EAST & WEST – AN INTEGRATIVE GRAND UNIFIED THERAPY (GUT)

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Eastern_exercise_theraapy

Preamble

We’ve got a problem¾an enormous one¾that affects every last one of us, rich and poor, young and old alike.

I would like to believe that we all, irrespective of our fields of endeavour and expertise, share a common concern, namely that of healing a sick planet. If we’re serious about this, then we have to address the causative factors and not merely alleviate or excise the symptoms. Succinctly, the root of the problem is people. Sick people, that is. By sick, I don’t mean just in body, but also in psyche and spirit.

The reality is that disease, disability and disharmony equates with dysfunctionality ¾ ergo the sick contribute the least, consume the most resources, and are the greatest waste makers. And the outcome is terra infirma.

So, what’s the fix?

Legislation is not the answer (you can’t enforce awareness or integrity). Likewise for preaching, praying, bullying, or bribing. Real and enduring change of the global status quo is contingent upon changing the individual’s perceptions, attitudes and behaviour. However, awareness and consciousness are not just cerebral processes¾psyche recapitulates soma¾hence attitudinal change requires meaningful address of health in the broadest terms. Mens sana in corpore sano. Accordingly, my approach to therapy is the restoration of health and functionality, and most importantly sanity.

The integrative modality that I’ve developed and use in clinic to achieve these ends is comprised of modules to develop the cognitive faculties, firm the will, strengthen and invigorate the body, and cultivate character. This modality, Kinergetix Movement Therapy (KMT), has evolved from the marriage of Western biomechanical and rehabilitation sciences with Eastern mind-body therapies and martial arts.

Synopsis

Chronic diseases / disabilities are pandemic and on the increase, and their attendant socioeconomic sequelae are crippling both the individual and society at large. Interventions to contain or reverse this trend have been largely unsuccessful.

It is universally acknowledged that physical exercise plays a vital role in managing and preventing many chronic health issues. The research shows that every exercise system¾ranging from strenuous physical workouts to static meditation¾has therapeutic merit; however, each also has limitations and contraindications.

The challenge has been to devise an exercise regimen that satisfies a number of criteria, viz.: relieve symptoms; address underlying impairments; inhibit regression; prevent initial occurrence; restore functionality (physical and cognitive); require minimal supervision, resources and time; is safe; and importantly, is enjoyable, stimulating, challenging and stress-free (for lack of which, participants lose interest or motivation, and won’t put in the time and effort to improve their health). In addition, the component exercises need to be relevant to modern lifestyles.

With all these considerations in mind, I have spent forty-five years investigating and trialing numerous rehabilitation, disease prevention and fitness-conditioning methods, both mainstream and alternative. Drawing on these, I have developed an innovative and eclectic exercise modality, Kinergetix Movement Therapy (KMT), which integrates Western exercise, physical therapy, and human movement sciences with Eastern mind-body therapies and martial arts.

However, KMT is not an ad hoc mélange or wholistic pizza with the lot¾it builds on a foundation of tried-and-true practices and understandings, but it develops these further into a genuinely new approach to health, vitality and self-development. In essence, this is much more than a physical fixer-upper¾it’s a tool for self-mastery.

I have extensively employed KMT in clinic over a period of twenty years, during which time it has been productive of significant and enduring outcomes in the management of a wide spectrum of chronic health issues across a broad demographic. Further considerations of cost-effectiveness of group sessions, outstanding compliance and program adherence of participants, safety of implementation, ease of learning, minimal requirement for specialised facilities or ancillary aids, and ease of scalability signify the importance of wider implementation and dissemination.

The Cultural Divide

We can broadly divide the world in terms of geography, culture, science, philosophy and religion into East and West. In certain important respects the cultural differences between the two are mutually exclusive and irreconcilable, or as Rudyard Kipling put it so succinctly, “East is East, and West is West, and never the twain shall meet”.

The intent of this paper however, is not to attempt a wide-ranging discourse on the essential or manifold differences between East and West. Rather, it will be constrained to discussing and comparing the relative benefits and limitations of their respective exercise strategies, whether as therapeutic tools or physical conditioning regimens for the cultivation of health and wellbeing.

The first and probably most fundamental difference between Western and Eastern approaches to health conditioning revolves around the concept of “spirit”. In the world of Western medicine there is a rigid dichotomy between science and mysticism; between physical and metaphysical. From a mechanist perspective, spirit is regarded as illusory; or tolerated as an (hopefully) innocuous myth; or is acknowledged superficially as a nebulous concept that is paid lip service to. Conversely, from the perspective of Eastern medicine, the concept of spirit is foundational and plays a central role in therapy ¾ as such, spirit cannot be expunged from traditional Oriental therapies without compromising or negating their effectiveness.

Carl Jung, the forefather of analytical psychology, had a deep interest in and high regard for Oriental religions and philosophies. Nevertheless, he believed that the tenets and practices of Hinduism, Buddhism and Daoism are so alien to the inherent psychic processes of the Occidental mind that he cautioned against their adoption by Westerners. In effect, he declared that Eastern doctrines and their praxis are not only irrelevant or misleading in regard to the healing and growth of the Western psyche, but are potentially dangerous. The following extract encapsulates Jung’s views on the subject, albeit with particular reference to the practice of Yoga.

The usual mistake of a Western man when faced with this problem of grasping the ideas of the East is … he contemptuously turns his back on science and, carried away by Eastern occultism, takes over yoga practices word for word and becomes a pitiable imitator. Thus he abandons the one sure foundation of the Western mind and loses himself in a mist of words and ideas that could never have originated in European brains and can never be profitably grafted upon them.’ 

CG Jung – Commentary on the Secret of the Golden Flower

The schism between East and West may be considered as both the reflection and projection of a bipolar psyche. Moreover, this schizophrenic state of being at war with oneself (and by extension the world at large) is a condition of dis-ease that plays a significant role in the evolution of much chronic disease and disability. The restoration and maintenance of health is in many respects contingent upon establishing internal harmony, i.e. a state of homeostasis in which body, mind and spirit are unified and act in concert with each other. Therein lies the conundrum and challenge in the sphere of exercise therapy ¾ how to reconcile and integrate such radically different practices and their associated ideologies. Prior to formulating such an integrative schema, viz. a Grand Unified Therapy (GUT), a discussion is warranted on the characteristics and relative merits of the major schools of exercise therapy that are utilised in Eastern and Western clinical practices.

Western Exercise Science

It is universally acknowledged that physical exercise plays a vital role in managing and preventing many chronic health issues. In the words of Booth et al. “ We know of no single intervention with greater promise than physical exercise to reduce the risk of virtually all chronic diseases simultaneously” (Journal of Applied Physiology, 2000).

The documented research shows that every exercise system¾ranging from strenuous physical workouts to static meditation¾has therapeutic merit; however, each also has limitations and contraindications. Accordingly, what follows is a brief overview of the most common Western exercise modalities together with a discussion of the practices, principles, applications and relative merits of each.

Broadly speaking, traditional gym-based physical workouts may be differentiated according to 1) aerobic conditioning exercises for promoting cardiopulmonary fitness; 2) resistance training for building strength and endurance, and; 3) flexibility / agility enhancement routines for extending articular range-of-motion (RoM). In addition to these, there is a plethora of therapeutic and conditioning modalities that may be employed in complementary or adjunctive roles (e.g., Pilates, Feldenkrais and Alexander Technique to name but a few).

There is a common misconception of the gym environment (and it’s associated practices) as being primarily the domain of sweaty, testosterone-drenched body builders and fitness junkies, whereas in fact muscle bulking (hypertrophy) is only one aspect of the various goals that gym clientele have. Medical professionals will often advise their patients to enrol in a gym program in order to proactively address health concerns such as stress / hypertension, weight management, physical injury, postural deficits, cardiovascular issues, mobility limitation, general fitness, coordination, balance, and flexibility issues.

Aerobic Training

Aerobic exercises are designed to promote cardiovascular (CV) fitness, their priorities being to strengthen the cardiac muscles, enhance respiration, elevate body-core temperature, stimulate circulation, develop endurance, and burn fat. Additional benefits accruing from aerobic workouts include lowered resting heart rate, normalisation of blood pressure, and attaining a state of general wellbeing.

The exercises grouped into this category range from brisk walking (a much underrated, widely applicable and highly beneficial exercise), to high-intensity cardio circuit workouts and quasi martial-art group routines such as Taebox. Regardless of the level that the abovementioned are performed at, the same basic training principle applies; namely, in order to maximise gains, the exercises need to be performed at a sufficient level of intensity and appropriate duration so as to maintain a specified heartbeat rate. The prescribed level varies with each person, and is determined by the individual’s age, weight, gender, state of health, prescribed medications, and medical history.

It is necessary however to take into consideration the possible adverse effects of improperly performing or prescribing aerobic exercises. Prior to embarking on a CV training program at even moderate levels of intensity, an individual who is unfit, disabled, medicated, or has a medical condition that may be adversely affected by exercise requires appropriate assessment and clearance. Of particular concern, aerobic exercises are frequently performed with great initial enthusiasm and a somewhat gung-ho attitude, and this can lead to over-exertion, strain and a host of attendant physical repercussions ¾ the oft-heard catchcry in this area is “no pain, no gain”.

Aerobic workouts may also incorporate an impact component. Dedicated impact routines (plyometrics) have been clinically validated as excellent for the development of a solid skeletal framework and bone re-mineralisation; however, the potential for self-inflicted injury is considerable, hence these routines need to be performed with due care and proper supervision.

A further consideration is that high-intensity aerobic workouts are pro-inflammatory, in which regard they accelerate the aging processes and contribute to physical degeneration. Contrary to the obsession and associated mythology associated with “fat burning” routines, there is certainly little or no justification for prescribing aerobic exercises as a weight control measure, as the research indicates that they are not only counter-productive, but are debilitating and occasionally lethal.

Resistance Training

Resistance exercises are designed to develop muscle and tendon, and to enhance neuromuscular functioning. Resistance programs are customised to focus on the development of strength, power and/or endurance in accordance with the practitioner’s needs and preferences. Within these programs, exercises may be undertaken as compound sets (in order to develop the large muscle groups), or targeted to isolated muscles through the desired RoM. Resistance routines find wide application in physical rehabilitation, sports training, work conditioning, and weight control (primarily weight gain).

Resistance training is generally performed using a combination of body weight, free weights, weight and cable machines (which offer the benefits of partial support as well as the facility to tailor the resistance through the various stages of a muscle’s contraction), and/or spring and elastic devices. Body weight exercises have the advantage of their suitability to being performed in confined spaces and without the need of specialised equipment, thus they may be incorporated at work, home or in transit.

It is important to recognise that skeletal muscles are not just concerned with the exertion of force, but also play a foundational role in stability (both of individual joints and the body as a whole). Muscles act in concert in different ways to achieve a co-ordinated, efficient, and stable action ¾ the performance of work or execution of a movement recruits sets of complementary but opposing muscles (agonists and antagonists) together with the relevant controller and stabilising muscles (synergists).

Flexibility Training

Limitations in RoM are a natural (although partially reversible) accompaniment of the aging process. In addition to functional deterioration or limitation occurring as a result of senescence, restrictions in RoM may be attributable to numerous issues including joint pathologies, stroke, tendinitis, gout, muscular dystrophy, neuropathy, soft tissue adhesions, fat or muscle mass, physical asymmetry, bursitis, or tenosynovitis. When movement evokes pain or causes discomfort, a common compensatory response is reduction of activity levels and/or RoM, however such a pain-avoidance strategy can then further exacerbate the problem and lead to contractures, loss of coordination, balance issues, fragility and increasing disability.

There are numerous physical conditioning stratagems that are commonly employed to increase RoM. In addition to the conventional static stretching postures incorporated prior to, during or at the end of exercise sessions, there are also bounce stretches, passive / active assisted stretches, proprioceptive neuromuscular facilitation (PNF) routines, and Yoga. Whilst this list is far from comprehensive, it is typical of the flexibility workouts prescribed for gyms.

Aquatic Routines

Mention should be made in passing of pool-based workouts. Aquatic routines can incorporate aerobic, resistance, and/or flexibility exercises, and thus are eminently suitable for incorporation in physical rehabilitation or conditioning programs. Hydrotherapy utilises water’s buoyancy, viscosity and turbulence properties to assist (or resist) the performance of exercises. The outstanding feature of hydrotherapy is that the aqueous medium partially (or wholly) supports body and limb weight, thereby enabling the participant to exercise joints and muscles through their RoM without undue strain or loading due to gravity.

Pilates

This method was first developed in Europe in the early part of the twentieth century. Joseph Pilates formulated his kinesiological routines as the result of an extensive background in the health sciences and martial arts, having been engaged by the military and police forces to train their personnel. In addition, he was widely consulted by many of the foremost dancers in Europe and the USA for the purposes of rehabilitation, postural correction and technique enhancement. In essence, the focus of his method is on core stability, i.e., the promotion of pelvic, abdominal and lumbar stability via the mechanism of low to medium intensity, dynamic, balance-oriented resistance exercises performed in coordination with the breath.

Pilates routines have virtually become de rigueur as part of the clinical armamentum in exercise therapy, despite the fact that they have limited application in either rehabilitation or injury prevention. The popularity of Pilates exercises stems from their focus on core stabilisation, however the method is somewhat contentious in that it employs phasic strengthening routines to condition tonic muscles. Furthermore, the programs are expensive, whilst the extensive use of floor routines and/or specialised training aids renders Pilates unsuitable for inflexible or geriatric patients.

Eastern Exercise Science

Eastern mind-body therapies are gaining increasing acceptance and application in the fields of rehabilitation and prevention of disease and disability, as well as for general health conditioning. Included in such therapies are the modalities of Qigong, T’ai Chi Ch’uan (TCC) and Yoga, which are designed to promote the health of both soma and psyche. These can be generically described as moving meditation practices, or in more recent and pedantic terminology, movement-based embodied contemplative practices (MECP).

As a clinical tool, MECP may be utilised to identify and correct pathomechanical movement, whether for physical rehabilitation, injury prevention, or performance enhancement. However, the therapeutic applications extend well beyond the address of pathomechanical issues, as the benefits have been well documented in the treatment and self-management of both psychological and physical symptoms, including chronic musculoskeletal pain, stress, exhaustion, and instability. Furthermore, as movement therapies are generally delivered in group-sessions, participants may benefit from increased social interaction, friendly competition, and support.

There are also partnership or one-on-one forms of interactive moving meditation that feature in some Eastern movement-based modalities. These dyadic routines have their origin in martial arts wherein they are utilised as combat drills: however, they also have therapeutic utility in the biomechanical sphere for training balance and core stability; and in the bioenergetic domain for tonifying and harmonising the physiological functioning of the neuroendocrine system, immune system and metabolism.

Meditation

A central feature of MECP modalities is mindfulness training. The focus of such training is promoting attentiveness of the practitioners to the milieu intérieur (via the interoceptive senses), as well as to their interaction with the environment (via the exteroceptive senses).

Essentially, the intent of meditation is to induce a state of deep relaxation, tranquillity, clarity of mind, and receptivity. However, static (or quiescent) meditation is generally not appropriate for sedentary or inactive lifestyles. Dynamic meditation, on the other hand, encompasses routines that range from high-intensity workouts featuring whole-body movement through full RoM, to low-intensity, slow, sedate workout drills characterised by minimal, subtle, or even imagined movements.

According to Edmund Husserl¾a philosopher who profoundly influenced twentieth-century and contemporary understandings of consciousness and perception¾meditation involves a phenomenological process known as “epoché” (lit. suspension). Epoché is an ancient Greek word used to describe the act of suspending judgment about externalia, to instead focus on the direct experience of a phenomenon. In the context of moving meditation, this process of epoché entails: 1) attaining a state of mental clarity by clearing the mind of distractions; 2) cultivating awareness by redirecting the attention to the proprioceptive senses and the breath; 3) being receptive to physical, physiological and emotional responses emerging from this contemplative activity; and 4) interfacing and interacting with the external environment in order to be able to initiate action, as well as to respond, both reactively and proactively.

T’ai Chi Ch’uan (TCC) and Qigong extend the concept of body movement by employing guided affective imagery, subtle movement, and motor-imagery techniques in their exercise routines. Motor imagery utilises the imagination to visualise and rehearse or simulate an action without subsequent execution of overt movement. It has wide application in enhancing motor learning, both in the arena of sports performance and in a clinic setting for improving motor skills, physical strength and neurological rehabilitation.

An important consideration is that exercise stratagems which are intended to address health concerns, whether from the aspects of therapy, health preservation or disease / disability prevention, need to take into account the reality that many people have little time and energy to spare for intensive physical workouts and/or protracted meditation sessions. Accordingly, amalgamating physical exercise and meditation makes for more efficient and effective usage of time and energy.

Life Force

In part, the challenge of bridging the cultural divide between Eastern and Western methodologies has been in translating Oriental esoterica into contemporary Occidental vernacular. In this instance, the challenge lies in translating the fundamental tenets of the biosciences and medical practices of one culture into the language, understandings and practices of another with a very different weltanschaung.

Oriental therapies are predicated upon the purported existence of an intrinsic élan vitale or ‘life force’, variously rendered as Qi (Chinese), Ki (Japanese), or Prana (Sanskrit). The properties and behaviour of this life force have been exhaustively studied, documented, and codified by Oriental practitioners over the course of several millennia. Congruent with this, Eastern rehabilitation and health-conditioning strategies are primarily concerned with fostering the generation, circulation/distribution (via mapped pathways or meridians), and storage of Qi.

However, this life force has proved to be elusive and ostensibly undetectable in the laboratory. Attempts to describe it in standard ergometric or metabolic terms, or to detect, isolate, measure and characterise it in biochemical or electro­physiological terms have been unsuccessful. Having said that, the research and theory of Bong-Han Kim on the Primo Vascular System is worth perusal and consideration, as it purportedly describes the association between the vascular network and the acupuncture meridians.

Despite the lack of an immediate correlate in Western biomedicine, some Traditional Chinese Medicine (TCM) practices which are immediately concerned with bioenergetics, e.g. acupuncture, have acquired a de facto legitimacy, and been incorporated into the standard clinical armamentum.

The absence of proof that validates the theory or proves the existence of life force is irrelevant. From the perspectives of both health provider and consumer, the only consideration needs to be whether the associated therapeutic practices are effective or not. In that regard, there is a vast body of empirical evidence that substantiates the use of bioenergy therapies for rehabilitation and prevention of many pathologic conditions.

Qigong

Qigong is a Chinese form of health maintenance dating back thousands of years. From its ancient origins in Shamanic lore and occult rituals, Qigong has evolved by absorbing the philosophies and practices of Daoism, Confucianism, Buddhism, TCM, and the martial arts.

The word Qigong (pronounced chee goong) contains two concepts: Qi, the vital energy of the body, and gong, the training or cultivation of the Qi. Even though Qi theory is rejected by Western medical institutions and health professionals, it is nevertheless accepted by sceptics that the practice of Qigong incurs health benefits.

Modern Qigong may be described as a fusion of physical exercise, meditation practices (active and passive), Qi meridian channel routines, massage (self-applied and passive receiver), herbal prescriptions, and a variety of rhythmic breathing strategies.

The practice of Qigong involves the integration of the interoceptive, proprioceptive, equilibrioceptive, and exteroceptive senses. The exercises are intended to promote a state of deep relaxation, mindfulness and physical wellbeing, i.e. internal harmony, thereby fostering physiological and psychological mechanisms of self-repair, regeneration and health recovery. Workout sessions can incorporate static and dynamic stretching, guided affective imagery, vibration and resonance therapy, self-massage, low-impact plyometrics, and vocalising.

Qigong also employs guided imagery techniques that consist of the practitioner focusing and directing the attention through the body with the intention of creating a sensation of a current of energy. The exercise routines incorporate overt movement (both large and subtle) as well as internal or imagined movement.

There is a vast repertoire of Qigong exercises, many of which have been designed to address particular diseases and disorders, and which are attracting interest from a growing number of outpatient clinics worldwide. The exercises are generally not overly complex or challenging, nor are they strenuous, hence they may be easily learned and performed by almost anyone of any age or physical condition.

Yoga

Yoga is a Sanskrit word meaning “to join, yoke together, or concentrate”, which is an apt description as it seeks to harmonise and unify the workings of body, breath and mind. The practice of Yoga originated in ancient India several millennia ago (although there is no consensus on its chronology). In the mid 19th century it attracted the attention of a select group of spiritually inclined Europeans, but only came into the public eye in the West in the 1960’s. Yoga’s initial appeal to the youth culture was as a method of transcendental meditation and physical tonification, however it soon gained acceptance as a therapeutic tool for improving health and wellbeing.

The three pillars of Yoga are meditation, breathing and exercise. The physical body is regarded as the vessel or primary instrument of personal evolution, and hence needs to be cared for diligently and with due respect. The aspiring yogi works towards self-mastery by cultivating the body, controlling the breath, and concentrating the mind via the process of meditation.

There are hundreds of different schools of Yoga, with approaches ranging from the extremes of populist bendy-stretchy physical agility (e.g. Hatha and Iyengar) to esoteric navel-gazing (Raja yoga). Generally however, they are all intrinsically concerned with the promotion of peace-of-mind and physical well-being through a series of exercises aimed at: a) tonification of the internal organs; b) conditioning of tendons and sinews; c) stimulation of the body’s vascular and lymphatic circulatory systems; d) regulation of the endocrine glands; and; e) harmonisation of breath and movement.

When performed with due sensibility and sensitivity, yogic meditation, breathing and stretching routines make for an invaluable adjunct to physical conditioning and internal purification regimens.

The benefits of traditional Yoga are well documented, however as an exercise modality it is limited in that it is incapable of promoting hypertrophy, effectively stimulating cardiopulmonary functioning, or burning fat. A further important consideration is that increasing RoM without strengthening and tonifying the muscles and ligaments responsible for stabilising the joints predisposes to sprains, strains and dislocation. Modern Yoga practices are largely based on Hatha yoga, but in recent times a range of more intense and physically challenging Yoga styles such as Ashtanga, Bikram and Yogalates have evolved ¾ these variants seek to provide a more comprehensive workout and physical development system.

Tai Chi Ch’uan

T’ai Chi Ch’uan (TCC) has been slowly gaining popularity amongst Western physical therapists, health / wellness practitioners and health-conscious individuals as a low-intensity mode of exercise therapy.

TCC has a documented history of some three centuries (although according to folklore it is considerably older), and its origins are partially attributable to a variety of military conditioning exercises that emulate animal movements. Until recent times TCC was primarily a martial art, however over the course of the last few decades, the form has been adapted as a therapeutic modality by modifying the movement patterns, tempo, performance intensity, and duration.

Currently there are a handful of major TCC styles (or schools), each of which may be further subdivided into an array of movement sequences (katas), but what they all have in common are their martial art origins. Consequently, the movement bias is frontal and guarded (protecting the head and lower abdomen), whilst the legwork emphasises kicks, military stance, and combat oriented stepping patterns. As such, the movements and kinematics / kinetics have limited relevance to activities of daily living (ADLs), and furthermore are not particularly suited for functional movement retraining for people with disabilities.

T’ai Chi translates from the Chinese as the “supreme ultimate”. As a form of dynamic meditation it has no equal, whilst in both the external arena of the martial arts as well as the internal realm of the healing arts it is superlative. However, TCC is far from comprehensive¾irrespective of whether it is considered from the perspectives of therapy, spiritual development or martial arts¾and in that respect fails to adequately address certain important aspects of training for health, strength, fitness, agility, and acuity. Accordingly, TCC requires adaptation and/or augmentation with supplementary exercises.

It is reassuring to observe that the directions in which TCC have been channelled over recent decades is being questioned. In the West, the new abbreviated kata forms have turned a powerful therapeutic-cum-transformational tool into a pleasant recreational activity with limited application or relevance to the biomechanics of daily living. The original TCC “ultimate fist” katas have been reduced to insubstantial “flower-fist” forms that may be best described as low-intensity callisthenics or dance forms that ultimately are more soporific than therapeutic.

Meanwhile, on the other side of the great cultural divide, TCC has devolved into a competition event in which strict adherence to choreographed form is sacrosanct. What’s more (in actuality, less), the doctrine of materialism that underpins both communist Chinese and Western medical science has been instrumental in removing life force, Qi, élan vital, prana, etc. from the biosciences. In other words, the concept of spirit has been dismissed as an irrelevant and inconvenient myth.

A further consideration is that TCC is a complex movement form requiring many hours of concentrated instruction and practice for the practitioner to master, even at a basic level. Whilst the research literature attests to TCC’s effectiveness in dealing with a number of health issues, it fails to mention the steep learning curve associated with it. Part of the challenge with TCC is that the health gains attributed to it depend on the individual correctly performing the movement sequence — that is to say, s/he needs to not only be familiar with the choreography, but also to be comfortable in performing it, failing which the movements are executed in robotic, unnatural, and rigid form. In order to realise the benefits of TCC, the practitioner needs to be deeply relaxed, fluid, focused, in balance, and natural.

Where these considerations¾viz. the length of time, self-discipline, and consistency of practice that are required to achieve technical mastery¾assume particular importance is in the area of program adherence. Many neophytes become discouraged by the rigor associated with learning TCC, and generally discontinue the practice feeling inadequate and confused, or dismiss TCC with a “been there, done that, got the T-shirt” attitude.

There are TCC practitioners (and self-declared masters) who will doubtless take umbrage at my remarks and audacity in daring to alter something they may regard as ancient, established and sacrosanct. My response to such is that the world we live in, our lifestyles, and medical science have all changed dramatically over the millennium since the legendary Chang San Feng first formulated TCC, and that TCC needs to adapt accordingly in order to maintain its relevance to modern times.

Comparative Summary of TCC and Western Physical Conditioning Sciences

TCC differs from Western physical conditioning sciences in a number of important respects as per:

  • TCC’s focus is more on wholistic, over-all tonification. In musculoskeletal terms, the benefits include tension relief; development of muscular endurance (particularly of the lower limbs); promoting elasticity of tendons and ligaments; and increasing RoM of the joints.
  • Gym style programs usually target specific muscles, muscle groups, and joints. In addition, there tends to be greater emphasis on muscular hypertrophy, cardiovascular conditioning, and upper body development than in the Oriental routines.
  • TCC schools essentially prescribe identical, group oriented, generic routines for all students, and as such their approach may be described as “one size fits all”.
  • The gym facility, in contradistinction, lays more emphasis on personally tailored “solo” routines. The constituent exercises are generally individually prescribed on the basis of a client’s needs and preferences. Programs—in the case of the more responsible fitness organisations at least—are presaged by fairly comprehensive fitness, strength and agility evaluation tests in conjunction with a medical, lifestyle, and activity questionnaire.
  • TCC routines are generally performed in unvarying sequence (referred to as a kata), and at a uniform pace and intensity. Whilst the martial katas may employ a more dynamic cadence and extended RoM than the internally-focused, slow, therapy-oriented katas, the underlying training principles are essentially the same.
  • Gym-based workouts utilise programmed variability in exercise pace, intensity, frequency, and prescribed routines (periodisation and progression) to maximise physical fitness gains and rehabilitation outcomes. Variability has been clinically demonstrated to expedite the learning and retention of new motor skills — as such, it is an important feature of neuromotor re-training strategies.
  • Work conditioning is an aspect of Western ergonomic-training routines, wherein exercises are prescribed specifically to prevent or minimise work-related injuries arising from overuse, overload, and contraindicated or deleterious biomechanical practices.

Towards an Integrative Grand Unified Therapy (GUT)

Chronic and aging-related diseases / disabilities are pandemic and on the increase, and their attendant socioeconomic sequelae are crippling both the individual and society at large. It is widely acknowledged that the stresses and demands of modern lifestyles play a central role in the evolution of these complex and debilitating (or even deadly) health issues. Mindful of such, the medical profession and the media exhort people to reduce their stress levels, improve their diets and lead more active lifestyles. Unfortunately, merely proffering advice, regardless of how well informed it may be, has made little difference in alleviating the situation; likewise, interventions to contain or reverse this trend have been largely unsuccessful.

Addressing this scenario requires a very different approach to management and prevention ¾ one that goes beyond the provision of therapy. Such an approach would of necessity involve educating, training and motivating people to effectively change their health behaviour, thereby empowering them towards proactive self-management. Anything less than this shifts the locus of control for health back to the government and the health authorities, and this status quo has proved to be an untenable situation. Ultimately, the individual is (or needs to be) mindful of and largely responsible for the management of his/her own health.

An action plan to successfully deal with chronic health issues entails a program that incorporates modules for physical fitness and conditioning, mindfulness, stress reduction / management, health awareness, home and workplace ergonomics, and nutrition.

The focus of the following section of this paper is a discussion about the proposed exercise component of an effective chronic disease management / prevention (CDM) program. As previously mentioned herein, it is universally acknowledged that physical exercise plays a vital role in managing and preventing many chronic health issues, and that every exercise system has therapeutic merit as well as limitations.

As it stands, the range of exercise routines utilised in Western clinics and fitness centres for physical conditioning is somewhat limited, being largely biased towards traditional gym-style exercises for rehabilitation, viz., hypertrophy, stretching, and aerobic routines. These are eminently useful for addressing musculoskeletal disability, particularly at a sub-acute stage, however their utility is limited in regard to resolving chronic and/or complex conditions.

Accordingly, there is a need for a more comprehensive and forward-looking approach to exercise prescription. The challenge is to devise an exercise regimen that ideally satisfies a number of criteria, viz.: relieves symptoms; addresses underlying impairments; inhibits regression and recurrence; prevents initial onset; restores functionality (physical and cognitive); requires minimal supervision and resources; and is safe in regard to injury potential. A further consideration is that modern lifestyles leave people with little time or energy for fitness activities, hence routines need to be sparing, efficient and relevant to ADLs.

Finally, and very importantly, regardless of how good any program or modality may be, its effectiveness will be compromised by a lack of participant compliance. This issue of program concordance is a major stumbling block for many therapeutic regimens¾to be effective, a program needs to be personally engaging, appropriately challenging, safe, rewarding and fun, failing which, motivation flags and the health goals are not attained.

With all these considerations in mind, I have spent forty-five years investigating and trialing numerous rehabilitation, disease prevention and fitness-conditioning methods, both Eastern and Western, mainstream and alternative. Drawing on these, I have developed an innovative and eclectic exercise modality, Kinergetix Movement Therapies (KMT). I have extensively employed KMT in clinic over a seventeen-year period, during which time KMT has been productive of significant and enduring outcomes in the management of a broad range of chronic issues.

Kinergetix Movement Therapy (KMT)

KMT embodies a wholistic approach to therapy, integrating clinically validated exercises compounded from Western exercise, human movement and fitness conditioning sciences with Eastern mind-body therapies and martial arts.

However, KMT is not merely a patchwork of discrete routines garnered from these various sources — rather, it has evolved from the consideration, analysis and deconstruction of the associated approaches together with their constituent elements from the perspectives of biomechanics, bioenergetics, ergonomics, life-style considerations, and user-friendliness. On the basis of these, routines have been evolved that are pertinent to modern lifestyles and compatible with the individual’s ADLs, recreational pursuits, and vocational demands.

KMT workouts are generally performed at low to moderate intensity, synchronously with breathing exercises. The sessions are supplemented with compact, high-intensity training (HIT) routines adapted from military style, body-weight resistance drills and aerobic conditioning exercises. Breathing routines are essentially based on diaphragmatic breathing techniques; however this component extends beyond traditional physiotherapeutic “deep breathing” exercises, and incorporates advanced mind-body-breath training. Notably, routines may be performed at home or work, and require neither training aids nor specialised equipment.

In addition to prescribed solo exercises, interactive partnership routines are utilised. These have their origin in Oriental Tuishou training drills that I have modified to incorporate passive- and active-assist / resist techniques, and which are based (in part) on proprioceptive neuromuscular facilitation (PNF) principles. These partnership routines are performed as a direct contact sport, and/or with the aid of cords, inflatable balls, staves, surgical tubing, and body weight. The social interaction afforded by these one-on-one routines has proved to be highly conducive to program participation and adherence. Moreover, group sessions encourage mutual co-operation as well as friendly competition.

Simply stated — because sessions are fun, challenging but safe, and personally gratifying, KMT participants are motivated to put in the time and effort.

KMT Objectives and Benefits

KMT programs are comprised of exercise routines designed to:

  • Create a solid foundation for physical activity by building lower-body strength, endurance and sure-footedness
  • Improve functional capacity and motor skills performance
  • Develop lumbopelvic core stability, a supple waist and firm back
  • Improve upper body mobility, shoulder-girdle stability, and scapulo-humeral rhythm
  • Enhance balance, flexibility, agility and coordination
  • Stimulate circulation—systemic, peripheral, lymphatic, synovial, and cerebrospinal
  • Correct postural deficits and pathologic or dysfunctional movement patterns
  • Increase vitality, boost libido and optimise metabolic processes
  • Heighten proprioceptive and equilibrioceptive awareness
  • Promote healthful homeostasis, self-healing and the regenerative processes
  • Boost resilience and immune system functioning
  • Reduce stress and increase wellbeing
  • Cultivate mindfulness and acuity by developing the cognitive and sensory faculties; promoting clarity of mind; enhancing sensitivity and receptivity; and improving the ability to focus the attention and sustain concentration.

Whilst including physical conditioning, rehabilitation, and disease/disability prevention strategies, KMT is in essence concerned with assisting clients with improving their quality-of-life, longevity prospects, health status, and independent living cum self-management skills.

Methods

KMT programs consist of weekly 90-minute group sessions staged over 4 or 12 weeks (depending on program). Each session comprises a 60-minute workout supplemented with a 30-minute presentation and discussion on relevant health topics including nutrition and diet; ergonomics (home and workplace); lifestyle issues; relationships; medication; herbal supplements; and risk-factor identification / reduction. Participants are encouraged to perform the exercises at home for a minimum of 30 minutes, 3 times a week

KMT trials were staged over a twelve-year period with a total of 470 participants aged 18-86 years, median age 52. Program participation was prefaced by, and concluded with an interview, assessment of fitness and physical functionality, medical history review, and pathology reports. These factors along with client self-reports were used to evaluate outcomes.

Results

KMT was productive of significant and enduring outcomes in the management of a broad range of chronic issues. These included arthritis, back/neck pain, balance, cardiovascular disease, chronic fatigue, diabetes, breast cancer, hypertension, osteoporosis, thyroiditis, respiratory disorders, autoimmune and neurodegenerative pathologies, and psychological issues such as anxiety, depression and self-efficacy. All participants reported and displayed improvements in mobility, ambulation and functional performance. No adverse events were reported.

Of particular note, program adherence was exceptional with a remarkably low attrition rate, and furthermore the greater majority of participants were regular and consistent in their practice. Client satisfaction with KMT was such that 85% of participants re-enrolled in advanced courses and were regular attendees for two or more years.

Conclusion

KMT has demonstrated that it has substantial potential for delivering significant health benefits to the broad demographic at risk of, or afflicted with chronic health issues. Further considerations of cost-effectiveness of group sessions, outstanding compliance and program adherence of participants, safety of implementation, ease of learning, minimal requirement for specialised facilities or ancillary aids, and ease of scalability signify the importance of wider implementation and dissemination.

A brief note about the author

David Labuschagne has established companies in Europe (Ene d.o.o.) and Australia (Kinaesthetics P/L and Kinergetix P/L) specialising in programs for the management and prevention of chronic & aging-related health issues, physical rehabilitation, fitness promotion, cognitive enhancement, and ergonomic training.

David is a Medicare-accredited Exercise Physiologist who holds a Master’s degree in clinical rehabilitation. In addition to his work as a therapist, he has worked in the sphere of medical journalism and has conducted research in exercise physiology, biomechanics, bioenergetics, and ergonomics on behalf of tertiary and corporate institutions. His background includes active and extensive involvement in the modalities of Complementary and Alternative medicine (CAM) over four decades, including some forty years as a teacher of Tai Chi / Qigong, and has studied with numerous masters of these arts in Australia, the USA and Europe.

Acknowledgements

I am indebted to those numerous TCC masters who have patiently instructed me in the intricacies of form and function, but most especially to Simon Lim, who has served as my esteemed mentor, guide and teacher over the years, and from whom I learned the sublime art of internal alchemy and transcending form. In addition, I am grateful to Prof. Steve Selig for his encouragement, supervision, support, and for the invaluable research opportunities he has provided in the realm of Exercise Physiology.

David Labuschagne MAppSc (Exercise Physiology)

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The range of exercises prescribed by physical therapists are basically limited to traditional gym-style exercises for rehabilitation.