Byline: Andrea Salzman, MS, PT
As a physical therapist, I was somewhat disturbed to note that at age 26, I was unable to do a round-off back handspring. It wasn't so much the handspring—as a child, I had once hidden in the gymnasium bathroom in shame to change my handspring score—I was never a Nadia. Rather, it was my poor showing in the cartwheel portion of the move that frightened me.
I was old. And my knees made funny noises. At 26. So I started exercising in water. Eventually I took my entire physical therapy practice into the pool and became an aquatic physical therapist.
From Despair to Discovery
When World-War II nuclear physicist Moshe Feldenkrais tore the cartilage in his knees playing soccer in the 1930s, his physician recommended a popular therapy for his time: Six months of bed rest. As a physical therapist, it is difficult to look back and imagine a time when the effects of immobilization were not understood. It is even harder to imagine the despair which would settle over a man who has been told to stop living or suffer permanent damage.
The physicist did not give in to despair. Instead he began to experiment with small movements while lying in bed, movements which he felt mimicked the natural developmental movements seen in children. Over time, he developed a series of movement patterns which required the body to move in strange combinations, patterns that would not be normal for an adult.
It was his contention that he could recondition his body's habitual, painful movement patterns by "starting over" as a newborn infant. This series of movements (which later became known as the Feldenkrais Method) allowed the bed-bound Judo Master to return to life without pain. His work reached international attention when published under the names "Body and Mature Behavior" and "Awareness Through Movement." Eventually the work was structured in a group format ("Awareness Through Movement") and a 1:1 intervention ("Functional Integration").
He brought the Feldenkrais school of thought to the United States in 1972 and since that time, more than 1,000 U.S. practitioners have been certified to practice Feldenkrais.
Fluid Movements
One such practitioner, Debbie Ashton, BS, MA, has taken the work of Moshe Feldenkrais and placed it within my grasp—in a warm water therapy pool. She has translated dozens of Feldenkrais "lessons" into the aquatic environment. In a therapy pool, movements become free from gravity and surrounded by a warm, viscous fluid which stimulates touch and pressure receptors while allowing movements to occur in a functional (upright) position. Land-based Feldenkrais lessons are often performed in a gravity-eliminated position, such as supine, to allow the body's systems to "turnoff" so that the patient may selectively choose to turn them on again.
The problem with such positional work is the same problem experienced during use of an isokinetic device: the position of the movement is artificial.
Immersion in water allows upright positioning without requiring much activity from antigravity muscles. At the same time, per Isaac Newton, for every aquatic action, there is an opposite and equal reaction—feedback. And feedback seems to be the soul of proprioception, our internal connection with the world around us. As a therapist, I revel in the thought that I may affect neural tension, soft tissue length and joint mobility (my skills as a therapist) in an environment which promotes proprioception.
Better Movement, Not More
Ashton's aquatic adaptations allow the practitioner to connect with the purpose of Feldenkrais—not more movement, but better movement. As third-party payers cast their collective votes for less reimbursement, it becomes easier to acquiesce and hurriedly teach our patient exercises to do at home.
Finesse, the heart of our profession, is suffocated. At some point, we have all been guilty of teaching strengthening exercises to a muscle which is not weak. Why? Because we can teach a muscle to contract in much shorter time than we can teach kinesthesia. Aston reminds us of the importance of finesse in movement. Her aquatic Feldenkrais lessons (Fluid Moves®) are studies in subtlety. The two lessons discussed in this article focus on the pelvis and the shoulder girdle. Individuals interested in more information should contact Ashton at the resource information listed in the References section.
Fluid Moves Lessons
Lesson I — Pelvic Clock
1. Stand with back against the pool wall. Bend knees so lumbar spine touches wall. Place feet hip-width apart, hands by sides and touching wall lightly for balance.
2. Press lumbar spine into wall (posterior pelvic tilt). This is 12 o'clock. Release posterior tilt and exaggerate lumbar lordosis (anterior pelvic tilt). This is 6 o'clock.
3. Roll the pelvis from 12 o'clock to 6 o'clock, maintaining contact with the wall. Notice how the knees are moving forward away from the wall. Turn your right knee in, toward the left, rotating on the ball of the foot. Repeat with left leg.
4. Break. Walk across the pool and assess if the right hip and hip flexors seem to move more freely.
Lesson II — Freedom for the Shoulders
1. Stand in chest deep water with right side against pool wall. Bend knees.
2. Place right arm against the wall at an angle perpendicular to shoulder. Place left arm next to right arm in starting position.
3. Slide left arm out by protracting the scapula, maintaining a loosely extended elbow. Allow the left fingertips to go further than the right fingertips. Release protraction and allow left scapula to retract and the left arm to slide back against the right.
4. Repeat and place left hand on forehead, finger over the eyebrows, parallel to hairline. Rotate cervical spine smoothly with hand. Follow the elbow with the eyes. Continue until left scapula touches wall behind it. Repeat and allow cervical spine and head to rotate with movement. Self-assess for rib or left hip movement. Rest and allow the arm to float.
5. Maintain scapular contact while extending left elbow so arm points toward the middle of the pool.
6. Protract and retract scapula so contact with the wall is lost and regained.
7. Break: Walk across pool, allowing arms to passively float behind you. Stand with feet apart, knees bent. Rotate the torso right-to-left, allowing the arms to swing passively in a trailing motion. See how the left shoulder feels in comparison to the right as you move through the water.
Is Your Pool Right for Aquatic Feldenkrais?
Pool Temperature: 86 to 94 degrees Fahrenheit.
Pool Depth: At least chest-deep for patient populations.
Physical Parameters: Flat wall surface available for patient contact.
Ambient Noise: A quiet environment is ideal but these movements may also be used for relaxation when the pool environment is stressful and noisy.
Practitioner Credentials: Individuals may use Feldenkrais-type movements such as those detailed in this article without special training, but may not advertise as Feldenkrais practitioners unless registered by the Feldenkrais Guild. To become a practitioner, practitioners attend intensive bouts of training (800-1000 hours of didactic studies spread out over 4 years of field work integration) and would then be registered with the Guild.
Integration of Techniques: Aquatic practitioners who wish to incorporate Feldenkrais-type movements into their practice without becoming Feldenkrais practitioners may choose to integrate these subtle movements as "homework" or "self-management" techniques for patients. Aquatic practitioners may also use audio tapes as reminders to guide patients through movements previously mastered.
Clinical Use: Until these treatment philosophies are grounded in observable anatomy, neuroanatomy and physiology, and are tested and repeated in clinical trials, practitioners need to be careful about basing an entire intervention on the theories of Feldenkrais. This should not prevent practitioners from delighting in the graceful kinesthetic lessons of the Method, both for patients and for themselves. In fact, this should propel practitioners who find this method helpful clinically to propose solid clinical research questions about its effectiveness.
Feldenkrais Resources
Debbie Ashton, BA, MS, Aquatic Feldenkrais Instructor
Provides national courses on integration of aquatic Feldenkrais into therapeutic settings.
Sells audio tape and videotape set "Feldenkrais on Land and Water" - Four lessons to mobilize hips, shoulders and pelvis and to regain balance.
The Well Being, 9113 Cedar Park Lane #C, Knoxville, TN 37923; 888-935-6287 (toll-free); (865) 690-9548.
Feldenkrais Guild
Provides information on locating Feldenkrais practitioners and information on training to become a Feldenkrais practitioner.
PO Box 489, Albany, OR 97321-0143; 800-775-2118 (toll-free); (541) 926-0572 (fax); www.feldenkrais.com
Want to read more about kinesthetic awareness and aquatic therapy? Check out this research: Flynn, S., Duell, K., Dehaven, C., & Heidorn, B. (2017). Kick, Stroke and Swim: Complement Your Swimming Program by Engaging the Whole Body on Dry Land and in the Pool. Strategies, 30(6), 33-38.