THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINEVolume 13, Number 6, 2007, pp. 593595 Mary Ann Liebert, Inc.
LETTERS TO THE EDITOR
EXPLORING FELDENKREISPRACTITIONERS ATTITUDES
TOWARD CLINICAL RESEARCH
Dear Editor:Dr. Moshe Feldenkreis (19041984) developed the
Feldenkreis Method (FM) in Israel over a 40-year period.FM is viewed as an educational system for the developmentof self-awareness, which relies on the body as the learninginstrument. It deals with the question of how to enable theindividual to reorganize and recall forgotten movement pat-terns. Unlike other complementary and alternative manualand touch modalities, FM is not aimed at curing or healinga client but rather at bringing about a change in his/herawareness, self-image and attitude toward the self, and tak-ing responsibility for their well-being. Learning takes placevia two modes: Awareness Through Movement (ATM),which is practiced in a group, and Functional Integration(FI), designed for the guidance of a single client.
Clinical research in the field of FM is in its preliminarystages and consists of mainly case studies and little quanti-tative research suggesting FM efficacy in the treatment ofchronic low-back pain,1 cervical complaints,2 and nonspe-cific musculoskeletal disorders.3 Stephens et al. showed ina randomized controlled trial how ATM lessons improvedbalance and confidence in people with multiple sclerosis.4
Netz and Lidor reported their observations on mood alter-ations in different exercise modes.5
Based on the current research suggesting possible FM ef-fectiveness in treating psychologic problems, we hypothe-size that FM may affect other psychologic disorders, suchas depression.
Objectives and methods
As a first step in the study of this hypothesis, a survey ofFM teachers in Israel was undertaken. The authors con-structed a questionnaire whose purpose was to establish theattitudes of certified Israeli FM practitioners toward clinicalresearch, in general, and to FMs influence on depression,in particular. The questionnaire included 10 multiple-choicequestions and a short personal profile.
The list of FM practitioners in Israel was available fromThe Israeli Feldenkreis Guild. Questionnaires were sent to200 active practitioners who pay yearly membership.
Sixty-nine (69) of the 200 active members returned thefilled-in questionnaires. Sixty-seven (67) of them werevalid for statistical analysis. The demographics of the re-spondents are shown in Table 1. Most practitioners (41/67,61%) thought that musculoskeletal problems would betheir first choice for pioneering research in the field ofFM. Other issues appropriate for a first study were chronicpain (25/67, 37%), mental illnesses (11/67, 16%), andcancer (4/67, 6%). When asked specifically about ini-tiating FM research in the realm of mental illnesses, 34respondents (50%) recommended research in the area of anxiety disorders, whereas the others recommended astudy in depression (25%) or post-traumatic stress disor-der (25%).
Thirty-four (34) practitioners reported on their experiencein working with clients with depression in the following set-tings: FI individual sessions (18 respondents; 53%), ATMgroup sessions (3 respondents; 10%) and both FI/ATM ses-sions (12 respondents; 37%).
Of the 50 practitioners who had responded to the ques-tion, What is the efficacy, in your opinion, of the FM intreating people with depression?, 21/50 (42%) consideredFM to be very efficient, 23/50 (46%) thought it was of mod-erate efficacy, and 6/50 (12%) related that it had low effi-cacy.
This study shows that most of the respondents are in fa-vor of research in joint and muscular/pain problems. Men-tal and emotional problems were ranked low as the mainreason for referral to FM. Nevertheless, a significant num-ber of participants stated that they had clinical experiencewith clients who had depression and who attended FMlessons. Moreover, 88% of respondents claimed that FM isa moderately to highly effective mode of treatment for de-pression.
If FM is a clinically effective and safe mode for the treat-ment of depression, why didnt most of the respondents rankit higher as the focus for research? The most straightforwardanswer is that FM is a manual and physical modality that isassociated, by both clients and practitioners, with treatmentof muscles, joints, and skeletal problems. However, the an-swer may be more multifaceted. Depression is a strong andindependent predictor for the onset of an episode of intenseand/or disabling neck and low-back pain. In chronic-pain pa-tients, there exists a high prevalence of depressive disorders,and in patients with major depression, pain is a frequent com-plaint. Further research is needed to study whether patientswho are referred to FM for musculoskeletal complaints haveconcomitant depression. If this is the case, FM may be foundto positively affect interweaving symptoms of mind and body.
The authors would like to thank Ms. Marianne Steinmetzfor editing the manuscript.
1. Smith AL, Kolt GS, McConville JC. The effect of theFeldenkrais Method on pain and anxiety in people experienc-ing chronic low back pain. N Z J Physiother 2001;29:614.
2. Ruth S, Kegerreis S. Facilitating cervical flexion using theFeldenkrais Method: Awareness Through Movement. J SportsPhys Ther 1992;16:2529.
3. Malmgren-Olsson E-B, Brnholm I-B. A comparison betweenthree physiotherapy approaches with regard to health-relatedfactors in patients with non-specific musculoskeletal disorders.Disabil Rehabil 2002;15:308317.
4. Stephens J, DuShuttle D, Hatcher C, et al. Use of AwarenessThrough Movement improves balance and balance confidencein people with multiple sclerosis: A randomized controlledstudy. Neurol Rep 2001;25:3949.
5. Netz Y, Lidor R. Mood alterations in mindful versus aerobicexercise modes. J Psychol 2003;137:405419.
Eran Ben-Arye, M.D.*
The Complementary and Traditional Medicine UnitDepartment of Family Medicine, Faculty of Medicine
TechnionIsrael Institute of Technology, Haifa, Israeland Clalit Health Services
Haifa and Western Galilee District, IsraelIlan Katz, Ph.D.*
Ohad Hochman, M.D.Feldenkreis Clinic, Zichron Yakov, Israel
Doron Hermoni, M.D.The Complementary and Traditional Medicine Unit
Department of Family Medicine, Faculty of MedicineTechnionIsrael Institute of Technology, Haifa, Israel
and Clalit Health ServicesHaifa and Western Galilee District, Israel
*The first and second authors are equal contributors.
Address reprint requests to:Eran Ben-Arye, M.D.
The Complementary and Traditional Medicine UnitDepartment of Family Medicine
Clalit Health Services6 Hashahaf Street
Haifa 35013, Israel
PREVALENCE OF CAM USE INCLUDESPATIENTS OF ASIAN BACKGROUND
I read with great enthusiasm the paper Use of Comple-mentary and Alternative Medicine for Weight Control in theUnited States.1 Sharpe and colleagues provided an excel-lent introduction to the prevalence of complementary andalternative medicine (CAM) use for weight loss in theUnited States, with a special emphasis on the Hispanic andnon-Hispanic black population.
One or two additional points can be made on this topic.First, it has been shown that white people, as opposed toAfrican-American or Hispanic people, use CAM more fre-quently.2 So the use of Hispanic and non-Hispanic blacksas subjects in this study as an adequate representation of thegeneral U.S. population is misleading. In addition, Asiansor Asian Americans, who were left out of this study, if in-cluded in such studies, may actually increase the prevalenceof CAM use because many of these people actually considerCAM as a conventional method of treatment rather than analternative treatment as a result their cultural background.3,4
The prevalence of CAM use and its specific modalities5
may also correlate with the number of competent CAM prac-
LETTERS TO THE EDITOR594
TABLE 1. DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS
Eligible responsesCharacteristic (n 67)
Sex, malefemale (%) 1052 (1684)Mean age (years) 53Mean years of practice 9.9Workplace Public clinics 8
Private practice 29Private and Public 21
FM modality FI only 6ATM only 8Both FI and ATM 53
FM Feldenkreis Method; FI Functional Integration; ATM Awareness Through Movement.
titioners in a given region and their area of expertise. It isimportant to identify not only the region where the subjectsare located but also the relationship of the number of spe-cific CAM practitioners in that area. If you have mostlyherbalists in a given region or acupuncturists, then the preva-lence of these modalities, for example, will increase.
Finally, herbal medicine is an integral part of TraditionalChinese Medicine and CAM. Therefore, it is important toinclude herbs, homeopathy, or naturopathy in the study.
I believe CAM will continue to be an important issue inthe management of weight and obesity. Further study willbe required to determine its efficacy and effectiveness. Iwould like to see whether including other ethnic groupswould skew the result as indicated in this study.
1. Sharpe P, Blanck H, Williams J, et al. Use of complementaryand alternative medicine for weight control in the United States.J Altern Complement Med 2007;13:217222.
2. Ashar B, Dobs A. Complementary and Alternative Medicine:Use of CAM. ACP Medicine. Online document at: www.medscape.com/viewarticle/535452 Accessed June 7, 2006.
3. Hsiao A, Wong M, Goldstein M, et al. Complementary and al-ternative medicine use among Asian