BODY SCHEMA, IDEOMOTOR ACTIVITY, AND ANATOMICAL IMAGE CONCEPTUAL RE-FRAMING: MULTI-MODAL EFFECTS ON PAIN MODULATION AND GAIT IN PATIENTS WITH LBP

Background: Back problems continue to be a leading cause for disability claims in traditional medicine and the number one symptom disorder for consulting complementary-alternative medicine (CAM) practitioners. Evidence from neuroscience continues to indicate that the human brain undergoes a process of somatotopic cortical reorganization – altered and sometimes distorted representations in the schema of the body in response to novel or challenging experiences and particularly in association with sustained states of chronic pain which invariably affect both quality and ease of movement, including gait pattern. Feldenkrais Method^® practitioners aim to create individualized multi-modal learning experiences that are believed to clarify new functional interrelationships in both perception and action; and to effectively make better use of an improved neuroplasticity-based change in the cognitive construct of one’s own body schema and its corresponding quality of action and movement in everyday locomotion.  

Purpose: A specific set of multimodal and anatomically constructed imagery techniques and corresponding sensory-motor kinesthetic learning / movement protocols were applied in routine daily practice to observe some responses to novel intervention in outpatients with mechanical, non-specific low back pain (LBP). A retrospective chart review of reassessment measures provided a basis for formatting a preliminary pilot study.

Methods: 40 subjects diagnosed with LBP had been initially evaluated for their first visit as physical therapy patients within the usual course of a Feldenkrais Method^® --based clinical practice; including Pain Intensity on Visual Analog Scale (VAS) and observations of Gait Quality on Dynamic Gait Index (DGI). Of them, N= 30 with gender distribution being 20 female and 10 male. Using anatomical skeleton models, video clips, and proprioceptive touch, three inquiries for primary learning conditions were made for each patient as follows:  Day 1: Pin-pointing The Hip Socket axis of rotation. Day 2: Re-framing the iliac ring as an inner bridge of leg support, and Day 3: correlating the vestibular apparatus through interoceptive imagery. The remaining sessions incorporated these themes into Feldenkrais Functional Integration^® (manual therapy / teaching component) and Awareness Through Movement® (guided movement re-education component) across varied ADL positions. No attention was given to treating isolated lumbar segments directly.

Results: All three conditions were novel interpretations of body awareness for patient’s previous notions for body schema. Pain on VAS reduced on average from 6/10 to 2/10. Patients presented qualitative improvements of more stable and supportive, less-wobbly, less deviating quality of gait during controlled variation and perturbation, with an average of 7 points improvement upon re-administration of Dynamic Gait Index.

Conclusion(s): Body Schema based somatic education interventions, like the Feldenkrais Method^®, deserve further investigation for pain perception modulation and functional improvements in patients with LBP, and do not appear to rely upon treating the anatomical regions of perceived involvement directly.

Implications: This pilot study additionally implies that novel conceptual and immersive imagery experiences in visual-kinesthetic-proprioceptive-tactile body schema awareness programs - independent of specific manual therapy or specific exercise being informed by specific spine diagnosis or structural pathology – can nonetheless contribute to symptomatic and functional improvements in patients with low back pain (LBP).

Funding, acknowledgements: N/A

Keywords: Body Schema, Ideokinesis, Imagery, Feldenkrais® Method, Low Back Pain

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Saybrook University

Committee: SIRB

Ethics number: SIRB_Sobie_2016