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Complementary Approaches

Movement Therapies

There are many therapies based on the concept of systematic movement of the body. They are best classified into a group that originates with Eastern medical practices and a group that is consistent with Western approaches.

The Eastern Movement Systems are ancient movement practices composed of physical movements, breathing exercises, directed focus of attention and meditation practice. They are practiced in Eastern cultures to enhance physical, psychological and spiritual health. Their use for various forms of pain management is in the early stages of study.

Tai Chi and Qigong are gentle movement practices that have been used for centuries in China for health, religious practice and self-defense. As a form of exercise and relaxation they have been used to improve balance and stability, reduce pain and stress, improve cardiovascular health, and promote mental and emotional calm and balance. In the area of pain management, scientific studies have shown their benefit in reducing stress, as evidenced by alpha and theta brain wave increases, increases in B endorphin levels and drop in ACTH levels (Ryu, 1996). Effectiveness has also been shown for complex regional pain syndrome, fibromyalgia, and chronic low back pain when combined with education and relaxation training (Creamer, 2000; Berman, 1997). Studies continue to clarify the mechanisms of action, benefits and applications of these movement practices for health maintenance and disease management.

Yoga is an ancient system developed in India that addresses the physical, mental and spiritual aspects of the individual. There are many different forms of yoga practice, each of which emphasizes different skills and goals. Hatha yoga, the path of the body, is the most well known approach in the United States and is used here mainly as a form of exercise and stress management. Within Hatha yoga, there are many different approaches. Some techniques are physically strenuous and demanding, while others are gentle and slow, focusing as much on the meditative aspects of practice as on physical development. This variety in approaches allows the individual to participate in yoga practice at a level that is both appropriate to one's physical abilities and mental/emotional/spiritual goals. Kripalu yoga consist of a series of gentle postures (asanas), breath work and meditation that emphasize flexibility, stretching, stress reduction and increased vitality to enhance balance of mind, body and spirit. The Iyengar style, created by B.K.S. Iyengar, focuses on understanding how the body works and on postural alignment to increase strength and flexibility for better health. This style is characterized by the use of various props, such as cushions, benches, wood blocks and chairs to achieve postures that are held for a longer amount of time than in many other yoga styles. Bikram yoga is a system of 26 postures performed in a standard sequence in a room heated to 85-110 degrees Fahrenheit, providing a fairly vigorous work out designed to cleanse the body. Ashtanga yoga is a physically demanding series of fast-paced postures performed in a continual flow using dynamic breath and other techniques. This practice offers a physical challenge in order to build strength, flexibility and stamina.

The potential benefits of yoga in pain management have begun to be documented. Studies have shown its positive effect on stress through a decrease in serum cortisol levels and increase in brain alpha and theta waves. It may also be of benefit by increasing self-awareness, relaxation on physical and emotional levels, respiration, and self-understanding (Nespor, 1991). Decreased stress may positively influence the emotional component of pain. On this basis, it has been advocated as part of a multimodality program for back pain (Nespor, 1989). In clinical studies, yoga has reduced the pain of osteoarthritis and carpal tunnel syndrome (Garfinkel, 2000), and promoted stress reduction and positive mood (Kerr, 2000; Schell, 1994). In a recent study, the combination of yoga and meditation was more effective than standard medical treatment alone for the management of chronic pain patients (Randolph, 1999). A combination of yoga and meditation is an integral and successful part of the well-known Stress Reduction and Relaxation Program founded by Jon Kabat-Zinn at the University of Massachusetts for chronic pain patients.

The Western Movement Systems, like the Eastern systems, are often tried by patients with chronic pain. Pain specialists have limited awareness of these approaches and they are only rarely incorporated into routine therapy.

The Alexander Technique, developed by F. M. Alexander in the 1890's, focuses on the alignment of the spine, particularly the relationship between the head and the neck, and what is called "good use" of the body. Using verbal instructions and light touch, the practitioner guides the student towards correct alignment both on the table and in everyday movements, such as sitting and walking. The goal is to find, through this new awareness and correct relationship of the parts of the body, a natural, easy and correct way of moving and using one's body in everyday activities of life ( .

The Alexander Technique is often used by people with postural problems, chronic back and neck pain, or a desire for improved performance in sports or the performing arts. Much of what is known about the benefits of the technique has been anecdotal. More recently, small scientific studies have suggested benefits for stress reduction, back pain during pregnancy and chronic pain (Atchison, 1999), pregnancy and childbirth (Stallibrass, 1997), enhanced relaxation (Kerr, 2000), improved balance in older women (Dennis, 1999), enhanced respiratory function (Austin, 1992) and improvement in posture, spasticity and anxiety in people with learning disabilities (Maitland, 1996).

Developed by Dr. Moshe Feldenkrais, the Feldenkrais Method consists of a large number of simple movement exercises that offer the student new ways of moving that are pain-free and not governed by tension and habit ( The work consists of two parts: 1) a series of movement lessons called Awareness through Movement, which are verbally guided by a teacher in group sessions, and 2) Functional Integration, which are individual, hands-on sessions during which the student is gently guided through various movement sequences by the practitioner. Recent studies of the Feldenkrais Method suggest that it may be useful for anxiety (Kolt, 2000), neck and shoulder pain, and disability (Lundblad, 1999), and anxiety in multiple sclerosis patients (Johnson, 1999).

Based on the work of Milton Trager, MD, the Trager Approach combines table work and simple movement practices (called Mentastics) to help the body/mind re-learn ways of moving and being that are easier, lighter and freer ( Table work consists of gentle rocking, stretching, compressing, and range of motion movements that are thought to allow the release of unconscious restrictive holding patterns that create pain, tension, stiffness and restricted movement. The Mentastics can be used to practice these new more beneficial movement patterns in daily life and support the changes that are experienced during the table work portion of the session.

Benefits of the Trager Approach have been suggested by case studies. A recent study on the combination of the Trager Approach and acupuncture found that the treatment was effective in reducing shoulder pain in spinal cord injury patients (Dyson-Hudson, 2001). An earlier study demonstrated positive effects on chest mobility in patients with chronic lung disease (Witt, 1986).



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