Ives.pmd Feldenkrais Research Journal • volume 1 (2004) Article Comments on “The Feldenkrais Method: A Dynamic Approach to Changing Motor Behavior” Jeffrey Ives Professor; Ithaca College, NY, USA Abstract The Feldenkrais Method® has recently been discussed to fit within a dynamic systems model of human movement. One basis for this discussion is that small changes in one system—for example, enhanced body awareness—has far reaching implications across the whole of human performance. An alternative view on the Feldenkrais Method is argued here. It is argued that the clinical data do not support the Feldenkrais Method as being an effective way to improve motor performance. Further, it is argued that positive outcomes in pain and other wellness measures following Feldenkrais interventions can be ascribed to self-regulation. As part of this discussion, the role of body awareness, attentional focus, and kinesthesia in motor learning and control are explored. Keywords attentional focus, kinesthesia, motor learning, self-regulation Copyright ©: The copyright for this paper remains with the author(s). First published: Research Quarterly for Exercise and Sport, Vol. 74, No. 2, p116-123, (2003). Please cite: Feldenkrais Research Journal, volume 1; 2004. Service marks: The terms Feldenkrais®, Feldenkrais Method®, Awareness Through Movement®, ATM®, Functional Integration®, and FI® are service marked terms of the International Feldenkrais® Federation (IFF) and Feldenkrais professional guilds and associations in many countries. In keeping with academic conventions, they will not be service marked in the entire text as may be required in nonacademic use, but only for the first and most prominent use of the terms. In recognition that these phrases are formal terms referring to specific practices within the Method, and to the Method as a whole, capitalization of all the words in each term has been retained. Published by the International Feldenkrais® Federation (IFF) https://feldenkrais-method.org Available online at https://feldenkraisresearchjournal.org https://feldenkrais-method.org/ https://feldenkraisresearchjournal.org 116116116116116 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 Ives Research Quarterly for Exercise and SportResearch Quarterly for Exercise and SportResearch Quarterly for Exercise and SportResearch Quarterly for Exercise and SportResearch Quarterly for Exercise and Sport ©2003 by the American Alliance for Health, Physical Education, Recreation and Dance Vol. 74, No. 2, pp. 116–123 Key words: attentional focus, kinesthesia, motor learning, self-regulation In a recent issue of this journal, Buchanan and Ulrich (2001) provided a thoughtful look at Feldenkrais Method® principles and how they fit within a dynamic systems model. Using this model, the authors proposed a number of potentially fruitful areas of research into the clinical effectiveness and theoretical bases of the Feldenkrais Method. This research is warranted, but as Buchanan and Ulrich mentioned, models other than dynamic systems may be appropriate to provide a research perspective. Proposed here are alternative models based largely on data rather than Feldenkrais theory. It is asserted that the clinical data show only marginal effectiveness and nar- row applicability of the Feldenkrais Method to enhance motor learning and performance, and these findings are readily explained by current data and theories on attentional focus, kinesthesia, and self-regulation. Spe- cifically, it is argued that the Feldenkrais emphasis on self- awareness is a relatively ineffective way to improve motor or perceptual motor performance and that self-regula- tion theory may be a suitable way to look at the psycho- logical aspects of the Feldenkrais Method. To justify these arguments, it is first necessary to examine closely the clinical data on the Feldenkrais Method. Prior Reviews of the Prior Reviews of the Prior Reviews of the Prior Reviews of the Prior Reviews of the Feldenkrais MethodFeldenkrais MethodFeldenkrais MethodFeldenkrais MethodFeldenkrais Method The clinical research of the Feldenkrais Method has been thoroughly reviewed. Literature reviews by Ives and his colleagues (Ives & Shelley, 1998; Ives & Sosnoff, 2000) and Ellis (1995) have concluded that the data are not compelling but that the poor quality of research makes interpretation difficult. Stephens’ (2000) brief review included a number of theses and conference abstracts and noted that, despite abundant method- ological flaws among the studies, the Feldenkrais Method showed positive results in pain management, range of motion, muscle activity, posture and breathing, func- tional mobility, and quality of life. In the most compre- hensive review to date, and one that included many of the same abstracts, unpublished theses, and nonjuried sources included in the Stephens (2000) paper, Ives and Shelley (1998) concluded that the findings “. . . do not match the extravagant anecdotal claims. . .” and that “. . . it Comments on “The Feldenkrais Method®: A Dynamic Approach to Changing Motor Behavior” Jeffrey C. Ives Submitted: March 19, 2002 Accepted: September 30, 2002 Jeffrey C. Ives is with the Department of Exercise and Sport Sciences at Ithaca College. The Feldenkrais Method® has recently been discussed to fit within a dynamic systems model of human movement. One basis for this discussion is that small changes in one system—for example, enhanced body awareness—has far reaching implications across the whole of human performance. An alternative view on the Feldenkrais Method is argued here. It is argued that the clinical data do not support the Feldenkrais Method as being an effective way to improve motor performance. Further, it is argued that positive outcomes in pain and other wellness measures following Feldenkrais interventions can be ascribed to self-regulation. As part of this discussion, the role of body awareness, attentional focus, and kinesthesia in motor learning and control are explored. Dialogue and Commentary Ives.pmd 4/15/2004, 12:41 PM116 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 117117117117117 Ives has not been shown that any of the positive findings can be directly attributable to Feldenkrais treatments apart from other factors, such as practice, relaxation, the Hawthorne effect, exercise/mobility training, biologic variability, spontaneous and normal recovery, or experi- mental error” (p. 85). Hopper, Kolt, and McConville (1999) similarly described the positive results found by many authors to be unsupportable because of serious methodological flaws. More recently, Ives and Sosnoff (2000) concluded that the best evidence of Feldenkrais effectiveness is for psychological benefits, a statement also supported by Huntley and Ernst (2000). Since the extensive review by Ives and Shelly (1998), other studies have been pub- lished that have been interpreted to provide strong evi- dence for the positive effects of the Feldenkrais Method. Scrutiny of these data, however, gives rise to alternative explanations that have important theoretical and clini- cal implications. Space does not permit a full descrip- tion of these studies, so the reader is urged to seek the original sources. Recent StudiesRecent StudiesRecent StudiesRecent StudiesRecent Studies A series of studies by Kolt and his colleagues (Hop- per et al., 1999; James, Kolt, McConville, & Bate, 1998; Kolt & McConville, 2000; Smith, Kolt, & McConville, 2001) have produced conflicting results regarding per- ceived exertion, hamstring flexibility and length, anxi- ety reduction, and pain reduction following single or multiple Feldenkrais lessons. For example, Kolt and McConville (2000) reported that after four treatment sessions participants in the Feldenkrais group and in the relaxation group displayed lower measures of anxiety, but these significant findings were only in the female participants and only due to a reduction in anxiety level from just before Treatment 4 to just after Treatment 4. These authors (Smith et al., 2001) found no significant (p = .13) reduction in state anxiety in low back pain suf- ferers following a 30-min audiotaped Feldenkrais lesson or in a control group (p = .06) that listened to an audiotaped story. In this study, the Feldenkrais group sig- nificantly reduced the affective dimension of pain, the control group significantly reduced the sensory di- mension of pain, and neither group significantly re- duced the evaluative dimension of pain (the Feldenkrais group had a nonsignificant increase). Examination of the pre to post mean values suggests that the control group actually fared better than the Feldenkrais group. In an uncontrolled case study examination of two stutterers, Gilman and Yaruss (2000) reported that fol- lowing 8 weeks of Feldenkrais lessons the patients felt more in control of their speech, were able to control tension during speaking, and had less anxiety, yet there was minimal change in the measurable degree of disfluency. In a well controlled study, Kirkby (1994) examined women with severe premenstrual symptoms undergo- ing Feldenkrais Awareness Through Movement (ATM) lessons or cognitive-behavioral coping skills training over 6 weeks. The women in the coping skills group had a greater improvement in quality of life and greater im- provements over a much broader range of symptoms and measures than did the ATM group, which generally showed improvements slightly better (but not statistically better) than the control group. One commonly cited article supporting the Fel- denkrais Method examined pain reduction in seven chronic pain sufferers (Bearman & Shafarman, 1999). The participants underwent 2 months of Feldenkrais treat- ments in which pain ratings and historical medical costs were collected alongside information from the National Pain Data Bank test instrument. Bearman and Shafarman reported that the Feldenkrais participants showed “dramatic improvements” by the end of the 2-month program, and at a 1-year follow-up the authors concluded that, “. . . while participants lost ground in most areas of pain control, function, and quality of life, they were judged generally healthier than at intake” (p. 26). Both these conclusions are difficult to evaluate because of the lack of data re- ported and no statistical tests. These findings were based on the patients’ recall of pain, which is often poor and underestimated (Feine, Lavigne, Dao, Morin, & Lund, 1998). The Feldenkrais participants were judged to have better results when compared to data provided by the National Pain Data Bank, but this comparison was inap- propriate, because the Feldenkrais patients were consid- erably different in many factors than the comparison group. Although a 40% reduction in medical costs for the Feldenkrais patients was reported, the sponsoring health care agency did not choose to include Feldenkrais in its scope of benefits. Stephens (2000) examined clinical data in 157 physical therapy patients with musculoskeletal problems over a 10-year period. The patients were typically seen by the physical therapist once every 1–3 weeks and were given a home program of regular physical therapy exer- cises or Feldenkrais ATM lessons to do on their own time. Presumably, the in-clinic sessions combined Feldenkrais with regular physical therapy. In comparison to the pre- ferred practice patterns and expectations for recovery published by the American Physical Therapy Associa- tion (1998), the outcome success and number of visits fell “within the expected range.” This statement sug- gests no special benefits with the Feldenkrais method. Malmgren-Olsson, Armelius, and Armelius (2001) looked at a normal comparison database of patients suf- fering with nonspecific musculoskeletal disorders com- pared to a group undergoing conventional physical Ives.pmd 4/15/2004, 12:41 PM117 118118118118118 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 Ives therapy treatments (a median of 20 treatment sessions), body awareness therapy (20 sessions), and the Feldenkrais Method (20 sessions). The Feldenkrais treatments con- sisted of both ATM and Functional Integration® (FI). All patients were tested for measures of psychological distress, pain, and self image over a 1-year period. In comparison to a nonintervention control group, the three treatment groups all improved over the year. From a statistical significance standpoint, none of the three treatment groups differed from one another, but an examination of effects sizes and mean values indicated that body awareness therapy was a little better than the Feldenkrais Method, which was a little better than the con- ventional treatment. These authors acknowledged that some, but not all, of the effects may have been due to placebo or simply improvement over time. They also made the observation that the active participation by patients in the body awareness and Feldenkrais groups in treating their own problems may have been the reason these methods compared favorably to the conventional treatment group. Another well controlled study did show positive effects of the Feldenkrais Method to lessen complaints from neck and shoulder problems when compared to con- ventional physical therapy (Lundblad, Elert, & Gerdle, 1999). Lundblad et al. examined 58 female factory work- ers complaining of neck and shoulder problems and tested them on 22 different clinical and physiological tests and 11 different complaint and pain measure- ments. Of the 22 clinical (e.g., neck and shoulder range of movement) and physiological (e.g., peak torque, V02, electromyographic measures) tests, the Feldenkrais group significantly improved on eight, the control group improved on six, and the physical therapy treat- ment group improved on two. The authors noted that the absolute differences among these interventions were minimal and coincided with a lack of statistical sig- nificance found for the combined treatment effects. The small differences found in all the groups from pre to post are of doubtful clinical significance and are most likely due to familiarization effects with the testing ap- paratus or, as the authors discussed, may have had some- thing to do with a change in work environment that occurred during the study period. The only clinical test the Feldenkrais group clearly performed better at com- pared to the other groups was a “cortical control” mea- sure, a measurement based on Feldenkrais methodology. This measurement, however, was not validated with any of the objective tests of muscle relaxation using elec- tromyography. The Feldenkrais group did improve sig- nificantly in 5 of 11 complaint and pain disability tests (e.g., pain perception, coping) compared to 1 of 11 for the control group and 0 of 11 for the physical therapy group. The percentage of improvement for the Feldenkrais group in some of these measures was large, especially when compared to the other groups that had a tendency to worsen from pre to post. However, it was not neces- sarily expected that the physical therapy group would improve, for Lundblad and her colleagues noted that traditional physical therapy has been shown to be inef- fective in similar cases (e.g., Feine & Lund, 1997). Preliminary Clinical ConclusionsPreliminary Clinical ConclusionsPreliminary Clinical ConclusionsPreliminary Clinical ConclusionsPreliminary Clinical Conclusions The current evidence supports two conclusions. First, the Feldenkrais Method has not been shown to be better than the treatments it has been compared against or if compared to successful treatments that have been indicated for a particular condition. Even the effects of pain reduction reported for the Feldenkrais treatments must be considered in comparison to targeted behav- ioral interventions that have been shown to be statisti- cally and clinically effective (e.g., Haugli, Steen, Lærum, Nygard, & Finset, 2001). Findings of improved emo- tional well being among Feldenkrais participants must similarly be compared to the near unequivocal effects reported for simple relaxation training (Linden, 1994) and exercise (Fox, 1999). From a clinical standpoint, it seems difficult to recommend the Feldenkrais Method above other techniques. Second, any effects noted appear to be psychologi- cal and not physiological. These psychological effects may be related to simple relaxation effects (Gilman & Yaruss, 2000), the interpersonal relationships devel- oped among clients and practitioner, or the feelings of wellness and anxiety reduction that may accompany touch-based therapy (Vickers & Zollman, 1999). These findings are consistent with suggestions that the Fel- denkrais Method may be more efficacious in women than men, particularly regarding pain and other psychologi- cal factors (Malmgren-Olsson et al., 2001). Most of the studies that have shown positive psychological effects have used predominately female participants (e.g., Johnson, Frederick, Kaufman, & Mountjoy, 1999; Kirkby, 1994; Lundblad et al., 1999). These data can be tied to the numerous findings that men and women differ in pain perception and manifestation of pain types (Berkley, 1997), somatization of stress (Nakao et al., 2001), and that women have been shown to positively respond to behavioral interventions for pain (Haugli et al., 2001). Using Feldenkrais methods to improve awareness may aid in some types of psychological and somatic complaints, but, again, when compared to other methods such a body awareness training (which has a considerable psy- chological counseling component, see Malmgren- Olsson et al., 2001) or simple relaxation (Smith et al., 2001), the Feldenkrais Method does not stand out. Changes in physiological performance, such as flexibil- Ives.pmd 4/15/2004, 12:41 PM118 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 119119119119119 Ives ity, movement efficiency, or postural control, have either not been shown, shown conflicting results, or been of minimal effect size. In light of the claims that the Feldenkrais Method is a movement re-education method, greater changes in physiological performance should be expected. Consider, for instance, three recent studies that looked at postural sway characteristics following Feldenkrais interventions (Buchanan & Vardaxis, 2000; Diedrich, Feng, Buchanan, Reese, & Thelen, 1999; Seegert & Shapiro, 1999). From a statistical and effect size stand- point there were few differences among the Feldenkrais treatments and control treatments that consisted of ei- ther no activity, stretching, or relaxation. There were also conflicting findings among the reports. Seegert and Shapiro (1999) reported after a single 75-min Feldenkrais session that their participants displayed less postural sway velocity and amplitude. In contrast, following a single Feldenkrais lesson Diedrich et al. (1999) reported that their participants swayed at higher frequencies than the control groups. After eight Feldenkrais lessons over 4 weeks, Buchanan and Vardaxis (2000) noted that sway had become more circular by reducing the amount of extreme excursions. Again, however, all of these find- ings must be viewed with reservation, because in all the studies there were few statistical and effect size differ- ences from pre- to posttest or among the Feldenkrais and control groups. Explanations and Alternative ViewpointsExplanations and Alternative ViewpointsExplanations and Alternative ViewpointsExplanations and Alternative ViewpointsExplanations and Alternative Viewpoints Given the arguments from Buchanan and Ulrich (2001) and others (e.g., see Bate, 1994) that the Feldenkrais Method fits motor learning and control theories, why has it not been shown to be more effective in producing notable motor performance changes? An essential fac- tor in the Feldenkrais Method is its emphasis on self-aware- ness, and this factor may be its shortcoming when training for better body coordination. As Buchanan and Ulrich pointed out, the self-awareness emphasis is con- trary to the literature on goal setting. Focusing on being aware of one’s own movements and exploration of one’s own sensory and perceptual cues are analogous to adopt- ing an internal focus of attention. An internal focus or “body awareness” may be a useful strategy at times for certain conditions, namely those with a large psychologi- cal dimension (e.g., pain, see Steen & Haugli, 2001), but an external focus is more effective in learning and performing motor skills, so much so that Singer, Lidor, and Cauraugh (1993) described the best motor skill learning as following a “nonawareness” approach. When learners focus attention on their own bodily movements (internal focus of attention) versus focus- ing attention on the effects of these movements (exter- nal focus of attention), learning and performance suf- fer (Wulf, McNevin, Shea, & Wright, 1999). Wulf and her colleagues have shown that movements ranging from object manipulation tasks to whole body movement and balance tasks were acquired, performed, and retained better with an external focus (Wulf et al., 1999; Wulf, Shea, & Park, 2001). Similar results can been found in the physical rehabilitation literature, where added pur- pose activities (physical activities with meaningful out- come goals or purposes) that take conscious attention away from the movement itself help develop more effec- tive movements (e.g., Hsieh, Nelson, Smith, & Peterson, 1994). These findings are all in line with the five-step approach of Singer et al. (1993), where learning and performing motor skills are best done without thinking about them, and attention is initially placed on some external cue or movement goal. If an external focus of attention is purported to be better for learning and performing motor skills, how can this be reconciled with evidence that high-level endur- ance athletes tend to adopt an associative strategy in which focus is placed on internal bodily sensations such as breathing, pain, and muscle tension (Masters & Ogles, 1998)? Association appears to work for low strat- egy endurance sports with a low motor skill component (e.g., running and swimming), where external cues are less important, and is tied to competitive environments, where the exercise intensity is high (Bachman, Brewer, & Petipas, 1997). In their review, Masters and Ogles (1998) concluded that associative strategies relate to faster performance, whereas dissociative strategies (e.g., external focus) relate to lower perceived exertion. This conclusion is consistent with reports that the mood-en- hancing qualities of recreational aerobic exercise can be diminished with an internal focus (Fillingim & Fine, 1986). Thus, an associative strategy appears not in har- mony with the desired outcomes of Feldenkrais lessons. Irrespective of the benefits of an external focus, can improving body awareness improve performance or enhance motor learning? Buchanan and Ulrich (2001) noted that Feldenkrais proponents “argue that by first improving the sensitivity of perception [i.e., goal is on bodily awareness] one can learn to adapt any behavior more easily” (p. 319). Body awareness requires a myriad of sensory and perceptual systems (e.g., tactile, proprio- ceptive, interoceptors), but kinesthesia predominates among nonvisual sensory systems and is emphasized in Feldenkrais lessons. The role of kinesthesia in motor learning and control and the effectiveness of kinesthetic training have been vigorously debated, and many ques- tions remain (Geron, 1986, see also Sims, Henderson, Morton, & Hulme, 1996, regarding kinesthetic sensitivity training). Nonetheless, evidence strongly suggests that kinesthetic cues, kinesthetic imagery, and kinesthetic Ives.pmd 4/15/2004, 12:41 PM119 120120120120120 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 Ives sensitivity are least used or least needed in the early stages of motor learning (Fleishman and Rich, 1963; Hardy & Callow, 1999; Laszlo & Sainsbury, 1993) and that conscious and focused effort is not required and per- haps not even important to improve perceptual sensi- tivity. For instance, movement repetitions improve position sense (Meeuwsen, Sawicki, & Stelmach, 1993), a single weight training session improves body aware- ness (Koltyn, Raglin, O’Connor, & Morgan, 1995), and children improve spontaneously in kinesthetic ability (Laszlo & Sainsbury, 1993). Aerobic exercise training has shown to increase internal body consciousness (similar to body awareness) and body competence (Skrinar, Bullen, Cheek, McArthur, & Vaughan, 1986). When an associa- tive strategy or internal focus may be beneficial to learn or perform certain skills, the ability to do so is learned quickly (Couture, Jerome, & Tihanyi, 1999; Miller & Medeiros, 1987). Early research indicated that kinesthetic ability was associated with athletic performance (Geron, 1986), but recent evidence contradicts these findings (Freeman & Broderick, 1996). This discrepancy is likely a result of the specificity of training principle, that is, kinesthetic ability is more likely to be found if the kinesthetic mea- sures are specific to the athletic movements most prac- ticed (Jacobson, Chen, Cashel, and Guerrero, 1997). Perhaps the most controversial topic in kinesthesia con- cerns kinesthetic training for children with motor prob- lems (e.g., see Sims et al., 1996). Although kinesthetic training may help children with or without motor prob- lems, there are other factors independent of kinesthe- sia that play a role (Sims & Morton, 1998). Furthermore, in young school-age children kinesthetic inability does not affect overall motor skill function (Laszlo & Sainsbury, 1993). As with other types of training with an internal focus, kinesthetic training can be brief (e.g., 10 min, see Laszlo & Sainsbury, 1993; Sims & Morton, 1998). Other factors also argue against the efficacy of ki- nesthetic training or the importance of conscious kines- thetic awareness in motor performance. For one, perceptions of movement-related effort in limb move- ment tasks are ambiguous measures that often hold little insight to physical performance related to biomechani- cal or metabolic efficiency (Rosenbaum & Gregory, 2002). Second, training using conscious attention to- ward proprioceptive signals may not be effective, because proprioception use in time-critical tasks is either reflex- ive or autonomic (Ashton-Miller, Wojtys, Huston, & Fry- Welch, 2001), or, as Henry (1953) found in his now classic study, purposeful movement adjustments to out- side force stimuli are often done below the level of con- scious awareness. In contrast to body awareness training, a number of training interventions to improve body con- trol by challenging multiple sensory systems and requir- ing the participant to focus on the task demands or accomplishing movement-related goals, have shown marked effectiveness in musculoskeletal rehabilitation and injury prevention (e.g., Holme et al., 1999). Without dismissing the idea that periodic kinesthetic “scanning” can be beneficial to motor learning, it is evident that em- phasizing kinesthetic training offers no particular benefit. In sum, the relative ineffectiveness of the Feldenkrais Method to elicit changes in motor performance can be explained based on an inappropriate attentional focus and an overemphasis on kinesthetic training. Put dif- ferently, these data provide little support for the use of Feldenkrais for improving motor skills. On the other hand, an appropriate framework to study the Feldenkrais Method may be self-regulation theory. The findings that the Feldenkrais Method has a psychological emphasis, that men and women may be affected differently, and that the Feldenkrais effects may be a result of individuals taking re- sponsibility for their own health (Malmgren-Olsson et al., 2001), are all consistent with models of self-regulation. Self-regulation refers to the psychological processes one undertakes in pursuing a goal and often takes on five steps: problem recognition, commitment or motiva- tion, acquisition and use of skills, maintenance pro- cesses, and transfer or generalization of skills (Crews, Lochbaum, & Karoly, 2001). As Crews and her col- leagues pointed out, examining (and, hence, under- standing) self-regulation is difficult because of the “sheer complexity of the process,” but even a cursory look at self-regulation reveals several things in common with the Feldenkrais Method. The most important similarities are that people can harness and self-regulate their own thoughts, actions, and emotions toward achieving goals and that increasing awareness can be a first step in the self-regulation process. (Awareness, however, in self-regu- lation terminology has a much broader meaning than in Feldenkrais terminology.) In contrast to the Feldenkrais Method, self-regulation has a much greater emphasis on deliberate efforts aimed toward accomplishing specific goals (Crews et al., 2001). Nonetheless, self-regulation theory may offer researchers and clinicians alike a use- ful perspective on the Feldenkrais Method. Comments on Methodology and SummaryComments on Methodology and SummaryComments on Methodology and SummaryComments on Methodology and SummaryComments on Methodology and Summary Aside from using appropriate controls, three fea- tures of Feldenkrais interventions need to be taken into consideration. First, practitioner skill level and the de- pendence on subjective assessments of movement dys- function raise concern. In chiropractic and other fields of manual medicine, such assessments have often been shown to be unreliable and invalid (e.g., Hestbœk & Leboeuf-Yde, 2000). Second, meaningful and valid cri- terion measures must be used. For example, postural Ives.pmd 4/15/2004, 12:41 PM120 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 121121121121121 Ives sway measures, like those used in some Feldenkrais stud- ies, are little understood in healthy persons, and, thus, changes due to intervention effects are difficult to in- terpret (Tarantola, Nardone, Tacchini, & Schieppati, 1997). If testimonials and other qualitative accounts are reported, appropriate methods must be used in ensure credibility (Denzin & Lincoln, 1994). Last, as Johnson et al. (1999) noted, expectancy effects may influence the results. A patient’s preference for a particular treat- ment affects the outcome of treatment (Awad, Shapiro, Lund, & Feine, 2000), and it would be anticipated that patient preferences would gravitate toward noninvasive and genial methods, such as Feldenkrais. Expectancy ef- fects also influence the researcher in that a researcher’s “therapy allegiances” can be associated with the treat- ment outcomes (Luborsky et al., 1999). Therapy alle- giances are plain to see in many of the research reports on the Feldenkrais Method. In summary, the current research on attentional focus and kinesthesia provide rationale as to the mar- ginal effectiveness of the Feldenkrais Method to produce changes in motor performance. In contrast, changes in psychological performance corresponding to a self- awareness approach suggest that it may be fruitful to examine the Feldenkrais Method in light of a self-regula- tion perspective. ReferencesReferencesReferencesReferencesReferences American Physical Therapy Association. (1998). Guide to physi- cal therapist practice. Physical Therapy, 77, 1175–1650. Ashton-Miller, J. A., Wojtys, E. M., Huston, L. J., & Fry-Welch, D. (2001). Can proprioception really be improved by exercises? Knee Surger y, Sports Traumatology, and Arthroscopy, 9, 128–136. Awad, M. A., Shapiro, S. H., Lund, J. P., & Feine, J. S. (2000). Determinants of patients’ treatment preferences in a clinical trial. Community Dentistry and Oral Epidemiology, 28, 119–125. Bachman, A. D., Brewer, B. W., & Petipas, A. J. (1997). Situa- tion specificity of cognitions during running: Replication and extension. Journal of Applied Sport Psychology, 9, 204– 211. Bate, T. (1994). Motor control theory: A possible framework for the Feldenkrais Method. Feldenkrais Journal, 9(Win- ter), 32–45. Bearman, D., & Shafarman, S. (1999). The Feldenkrais Method in the treatment of chronic pain: A study of efficacy and cost effectiveness. American Journal of Pain Management, 9, 22–27. Berkley, K. J. (1997). Sex differences in pain. Behavioral and Brain Sciences, 20, 371–380. Buchanan, P. A., & Ulrich, B. D. (2001). The Feldenkrais Method®: A dynamic approach to changing motor behav- ior. Research Quarterly for Exercise and Sport, 72, 315–323. Buchanan, P. A., & Vardaxis, V. G. (2000). Effects of Feldenkrais Awareness Through Movement on balance during stand- ing. Journal of Athletic Training, 35 (2, Suppl.), S-81. Couture, R. T., Jerome, W., & Tihanyi, J. (1999). Can associa- tive and dissociative strategies affect the swimming per- formance of recreational swimmers? Sport Psychologist, 13, 334–343. Crews, D. J., Lochbaum, M. R., & Karoly, P. (2001). Self-regu- lation: Concepts, methods, and strategies in sport and exercise. In R. N. Singer, H. A. Hausenblas, & C. M. Janelle (Eds.), Handbook of sport psychology (2nd ed., pp. 566–581). New York: Wiley. Denzin, N. K., & Lincoln, Y. S. (Eds.) (1994). Handbook of quali- tative research. Thousand Oaks, CA: Sage. Diedrich, F. J., Feng, J., Buchanan, P. A., Reese, M., & Thelen, E. (1999). The Feldenkrais Method and the dynamics of change. Proceedings: Progress in motor control II. State Col- lege, PA: Pennsylvania State University. Ellis, B. K. (1995). Feldenkrais physical therapy and research. A literature review. Sjukgymnasten, Vetenskapligt Supplement, 2, 34–41. Feine, J. S., Lavigne, G. J., Dao, T. T. T., Morin, C., & Lund, J. P. (1998). Memories of chronic pain and perceptions of relief. Pain, 77, 137–141. Feine, J. S., & Lund, J. P. (1997). An assessment of the efficacy of physical therapy and physical modalities for the con- trol of chronic musculoskeletal pain. Pain, 71, 5–23. Fillingim, R. B., & Fine, M. A. (1986). The effects of internal versus external information processing on symptom per- ception in an exercise setting. Health Psychology, 5, 115–123. Fleishman, E. A., & Rich, S. (1963). Role of kinaesthetic and spatial-visual abilities in perceptual motor learning. Jour- nal of Experimental Psychology, 9, 310–313. Fox, K. R. (1999). The influence of physical activity on men- tal well being. Public Health and Nutrition, 2, 411–418. Freeman, M. L., & Broderick, P. (1996). Kinaesthetic sensitivity of adolescent male and female athletes and nonathletes. Australian Journal of Science and Medicine in Sport, 28, 46–49. Geron, E. (1986). Kinesthesis. In L. D. Zaichkowsky & C. Z. Fuchs (Eds.), The psychology of motor behavior: Development, control, learning, and performance (pp. 215–235). Ithaca, NY: Mouvement Publications. Gilman, M., & Yaruss, J. S. (2000). Stuttering and relaxation: Applications for somatic education in stuttering treat- ment. Journal of Fluency Disorders, 25, 59–76. Hardy, L., & Callow, N. (1999). Efficacy of external and inter- nal visual imagery perspectives for the enhancement of performance on tasks in which form is important. Jour- nal of Sport & Exercise Psychology, 21, 95–112. Haugli, L., Steen, E., Lærum, E., Nygard, R., & Finset, A. (2001). Learning to have less pain—is it possible? A one-year fol- low-up study of the effects of a personal construct group learning program on patients with chronic musculoskel- etal pain. Patient Education and Counseling, 45, 111–118. Henry, F. M. (1953). Dynamic kinesthetic perception and adjustment. Research Quarterly, 24, 176–187. Hestbœk, L., & Leboeuf-Yde, C. (2000). Are chiropractic tests for the lumbo-pelvic spine reliable and valid? A system- atic critical literature review. Journal of Manipulative and Physiological Therapeutics, 23, 258–275. Ives.pmd 4/15/2004, 12:41 PM121 122122122122122 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 Ives Holme, E., Magnusson, S. P., Becher, K., Bieler, T., Aagaard, P., & Kjaer, M. (1999). The effect of supervised rehabili- tation on strength, postural sway, position sense, and re- injury risk after acute ankle ligament sprain. Scandinavian Journal of Medicine and Science in Sports, 9, 104–109. Hopper, C., Kolt, G. S., & McConville, J. C. (1999). The ef- fects of Feldenkrais Awareness Through Movement on hamstring length, flexibility, and perceived exertion. Jour- nal of Bodywork and Movement Therapies, 3, 238–247. Hsieh, C.-L., Nelson, D. L., Smith, D. A., & Peterson, C. Q. (1994). A comparison of performance in added-purpose occupations and rote exercise for standing balance in persons with hemiplegia. American Journal of Occupational Therapy, 50, 10–16. Huntley, A., & Ernst, E. (2000). Complementary and alterna- tive therapies for treating multiple sclerosis symptoms: A systematic review. Complementary Therapies in Medicine, 8, 97–105. Ives, J. C., & Shelley, G. (1998). The Feldenkrais Method in rehabilitation: A review. Work, 11, 75–90. Ives, J. C., & Sosnoff, J. (2000). Beyond the mind-body exer- cise hype. Physician and Sportsmedicine, 28, 67–81. Jacobson, B. H., Chen, H. C., Cashel, C., & Guerrero, L. (1997). The effect of T’ai Chi Chuan training on balance, kinesthetic sense, and strength. Perceptual and Motor Skills, 84, 27–33. James, M., Kolt, G., McConville, J., & Bate, P. (1998). The ef- fects of a Feldenkrais program and relaxation procedures on hamstring length. Australian Journal of Physiotherapy, 44, 49–54. Johnson, S. K., Frederick, J., Kaufman, M., & Mountjoy, B. (1999). A controlled investigation of bodywork in mul- tiple sclerosis. Journal of Alternative and Complementary Medicine, 5, 237–243. Kirkby, R. J. (1994). Changes in premenstrual symptoms and irrational thinking following cognitive-behavioral cop- ing skills training. Journal of Clinical and Consulting Psy- chology, 62, 1026–1032. Kolt, G. S., & McConville, J. C. (2000). The effects of a Feldenkrais® Awareness Through Movement program on state anxiety. Journal of Bodywork and Movement Therapies, 4, 216–220. Koltyn, K. F., Raglin, J. S., O’Connor, P. J., & Morgan, W. P. (1995). Influence of weight training on state anxiety, body awareness, and blood pressure. International Journal of Sports Medicine, 16, 266–269. Laszlo, J. I., & Sainsbury, K. M. (1993). Perceptual-motor de- velopment and prevention of clumsiness. Psychological Research, 55, 167–174. Linden, W. (1994). Autogenic training: A narrative and quan- titative review of the literature. Biofeedback and Self-Regu- lation, 19, 227–264. Luborsky, L., Diguer, L., Seligman, D. A., Rosenthal, R., Krause, E. D., Johnson, S., et al. (1999). The researcher’s own ther- apy allegiances: A “wild card” in comparisons of treatment efficacy. Clinical Psychology: Science & Practice, 61, 95–106. Lundblad, I., Elert, J., & Gerdle, B. (1999). Randomized con- trolled trial of physiotherapy and Feldenkrais interven- tions in female workers with neck-shoulder complaints. Journal of Occupational Rehabilitation, 9, 179–194. Malmgren-Olsson, E.-B., Armelius, B.-Å., & Armelius, K. (2001). A comparative outcome study of body awareness therapy, Feldenkrais, and conventional physiotherapy for patients with nonspecific musculoskeletal disorders: Changes in psychological symptoms, pain, and self-im- age. Physiotherapy Theory and Practice, 17, 77–95. Masters, K. S., & Ogles, B. M. (1998). Associative and dissocia- tive cognitive strategies in exercise and running: 20 years later, what do we know? Sport Psychologist, 12, 253–270. Meeuwsen, H. J., Sawicki, T. M., & Stelmach, G. E. (1993). Improved foot position sense as a result of repetitions in older adults. Journal of Gerontology: Psychological Sciences, 48, P137–P141. Miller, M. I., & Medeiros, J. M. (1987). Recruitment of inter- nal oblique and transversus abdominis muscles during the eccentric phase of the curl-up exercise. Physical Therapy, 67, 1213–1217. Nakao, M., Fricchione, G., Zuttermeister, P. C., Myers, P., Barsky, A. J., & Benson, H. (2001). Effects of gender and marital status on somatic symptoms of patients attend- ing a mind/body medicine clinic. Behavioral Medicine, 26(4, Special Issue), 159–168. Rosenbaum, D. A., & Gregory, R. W. (2002). Development of a method for measuring movement-related effort. Bio- mechanical considerations and implications for Fitts’ law. Experimental Brain Research, 142, 365–373. Seegert, E. M., & Shapiro, R. (1999). Effects of alternative exercise on posture. Clinical Kinesiology, 53, 41–47. Sims, K., Henderson, S. E., Morton, J., & Hulme, C. (1996). The remediation of clumsiness. II. Is kinaesthesis the answer? Developmental Medicine and Child Neurology, 38, 988–997. Sims, K., & Morton, J. (1998). Modeling the training effects of kinesthetic acuity measurement in children. Journal of Child Psychology and Psychiatry, 39, 731–746. Singer, R. N., Lidor, R., & Cauraugh, J. H. (1993). To be aware or not aware? What to think about while learning and performing a motor skill. Sport Psychologist, 7, 19–30. Skrinar, G. S., Bullen, B. A., Cheek, J. M., McArthur, J. W., & Vaughan, L. K. (1986). Effects of endurance training on body-consciousness in women. Perceptual and Motor Skills, 62, 483–490. Smith, A. L., Kolt, G. S., & McConville, J. C. (2001). The effect of the Feldenkrais Method on pain and anxiety in people experiencing chronic low back pain. New Zealand Jour- nal of Physiotherapy, 29, 6–14. Steen, E., & Haugli, L. (2001). From pain to self-awareness— A qualitative analysis of the significance of group par- ticipation for persons with chronic musculoskeletal pain. Patient Education and Counseling, 42, 35–46. Stephens, J. (2000). Feldenkrais Method. Background, re- search, and orthopaedic case studies. Orthopaedic Physi- cal Therapy Clinics of North America, 9, 375–394. Tarantola, J., Nardone, A., Tacchini, E., & Schieppati, M. (1997). Human stance stability improves with repetitions of the task: Effect of foot position and visual condition. Neuroscience Letters, 228, 75–78. Vickers, A., & Zollman, C. (1999). ABC of complementary medicine. Massage therapies. British Medical Journal, 319, 1254–1257. Ives.pmd 4/15/2004, 12:41 PM122 RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003RQES: June 2003 123123123123123 Ives Wulf, G., McNevin, N., Shea, C. H., & Wright, D. L. (1999). Learning phenomena: Future challenges for the dynami- cal systems approach to understanding the learning of complex motor skills. International Journal of Sport Psychol- ogy, 30, 531–557. Wulf, G., Shea, C., & Park, J.-H. (2001). Attention and motor performance: Preferences for and advantages of an ex- ternal focus. Research Quarterly for Exercise and Sport, 72, 335–344. Author’Author’Author’Author’Author’s Notes Notes Notes Notes Note Please address all correspondence concerning this ar- ticle to Jeffrey C. Ives, Department of Exercise and Sport Sciences, Center for Health Sciences, Ithaca College, Ithaca, NY 14850. E-mail: jives@ithaca.edu Ives.pmd 4/15/2004, 12:41 PM123