Natural Healthcare 101: Movement Therapies

So you are injured. (First of all, I’m sorry to hear that and I hope you feel better soon.) But what do you do? Below are overviews of various movement therapies that can help you recover in the short-term and teach you long-term strategies to help you move in healthier ways. Some of the techniques relieve pain and some re-train your muscles or ligaments. The different modalities are not mutually exclusive: if you have the resources and the determination, you might engage in physical therapy as well as Alexander Technique for example. Or you might do physical therapy in the short-term and Feldenkrais Method afterward.

Treatment of the wrist

All of these therapies require work, willpower, and commitment. All practitioners will give you work to do in between sessions. It is easy to push the homework to the side and devise excuses for not doing it. I have sustained a fair number of injuries over the last decade and can tell you that there can be a huge difference between doing the work in between sessions and not doing the work. The homework can speed up your recovery and, because most injuries never fully heal, it can help you avoid further injury or pain down the line. I sustained an elbow injury in 2007 that made typing on a computer excruciatingly painful. To this day, the pain returns if I am regularly typing but not doing my exercises for a few weeks. Develop the habit of doing your exercises on your own. It will be much harder to pick up later, when you’re no longer regularly seeing a practitioner.

Western Approach: Physical Therapy

What is it?

Physical therapy is generally the therapy that a Western doctor or orthopedist will recommend for injuries. It is usually the first stop after injury, before alternative healing modalities, because it addresses the immediate problem.

According to the American Physical Therapy Association’s website, “Physical therapists (PTs) are… licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects. Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.” [1]

What does a typical session include?

The initial assessment is generally 45 minutes to an hour and subsequent sessions can last anywhere from half an hour to an hour and a half depending on the severity of your injury and the management plan that has been developed for you. Most management plans include one to three visits per week for at least a few weeks, depending on the severity of the issue. Some management plans can last for months.

A session may include: electrical nerve stimulation, heat or ice therapy, ultrasound therapy, weights, stationary equipment, bands and exercise balls such as those found in gyms, balance boards, foam rollers, deep tissue massage, whirlpools. There will likely be exercises for you to do at home as well.

Things to consider when choosing a practitioner

1. Do you prefer a generalist or a specialist? If you’d like a specialist, you might look for someone who specializes in a particular body part (i.e. hand, ankle, pelvic floor). You also might ask about the typical clientele (i.e. athletes, older people, women).

2. Particularly if you are seriously injured, location and hours of operation may be a consideration because you may need to go often (i.e. three times a week). If you are working or have daily obligations, you will need to find a place that has long hours—many PT clinics will have early morning and Saturday hours. PTs who work in hospitals may not have these options.

3. Does the physical therapist employ assistants? If so, how much time on average will be spent with the physical therapist and how much time will be spent with the assistants? On average, how many clients is a PT seeing at any given time? (Some PTs will see multiple patients at a time—the PT will start off with one patient and the PTA will work with them for the remainder of the time while the PT sees other patients, occasionally checking in.)

4. Do they provide handouts of exercises for you to do in between sessions or after you’ve completed your course of treatment (as opposed to explaining the exercises orally)?

5. Will you need to wear special clothing (i.e. short sleeves, shorts, sneakers, or clothes that can get ultrasound gel or lotion on them)?

6. Does the physical therapist use ultrasound and if so, is this something that you want to do? Most PTs use ultrasound but there is little scientific evidence to show that ultrasound works and some scientific evidence to show that it can damage some sensitive or already damaged tissues. [2]

7. Does your insurance cover physical therapy? If so, how many visits do they cover each year? What does the coverage process entail? [NOTE: Health insurance may cover most or all of the cost of physical therapy visits but most plans only cover a set number of visits per year. The coverage process can sometimes be quite involved as some health insurance policies will only approve payment for a small number of visits and then require PTs to submit regular progress reports. This report is evaluated by an auditor within the insurance company. The auditor either denies further coverage or approves another small number of sessions. This auditor only evaluates coverage through the report—they have never met you and do not know your health history.]

What does it generally cost?

If your insurance covers visits, there may be a co-pay. Average co-pays are between $10-$75/visit. Out-of-network or out-of-pocket physical therapy ranges considerably. Average cost is $50-$350/visit. [3]

Alexander Technique

What is it?

The Alexander Technique was developed in the first half of the 20th century and is both a way to prevent injury and a way to heal from injury.

According to the Alexander Technique website: “The Alexander Technique is a way of learning to move mindfully through life. The Alexander process shines a light on inefficient habits of movement and patterns of accumulated tension, which interferes with our innate ability to move easily and according to how we are designed. It’s a simple yet powerful approach that offers the opportunity to take charge of one’s own learning and healing process, because it’s not a series of passive treatments but an active exploration that changes the way one thinks and responds in activity. It produces a skill set that can be applied in every situation. Lessons leave one feeling lighter, freer, and more grounded.”

“The Alexander Technique is a method that works to change (movement) habits in our everyday activities. It is a simple and practical method for improving ease and freedom of movement, balance, support and coordination. The technique teaches the use of the appropriate amount of effort for a particular activity, giving you more energy for all your activities. It is not a series of treatments or exercises, but rather a reeducation of the mind and body. The Alexander Technique is a method which helps a person discover a new balance in the body by releasing unnecessary tension. It can be applied to sitting, lying down, standing, walking, lifting, and other daily activities…” [4]

Many performers, people with alignment and joint problems such as back pain or carpal tunnel, find it helpful and many practitioners are current or former performers. Scientific studies support some of these favorable claims as well as the use of Alexander Technique in helping Parkinson’s patients. [5]

What does a typical session include?

You can work one-on-one with an Alexander Technique teacher or in a group class. Sessions are generally 30 minutes to an hour.

The teacher may use props such as a chair, a table or other things you encounter in your everyday life as well as mirrors to help you understand your movement or alignment patterns. Expect gentle touch from the teacher.

Wear comfortable clothing that you can easily move around in—you will be fully clothed the entire time. Also wear socks that you’re comfortable showing to other people. (You will take off your shoes.)

Because Alexander Technique entails re-training the mind, sessions are pretty cerebral. You focus your mind on different body parts at different times and, if successful, you will become intimately familiar with your body and its movement.

See also the “What does a typical session include?” section of the Feldenkrais Method for more.

Things to consider when choosing a practitioner

Because you are working with a teacher as opposed to a therapist, it may be helpful to get a sense of the practitioner’s teaching style as well as their background. I’d recommend calling any teachers you are considering working with and asking them a few key questions:

  1. What is their background and why did they choose to go into this profession? For example, a teacher who has a dance background may be great if you are also a dancer because they can use language you already understand to explain techniques. Ultimately, you want to work with someone with whom you have a connection and good communication.
  2. How have they handled students who do not understand what they are being asked to do? Ask them for an example from a real situation.
  3. Do they provide handouts of exercises for you to do in between sessions (as opposed to explaining the homework orally)?
  4. What is the average duration of sessions? In other words, how long do their clients typically stay with them for? This is a valuable question to ask because it can take a while to understand the technique.

What does it generally cost?

Average one-on-one lessons can run $50-$90/session, depending on the teacher’s experience. Initial consultations may be a bit more and last a bit longer than regular sessions. Some practitioners offer package deals. Group lessons generally reduce the cost to about $40-$50/person/class.

Feldenkrais Method

What is it?

Like Alexander Technique, Feldenkrais was developed in the first half of the 20th century and re-trains your mind and body to move in what practitioners consider to be more efficient ways. According to the Feldenkrais Center for Movement Education: “The Feldenkrais Method® is for anyone who wants to make the things they do easier, more efficient and pleasurable. Feldenkrais Method is a mind-body approach, which combines movement and awareness to help you move and live more comfortably and effectively. Whether it is basic actions like sitting or walking, the daily demands of work and home, or your recreational activities – from painting and gardening to running or dance – Feldenkrais offers enjoyable and effective ways to improve how you move. Injury, illness, pain, stress and the effects of ageing can diminish your capacity and the enjoyment of your movement – and your life. Feldenkrais classes and individual sessions allow you to rediscover lost abilities and pleasure in your movement.” [6]

Various studies show the positive effects of the method on various ailments but many of these studies were conducted by Feldenkrais practitioners. A more comprehensive analysis of the studies would need to be conducted to reveal less biased perspectives however. [7]

What does a typical session include?

You can work one-on-one with a Feldenkrais teacher (called Functional Integration) or in group classes (called Awareness Through Movement, or ATM). In each, the teacher guides you through various positions and postures to retrain the way you move. Functional Integration classes are typically conducted on a low table and group ATM classes are typically conducted on the ground. Expect gentle touch from the teacher.

Wear comfortable clothing that you can easily move around in—you will be fully clothed the entire time. Also wear socks that you’re comfortable showing to other people. (You will take off your shoes.)

Alexander Technique focuses on releasing compression in each movement, particularly as your movement relates to the neck and spine. Feldenkrais Method however concerns itself with efficient movement by relying on the entire, larger skeletal structure. [8]

Here is an interesting point to consider:

“Selecting individuals for various alternative medicine treatments is not an exact science. It is impossible to know who will succeed with their treatment and who will not. The overall goal of the Feldenkrais method and Alexander technique differs from most medical or even alternative treatments in that these methods are not trying to fix a problem or cure an ailment. Rather, the goal of these movement techniques is to teach the student to become more aware of his or her own movements functionally and kinesthetically. The result may be an improvement, however, of posture or liberation of muscle tension. Others may have an improvement of voice projection or quality. Additionally, for some, the techniques may improve chronic pain, balance, coordination, or flexibility. The techniques also may improve breathing patterns and an overall fluidity of movement. Overall, the techniques primarily teach students a general awareness of movement, and all else is added benefit.” [9]

Things to consider when choosing a practitioner

I recommend asking the same questions of a Feldenkrais Method teacher as an Alexander Technique teacher:

  1. What is their background and why did they choose to go into this profession? For example, a teacher who has a dance background may be great if you are also a dancer because they can use language you already understand to explain techniques. Ultimately, you want to work with someone with whom you have a connection and good communication.
  2. How have they handled students who do not understand what they are being asked to do? Ask them for an example from a real situation.
  3. Do they provide handouts of exercises for you to do in between sessions (as opposed to explaining the homework orally)?
  4. What is the average duration of sessions? In other words, how long do their clients typically stay with them for? This is a valuable question to ask because it can take a while to understand the technique.

What does it generally cost?

One-on-one sessions are generally comparable to massage therapist rates, approximately $100-$120/hour for regular visits and sometimes more for initial consultations. There is a Feldenkrais low-fee clinic in Manhattan though that charges a sliding scale, between $30-$70/class. Group classes vary significantly and can be $10-25/class or more for lengthier workshops. Class packages are sometimes offered and may reduce the price.

Have you tried a movement therapy or are you are curious about one not mentioned in this blog? Let us know. Leave a comment below!

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[1]  American Physical Therapy Association’s website.

[2]  See for example KG Baker, et al. “A Review of Therapeutic Ultrasound Effectiveness Studies.Physical Therapy 81 (7) July 2001: 1339-1350 and for precautions, see an overview of Ultrasound Therapy on SportsInjuryClinic.com.

[3]  http://health.costhelper.com/physical-therapist.html

[4]  Alexander Technique website. Further reading: “Some Common Misconceptions about the Alexander Technique.

[5]  See for example Paul Little et al. “Randomised controlled trial of Alexander technique lessons, exercise, massage (ATEAM) for chronic and recurrent back pain.” BMJ 2008: 337:a884; JP Woodman and NR Moore. “Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systemic review.” International Journal of Clinical Practice 2012 Jan; 66(1): 98-112. See also, Andrea Matthew. “Why Performers Need the Alexander Technique.”

[6]  Feldenkrais Center for Movement Education website.

[7]  For an overview of various studies conducted prior to 2012, see pp. 13-17 and “Table of Feldenkrais Research Studies” in Australian Feldenkrais Guild, Inc. “Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies.” Submission to the Department of Health and Aging, 2012/13.

[8]  See Nora Nausbaum. “What is the Difference between the Alexander Technique and Feldenkrais Method.” Strings. Sept/October 1997, vol 64.

[9]  S. Jain et al. “Alexander Technique and Feldenkrais Method: A Critical Overview.” Physical Medicine and Rehabilitation Clinics of North America 15 (2004) 823.

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