surprising results. One option that CPPT offers is the Seniors Exercise Classes (SExC) and Therapeutic Restorative yoga classes. Central Park Physical Therapists are uniquely qualified to prescribe the most effective exercise regimen, which may help individuals avoid painful, costly procedures, like hip and knee replacements that require months of recovery, if initiated before extensive damage is done.
Authors of a new study on carpal tunnel syndrome (CTS) say that when you toss out the splints, steroid injections, lasers, and other treatments often lumped in with physical therapy as part of a "conservative" approach and focus solely on a debate about surgery vs specific multimodal physical therapy, physical therapy makes a compelling case for itself.
How compelling? Researchers found similar improvement in self-reported function and CTS symptom severity for both surgical and physical therapy patients after 1 year, but the physical therapy group reported more significant gains in the first month. That speedier gain early on is worth noting, researchers believe, because it allows these patients to return to work and other activities sooner than their peers who underwent surgery. Results were published by Fernández-de-Las-Peñas C et al. in the Journal of Orthopaedic and Sports Physical Therapy.
The specific techniques included:
Soft Tissue Mobilization of the pectoralis, biceps muscles
Dynamic Stretching Stroke the wrist Ligaments
Mobilization of the small finger muscles found between the hand bones (Metacarpals)
Joint and soft tissue mobilization to the neck
Mobilization of the Upper ribs and collarbone
Patients in the physical therapy group also received cervical spine exercises for stretching neck muscles, which they were encouraged to perform at home during the follow-up period as needed. The physical therapy group showed average 1-month gains that exceed those of the surgery group. When reassessed at 6 and 12 months, however, both groups posted similar scores on both assessments.
Better short-term outcomes were found with manual therapy, patients may be able to return earlier to their activities of daily living and work when they receive manual therapy, compared to those who undergo surgery.
While earlier studies tended to give surgery the edge over conservative treatments, those "conservative" approaches usually lumped in physical therapy with a host of ineffective treatments including splints, steroid injections, lasers, and transcutaneous electrical nerve stimulation. Authors of the current study say theirs is the first to make a clean comparison between surgery and well-defined multimodal manual therapy.
Therapeutic or restorative yoga sessions are often recommended for people recovering from injuries or for those with chronic pain. A Restorative Therapeutic Yoga class is one in which the student slowly moves and props oneself on the matted floor in deep relaxation. Students practice restorative yoga to help them release layers of tension and feel at ease in their bodies. You carefully stretch and loosen your body and then walk away feeling loose and calm with a smile on your face.
Students will learn:
·Relaxation strategies
·Improved alignment to minimize postural stress and promote optimal energy flow
·Restorative poses for therapeutic recovery and healing
·Breath-play
·Meditation and visualization for healing
·The use of props to achieve soothing comfort in poses
·Restorative yoga as a form of relaxation, pain relief and increased function
·Strategies for improved sleep
·To decrease pain
·How to increase flexibility and strength
·Improve balance
·Lower resting heart rate
However, therapeutic yoga isn’t only for those with lingering body pain. It can benefit almost anyone else including those who don’t stretch much and for people who sit all day at work.In restorative yoga, you don’t need any cute yoga clothes and you probably won’t even break a sweat. No downward dogs required. In fact, This yoga class is all about nourishing and restoring your life force. You should never be in pain during class, or even uncomfortable.
Give therapeutic yoga a try and enjoy a nourishing, relaxing session in the studio. Many first time students are surprised and impressed with the positive results achieved with such pampering of your body and soul.
Your Teacher: Jenna Crivelli RYT200
Jenna is an aide at CPPT, a Physical Therapy student, and a yoga practitioner for 10+ years. She completed her yoga certification at the Yoga Room and has completed advanced yoga teacher training workshops at goodyoga in Brooklyn, NY.
The class logistics:
·Date: Fridays
·Time: 6:00 p.m.
·Location: 30 East 60th Street
·Cost: $11 per class
·The Theme of each class is determined by the needs of the students in the class. So each class is “all about you”
"I align with B.K.S. Iyengar: It is through the alignment of the body that allows for the alignment of my mind, self, and intelligence." – Jenna Crivelli
Ingredients: 1-2 frozen banana 1 cup iced coffee 1-2 tablespoons peanut butter 1-2 tablespoons unsweetened cocoa powder 1-2 teaspoons honey, agave or maple syrup Optional: ¼ cup Vanilla Yogurt or milk Instructions Add all ingredients to a blender and blend until smooth. Pour into a glass, serve, and enjoy!
Nutritional education becomes an incredibly useful tool to improve overall health outcomes for physical therapy patients and specifically to reduce inflammation qualifying the oft-quoted Hippocrates' "Let food be thy medicine”. Nutrition is a major link to help patients manage and relieve pain. Nutritional strategies can make a difference in several conditions associated with pain. For example:
Inflammation. Copious inflammatory foods, including vegetable oils, populate the Western diet. Most studies show a diet rich in healthy fatty acids, fruits, vegetables and fiber, provides anti-inflammatory benefits. Among specific conditions, studies show a Mediterranean diet rich in polyunsaturated fatty acids and antioxidants provide anti-inflammatory effects that benefit individuals with rheumatoid. Obesity. Obesity contributes to numerous chronic pain conditions, and the pain in turn can lead to sedentary behavior that increases obesity. Studies prove weight loss must become a crucial aspect of overall pain rehabilitation. Osteoarthritis (OA). Studies have shown a relationship between pain and food intake among overweight and obese patients with OA. One study found scientific evidence to support specific nutritional interventions–including omega 3 fatty acids–to relieve symptoms among patients with OA. Studies also show various nutrient deficiencies, including vitamins C and D as well as selenium, contribute to OA. Re energize with this super easy to make post exercise snack: Oatmeal Balls: 1 cup oatmeal 1/2 cup peanut butter 1/2 cup cut up dried dates 1 cup coconut flakes 1/3 cup honey 1/2 cup flax seed 1/2 cup chocolate chips 1 tbs of vanilla extract Mix all dry ingredients, then add honey, peanut butter and vanilla extract. Mix and shape into balls.
Inversion poses are those in which the heart is above the head. Inversions can be a simple as poses known as Downward facing Dog, Forward Flexion, Legs Up the Wall, Happy Baby. Inversions that can be more challenging are the popular head stand, hand stand and shoulder stand. Inversion benefits are: Inversions reverse the blood flow in the body and improve circulation: Increase immunity and prevent illness: Energize: Both physical invigoration and mental revitalization are achieved. Relax: Inversions calms the nervous system. Improve balance: Increases Core Strength Improve Self Esteem Inversions are fun: this is a time that allows you to be playful
Sphynx Licks help to improve posture by improving head alignment over the shoulders and helps alleviate neck pain. Prop yourself in a sphynx pose on elbows and forearms, palms down, one hand on top of the other Protrude chin forward toward knuckles as if to lick paws like a cat Retract head back Repeat licking paws action While licking move towards one elbow then the other in 1 inch increments
Follow these steps for results to lose weight and become healthier:
1) Place food into mouth 2) Place your utensil down 3) Chew the food until it liquefies in your mouth 4) Swish the “jucified” food around in your mouth 5) Be fully aware of textures, flavors, spices etc. 6) Swallow, “drink your food” 7) Take 2 breaths 8) Lift utensil and repeat steps #1 to #6 What this does for you: Food is digested more efficiently especially if you inhale you food or eat fast. Food mixes with the amylase in saliva that starts digestion with chewing. This makes it easier for the stomach and intestines to digest the food completely. Otherwise the food is partially digested, stagnates in the intestines, causing gas, bloating, bulging abdomen and fattening. By “Jucifying” your food: 1) You appreciate the taste and texture by savoring the food 2) Satiation sensors are activated prior to overeating a) Stomach fullness and b) Blood sugar levels. You will eat less, trim down and lose weight.