EAST & WEST: AN INTEGRATIVE APPROACH TO EXERCISE THERAPIES

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Eastern_exercise_theraapy

INTRODUCTION

The range of interventional modalities presented within exercise physiology courses are limited and largely biased towards traditional gym-style exercises for rehabilitation, viz., hypertrophy, stretching, aerobic, and aquatic routines. Whilst these approaches are appropriate for addressing musculoskeletal disability, particularly at a sub-acute stage, their utility is limited for effectively managing, resolving or preventing chronic and/or complex conditions. Treatments aimed at alleviating symptoms are merely the first step in the therapeutic process¾effective resolution of morbidity and disability needs to include interventions for improving mobility, gait strategies, functional performance, cognition, and stress reduction.  

LIFESTYLE and HEALTH

Disease and disability that are not directly attributable to physical mishap, toxic exposure, infection or genetic issues (inherited or otherwise acquired), frequently have their origins in lifestyle factors. Even where these factors are not the primary causal agents in a pathologic condition, they are usually implicated in its aetiology. The partial ramification of such is that achieving meaningful gains in health, wellness, and functionality is contingent upon modification of inappropriate or contraindicated factors and health behaviour. Explicitly, long-lasting change in health status is inextricably linked with changes in attitude, self-perception, behaviour, and habits.

The foregoing statement should not be construed as implying that overarching changes in lifestyle are essential (or desirable) for the restoration and maintenance of health. Indeed, advocating such measures would probably be counterproductive, engendering considerable resentment and resistance from the client. Accordingly, rather than immediately introducing new elements into the client’s daily agenda, my approach is to initially work within the limitations of their daily routines. In that respect, I view the ‘manner’ in which activities of daily living (ADLs) as well as job-related and leisure-time activities are performed, to be equally, if not more pertinent than the ‘matter’ or nature of the involved activities.

MOTOR LEARNING

This consideration of the qualitative aspects of human movement forms the basis of my clinical sessions in both functional assessment and program design. In a very real sense, the rehabilitation process is (or should be) educative, such that it informs clients firsthand about their own physical, biomechanical, and physiologic functioning and limitations. I regard such measures as integral to promoting mindfulness and kinaesthetic / kinesiological awareness in all aspects of ADLs, whether work or play.

On a neurological level, learning new movement patterns and unlearning (or dehabituating) pathomechanical practices may be facilitated by neuromuscular re-programming techniques. In the words of Janet Travell MD (progenitor of Trigger Point Therapy), “… when injured, most tissues heal, but skeletal muscles learn.” It is with these considerations in mind that I have aimed to create programs that utilise (and expand upon) ADLs and prescribed work activities.

BIOENERGETICS

In essence, 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 prevention strategies are primarily concerned with fostering the generation, circulation/distribution (via mapped pathways or meridians), and storage of qi / prana.

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 electro-physiological terms have been unsuccessful. Despite the lack of an immediate correlate in Western biomedicine, some Traditional Chinese Medicine (TCM) practices which are immediately concerned with bioenergetics, viz. acupuncture, have acquired a de facto legitimacy, and been incorporated into the standard clinical armamentum. Research efforts to identify and describe the neurophysiological pathways or mechanisms associated with acupuncture points and meridians have been largely unsuccessful, accordingly further research into bioenergetic mechanisms, factors, and pathways is warranted.

The absence of proof that validates the theory or proves the existence of life force is unimportant. 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.

KINERGETIX MOVEMENT THERAPY (KMT)

I have created proprietary exercise routines that incorporate and build upon the principles and practices of various movement therapies, both Eastern and Western, conservative and alternative. Included in such are taiji, qigong, yoga, Pilates, aerobics, resistance training, Laban Movement Analysis, Rolfing Movement Integration, Neurokinetics (Aston Patterning), Mentastics (Trager Psychophysical Integration Bodywork), Guided Affective Imagery, and callisthenics. The integration of these conditioning strategies constitutes the foundation of an eclectic modality, Kinergetix Movement Therapies (KMT), which I have used extensively in clinic over the course of the last twelve years.

Whilst movement therapies are a central feature of the KMT modality, these have been integrated with best-practice rehabilitation exercises, awareness training, ergonomics, and dietary counselling in the formulation of treatment regimens.

KMT programs are focussed on the promotion of lower-body strength and endurance; enhancing balance, flexibility, and agility; stimulating circulation (systemic, peripheral, lymphatic, synovial and cerebrospinal); correcting postural deficits and pathologic or dysfunctional movement patterns; developing coordination; increasing personal energy levels; and, heightening kinaesthetic awareness / acuity. The routines are generally performed at low to moderate intensity, synchronously with breathing exercises. KMT programs are supplemented with resistance training, aerobic conditioning exercises, warm-up / cool-down routines, and prescribed stretches. In many respects, the KMT method is in a constant state of flux and evolution.

All exercises are suitable for home and workplace practice, and are performed without training aids or specialised equipment. In addition, interactive routines are utilised in one-on-one as well as group sessions. These partnership exercises have their origin in Oriental pushing handstraining drills, but have been modified to incorporate passive- and active-assist / resist techniques, which are based (in part) on proprioceptive neuromuscular facilitation (PNF) principles. The partnership routines are performed either as a gentle, direct contact sport, or as routines involving cords, inflatable balls, staves, elastic 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 clients have been motivated to put in the necessary time and effort to obtain significant and enduring gains in their health status.

Breathing routines are integral to KMT sessions, and are essentially based on diaphragmatic breathing techniques. However, this component extends beyond traditional physiotherapeutic “deep breathing” exercises, and incorporates advanced mind-body-breath training.

Conjoint with the aforementioned movement therapies, compact aerobic and strengthening exercises are prescribed for home use—this component is based on adaptations of military conditioning routines. In brief, these are graded  “11 minutes a day” fitness programs that utilise sets of compound body-weight exercises for large muscle groups, and which are supplemented with a 15-minute brisk walk or jog.

Some of the constituent elements of the KMT modality may seem to be somewhat esoteric (and hence culturally inappropriate or foreign to rehabilitation clients and practitioners), however considerable work has been done by the author to ensure that the principles and practices are readily understood and easily assimilable by the general populace. The use of foreign names or concepts is studiously avoided during training sessions. In part, the challenge has been in translating Oriental esoterica into contemporary Occidental vernacular. Bridging this cultural divide is more than simply a matter of creating a therapeutic mélange based on an ad hoc assemblage of disparate elements (usually presented under the banner of wholistic, alternate, and/or complementary medicine).

Preliminary trials and pilot studies (albeit, uncontrolled) have produced promising clinical data suggestive of KMT’s particular relevance to the management and prevention of chronic, complex, and age-related health conditions. These include arthritis, back/neck pain, diabetes, balance issues, hypertension, cardiovascular disease, respiratory and autoimmune disorders, chronic fatigue, osteoporosis, and repetitive-stress injuries.

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