07.2010 : The Feldenkrais Method
07.2010 : New Movement: Alternative Therapy and Breast Cancer
02.2009 : Get in Touch with Your Core
10.2005 : The Road Back: Reclaiming the Body After Breast Cancer
07.2005 : OH NO, it's Carpal Tunnel Syndrome! OR IS IT?

The Feldenkrais Method

Chicago Collection - Summer 2010
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All new parents are excited to watch their babies move through the typical, much-anticipated milestones: rolling over, sitting up, crawling, walking. And it’s no coincidence that a child’s early life is marked by these physical changes. “Developmental patterns are based on physical advances,” says Kathleen aharoni, owner of WATER OVER STONE (3309 N. Clark St., 773.755.1347). It’s a pattern that persists: As a dancer, Aharoni consistently observed how movement related to emotional response, and as a kid, her self-esteem had always been rooted in physical activity.

This body-mind connection plays center stage in the Feldenkrais Method®, a bodily education system developed by Dr. Moshe Feldenkrais that uses movement to enhance human function. “It facilitates awareness of the body and how to really be in our body–and therefore our lives–at the present moment,” says Stephanie Davies, who uses the method at her studio, SD REHAB (1962 N. Bissell St., 773.477.7599,

Indeed, awareness is perhaps the most important component and goal of the Feldenkrais Method. Aharoni described is thusly: “Imagine that what you know about yourself as a person is a circle, divided into quarters. As we move through life, we have only those quarters to draw upon; we only know ourselves in those ways. That’s why we have habits. But through Feldenkrais, those quarters start dividing and dividing until they are microslices. We learn all the shapes and nuances of what we’re actually capable of. It helps us to become bigger and better choosers and creators in our lives.”

Feldenkrais can be used to rehabilitate injuries, alleviate chronic pain or simply help individuals reach their fullest potential. It’s popular with athletes and musicians looking to refine their stride or improve dexterity and coordination. “I worked with a musician who experienced a complete reorganization involving her tongue, mouth, throat and fingers,” Aharoni says. “[Afterwards], the sound that came out of her instrument was amazing.”

How exactly does Feldenkrais accomplish these minor miracles? The discipline employs two distinct methods. During “Awareness Through Movement,” an instructor verbally leads students through a sequence of movements (many of which are based on everyday motions, like reaching or sitting down). “Functional Integration,” on the other hand, finds the instructor guiding an individual’s movement through touch. In either case, the goal is to facilitate awareness of the body and the relationships between muscles, joins and posture–as well as to recognize and break habitual movements in an effort to improve flexibility and coordination.

“I might have a student lie down on the floor, and I’ll ask him or her to cross one leg over the other and tilt them to the right,” Aharoni says. “Then I’ll ask how much of your body you can feel participating in that movement. At first, it might just be the legs and the hips. But by the end of the lesson, you’ll feel how multiple parts of you–the spine, the ribcage, the head–are working together in that movement.”

As much as Feldenkrais focuses on how the body connects, it’s really about how we connect with ourselves. Aharoni says, “It helps you feel all of you as you. It helps people break any patterns that aren’t serving them, and it gives them the tools to help themselves.”

New Movement: Alternative Therapy and Breast Cancer

Chicago Collection - Summer 2010
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Irene Hays is a survivor. After being diagnosed with breast cancer 10 years ago, at the age of 48, Hayes opted for a fairly traditional treatment plan: a mastectomy (along with reconstruction) followed by chemotherapy and radiation. The program was successful, and today, Hayes is considered cured.

Of course, the real story of a survivor is not so simple.

According to the American Cancer society, the five-year survival rate for all women diagnosed with breast cancer is 89 percent (meaning that 89 out of 100 patients will survive for at least five years; most will never experience a recurrence). If cancer is detected before it has spread, that rate jumps to 98 percent. In ways the medical field has become fairly adept at conquering breast cancer.

Still, when Hayes embarked on her treatment and rehabilitation, “I had goals other than just getting rid of cancer,” she says. “I wanted to optimize my own health.”

Breast cancer treatment comes with a variety of risks and consequences, the most serious being lymphedema, a swelling of the limbs frequently related to the removal of lymph nodes (a common component of treatment). Preventing this potentially serious complication is important, and back when Hayes was diagnosed, patients were told to never lift more than five pounds with the arm on the side affected by their surgeries; tennis buffs often had to give up the game.

Additionally, such surgical procedures have long-lasting effects on patients’ movement and flexibility. During breast reconstruction, for example, doctors often remove muscle from the upper back or stomach, creating an imbalance that can cause tension and pain in the chest, limbs, spine and more. Scarring also changes how a body can stretch and move.

It is these secondary effects that frustrate patients even once they have been proclaimed cured. Fortunately for Hayes, she met Stephanie Davies, an occupational therapist and owner of SD REHAB (1962 N. Bissell St., 773.477.7599, Using a combination of Feldenkrais Method®, Pilates (particularly STOTT®) and GYROTONIC® (a kind of moving yoga), Davies helps patients regain movement in their chest and arms and, perhaps most importantly, “helps them reconnect with a part of their body that they have been protecting, one that has been scarred,” she says.

“I became so much more aware of my own body. I noticed how I was overcompensating for my asymmetry,” says Hayes, who had muscle removed from her abdomen for a type of reconstruction called TRAM flap. “My work with Stephanie helped prevent lymphedema, but it also made me stronger and gave me better posture. It encouraged me to look at my contribution to life in general, and being healthy is a huge part of that. I’m back down to the weight I was at in my 20s. Becoming more confident physically helped my emotional state. I feel healthier now that I did before my diagnosis.”

Susie Rodriguez, another of Davies’ clients, was diagnosed with breast cancer two years ago. She initially turned to Davies for help in restoring normal range of motion in her right arm. “She also helped me work with my core. It’s not just about my arm moving; it’s about engaging all of my muscles and about being aware of what I’m doing myself to affect my healing,” she says.

Rodriguez’s healing also became about more that her physical condition. “You wouldn’t think that losing this little part of your body would hurt so much, but it does,” she says. “I had that moment of asking ‘is anyone ever going to love me?’ [My work with Davies] is about learning to accept myself now and saying, “I’m alive.”

Get in Touch with Your Core

Organic Beauty Magazine - February 2009

According to Stephanie Davies, founder of SD Rehab in Chicago (, good posture should be effortless. "Our body is meant to stack the bones of the spine," says Davies, who recommends learning the body's "sensory cues" to find proper alignment. "Once you find your relationship to gravity, it becomes easier to carry to head over the bowl of the pelvis because you've learned to feel yourself in space."

Image of instructor laying on a roller

Develop Your Sensory Cues

Standing: Stand flat against a wall (or lie on your back). Don't plaster yourself, just notice which body parts resist. Not only are they telling you where you are out of balance but daily practice with this exercise will help you properly use the forces of gravity to stand tall.

Sitting: Here's one that can be done at your desk. Bite down on the middle knuckle of your index finger. Create opposition by pulling the finger forward while pulling back on your upper cervical and skull. That's what proper alignment should feel like, both elongated up and grounded.

Straighten Out Your Act

Swopper: Swap out your desk chair with one of these. The seat is a dynamic surface, moving from front to back and side to side. This allows your core muscles to be in the constant balance-reaction mode, allowing you to find, engage and adjust your center with each movement.

Elastic Resistance Bands: For proper back alignment, Davies recommends "funneling," which develops core muscles and spinal alignment. Wrap the band around your ribcage, palms up and elbows bent and out. Exhale as you pull and tighten the band. Hold and notice how the action elongates and centers your spine like an "internal corset."

Other Techniques

Bar Method: The newest in core-strengthening and stretching techniques, this method takes its name from the ballet barre, which is used as a balancing prop, and combines yoga, Pilates, and ballet. each core muscle is targeted and worked with "until they tremble," according to founder Burr Leonard. For the advaned and the intrepid. Class locations:

The Road Back: Reclaiming the Body After Breast Cancer.

Chicago Health Magazine - October 2005
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One in seven women will be diagnosed with breast cancer in 2005. All will struggle with the decisions and questions surrounding the diagnosis as they adapt their lives to the demands of treating this growing problem. Most will undergo surgery followed by chemotherapy and/or radiation treatment, some will choose reconstruction.

However, recent medical advancements have allowed for increasing survival rates. Women of all ages are living fulfilling lives long after their diagnosis, whether that occurs at age 29, 55 or 70. Providing education and resources for these women to maximize their quality of life is now a priority.

Using a small sample as an example, this focus here is on a weekly pilates class that meets at a north side health studio. As per the usual regimen, the instructor leads seven women through a spinal rotation stretch. As they breathe into the stretch, the tension around their necks and shoulders melt away, their chests expand and their backs become more flexible. Each savors the freedom they gain and await the rest of the stretching and strengthening exercises the hour class offers.

What is so interesting about this scenario? Two of the women are breast cancer survivors. Eileen, 53, and Laurie, 29, have unique stories, yet are joined together on a recovery path while participating in this exercise class.

After class, the two women meet Amy for the first time. Amy is 30 and just finished a private session to regain lost mobility and help prepare her for eventual participation in a group pilates class. The women reassure Amy how important it is for her to re-acquaint herself with her body, as this will ensure safe exercise in the future. Regaining flexibility, strength and vitality while increasing individual body awareness is essential after treatment for breast cancer.

Long road back
After treatment, many women have some trouble resuming normal activity levels. Immediately following breast surgery, one should minimize the stress on healing surgical incisions and drains.

In addition to this, physicians often recommend that a woman limit her physical activity dramatically to avoid the development of secondary problems associated with the strain on the body that's caused by exercise and acute exertion. This strain may be a contributing factor in the build up of excessive fluid in the arms, hands and chest, a condition known as lymphedema (see below).

Compounded problems

Unfortunately, these limits can have a trickle-down effect on the entire body. Resulting fears and ongoing diminished activity lead to decreased strength and flexibility and lower a woman's overall endurance and postural changes.

The risks for developing lymphedema under these circumstances may even increase. At a time when life-threatening disease encourages overall lifestyle changes, balanced exercise-including guided upper body strengthening-should be encouraged.

According to Susan M. Love, MD, a respected breast cancer specialist, "It is critical for women to start moving right away after treatment and that they continue moving if they are to maintain their mobility."

Laurie endured a procedure that involved large lumpectomy with lymph node removal, plus chemotherapy and radiation. As a result, she had lost significant strength and flexibility in her chest and shoulder, limiting her movement. The resulting surgical scars, along with changes in the lymphatic system alone made it imperative that Laurie should pursue an individualized rehabilitation program-and she did.

"I proactively explored every aspect that this treatment would have on my body," Laurie says. "Yet despite all of my research, I felt completely incapable of going through exercises alone. I needed the guidance and reassurance that my occupational therapist was able to give me."

Professionals required

A professional with experience working with breast cancer patients should guide the exercise regimen. Such individuals include occupational or physical therapists. The professional can help to identify the specific concerns associated with individual treatment and reconstruction.

All the aforementioned women had lymph nodes removed during their surgeries, leaving them at risk for lymphedema if stress or injury were to occur during exercise. However, different surgical procedures and individualized reconstruction will form different scar tissue and varied muscle imbalances. These variations require attention.

After her large Lumpectomy, Amy chose to have a second surgery to reconstruct the altered breast. In consultation with her doctor, she decided that the best option for her was a Latissimus Dorsi muscle flap. A plastic surgeon tunneled a muscle from Amy's upper back to the chest to fill in the missing breast tissue (see figure 2A). The "cost" of the reconstruction was that Amy was left with an asymmetrical amount of strength and structural support in her upper back and shoulders.

Tension is multiplied

Even without this type of surgery, a person's tendency is to carry tension around the necks and shoulders. Amy is vulnerable to having her shoulder and neck pulled into painful postures if she does not properly learn how to use the remaining back muscles to oppose the pull (see figure 2B).

Bc Fig1

Amy is in the process of learning how to rebalance the strength that she lost in her back in addition to the stretches to reduce scar tissue and the shoulder flexibility exercises that helped Laurie. As she endures chemotherapy and radiation treatments, she is creating new body awareness and muscle tone, preventing her shoulders from becoming uneven and her spine from curving (figure 2B). Like Laurie, she will require patience and discipline to move forward to a point of independence and confidence.

As Amy stated just weeks after her surgery and in the midst of her chemotherapy treatments, "my exercises give me a sense that I have some control over my body again. I am able to learn what I can do to affect my body while the chemo drugs are fighting the disease."

Eileen is now a five-year survivor. Five years ago, she underwent surgery for a left mastectomy and lymph node removal with concurrent TRAM flap reconstruction. A portion of Eileen's stomach muscle (rectus abdominus) was tunneled through her chest to form a very realistic new breast (see figure 1, inset).

The resulting stomach-to-back strength imbalance and protective rounded shoulder position she developed immediately after surgery is very different than the asymmetrical muscle imbalance Amy experienced (see Figure 1 A and B). In addition to losing the range of motion in her left shoulder, Eileen had significant amounts of scar tissue throughout her abdomen and chest, and a nagging sense of lower back and hip pain.

Bc Fig2

Eileen was thus taught how to retrain the remaining abdominal muscles so that she felt less strain in her hip and back. She learned breathing and flexibility stretches to break up the scar tissue while regaining full use of her left shoulder. While monitoring for any signs of lymphedema, she slowly built back the strength in her left arm. She can now carry items of moderate weight without overexerting herself and causing stress.

"I have a family history of osteoporosis so staying active was very important to me. But I was also very concerned about getting Lymphedema," Eileen says. "I knew I needed to find a balance of strengthening and aerobic activity that would allow me to regain and even improve my level of fitness from before my diagnosis. Pilates and Gryotonic were key to safely achieve strength and flexibility."

After five years of implementing both exercises, Eileen has avoided Lymphedema and created a vital supportive posture on which to build her lifestyle. Though this process has been long, requiring discipline and patience, Eileen is confident with most activities. Whether that is during her biweekly pilates class, kayaking on the lagoon, or when participating in the Avon two-day breast cancer walk, she knows her body and she knows its limits and skills.

Injury risk minimized

As all of these women move forward with their lives, they carry with them a new understanding of their bodies, its circulatory system, breathing capacity, skeletal foundation and muscle strength. This knowledge not only builds their confidence and sense of vitality, it minimizes the risk for wear and tear.

Professionals should be vigilant so that treatment can be administered early if lymphedema occurs. A sense of body awareness can increase the likelihood that the symptoms are recognized early and addressed.

Two months after their first meeting, the women see each other at the studio again. Amy recognizes Laurie's face as she enters her first morning pilates class. As the women exchange greetings and Laurie provides encouragement, Eileen catches their attention with a wave. She explains that she has advanced to the next level pilates class and won't be taking class with Amy and Laurie. Though their experiences are similar, these women are still advancing down their individualized recovery pathways.

Stephanie Davies is a licensed and certified occupational therapist, pilates instructor and Gyrotonic teacher specializing in breast cancer recovery regimens.

Lymphedema not curable but manageable
Lymphedema is swelling of an arm or leg due to the accumulation of fluid. It is most frequently related to damage of the lymphatics and removal of lymph nodes necessary during cancer treatment. The fluid is naturally occurring in the body but the mechanism for circulating the fluid has been compromised and often leads to residual fluid retention in a limb. It is not a form of cancer or reoccurrence of cancer. Though there is no cure for lymphedema, there is effective treatment and management. Most importantly, women need to understand the risks, the prevention strategies and the initial symptoms. If swelling is noted, it is very important to be evaluated and treated by a knowledgeable medical professional familiar with lymphedema.

OH NO, it's Carpal Tunnel Syndrome! OR IS IT?

Chicago Health Magazine - July 2005
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Many people wonder if the nagging pain that occurs in the wrist or fingers is the first symptom of Carpal Tunnel Syndrome (CTS). It may not always be this syndrome, but one thing is clear: The more that's understood about CTS, the more it can be prevented and get properly treated when it does occur. The following are three examples of people who dealt with the issue of this repetitive stress injury:

• Pam is a 47-year-old medical transcriptionist who works all day at a computer. When she began to feel wrist pain, she thought it was the onset of CTS. She assumed it was an inevitable problem for someone in her position.

• Jeffrey is a 55-year-old storeowner who never dreamed that he would get CTS. Jeffrey hardly ever spent time at his computer anymore, so when the doctor told him he had CTS, he was shocked.

• Lilly G. is a 35-year-old dental hygienist just beginning a new job. She was working hard to keep up with the fast pace of her new employer, so she tried to ignore the tingling in her fingers. But when she started dropping her tools at work, she wondered, did she have CTS?.

Compressed Nerve

Carpal tunnel syndrome occurs when the median nerve is compressed as it travels through the "carpal tunnel," an actual location in the body. The grouping of small bones at the base of the palm, the carpal bones, form the bottom of this tunnel where the median nerve travels to supply nerve impulses to the hand. This is the area at the base of the palm, not the wrist as is commonly thought.

These nerve impulses provide sensation to the thumb, index and middle fingers in addition to strength for many of the small muscles of the hand. The ligament that bridges the top of the tunnel and encloses the median nerve is called the transverse carpal ligament. The median nerve is joined by nine tendons in the tunnel. These tendons flex our wrist and fingers--hence, the importance of avoiding repetitive movements that may eventually inflame the tendons.

When the pressures in the tunnel are normal, the median nerve keeps the hand strong and coordinated by carrying nerve impulse like a hose carries water. However, when trauma, inflammation or external pressures interfere, the flow of the nerve is blocked, similar to a kink in a hose, and sensation, coordination and dexterity are compromised. Over time, this starves the tissues of the hand, resulting in a loss of sensation, lack of coordinated fine movement and loss of grip strength.

Irreversible damage?

Symptoms usually begin gradually with a tingling, burning or prickling sensation in the palm, thumb, index and middle finger--the areas supplied by the median nerve. Frequently the onset of symptoms occurs during the night. As symptoms progress, the fingers become numb and the hand weakens. Fingers feel swollen though no external signs of swelling exist. The symptoms may now be present during the day. If left untreated, irreversible damage to the nerve results and may cause significant weakening of the muscles of the hand.

Effective treatment of CTS starts with proper diagnosis, as other comparatively minor problems can create similar symptoms. Pam, the aforementioned transcriptionist, was eventually diagnosed with severe tendonitis, not CTS. Years of typing had created a muscular imbalance in her forearms. This is what caused the strain and inflammation in the flexor tendons as they passed through the carpal tunnel.

Pam's pain resulted from chronic muscle fatigue and increasing inflammation. Her pain disappeared after she started a regular stretching and postural awareness program given to her by an occupational therapist (OT) referred by her doctor. However, if Pam had left this condition untreated, any increased pressure in the tunnel may have led to CTS.

In Jeffrey's case, the numbness in his hand was reason enough for the orthopedic surgeon to recommend nerve conduction studies that test nerve impulses as they travel. Jeffrey's study showed that the impulses were severely impaired as a result of damage to the nerve. It seems that his years of home improvements and tool use had placed external pressure on the nerve, causing the loss of sensation.

Don't ignore symptoms

Because Jeffrey was not working on computers, he ignored the symptoms--only seeking medical treatment when loss of function occurred. Surgical release was necessary to prevent further damage. The transverse carpal ligament that bridges the tunnel was cut to remove the pressure on the nerve. In Jeffrey's case, as in most cases, symptoms abated once post-operative healing occurred. If the source of the problem is not eliminated the symptoms may return. After proper healing time Jeffrey worked with an occupational therapist to regain his strength and learn how to prevent reoccurrence.

In Lilly's case, the dental hygienist wascomplicated further by genetics. Not only is carpal tunnel more prevalent in women overall, but X-rays revealed that Lilly had inherited a very small bone structure in herwrists. This made the carpal tunnel very narrow. Combined with the awkward hand positioning required to hold instruments, her median nerve became pinched in the tunnel.

Because Lilly's conduction test showed mild slowing, the surgeon recommended a conservative approach that included a course of anti-inflammatories and occupational therapy. Her particular regimen focused on stretching, instruction on changing her posture, plus altering other daily habits at work and at home that contributed to her problems. In addition, she was issued a wrist splint to wear at night to rest the nerve and tendons. Withina month, her symptoms were eliminated, enabling her to avoid surgery.

Conquering CTS

Surgery is not the only option to treat CTS, and should be pursued only in extreme cases. Small changes in the muscular imbalances and positioning can eliminate symptoms of carpal tunnel syndrome and may even prevent its occurrence. Take regular breaks during work and other activities. Maintain muscle balance by stretching the hands and wrists. Avoid applying sustained pressure on the carpal tunnel at the base of the palm.

People should also check to make sure their wrists are not flexed in an extreme flexed position. Posture can be a big factor in CTS, and many people have to make adjustments. Also, be sure to drink plenty of water and participate in an aerobic exercise routine to maintain good circulation. Lessening one's symptoms may simply be a change in one's habits... and for some, they might not be suffering from CTS after all.

Stephanie Davies is an occupational therapist at Rehabilitation and Alternative Fitness on the near-north side of Chicago.

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