MD, PhD, FMedSci, FSB, FRCP, FRCPEd

On this blog, we have discussed many different alternative treatments. As it turns out, hardly any of them fulfil the criteria for being used routinely in clinical practice. But here I present one that might be the exception.

The Feldenkrais Method (FM) aims to reduce pain or limitations in movement, to improve physical function, and to promote general wellbeing by increasing the patient’s awareness of herself and by expanding her movement repertoire. The FM is an educational method similar to the Alexander Technique.

The practitioner directs his attention to the patient’s habitual movement patterns which are inefficient or strained, and teaches new patterns using gentle, slow, repeated movements. Slow repetition is believed to be necessary to impart a new habit and allow it to begin to feel normal. These movements may be passive (performed by the practitioner on the recipient’s body) or active (performed by the patient).

At this point, we should ask: but does FM really and demonstrably work?

Ten years ago, we published a systematic review of all RCTs available at the time testing the effectiveness of FM. Six studies met our inclusion criteria. They were all burdened with significant methodological weaknesses. The indications included multiple sclerosis, neck/shoulder problems and chronic back pain. All but one trial reported positive results.  We concluded that the evidence for the FM is encouraging but, due to the paucity and low quality of studies, by no means compelling.

Since then, more research has become available, and an update of our research seemed necessary. This new review aimed to update the evidence for the benefits of FM. Included studies were appraised using the Cochrane risk of bias approach and trial findings analysed individually and collectively where possible. Twenty RCTs were included (an additional 14 to our earlier systematic review). The population, outcome, and findings were highly heterogeneous. Meta-analyses were performed with 7 studies, finding in favour 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. Risk of bias was high in all studies, thus tempering some results. The effects seemed to be generic, supporting the proposal that FM works on a learning paradigm rather than disease-based mechanisms.

The authors concluded that further research is required; however, in the meantime, clinicians and professionals may promote the use of FM in populations interested in efficient physical performance and self-efficacy.

One might discuss whether or not FM is truly an alternative therapy; it has many characteristics of a physiotherapy, and physiotherapists often employ FM. On the other hand, it is considered to be alternative by some practitioners. So, for the purpose of this article, I will call it alternative.

The evidence for FM has become substantially more promising since we last looked at it systematically. The indication for which the evidence is most convincing is the improvement of elderly people’s balance. Considering that FM is virtually risk-free and inexpensive, I feel that it is one of the rare alternative therapy that could be integrated into clinical routine (for this particular indication).

2 Responses to An alternative treatment that could actually be integrated into clinical routine !?!?

  • I had never heard of the Feldenkrais Method until this article. It prompted me to do a bit of web searching. “One might discuss whether or not FM is truly an alternative therapy”. Indeed! Neither on websites nor in peer-reviewed literature were any of the usual hallmarks of faith and witchcraft medicine evident.
     
    A couple of websites include Feldenkrais alongside pilates, yoga and the like, but if you remove the metaphysical woo from the latter the exercising part of their activity probably merges with Feldenkrais under the general heading of physiotherapy. The worst I could find on websites (in an admittedly cursory search) was the list of things Feldenkrais claims as conditions that respond to the method. This was at http://www.feldenkraisinstitute.org/articles/a_apps.html. While the list was far from the usual “cures everything” nonsense one associates with the Big Snakeoil industry, it was a far cry from the OP’s “The indication for which the evidence is most convincing is the improvement of elderly people’s balance.”
     
    I normally search peer-reviewed literature via Ovid-Medline, which picks up everything published even in the most obscure journals since 1946. A search for articles with “Feldenkrais” in the title produced 37 articles (an improvement on the 17 that turned up when I recently searched for “gua sha”!). They were published in a variety of type of journal, including several in dedicated altmed periodicals, confirming the association of Feldenkrais with altmed. The nearest I could find to metaphysics in one of these articles was in Kimmel et al. Frontiers in Psychology 2014,5:1424, where the abstract reads like something created by the wonderful Postmodern Generator. But then, it’s a psychology journal — need one say more?! (A tiny sample from the abstract: “Expressed in dynamic systems parlance, both disciplines foster metastability, adaptivity, and self-organization in the client’s somato-personal system by progressively reconfiguring systemic dispositions, i.e., an attractor landscape. Doing so requires a keen embodied apperception of hierarchies of somato-systemic order.”)
     
    My personal bottom line, totally in agreement with the OP, is that the Feldenkrais Method generally lacks the normal hallmarks of complementary and alternative medicine, viz. scientifically illiterate basis of action, obsolete metaphysical underlying concepts, claims to be panacea for all types of disease, and absence of robust evidence for clinical effect. The Hillier and Worley systematic review linked to in the OP provides a basis of evidence for considering the approach may well have some value. As one aware of declining balance and increasing sense of vertigo with advancing years, I might even give it a go.

  • Intensive repetition of functional movements is based on the principles of motor learning that underpin many experimental interventions e.g. Constraint Induced Movement Therapy that aim to improve activity limitation in children and adults with neurological disease . Passive movements are not thought to induce plastic changes, but active and guided (active-assisted) movements are.

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