Osteoarthritis is a disabling and costly disease in Australia, with almost 50% of people aged over 65 years having arthritis [
Atrophy of muscles controlling the hip and knee and reduced ankle strength have been observed in those with OA, thus altering the biomechanics of movements such as walking [
The Feldenkrais Method has the potential to help older people with OA. Developed by Dr. Moshe Feldenkrais, the method is a gentle form of exercise which has been shown to be acceptable for older people who have limited movement [
Awareness Through Movement lessons are verbally guided explorations of movement that are about 30–60 minutes long. Each lesson explores movement related to a particular function (e.g., walking) to enhance awareness of how movements are performed and invite the participant to investigate how they might expand their action and ability to function. The lessons address habitual patterns of movement and expand a person’s self-image. By exploring novel movement sequences, attention is drawn to parts of the self which the person may not be aware of and may have excluded from their functioning. The method aims for a heightened self-awareness, an expansion of a person’s repertoire of movement, and improved functioning where the whole body cooperates in movement and where maximum efficiency is achieved with minimum effort. Dr. Feldenkrais described the aim of the method as “a person who is organised to move with minimum effort and maximum efficiency, not through muscular effort, but through increased consciousness of how movement works” [
The Moving With Ease program is a selection of Awareness Through Movement lessons from the Feldenkrais Method. Because the lessons are gentle and enjoyable, they may enable people with OA to move more easily and better manage their pain. The self-exploratory nature of the classes provides an opportunity for participants to become aware of how they move, thus learning to minimize their functional limitations. Therefore the lessons become a form of self-management that addresses a significant aspect of the process of disablement in people with osteoarthritis [
Several recent studies have demonstrated the effectiveness of the Feldenkrais Method in improving balance related outcomes for older people [
The purpose of this study was to investigate whether community-dwelling adults with osteoarthritis undertaking a series of Feldenkrais Method classes improved on measures of mobility, function, balance, quality of life, and pain. This was a pragmatic study of a group of older adults with osteoarthritis already enrolled in Feldenkrais Method classes.
The project was approved by the Human Research Ethics Committee at the University of Melbourne.
A sample of convenience was recruited, drawn from community-dwelling older adults with osteoarthritis responding to an advertisement of Feldenkrais Method classes to be conducted in a community health setting.
Inclusion criteria were aged between 55 and 75 years, OA diagnosed by a medical practitioner using the clinical criteria for diagnosis of OA of the hip and/or by radiographs [
Participants were assessed on outcome measures prior to starting the classes and at completion of the program. Assessments included the timed up-and-go test (physical function) [
Physical assessments were performed in the Movement Laboratory at the Rehabilitation Sciences Research Centre by independent assessors. For gait analysis, reflective markers were attached according to the Vicon Plug-in Gait model. Participants completed several walking trials on a level walkway at self-selected speed and at 1.2 m·s−1 and 1.4 m·s−1. An eight-camera motion measurement system (VICON) and 3 AMTI force plates (Watertown), were used to collect kinematic and kinetic data at the ankle, knee, and hip.
The Moving With Ease program comprised a series of 60 Awareness Through Movement lessons drawn from the vast catalogue of lessons which comprise the Feldenkrais Method (see Supplementary Material available online at
The lessons were selected with the aim of improving hip, knee, and ankle function in the context of improving overall function. Each 10-week segment had an overall theme. The first segment focussed on helping participants to learn to pay attention and develop awareness, learning self-care, and improving fundamental range of motion (flexion, extension, and rotation). Segment 2 focussed on the function of the pelvis and lower limbs. The themes included gaining control of the pelvis, freeing the hip joints, and improving ankle, knee, and hip function. Segment 3 focussed on improving balance, improving walking, and integrating ankle, knee, and hip function with walking. Each individual lesson had a functional theme. Lessons would often return to previous functional themes building upon them as the program progressed. An example of this thematic development can be seen on video on
Figure
Participant characteristics.
Participant | Gender | Age | Condition |
---|---|---|---|
FP002 | M | 69 | R hip, lumbar spine |
FP003 | F | 73 | Lumbar spine |
FP004 | F | 61 | R knee |
FP006 | F | 70 | Both knees, lumbar spine |
FP007 | F | 72 | R knee, lumbar spine |
FP008 | F | 63 | Both knees |
FP009 | F | 71 | L ankle, L knee, R toe |
FP010 | F | 75 | R hip |
FP011 | F | 59 | L knee |
FP012 | F | 62 | Multiple joint arthritis; fusion of large toes of both feet July 2011 |
FP013 | F | 63 | L knee |
FP017 | M | 68 | Knees, lumbar spine; at reassessment: Morton’s neuroma and plantar fasciitis on L; injured cartilage L knee |
FP018 | F | 61 | R knee and hip |
FP019 | F | 67 | Neck, lumbar spine, knees |
FP023 | F | 72 | Both knees |
Flow chart of participant recruitment and retention.
Given the small sample size, statistical analyses were not conducted on the results of the clinical tests and questionnaires, therefore the raw scores have been provided in Tables
Human activity profile.
Participant | MAS 1 | MAS 2 | Change MAS |
MAS 3 | Change MAS |
AAS 1 | AAS 2 | Change AAS |
AAS 3 | Change AAS |
---|---|---|---|---|---|---|---|---|---|---|
FP002 | 72 | 64 | − |
73 |
|
63 | 41 | − |
64 |
|
FP003 | 78 | 69 | − |
78 |
|
65 | 58 | − |
62 | − |
FP004 | 82 | 65 | − |
82 |
|
70 | 40 | − |
62 | − |
FP006 | 82 | 63 | − |
82 |
|
68 | 34 | − |
64 | − |
FP007 | 77 | 73 | − |
78 |
|
73 | 63 | − |
75 |
|
FP008 | 70 | 66 | − |
66 | − |
61 | 48 | − |
56 | − |
FP009 | 57 | 32 | − |
53 | − |
47 | 4 | − |
38 | − |
FP010 | 75 | 55 | − |
70 | − |
63 | 30 | − |
61 | − |
FP011 | 82 | 62 | − |
82 |
|
71 | 53 | − |
— | — |
FP012 | — | — | — | 58 | — | — | — | 26 | — | |
FP013 | 70 | 60 | − |
70 |
|
61 | 44 | − |
63 |
|
FP017 | 82 | 76 | − |
82 |
|
75 | 59 | − |
74 | − |
FP018 | 80 | 46 | − |
61 | − |
61 | 8 | − |
52 | − |
FP019 | 82 | 56 | − |
78 | − |
70 | 47 | − |
74 |
|
FP023 | 77 | 75 | − |
82 |
|
74 | 66 | − |
77 |
|
1 = baseline; 2 = 6 month mark; 3 = final.
MAS (maximum activity score): highest oxygen-demanding activity still being performed; best estimate of highest level of energy expenditure in comparison with peers of same age and gender.
AAS (adjusted activity score): a measure of usual daily activities; best estimate of average level of energy expenditure in comparison with peers of same age and gender.
WOMAC average scores.
Pain 1 | Pain 2 | Change pain |
Pain 3 | Change Pain |
Stiff 1 | Stiff 2 | Change Stiff |
Stiff 3 | Change Stiff |
Func 1 | Func 2 | Change Func |
Func 3 | Change Func |
|
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
FP002 | 11.9 | 13.7 |
|
9.6 |
|
3.8 | 7 |
|
10.9 |
|
18.1 | 15.5 |
|
19.5 |
|
FP003 | 4.1 | 2.4 |
|
6.3 |
|
3.3 | 2.2 |
|
7.9 |
|
9.6 | 8.9 |
|
15.9 |
|
FP004 | 22.9 | 22.6 |
|
29.4 |
|
8.2 | 9.4 |
|
8.4 |
|
61.1 | 66.1 |
|
83 |
|
FP006 | 9 | 8.4 |
|
24.7 |
|
8.1 | 7.9 |
|
8 |
|
24.2 | 10.6 |
|
— | — |
FP007 | 5.1 | 3.2 |
|
10.3 |
|
9.3 | 2.9 |
|
8.1 |
|
29.2 | 14.5 |
|
22.2 |
|
FP008 | 10.8 | 10.3 |
|
12.8 |
|
11 | 9.1 |
|
15 |
|
68.2 | 54.4 |
|
75.2 |
|
FP009 | 3.9 | 22.5 |
|
19.2 |
|
0.5 | 9.1 |
|
10.7 |
|
28.3 | 49.7 |
|
— | — |
FP010 | 9 | 11.1 |
|
4.9 |
|
8.1 | 7 |
|
4.6 |
|
30.4 | 33.1 |
|
33.4 |
|
FP011 | 6.2 | 6.7 |
|
6.6 |
|
13.3 | 4.1 |
|
11.5 |
|
33.4 | 21.6 |
|
42.1 |
|
FP012 | 24.5 | — | — | 9.2 |
|
14.4 | 0 | — | — | 62.9 | 0 | — | — | — | |
FP013 | 0 | 6.7 |
|
2 |
|
4.8 | 4.5 |
|
3.6 |
|
22 | 18.3 |
|
9.3 |
|
FP017 | 9.9 | 12.8 |
|
10.5 |
|
2.2 | 7.1 |
|
5.5 |
|
14.8 | 25.8 |
|
45.1 |
|
FP018 | 4 | 12.7 |
|
5.9 |
|
4.1 | 10.2 |
|
2.8 |
|
12.8 | 21 |
|
37.6 |
|
FP019 | 12.9 | 5.2 |
|
11.5 |
|
10.7 | 3.9 |
|
5.7 |
|
42.6 | 17.9 |
|
37.4 |
|
FP023 | 9.8 | 7.3 |
|
10.7 |
|
5 | 7.1 |
|
6.2 |
|
27.7 | 21.2 |
|
20 |
|
Visual analogue version used; 1 = baseline; 2 = 6 months mark; 3 = final. Negative numbers indicate improvement.
Stiff: stiffness; Func: function.
Assessment of quality of life (AQoL).
Participant | AQoL 1 | AQoL 2 | Change |
AQoL 3 | Change |
---|---|---|---|---|---|
FP002 | 3 | 4 |
|
4 |
|
FP003 | 7 | 7 |
|
5 | − |
FP004 | 8 | 7 | − |
8 |
|
FP006 | 9 | 8 | − |
6 | − |
FP007 | 4 | 6 |
|
9 |
|
FP008 | 10 | 8 | − |
16 |
|
FP009 | 22 | 20 | − |
10 | − |
FP010 | 11 | 11 |
|
6 | − |
FP011 | 7 | 7 |
|
7 |
|
FP012 | 11 | 0 | − |
— | — |
FP013 | 3 | 4 |
|
— | — |
FP017 | 7 | 0 | − |
1 | − |
FP018 | 2 | 0 | − |
2 |
|
FP019 | 6 | 5 | − |
6 |
|
FP023 | 4 | 3 | − |
4 |
|
Higher scores mean lower quality of life.
1 = baseline; 2 = 6 month mark; 3 = final.
Leg Power, TUG, 6MWT, and 4SST.
Participant | Leg power 1 | Leg power 2 | Change | TUG 1 | TUG 2 | Change | 6MWT 1 | 6MWT 2 | Change | 4SST 1 | 4SST2 | Change |
---|---|---|---|---|---|---|---|---|---|---|---|---|
FP002 | 17.09 | 18.60 |
|
9.21 | 8.72 | − |
438.5 | 430.3 | − |
6.85 | 5.94 | − |
FP003 | 9.50 | 9.73 |
|
10.15 | 7.93 | − |
339 | 400.2 |
|
5.41 | 4.65 | − |
FP004 | 18.00 | 18.71 |
|
8.91 | 8.37 | − |
436 | 394.2 | − |
4.29 | 4.08 | − |
FP006 | 13.19 | 11.86 | − |
8.61 | 8.29 | − |
372 | 372 |
|
6.02 | 5.14 | − |
FP007 | 18.89 | 16.37 | − |
7.39 | 7.99 |
|
420 | 462.5 |
|
4.27 | 4.23 | − |
FP008 | 13.56 | 13.05 | − |
9.33 | 9.83 |
|
428 | 417 | − |
5.02 | 4.92 | − |
FP009 | 8.97 | 8.09 | − |
11.20 | 10.88 | − |
279 | 264.8 | − |
6.83 | 5.37 | − |
FP010 | 14.78 | 14.97 |
|
8.28 | 8.20 | − |
420 | 434 |
|
5.26 | 5.19 | − |
FP011 | 16.24 | 19.56 |
|
8.08 | 8.19 |
|
366 | 363.1 | − |
5.91 | 4.42 | − |
FP012 | 12.95 | 17.10 |
|
9.82 | 10.08 |
|
372 | 413.5 |
|
7.49 | 4.46 | − |
FP013 | 9.82 | 17.22 |
|
8.50 | 6.02 | − |
394 | 439 |
|
6.22 | 3.96 | − |
FP017 | 26.15 | 20.04 | − |
8.07 | 7.36 | − |
432.3 | 442.4 |
|
6.20 | 5.21 | − |
FP018 | 9.47 | 10.37 |
|
7.16 | 7.52 |
|
396 | 466.25 |
|
7.10 | 4.25 | − |
FP019 | 18.61 | 19.68 |
|
7.54 | 6.19 | − |
412 | 442 |
|
3.44 | 3.06 | − |
FP023 | 13.77 | 14.66 |
|
8.50 | 8.61 |
|
420 | 438 |
|
5.24 | 4.66 | − |
Leg power = [(weight * height of stairs (m))/time (sec)] (positive values indicate improvement).
TUG: timed up-and-Go test (negative values indicate improvement).
6MWT: 6-minute walk test (positive values indicate improvement).
4SST: four square step test (negative values indicate improvement).
1 = baseline; 2 = final.
All participants were able to walk without external aids; however, two of them were not able to walk at the highest speed (1.4 m·s−1) and were therefore excluded from all analyses of this condition. Both subjects reported left knee OA and one of them also had OA in the left ankle and right toes. Descriptive statistics and repeated measures ANOVAs for the spatiotemporal and kinetic measures are summarized in Tables
Spatiotemporal and kinematic data baseline and final intervention.
Spatiotemporal and kinematic variables | 1.2 m |
Self-selected | 1.4 m |
||||||
---|---|---|---|---|---|---|---|---|---|
Mean | SD |
|
Mean | SD |
|
Mean | SD |
| |
Walking speed (m |
|||||||||
Baseline | 1.18 | 0.04 |
|
1.27 | 0.18 | 0.14 | 1.37 | 0.05 | 0.19 |
Final | 1.20 | 0.04 | 1.30 | 0.18 | 1.38 | 0.04 | |||
Cadence (steps/min) | |||||||||
Baseline | 56.99 | 3.74 | 0.07 | 60.00 | 4.85 | 0.33 | 60.71 | 3.09 | 0.07 |
Final | 57.79 | 3.75 | 60.47 | 3.49 | 61.47 | 3.74 | |||
Step length (cm) | |||||||||
Baseline | 63.2 | 6.9 | 0.01 | 62.5 | 3.7 | 0.53 | 67.9 | 3.5 | 0.05 |
Final | 64.6 | 7.3 | 62.7 | 3.7 | 68.2 | 4.0 | |||
Stride length (m) | |||||||||
Baseline | 1.25 | 0.08 | 0.42 | 1.27 | 0.13 | 0.36 | 1.35 | 0.08 | 0.59 |
Final | 1.26 | 0.08 | 1.28 | 0.17 | 1.35 | 0.08 | |||
Step width (m) | |||||||||
Baseline | 0.08 | 0.04 | 0.65 | 0.09 | 0.04 | 0.54 | 0.09 | 0.04 | 0.13 |
Final | 0.08 | 0.04 | 0.08 | 0.04 | 0.08 | 0.04 | |||
Stance (% of gait cycle) | |||||||||
Baseline | 61.91 | 2.81 | 0.46 | 61.45 | 2.41 | 0.11 | 60.54 | 2.07 | 0.89 |
Final | 61.70 | 2.17 | 61.02 | 2.19 | 60.58 | 1.86 | |||
Single stance (% of gait cycle) | |||||||||
Baseline | 38.27 | 3.76 | 0.39 | 38.53 | 2.81 | 0.17 | 39.30 | 2.83 | 0.81 |
Final | 38.58 | 2.29 | 38.96 | 2.56 | 39.37 | 2.21 | |||
| |||||||||
Anterior pelvic tilt (°) | |||||||||
Baseline | 14.25 | 6.05 |
|
14.78 | 5.83 |
|
14.84 | 6.42 |
|
Final | 11.95 | 5.79 | 12.01 | 5.97 | 12.18 | 6.17 | |||
Hip extension (°) | |||||||||
Baseline | −9.93 | 8.30 | 0.04 | −9.68 | 8.02 |
|
−10.42 | 8.58 | 0.02 |
Final | −11.98 | 8.81 | −12.46 | 9.04 | −12.96 | 9.58 | |||
Hip flexion (°) | |||||||||
Baseline | 33.18 | 7.83 | 0.07 | 33.50 | 7.81 | 0.11 | 35.05 | 8.76 | 0.02 |
Final | 31.63 | 6.94 | 32.10 | 7.10 | 32.76 | 7.31 | |||
Ankle plantar flexion (°) | |||||||||
Baseline | −11.24 | 4.86 | 0.24 | −10.84 | 4.87 | 0.20 | −12.92 | 5.28 | 0.86 |
Final | −11.89 | 4.76 | −11.57 | 4.93 | −13.04 | 5.39 | |||
Knee extension at heel contact (°) | |||||||||
Baseline | 5.05 | 5.01 |
|
5.29 | 4.53 |
|
6.63 | 4.34 | 0.04 |
Final | 7.06 | 5.19 | 7.34 | 5.01 | 7.81 | 5.20 | |||
Knee flexion at load reception (°) | |||||||||
Baseline | 19.75 | 15.08 | 0.18 | 20.68 | 14.72 | 0.22 | 24.57 | 16.24 | 0.92 |
Final | 22.07 | 14.59 | 22.71 | 13.49 | 24.39 | 13.61 | |||
Knee extension at late stance (°) | |||||||||
Baseline | 1.20 | 6.31 | 0.08 | 1.27 | 6.38 | 0.94 | 0.81 | 6.87 | 0.09 |
Final | 2.56 | 6.94 | 1.33 | 7.07 | 2.29 | 7.34 | |||
Knee flexion at swing (°) | |||||||||
Baseline | 56.21 | 4.52 | 0.01 | 56.26 | 4.65 |
|
58.68 | 4.45 | 0.73 |
Final | 57.66 | 5.46 | 57.90 | 5.44 | 58.87 | 4.82 |
Kinetic data baseline and final intervention.
Joint powers (W/kg) | 1.2 m |
Self-selected | 1.4 m |
||||||
---|---|---|---|---|---|---|---|---|---|
Mean | SD |
|
Mean | SD |
|
Mean | SD |
| |
Ankle power absorption at heel off (A1) | |||||||||
Baseline | −0.83 | 0.22 | 0.41 | −0.87 | 0.24 | 0.27 | −0.86 | 0.26 | 0.60 |
Final | −0.81 | 0.26 | −0.91 | 0.32 | −0.84 | 0.25 | |||
Ankle power generation at late stance (A2) | |||||||||
Baseline | 3.69 | 0.58 | 0.50 | 3.95 | 1.00 | 0.13 | 4.22 | 0.73 | 0.36 |
Final | 3.73 | 0.57 | 4.12 | 0.97 | 4.30 | 0.76 | |||
Hip extensor power generation at stance (H1) | |||||||||
Baseline | 0.46 | 0.27 | 0.73 | 0.51 | 0.32 | 0.05 | 0.60 | 0.34 | 0.50 |
Final | 0.44 | 0.28 | 0.58 | 0.34 | 0.57 | 0.33 | |||
Hip flexor power absorption at late stance (H2) | |||||||||
Baseline | −0.84 | 0.42 | 0.61 | −0.94 | 0.52 | 0.40 | −0.99 | 0.51 | 0.43 |
Final | −0.86 | 0.41 | −0.99 | 0.45 | −1.04 | 0.45 | |||
Hip flexor power generation at toe-off (H3) | |||||||||
Baseline | 1.60 | 0.47 | 0.42 | 1.77 | 0.51 | 0.32 | 1.95 | 0.43 | 0.97 |
Final | 1.56 | 0.42 | 1.83 | 0.55 | 1.95 | 0.40 | |||
Knee flexor power generation at heel contact (K0) | |||||||||
Baseline | 0.78 | 0.51 | 0.99 | 0.93 | 0.58 | 0.10 | 1.01 | 0.60 | 0.16 |
Final | 0.78 | 0.44 | 1.04 | 0.63 | 1.12 | 0.66 | |||
Knee extensor absorption power at initial stance (K1) | |||||||||
Baseline | −0.67 | 0.42 | 0.02 | −0.88 | 0.56 | 0.04 | −1.12 | 0.72 | 0.17 |
Final | −0.80 | 0.46 | −1.01 | 0.52 | −1.23 | 0.61 | |||
Knee extensor power generation at mid stance (K2) | |||||||||
Baseline | 0.44 | 0.27 | 0.24 | 0.57 | 0.38 | 0.58 | 0.69 | 0.43 | 0.94 |
Final | 0.48 | 0.31 | 0.59 | 0.33 | 0.69 | 0.34 | |||
Knee extensor power generation at late stance (K3) | |||||||||
Baseline | 0.32 | 0.24 | 0.22 | 0.38 | 0.33 | 0.37 | 0.39 | 0.32 | 0.12 |
Final | 0.28 | 0.25 | 0.35 | 0.31 | 0.33 | 0.25 | |||
Knee extensors power absorption at initial swing (K4) | |||||||||
Baseline | −1.25 | 0.42 | 0.22 | −1.42 | 0.46 | 0.77 | −1.52 | 0.37 | 0.76 |
Final | −1.20 | 0.35 | −1.44 | 0.49 | −1.51 | 0.40 | |||
Knee flexors power absorption at final swing (K5) | |||||||||
Baseline | −1.36 | 0.35 | 0.01 | −1.57 | 0.55 |
|
−1.67 | 0.45 |
|
Final | −1.47 | 0.35 | −1.74 | 0.59 | −1.86 | 0.46 |
Peak joint angles and joint powers.
Spatiotemporal measures of cadence, step length, stride length, step width, percentage of gait cycle in stance, and percentage of gait cycle in single stance were compared before and after intervention. When comparing the effect of intervention for all subjects at all speeds conditions, no significant differences were found for any measures (
When comparing pre- and post-interventions peak joint angles for all subjects at all speeds tested, no significant differences were found for most of the measures (
No significant increases were found for ankle peak joint power generation (A2) at all speed conditions after intervention. Except at self-selected speed, where subjects walked faster than prior to intervention, ankle absorption power (A1) remained similar after intervention.
At the knee, most of the intervention effects were observed when subjects walked at self-selected and 1.4 m·s−1 conditions, but not at 1.2 m·s−1. At the two highest speed conditions, no significant increases were found for knee power generation at the beginning of stance (K0) and decreases for knee power absorption (K1). Most importantly, a significant increase (
At the hip, no significant changes were observed at all speed conditions for all peak joint powers analysed. Small increases, however, were observed for hip power generation after toe-off (H3) in the post-intervention gait pattern, especially at self-selected speed (0.06 W/kg increase).
Class attendance was high (76.5%), and feedback from the satisfaction survey was positive. All 15 participants said they enjoyed the program “very much.” Eleven of the fifteen participants reported improvements in their ability to do everyday things since the beginning of the program, including going up and down stairs, ability to stay longer in the garden, better deportment, improved walking, and more flexibility. When asked to describe what they had learnt by participating in the program, comments included “how exercise/movement is crucial to managing pain,” “to exercise where it is comfortable, not to force it,” “to walk with a more fluid, gentle motion,” and “learnt to incorporate some of the exercises into my daily life.” Participants were asked to comment on their experience of pain and, in particular, the pain associated with their osteoarthritis after participating in the program. Ten of the fifteen participants said their pain level had improved, three were unsure and two said they had not noticed any difference. Comments included “the pain is continual, but I manage it better,” “at the end of the session I was free from pain and felt energized,” “I can experience less pain in the knees, which is where the osteo appears for my body,” “the lessons…eased the pain in my lower back,” “no pain in the knees when going up stairs,” and “it is not a cure! however, it is the best “exercise” I have experienced for managing my osteoarthritis”. Participants were asked to comment on their experience of the program in relation to balance, confidence, or walking. Eight of the fifteen participants reported an improvement in one or more of these areas. Comments included “my balance and confidence in my walking have all improved,” “feel more confident of walking/climbing up/down,” “less pressure on the knees when walking,” “getting up and down from the floor is much easier” and “the program has helped me in every way. The best thing about it is that I know I can do this exercise”. Participants were asked whether they experienced any other benefits from attending the program. Comments included, “It has made me move in time with my body,” “I feel more energetic, brighter, sleeping better,” “I am more positive even though pain is still prevalent,” and “enabling, empowering … . I feel so confident and grateful that I have found an exercise that suits me.” When asked whether participants would undertake Feldenkrais classes in the future, eight responded “definitely,” three responded “probably,” three responded “maybe, depending on cost,” and one person responded “no”.
Given the participants’ comments on the final questionnaire, it is clear that the physical assessments and questionnaires did not adequately capture the types of functional changes resulting from undertaking the Feldenkrais classes. These included a change in the quality of their movement (i.e., moving with ease), ability to manage their pain, the ability to get up and down from the floor and climb stairs, better balance, and improvement in walking. The small sample size makes it difficult to conclude that there were positive changes in function; however, the uniformly positive improvement on the four square step test, coupled with the changes in gait detailed below indicating a more upright posture, is suggestive of an improvement in balance. Since people with OA have balance deficits [
We undertook gait analysis in order to identify any changes in gait patterns associated with the Feldenkrais classes. To our knowledge, this is the first study to do so. The findings of decreased anterior pelvic tilt across all speed conditions may indicate an effect of the Feldenkrais intervention in correcting upright posture. This kinematic change may have reduced the forward inclination of the trunk and reduced loads at the low back when walking [
Anterior pelvic tilt reductions coupled to an increased hip extension may allow increases in hip extension (absorption) power (H2) leading to higher elastic energy storage mainly in the iliopsoas muscle [
DeVita and Hortobagyi [
A significantly lower K5 (higher absorption) at the end of the gait cycle indicates an increased eccentric activity of the hamstring muscles after intervention. This may have influenced the higher knee flexion observed at heel contact at the beginning of a new gait cycle. An increase in K5 power absorption is associated with a reduced step length; however, it may also increase stability of the knee and reduce forward foot speed in order to prepare for landing, leading to reduced slip-induced falls [
Increases in the second peak of knee flexion, significant at the self-selected speed, may contribute to a better foot clearance, decreasing the probability of tripping and falling when the limb is in the swing phase [
Only sagittal plane gait analysis was performed in this study. Despite controlling over-ground gait speed using timing gates, significant differences for speed were found when participants were asked to walk at 1.2 m/s. This may be explained by the fact that participants walked closer to the lower speed limit allowed during the baseline assessment and closer to the higher limit during the final assessment. This is also reflected in the higher self-selected walking speed exhibited after intervention for this condition.
It is a tenet of the Feldenkrais Method that efficient movement occurs when the work is spread throughout the body. Although our analyses have focused on changes in gait, the intention of the lessons was not to focus solely on the lower limbs, but to teach a comprehensive program that would improve overall movement organisation. Future studies could evaluate this aspect further.
A major limitation of this study was the lack of a comparison group due to the pragmatic nature of this study. The participant group was a sample of convenience, recruited from people who responded to an advertisement of Feldenkrais Method classes. It is acknowledged that the group was not homogeneous with respect to gender and the joints affected by osteoarthritis. The greater proportion of women in our group reflects the fact that more women are affected by arthritis than men [
However there were no adverse effects such as falls or reports of injuries during the classes and participants who continued with the program reported meaningful changes in their function.
The results, high class attendance (76.5%), and survey feedback indicate that a 30-week series of Feldenkrais classes held twice per week was feasible in the community setting and may be acceptable for other people with OA. The lessons led to improvements in performance of the Four Square Step Test and changes in gait. Further investigation of the Feldenkrais Method for people with OA is warranted.
The authors wish to thank all the participants involved in this study. This work was supported by a grant from the Merri Community Health Services Ltd.