Working with people with Multiple Sclerosis
12/1/2016
Beth Rubenstein, GCFP
Thursday, December 1, 2016
by: Beth Rubenstein, GCFP

Section: Recovery




Multiple Sclerosis (MS) has left its indelible mark on my family. My paternal uncle, Benjamin (for whom I am named) was diagnosed and died of it in the 1930's. In the 50s, the disease took my father two weeks after my fourth birthday. In 1986, it claimed the life of my sister, Susan. 
 
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.” As a child, my friends and I charged money for our backyard shows and donated the proceeds. Today, my brother and I remain involved. I 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 Feldenkrais® practitioner, I taught a weekly Awareness Through Movement® (ATM®) class sponsored by the MS Society.
 
How does the Feldenkrais Method® benefit those with MS?
The Feldenkrais Method explores how the brain and our nervous system can change. Multiple Sclerosis is a disease that affects the brain and the nervous system. Here’s why I find the Feldenkrais Method to be beneficial to those 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 little to no stress, energy use, pain, or sweat. It can lower an over-heated body temperature by relaxing the “fight or flight” system.
 
There are four primary types of MS; relapsing-remitting, secondary-progressive, primary-progressive, and progressive relapsing. Even though there are common factors among those with MS, everyone is an individual. Depending on what type a person has, symptoms can vary widely from day to day. That means there’s no cookie cutter approach to increasing function. Since the Feldenkrais Method is about awareness, how to attain it, and how to use it, each student learns how 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.

Let’s get more specific!
Most people don’t think about what they do or how they move until movement becomes 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. As Moshe Feldenkrais said, “If you don’t know what you’re doing, 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.
 
WALKING
Walking is the primary reason that people with MS come to see me. I start by exploring my client’s awareness of where their body parts are in space. In medical language, this is called kinesthetics/proprioception. I take them through a series of movement sequences, either verbally or through touch. These very gentle, easy movements allow the student to relax; it is only after we’re relaxed that we can explore movement! Students often discover movement patterns that have been holding them back. They learn how to let go of habitual movement patterns that are not working. Through these subtle movement lessons, students develop awareness, leading to flexibility, and increased coordination.   
 
Another symptom that makes walking difficult is spasticity. Spasticity is a state where certain muscles are contracted at all, or inappropriate, times. When students learn to move with little effort, it enables them to stop or reverse any movement before the muscles become excited or overexcited. Movements are slow, gentle, and safe. Clients find that they have more ability to modulate how their muscles begin action. This provides them with the opportunity to make minor adjustments based on their 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. Actions utilize certain muscle sequences. For example, you bend your 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 explored during a Feldenkrais lesson teach control of movement in space. This includes the ability to control direction, quality, and speed. 
 
BALANCE
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.”
 
HEAT
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 the body’s energy to flow freely. By using attention and breath, one can learn to detect (and thereby avert) increased body temperature *before* problems begin.                    
 
STRESS
Living with MS can mean change and stress. Stress depletes an individual both emotionally and physically and increases fatigue. Using the Feldenkrais Method, 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 the 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
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.
 
FLEXIBILITY
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 oneself 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.
 
I have worked with people with Multiple Sclerosis since graduation from PT school in 1975. I have been involved with the devastating disease since 1955. Although it usually is a progressive disease our work gives people the ability to learn about themselves, how they function, how to have options to continue to enjoy and have meaningful lives.

Beth Rubenstein, GCFP, helps people who are feeling limits in their movement, due to pain and creakiness, discover ways to move and think that feel as good as it did ten years ago. She teaches individual sessions, classes, and workshops where people can explore their movement, their habits, and learn to move with pleasure and efficiency. Find out more about Beth at: www.bethrubenstein.com/

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Comments (7)
Cheryl Stenzel
1/30/2017 10:42:37 AM
While every person is unique, a Felde myself, I know of recovery from autoimmune disorders, like MS, Hashimotos, Vitaligo that used in addition to diet, natural supplementation directly to the pituitary supporting HPA axis communication, resetting the stress response. It is possible! Cheryl welcomeenterprizes@gmail.com


Louise
1/8/2017 12:14:34 PM
I have MS, and also back problems (herniated discs and, spinal fusion) and I want to return to riding my horse. Even though I exercise daily, include riding my exercise bike, I don't seem to feel stronger. I'm wondering if the Feldenkrais Method might help me progress...Could you please contact me?

Thank you,
Louise


Steven Holtz
12/11/2016 1:56:57 PM
I am an ABM Practioner of Feldenkrais. Sadly, I have been remiss in my practice due to other obligations I have.
My aging mother-in-law has MS. I'd love to work with her, but her steadfast belief in traditional medicine has lead to skepticism in the Feldenkrais Method.
Because of all of the above I would like some help from you in the way of putting together about 10 ATM lessons and a few FS lessons for me to work with my 94 year old mother-in-law. I'd really appreciate your help.
I will also use your suggested lessons to do more work with people with MS.
Thank you,
Steven Holtz
sgh@lifeswing.com


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