Friday, July 29, 2016

More on Multiple Sclerosis # 3

More but not the end......

There are four primary types of MS; relapsing-remitting, secondary-progressive, primary-progressive, and progressive relapsing.  But even though there are common factors among those with MS, everyone is an individual. That means there’s no cookie cutter approach to increasing function.

Still, there are similarities, so let’s consider them here…

In my last two posts, I touched on how we approach the issues of knowing where we are in space, spasticity, coordination, and balance.spasticity, coordination, and balance   Here, we’ll look at heat and stress, fatigue, and flexibility.

Heat can cause a temporary worsening of MS symptoms and stress and tension can raise core body temperature. With the gentle movement of a Feldenkrais® lesson, a participant can learn to release stress and tension.  This helps turn down the heat while allowing body energy to flow freely. By using attention and breath, one can learn to detect (and thereby avert) increased body temperature *before* problems begin.                    

Living with MS can mean change and stress. Stress depletes an individual both emotionally and physically and adds to fatigue to boot.  Using the Feldenkrais Method® helps those with MS learn how to function in a more relaxed state, thus quieting the sympathetic nervous system (your “fight or flight” response.) Since the movements are based on functional activities, people are given the opportunity to notice their habitual anxiety patterns and to explore more effective ways to cope. While teaching regular classes for the MS Society, we frequently met in less than optimal facilities.  There was often noise or movement in the room, but I chose not to change the location of these sessions because I knew my students needed to learn to calm and sense themselves in all surroundings.  After all, malls, noisy restaurants, and traffic jams don’t go away just because you have MS!

Fatigue can be the biggest challenge because we can create it without even knowing it.  Strain, tension, and fatigue are often the result of smaller muscles doing the work of larger ones. Learning does not occur when fatigue is present, so students are given the opportunity to modulate their own sense of fatigue.  Because participants are able to move or rest at their own pace, they gain more control over fatigue.

Flexibilty is the ability to switch and use a different part of the body for an activity.  Learning to use muscles to move rather than to support will improve range of motion and aid in increasing energy.  Initiating motion from large muscles closer to the center of our bodies also allows for more proportional distribution of movement, and that conserves energy and strength.  Those are the keys to maintaining the joint and muscle flexibility that is important for walking and other daily living activities.

Although I accommodate all ability levels and use many positions, I like lessons on the floor because it helps people feel and sense in a different way and explore what works.  This enables students to discover a new way to walk, get up from the floor, or play with a child.  I teach my student to notice what is happening. 

I ask students to do less than they can so that they can focus on learning how to be their own “inner advisor”.  Once moving becomes easier, they naturally want to do more.

Comment or ask questions here, or contact me at

Keep exploring and keep asking questions,

Friday, July 15, 2016

More About How I work with Multiple Sclerosis

Let’s get more specific about what I do for people with Multiple Sclerosis

In my last blog, I wrote about how the Feldenkrais Method® can benefit people with Multiple Sclerosis (MS). This blog will be the second of 3 blogs about MS and will get into more details for folks who would like more information.

Most people don’t ever think about what they do or how they move, that is until movement becomes a little harder.  When we slow down and pay attention to how we move and what we do, we are able to fine tune our movements and actions.  In other words as Moshe Feldenkrais said, “If you don’t know what you do, you can’t do what you want.”  This is exactly what we learn when we practice the Feldenkrais Method®.

If you have MS, or know somebody who does, (there are approximately 200,000 people in the US and 2.5 million worldwide with MS) then you know about some of the debilitating symptoms. Because the symptoms are so varied, when working with MS, one must have a clear understanding of the interweaving nature of the brain and body. One cannot “correct” one part without affecting the others.  We cannot change walking if we don’t work on breathing or knowing where we are in space. The Feldenkrais Method® is based on connections of parts and the whole and how they work together and separately.

I will use the example of walking and in this blog, I will cover 4 symptoms of MS and how I work with them.  I will cover 4 more in my next blog.  Some of the words I use may not be familiar to you, but if you have MS, or know MS, you know what these words are.

Walking is the primary reason that people with MS come to my practice.  What do you need to be able to walk?  We will start with an awareness of where your body parts are in space. In medical language, this is called kinesthetics/proprioception.  I take you through a series of movement sequences, either verbally or by touching you.  These very gentle, easy movements allow you to relax.  When you become relaxed you can explore the movement. You can become aware of movement patterns that are holding you back. You can learn how to abandon habitual movement patters that are not working.  No doubt, they used to work, but not now.  Through the subtle movement lessons, one can develop awareness, leading to flexibility and coordination.   

Another symptom that makes walking difficult is spasticity. Spasticity is a state where certain muscles are contracted at all, or inappropriate times.  The Feldenkrais Method® encourages students  to move with little effort, enabling them to stop or reverse any movement before the muscles can become excited or overexcited.  Movements are slow, gentle, and safe. You will be better able to modulate the how your muscles begin action. You now will be allowed to make minor adjustments based on your own perception.

Problems with coordination are quite common among people with Multiple Sclerosis, because of decreased communication within the brain and spinal cord.  Coordination is complicated, at best.  Actions utilize certain muscle sequences.  An example, you bend you knee, and lift your foot before your hip moves your leg forward for walking.  However, before you even move your legs, you see something you want to walk to or for, either in reality or in your imagination. You also have to maintain an upright posture and you must be breathing if you want to move efficiently.   The movement sequences in either modality of the Feldenkrais Method® teaches control of movement in space. This includes the ability to control direction, quality, and speed. 

So often people with MS have difficulty maintaining balance.  Through the Feldenkrais Method®, students with MS are given the opportunity to explore “dynamic posture,” where the skeleton carries the weight and the muscles are freed up to move more efficiently.  The relationship between the skeleton and muscles is explored.  Movement through the center of the body is emphasized, rather than holding at the “core.”

My next blog will explore heat sensitivity, fatigue, stress, and flexibility.
Contact me if you would like to talk about yourself or a loved one with MS on Feldenkrais and MS

Do I Work with People with Multiple Sclerosis

The first of three.....

The Feldenkrais Method explores how the brain can change. Multiple Sclerosis is a disease that affects the brain, the nervous system.  I often work with those who have Mulitple Sclerosis, (MS). I have worked with folks with  Multiple Sclerosis but I also have a relationship that’s up close and personal.  While I don’t have the actual condition, it’s been a part of my life since I was four and my father was diagnosed.  The disease took him two weeks after my fourth birthday, on April 30th 1955.  My father's brother, Benjamin (for whom I am named) was diagnosed and died of it in the 1930's.  In 1986, it claimed the life of my sister, Susan. 

Multiple Sclerosis has left its indelible mark on my family.

My family has been involved with the MS society for as long as I can remember.  As a small boy, my brother Eli walked house to house with the little box collecting for the MS “hope chest.”  My friends and I put on backyard shows, charging money and donating.  My brother and I remain quite involved and I still write and speak about MS to whoever will listen. My daughters and I have participated in the MS walk every year since they were born.

When I was a young physical therapist in 1976, I started the first class for MS patients at UCLA. In 1991, after I became a  Guild Certified Feldenkrais Practioner® I taught a weekly Awareness Through Movement®class sponsored by the MS Society.

Here’s why I find that the Feldenkrais Method® to be an ideal approach to work with people with Multiple Sclerosis:

Since we know that MS can affect any part of the nervous system that is covered with myelin (the “insulation” covering nerves), any approach to increase function must involve the whole person.  That makes the Feldenkrais Method® a good match; not only because it connects one part of the body to others, but because it involves no stress, increased energy use, pain, or sweat.  Also, it actually can lower an over-heated body temperature by relaxing the “fight or flight” system.

What also makes the Feldenkrais Method® such a great fit for MS is that depending on what type a person has, symptoms can vary widely from day to day.  Since the Feldenkrais Method® is about awareness, how to attain it, and how to use it, the student (patient) is able to assess herself continuously and create her own strategies for change.

The combination of awareness and flexibility is very powerful in combating the effects of this disease. Using muscles to move rather than to support will improve range of motion and aid in increasing energy.  Initiating motion from the large muscles closer to the center of our bodies will allow for a more proportional distribution of movement, thus allowing energy and strength conservation, two major concerns for MS patients. In turn, these components add to the maintenance of flexibility of the joints and muscles that are important for walking and other daily living activities. 

All of us have enormous potential for learning, no matter what our physical ability is in any moment.  Learning about awareness, flexibility, and change will  enhance function.

 Think about this for a bit. I have two more blogs coming on this subject.  Contact me with questions or comments

Beth Rubenstein, MS,PT, GCFP