Mayo Clinic Bones For Life(R) and Osteoporosis Interview

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Interview with Mary Jurisson, MD and Feldenkrais Practitioner
Physical Medicine and Rehabilitation, Mayo Clinic
Osteoporosis and Bones for Life® program
March 2015

osteoporosis

MJ: What do healthcare providers need to know about the Bones for Life® program?
Should they refer patients to such programs?

MONTGOMERY: The Bones for Life® program was created by Ruthy Alon and is based on Dr. Moshe Feldenkrais’ approach to somatic education. Most somatic education programs explore developmental movements and access the power and plasticity of the brain in order to improve human function through self-awareness in movement. Somatic education attempts to de-program habitual fixations that follow chronic and acute injury or illness, counter-productive movements due to faulty posture, and poor joint alignment. Reconnecting individuals to their natural capacity for feeling, thought, and action, the Bones for Life® program improves movement coordination and the collaborative functions of the skeletal, muscular, and nervous systems.

The Bones for Life® program is typically offered in a weekly, 60- to 90-minute class format. It uses both demonstrated and verbally-guided movement sequences that are modeled after primal patterns of locomotion, including the elements of crawling and creeping. The exercises are largely dedicated to developing an upright posture that is well-aligned and able to withstand and transmit pressure proportional to environmental demand with the least amount of joint sheer and extraneous muscular effort, thus eliminating the need for obsessive, unsupportive habits of tension. Not dependent on targeted muscle strengthening and specific joint range-of-motion exercises, the program uses a variety of positions and novel movement activities, including: unsupported sitting with unilateral weight-shifting; lying on the back and pressing a foot on the wall; rolling with hand-eye coordination; standing and bouncing on the heels; general movement patterns that facilitate lateral bending and rotation of the trunk; and spiraling movements of the extremities in reference to an imaginary center line.

A hallmark of the Bones for Life® program is the creation of an environment where participants can improve, regardless of their entry-level functional capacity. Simple tools are used to facilitate the development of controlled resistance to pressure, like using a strip of cloth as a harness (Bones Wrap), using rollers, pushing a wall, lifting light weights, using self-touch for orientation and joint stimulation, and making use of multiple options for positioning (sitting, standing, lying). The suggested ways of moving are explored slowly, and participants are assisted with movement patterns, as needed. Appropriate periods of rest are utilized during each lesson to maximize learning and encourage the integration and reciprocal coordination of all body parts with respect to specific movement patterns.

Healthcare providers should know that Bones for Life® does not replace traditional therapeutic interventions, nor does it replace load-bearing activities like weight lifting or walking. Instead, the program complements traditionally-recommended treatment interventions. The strength of the somatic-based platform of learning is in teaching clients to effectively recognize stress, unconscious strain, and poor habits within themselves, and to allow for better body usage and alignment during the rehabilitative process — leading toward a positive impact on health, vitality, and an overall improved quality of life.

MJ: Should these practices be covered by insurance, or is it one of the many health-enhancing leisure activities better suited for a health or athletic club?

MONTGOMERY: Because of its positive impact on improved sitting, standing, and walking — foundations of all therapeutic disciplines — the Bones for Life® program is far-reaching in its influence, from the recreational field to the rehabilitative field. Indeed, many physical therapists, occupational therapists, massage therapists, personal trainers, and Feldenkrais Practitioners® have become certified Bones for Life® teachers and/or trainers. Classes are available and taught to the public throughout North America and internationally in the private rehabilitation sector, health/fitness clubs, and yoga and Pilates studios.

As with Tai Chi, the Feldenkrais Method® of Movement, and other somatic-based programs, evidence-based research is a prerequisite for acceptance into mainstream healthcare. Even then, there are no guarantees that such programs will be reimbursed by insurance companies. A recent pilot study (Montgomery, Allen and Farber) awaiting publication acceptance suggests that the Bones for Life® program may be a safe and effective way for seniors to improve their functionality. With minimal expense, community-dwelling seniors with diverse physical capabilities and medical challenges saw improvement in function and balance after just six weeks of Bones for Life® classes. Evidence suggests that the program increases the stability of organized single-leg stance during movement and successfully carries over into more challenging postural tasks that require a smaller base of support like walking, turning, reaching, and climbing. Class participants reported improvement in chronic aches and pains and an increased comfort level with movements in and out of the classroom. Additionally, participants reported positive changes in the quality-of-life measures of mental and physical health — peace, happiness, calmness, and increased energy. The pilot study serves as a call for funding and a footprint for further investigation.

MJ: Do you think of these practices as recreation, therapy, prevention, or something else?

MONTGOMERY: The Bones for Life® program uses movements that are specifically designed to communicate directly with the brain and nervous system in order to alter the tonus of muscles, joint and postural alignment, and balance during sitting, standing, walking, and other basic functional activities of daily living. Participants frequently describe the therapeutic benefits of pain relief, lowered levels of tension, stress, and discomfort, and positive quality-of-life indicators like peaceful, happy, calm, and increased vitality. Specifically, Bones for Life® offers a preventative role for people suffering from osteoporosis. Because the movements of the program are designed to help participants develop a well-aligned, upright posture that is able to withstand and transmit pressure proportional to environmental demand, Bones for Life® encourages a kinesthetic sense of optimal dynamic alignment that can be consistently and effortlessly reproduced when engaging in other recommended alternative or conventional exercises. This is accomplished with the least amount of joint sheer and extraneous muscular effort, helping those with osteoporosis minimize further injury or risk of exacerbating symptoms that can occur during repetitive, traditional exercise routines and weight lifting. By sensing the weight distribution across the sole of the foot and knowing how to use this weight distribution to generate ankle sway into the single leg stance, the Bones for Life® program empowers participants to transition fluidly from one action to the next. Directing their attention to how they initiate patterns of movement and improving their ability to follow its influence on skeletal alignment allows the transmission of force through the knee, hip, spine, chest, and head. Additionally, the program promotes optimal and proportional weight bearing through the skeletal areas in need of bone stimulation without defaulting to the posterior elements of the spine that have habitually accepted the load and, systemically, led to the development of osteoarthritis in the first place. Bones for Life® is a program based on movement awareness. Classes are usually offered in wellness facilities in a group setting, with a focus on improving overall health, function, and well-being.

MJ: What is relaxation and what is its role in well-being in individuals with problems associated with osteoporosis? Is relaxation a part of Bones for Life®?

MONTGOMERY: There is an intimate partnership between well-being and relaxation. Anyone who has been diagnosed with a chronic illness or suffered an unresolved tragedy is familiar with the underlying psycho-social stress and accompanying anxiety — stressors that can impact cognitive performance and disrupt the fundamental movements of daily living. Fortunately, in the last decade, there has been an explosion of research in the fields of neuroscience, psychology, movement, and complementary and alternative medicine that has validated the brain-mind-body connection. The body is no longer a servant of the brain, and the mind is no longer separate from the brain and body. Current research is shifting the focus of rehabilitation in healthcare from palliative to preventative, from aging to wellness, and from alleviating chronic diseases to improving quality of life. Medical technology now demonstrates the collaborative influence of these parts on a person’s overall perception of well-being and relaxation.

When faced with a diagnosis — specifically osteoporosis — one’s self-image is forever changed. A diagnosis of has many patients imagining a future of being humpbacked, bent over, and fragile, moving cautiously, fearful of falling and breaking a back or a hip, and the inevitable downfall of life as they know it. Research in eastern practices like meditation and most recently, the neuroplasticity of the brain, help explain that we have more influence over where our minds rest than we know. Therefore, we have more control over our perceived quality of life than we realize. An anxious, worried, and self-critical state of mind activates a part of the brain known as the limbic brain. The limbic brain serves an important role in sensing threats (both real and perceived) and revs up the interconnected systems throughout the body, signaling the need to do everything it can to keep it safe. Chronic stress, anxiety, and fear of change or loss continually stimulate and shape this area of the brain and produce a fixed state of high muscle tension, changes in joint range of motion, posture, and disease of movement. Physiologically, changes in breath and respiratory rate, blood pressure, and oversensitivity and activation of the immune system alter the ability to relax and block the ability to connect with a deeper sense of well-being. Mentally, an increased feeling of vulnerability leads to greater emotional reactivity, which in turn leads to the repetitive loop of anger, sadness, and guilt. When the limbic brain is unconsciously and repetitively activated, it severely dimishes feelings of general well-being, happiness, and satisfaction.

The good news, however, is that the research also indicates that the mind can be directed to other parts of the brain as well — to parts of the brain that develop and control our attention and allow us to tune into ourselves and others and affect positive changes in perception and feelings of peace, happy, calm, and security, even in the face of a negative diagnosis or illness.

Here is where the practice of relaxation comes in. Perhaps the simplest definition of relaxation is “letting go and letting in.” The physiological experience of “letting go” is often described as the absence of excessive muscular tension, a decrease in pain or movement discomfort, and an ease in breathing in or out. Both the physical and psychological release of dread, loss, and fear cannot be accomplished by simply telling yourself to “stop doing that.” The brain cannot think without eliciting a physical motor function, and every emotion is directly connected to changes in facial expressions and posture.

Turning on the area of the brain that fosters relaxation and well-being releases the dominance of the limbic area. The researched fields of neuroscience and neuroplasticity demonstrate the potency in learning how to direct conscious attention and thus become better observers of one’s thoughts and movements. To sense the difference between relaxation and tension, somatic-based programs like Bones for Life® teach people to use slow, small, differentiated movements of various parts of the body found in functional movement patterns. Only by learning and practicing how to focus on these specific areas of unconscious habitual holding patterns can meaningful change and choice occur. These skills can help osteoporosis.

Relaxation raises awareness that change is possible and even pleasurable. Consciously “letting in” and experiencing situations that feel comfortable, safe, relieved, relaxed, and novel lead to lasting changes in the neural network of the brain. The repeated mental and neural activity of consciously noting positive differences helps develop inner strength, contentment, resilience, and insight, which also helps people cope and accept the more challenging side effects associated with chronic conditions, illnesses, and pain.

MONTGOMERY: In the last five years, the causal effect of posture on the mental experience of power is gaining research attention. The well-being in movement is lost when pain or the fear of pain with movement is present. Posture is a direct reflection of that fear. The simple act of inhaling, sleeping, dressing, toileting, sitting, standing, and walking are no longer simple and are often dreaded. A gradual sense of withdrawal and isolation is common, as is the undesirable side effects from long-term use of medication.

“There is no pill for posture,” is a phrase often used in the Bones for Life® community. Ruthy Alon is 85 years old and the creator of Bones for Life®. She studied the alignment and gait of West African women, who are known for their low rates of osteoporotic fractures. She was struck by the beauty, grace, and extraordinary physical capacity of these women for carrying loads on top of their heads — sometimes up to 20% of their body weight — with ease and efficiency. She created movement exercises in her Bones for Life® program that incorporate aspects of this fundamental organization of skeletal alignment for the purpose of restoring well-being in movement and thus improving the lives of people struggling with chronic illness or pain.

MONTGOMERY: I hope the answers to your questions are informative about to your potential readers and spark their curiosity to seek out Bones for Life® classes or other somatic education programs in their local area or online to help augment the strain and stress of an osteoporosis diagnosis.

As always, I appreciate any chance to speak or write about the benefits of the Bones for Life® program. You may have noticed that I did not write about Walk for Life®. This is another somatic learning platform that Ruthy Alon offers. It is very similar to Bones for Life® and incorporates the use walking sticks/poles, which are very helpful and positively impact upright posture. This is NOT like Nordic pole walking or trekking. all methods of gait training are effective for osteoporosis.

http://www.ctcpjournal.com/article/S1744-3881(14)00064-4/abstract
“A novel sensorimotor movement and walking intervention to improve balance and gait in women”
— Erik Swartz, Ph.D., et al, November 2014
Complementary Therapies in Clinical Practice
20 (2014) 311-316

I am sure you are aware of the wonderful information available to your readers on the Feldenkrais Method, especially in Norman Doidge’s newest book, The Brain’s Way of Healing, http://www.normandoidge.com/

To learn more about osteoporosis and somatics, contact us.

Carol is a physical therapist, a co-creator of Integral Human Gait theory, a certified Feldenkrais practitioner, and a Senior Trainer in Movement Intelligence. Focus, Align, Teach and Inspire! These qualities not only describe her work, but they also describe her presence. She is passionate when it comes to reconnecting learning with human function and health. Carol is in private practice at MontgomerySomatics.com in Columbus, Indiana.

 

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