The Trager Approach to Breaking the Pain Cycle

by Ilene Shunfenthal Watrous, MA, RPT and Susan March

Anyone who follows a holistic approach to life is well aware of the interrelationship between mind and body, yet surprisingly few people adhere to this psycho-physical principle when they seek treatment for muscle and joint injuries, or reduction of chronic pain.

Although these traditional methods may provide a patient with some welcome short-term relief, most do little to effect long-term, healthy movement of the entire body because treatment is typically confined to the injured area. Little instruction is imparted that empowers the patient to treat his or her own pain in the future -- in essence, to become one's on therapist.

With a manipulative perspective, some traditional therapies employ deep pressures and sharp movements as if they were necessary evils of successful treatment. Thus, pain becomes an integral part of the experience.

What these therapies fail to recognize is that the human mind houses the ability to actively participate in the healing process and that the process need not be painful. Quite simply, they fail to tap the power of the mind.

The healing properties of the mind are based in fact, and there is ample evidence to support the interplay between the nervous system (mind) and the muscles (body). The human mind and its muscles are engaged in constant sensory-motor feedback loops, and a change in the feelings of the nervous system can elicit change in the muscles.

Over 60 years ago, Milton Trager began to make use of this phenomenon and developed the Trager© Approach to physical rehabilitation. For Dr. Trager, "the attributes of the body and mind are holistically interrelated in the whole electro-mechanical force field that is living matter."

Through a series of gentle compression, lifting, swinging, flexing, rocking and range of motion movements, Dr. Trager gave birth to an alternative bodywork, useful for the treatment of any number of muscle and joint ailments that plague people, from chronic back pain to sports injuries to the problems associated with disorders such as multiple sclerosis and Parkinson's disease.

More than a massage therapy, the Trager Approach is, in its truest sense, a communication between the practitioner and the unconscious mind of the patient, where the "message" is freedom of movement, freedom from pain, re-integration of body parts and comfort within the body. Through Tragerwork, the body relearns to use its injured and dormant parts.

In Dr. Trager's own words, the communication between therapist and patient is transmitted "through the autonomic nervous system from the therapist's mind, through his hands, to the involved area. This feeling is picked up in the patient's mind because of the manner in which the tissues are worked, creating the feeling of relaxation...

"It is the manner in which I work, not necessarily the movements I do, that brings about the change. Every move, every pressure of my hands, every thought is directed toward bringing new feeling experience to the unconscious mind of how the affected areas should feel."

The movement performed during the session is a subtle and positive suggestion to the nervous system about what motion is possible. None of these movements are forced. With gentle rocking, the body is never put into positions which are stressful. And because active participation of the patient is discouraged, the passive body can freely lean which positions and movements are easily possible.

During a Trager session, there is no deep prodding or squeezing, as is found in some forms of bodywork and massage. In fact, one of the guiding principles of Tragerwork is to avoid inflicting any sort of pain. Trager practitioners "back off" if they encounter tightness or resistance in body parts or muscles. There is no attempt to "work through" a tight area. Lightness and freedom are the operative words in a practitioner's daily vocabulary.

For the patient, the session is an extremely pleasant experience -- the non-threatening rocking motion is hypnotic and relaxing. Variations of movements reduce any anticipation of actions and encourage a passive experience.

Another unusual aspect of the Trager Approach is the attitude of the participants. Dr. Trager has always expressed his desire that patients come to him to learn, rather than to receive treatment.

Likewise, Trager practitioners also bring an unusual attitude to the session -- the movement of joints and muscles is not viewed as the isolated goal. Rather, the practitioners purpose is to introduce motion into the muscles and joints that will produce positive and pleasurable feelings into the nervous system that will effect tissue change.

Though the tablework portion of the Trager Approach discourages active participation, there are some post-session activities, or exercises, that are taught to patients to help them recreate the pleasant and positive feelings they experienced with the practitioner. These are called Mentastics℠, a term coined by Dr. Trager meaning mental gymnastics. These exercises consist of playing with, then releasing, the weight of various parts of the body. They remind the patient of the feelings experienced during the session. By performing Mentastics, patients can recall during the following days the deep relaxation felt on the practitioner's table.

So much of what people feel, both physical and psychological, is negative. Through the Trager Approach, negative pain cycles can be broken and replaced by movements and feelings that are positive, pleasant, and more pain free.

Ilene Watrous has been in private practice in Princeton Junction, NJ, since 1986 and has been a Certified Trager Practitioner since 1987. She can be reached at 609-799-5204.
Susan March is a free-lance writer based in West Windsor, NJ. She can be reached at 609-275-7185.

[From Holistic Living: a celebration of life; Volume IX, Number 4; July/August 1992]


Trager, Revolution, Post Traumatic Stress & Peace

by Kate Rose, Certified Trager Practitioner /Tutor/Instructor

I received a request to come to Cairo and teach 2 Level 5's back to back. “Patterns & Positions” and “Feeling: The Heart & Soul of Trager”. My last visit to Cairo had been in 2009, and I was on my way there in 2011 from France, when the Revolution happened and all travel was stopped. So it had been 5 years since I was last there.

This would be my 5th trip to Cairo. I have always felt strangely at home in Egypt and had missed both the community and the country. It is not an easy place to be at any time, given that the high, high levels of pollution make breathing a challenging proposition and the beauty and splendor side by side with the terrible poverty. But I have always loved it. The Pyramids, the Sphinx, the Nile - the ancient side by side with the modern. Lines of camels and lines of cars.

The Cairo Trager Community is a wonderful group of women, learning and practicing Trager and other forms of healing in a world where these things are not allowed. And of course the incredible hospitality. It is a level of welcome and generosity that one can only be humbled by. A lesson in receiving. And it is from everyone. It is in the DNA of the culture.

I was scared, to be sure, about the trip. Only reading the news and hearing of all the shootings and bombings, I decided to choose to trust what I have always trusted. In this work that I truly believe can and does create Peace, being called to a place of war seemed like a great honor and responsibility. So I went.

One always arrives in Cairo at about 2 a.m. and then there is the process of getting a Visa Stamp, 15.00US, and then getting through customs and of course finding your luggage. So it is close to three when one finally exits the airport. I was to be picked up by a man named Hassan, a Nubian gentleman who is both driver and protector. I have known him for many years, trust him with my life, and although we do not speak each other's language, we communicate very clearly. As soon as I saw him, I felt utterly safe. “Sabah al kheer, Hassan, I say. This is the greeting of Good Morning in Egypt, which translated literally means something like “ I wish you Light and Blessings on your Day”

Answered by Sabah al Noor enjassim which is I wish you Light and Jasmine” Such an incredible language.

And he said Good Morning Madame, and shook my hand which is very rare. In Egypt if someone is in the position of serving they usually back away from you if you approach. But Hassan and I were very happy to see one another. And shared in this exchange, the awareness and joy of knowing what he and his country had been through and my own deep happiness at my return.

We then drove for about 40 minutes, first through Cairo and then into the desert to where Katrina Shawki lives. I had taken this ride many times and was familiar with the ride through the empty desert into the villages and then onto the farm.

But as I looked out the window, even in the dark, I could see everywhere buildings and a road I did not recognize with a line of trees down the middle...where did all this come from? I arrived at the house at about 4 am to be greeted of course by Katriona and a cup of tea.

She told me that after the revolution, because there has been basically no government to enforce regulations, people just began to build at great speed, because they all know that once the government would be established, permits would be required etc. So villages have disappeared and big buildings and homes are in their place.

Cairo itself as we drove through on the main motorway seemed suspended somehow. Quiet, but waiting, an inward breath. It is such a huge city, one drives over the Nile, seeing Minarets, Mosques and Hotels, everything altogether.

I had one day to rest, and then on Thursday we drove into Cairo for the class. Hassan took us on an amazing circuitous route that only he could have discovered or created. Sometimes it seemed we were not even on roads. The traffic is so terrible now, much worse than 5 years ago, that a ride that would take under an hour could take 4 hours. Unless you have a brilliant person at the wheel.

It was so wonderful to enter the studio and greet all the wonderful women I had not seen for so long, who had lived through and survived this incredible revolution and learned to deal with the daily challenges that I cannot even imagine.

As we sat in our opening circle in silence, I could feel, like a heavy cloud, the weight of these 3 years of fear and violence and I know that this is what we were here to bring out into the open, to share, and balance and heal. And so we began. You must imagine that daily conversation could go something like this:

“Did that gunfire wake you up yesterday morning? “& “Where were you when that bomb went off?' In the same way that we might say,”Did you see the new Captain America movie?”

After lunch the first day, I shared my experience of listening to the conversations and we began to explore the telescoped reality that everyone had been living in. We did this is the context of the first Level 5 “Patterns& Positions”. Looking at the actual positions that our bodies are in as a result of trauma, violence, fear, etc, how we get used to it and accommodate it in our systems, the toll it takes on us, the position it puts us in and the pattern it creates. We explored this within the context of discussion, Mentastics, both on our own and with a partner or in a triad and at the table from both directions, i.e.: as the Practitioner practicing while holding unconscious and conscious trauma, and as the receiver, receiving loving care and support to release trauma throughout the system; through gentle suggestion, silent and spoken, exploring new positions, of mind and body. The partnerships we created and experienced were so profound and so healing. There was so little doing, and so much listening and receiving, using the work creatively, intuitively, simply. Embodying the principles to allow the openings, to create the questions. It was remarkable. So for 3 days we explored our Positions and our Patterns. Then we had a break of a couple of days and came back to 3 days of “Feeling: The Heart and Soul of Trager”. From our first three days we had identified and explored where we were, the shapes we had created, the needs that arose. In these next three days we flowed into continuous questioning and exploration of feeling on as many levels as possible and the needed integration to bring everyone back to themselves, the recall of what it felt like before 3 years of violence and upheaval. To access the somatic and unconscious memories, let them move and find ourselves and each other in our innate wholeness.

It was incredibly beautiful to observe and interact with the artistry, skill, humor, and joy that these 12 women expressed more and more as the days went on. And to see the truth of Trager creating Peace.

So in the midst of bomb threats and tanks and machine guns, fear everywhere, we became an island of peace and inspiration.

For me it was a process of being aware of my own fears and being present with them as I facilitated the class.

The tears of exhaustion fear, and trauma were replaced by tears of joy and so much laughter.

We began to work on translating Trager into Arabic, as several people were becoming Intro leaders and we explored how to share Trager in Arabic. Some of the expressions are so exquisite. Like.....” this particular feeling is described as that amazing Egyptian rose that one just smells the fragrance of and is immediately transported into softness.” That was one word. It is a language of grace and fluidity. And the laughter of the transplanted expatriates and their stories of trying to communicate and the ridiculous things that get said when one is learning a language.

We ended with laughter and joy, renewed strength, and a sense of having cleared and released so much that had been imposed by living through a revolution.

Teaching the trainings back to back was a marvelous experience, seeing how they seamlessly wove perfectly into each other and the effectiveness of what became for all intents and purposes a 6 day Level 5 Immersion. The effectiveness of Trager with Trauma and Post Traumatic Stress cannot be understated. It is a simple and profoundly effective technique/approach that organically, naturally brings through recall and movement, balance, harmony, release, integration and ease to a system stressed and damaged in ways that are only present in a situation where a human being must deal with the ravages of violence and fear.

On a final personal note. The last night I was awakened at 2 am by gunfire. First several shots and then what sounded like an automatic weapon. I said to myself, Kate, that is gunfire. Then I said,” I think you should probably not turn on the lights.” (I was in a huge compound surrounded by a high wall, never the less...) then I said to myself, “You are in your pajamas, maybe you should dress and gather some things in case.”...... and then I said,” Kate, my darling, if someone comes to shoot you, being dressed or in pajamas is not going to make a difference. “

So I laid there until dawn and then fell asleep for a few hours. When I met Katriona at breakfast, I asked her, “Did you hear the gunfire?” She said,” No. “ I said, “What do you think it was? “

She said, “Well, it could have been a wedding, they fire guns for that, or it could have been the men who protect the farm just telling the world they are there and this place is protected.”

I thought, how amazing. One sound and it could have been, Death, or Celebration, or just Hello.

A powerful and formidable lesson.

My deepest thanks to the Brave Trager Women of Egypt.

Peace Peace Peace. Peace be unto us and unto all living beings.

The Trager Approach: An Effective Tool for Physical Therapy

by Ilene S. Watrous, MA, PT

The Trager Approach is essentially a communication between the Trager practitioner and the unconscious mind of the client. The medium is, for the most part, pleasant-feeling, gentle rhythmical rocking movements. The message is freedom of movement, freedom from pain, reintegration of the body parts, and comfort within the body.

The technique involved in Trager work consists for the most part of gentle compression, lifting, swinging, flexing, rocking and range of motion movements. There is no deep prodding or squeezing as is found in some other forms of bodywork and massage. The subject is passive; the practitioner varies the movements to prevent the subject from voluntarily "helping" in the movements.

Throughout the session, the practitioner is observing. What does this body feel like? Is it tense? Does is move freely? Are its ranges symmetrical? How could the motion of the body be more relaxed - freer? The movement and observation is a constant feedback loop. The observation aspect is what is emphasized in the Trager approach.

The patient, on the other hand, experiences the Trager session as a very pleasant experience. The gentle movements are not threatening. The rocking motion is hypnotic and relaxing. The variations of movement reduces the ability of the subject to anticipate actions, and so encourages the passive experience.

There are several mechanisms by which Trager is effective. It is a profound tool for relaxation. The rhythmical rocking motion, through its actions on the vestibular and reticular activating systems, has a calming effect on the nervous system.

The movement done during the session is a subtle suggestion to the nervous system as to what motion is possible. None of the movements done in a Trager session are forced. With gentle rocking, the body is never put into positions which are stressful to it. With the active participation of the subject removed, the body itself is learning in a proprioceptive way just what positions and movements are easily possible. Potential learned patterns of movement resulting from previous pain avoidance can be overcome in this way.

Stimulation of the nerve endings in the joints reduces perception of pain and influences muscle tone. Barry Wyke [Wyke 85] writes that "the afferent discharges derived from the articular mechanoreceptors are of particular importance to manipulative therapists, by virtue of the threefold effects:" 1) "The articular mechanoreceptor afferent nerve fibres...contribute to the continuous modulation of activity flowing around all the fusimotor-muscle spindle loop systems. By this means the articular mechanoreceptors exert reciprocally co-ordinated reflexogenic influences on muscle tone and on the excitability of stretch reflexes in all the striated muscles. It is through this mechanism that manipulation of joints by therapists gives rise to the reflex changes in muscle tone (involving both facilitation and inhibition of motor unit activity)." 2) they "make a significant contribution to the perceptual experiences of postural sensation and kinaesthesis. ...patients whose articular mechanoreceptors are destroyed by joint trauma, inflammation, or degenerative disease processes manifest impairment of postural and kinaesthetic sensibility in the regions of their body thus affected." and 3) "it is primarily through controlled stimulation of peripheral tissue mechanoreceptors by the application of static or phasic forces that manipulative therapists are able to produce relief of pain."

When a person has an injury, for example to the ankle, there is decreased mechanoreceptor input into the brain. Adaptations throughout the body occur as a result of the injury - decreased hip rotation, shoulder rotation, in fact, the entire way the person experiences movement is changed. Using the Trager approach, the practitioner helps facilitate and restore normal movement to the ankle through repetitive, painless stimulation and also increase the "available" movement patterns to the hip, ankle, cervical region as in Trager the whole body is worked on. The joint mobilization aspect of the Trager approach involves accessory and physiological motions that not just mobilize the specific extremity part that the therapist is working on but affect the entire body simultaneously.

Trager may be effective in improving chest wall mobility, as evidenced by the increased chest expansion of the subjects in a study by Philip Witt [Witt 86], which would enable patients with a chronic lung disease to have larger Functional Vital Capacities. The mechanism he postulated is increased chest wall mobility. The author sees patients with COPD. They frequently exhibit a decreased respiratory rate following treatment. They often report sleeping more restfully and breathing more easily.

Witt also reports that the results of the Trager treatment to a 13 year old male with severe spastic diplegia were positive [Witt 88]. There was substantial improvement in both passive and active trunk ROM in all trunk motions and some improvement of hip and knee motion bilaterally. In this case, Trager bodywork was effective in increasing ROM in a boy with long-standing restricted range of motion.

The author has had positive results in treating the following conditions utilizing the Trager Approach in conjunction with elements of a traditional Physical Therapy program: multiple sclerosis, Parkinsons, post laminectomy with pain, low backpain - chronic and acute, orthopedic patients, and various neurological problems. It is quite fulfilling to use on chronic back pain patients where traditional Physical Therapy treatment alone has had little success, especially post surgical laminectomy patients who continue to experience pain.

Though the tablework portion of the Trager approach discourages active participation (except for a resistance aspect, taught much later and called Reflex-Response), there are also associated exercises which are taught the subject. These are called Mentastics (a term coined by Dr. Trager from the words "mental gymnastics"). The exercises consist of playing with the weight of, e.g., an arm or a leg then releasing the weight. Experiencing this reminds the subject of the passive state of the Trager session and the feelings associated with it. By performing Mentastics, they can recall during the following days the deep relaxation they experienced on the table.

Trager work is also beneficial to the Physical Therapist. Aside from being an effective tool to produce results, it adds a new dimension to the evaluation of the patient. During the typical Physical Therapy evaluation, an interview is done and muscle and range of motion tests are performed. In a Trager session, the gentle rocking motion is also constant range of motion testing. The therapist experiences directly the limits of the body. And, as the tension and pain avoidance patterns of the patient disappear, the therapist gets instant feedback on the progress.

So much of what our patients feel (since injury, e.g., MVA, stoke) or feel (possible preceding family trauma of abuse, physical or psychological) is negative. We cannot change the past, but we can be introducing into our patient's nervous systems profoundly positive movement experiences. If a patient begins to feel pain, burning, or aching every time they move, then they begin to accept that as the norm. This approach can turn the pain cycle around by creating movement that is positive and more painfree. The Trager Approach is an effective treatment modality for achieving Physical Therapy goals and can be an appropriate and recommended approach.

Ilene Watrous has been in private practice in Princeton Junction, NJ, since 1986 and has been a Certified Trager Practitioner since 1987.
[Juhan 87]
Juhan, Deane. The Trager Approach: Psychophysical Integration and Mentastics. The Trager Journal II:1-3, Fall, 1987.
[Savage 89]
Savage, Fred L. Osteoarthritis: A Step-by-Step Success Story To Show Others They Can Help Themselves. Station Hill Press, Barrytown, NY, 1989.
[Trager 82]
Trager, Milton, MD. Psychophysical Integration and Mentastics. The Trager Journal I:5-9, Fall, 1982.
[Trager 87]
Trager, Milton, MD, with Guadagno, Cathy, PhD. Trager Mentastics: movement as a way to agelessness. Station Hill Press, Barrytown, NY, 1987.

[Witt 86]
Witt, Phil, PT. Trager Psychophysical Integration: A Method to Improve Chest Mobility of Patients with Chronic Lung Disease. Physical Therapy 66(2):214-217, February, 1986.

[Witt 88]
Witt, Phillip L., MS, PT, Parr Carol A., MS, PT. Effectiveness of Trager Psychophysical Integration in Promoting Trunk Mobility in a Child with Cerebral Palsy: A Case Report.

[Wyke 85]
Wyke, B.D., MD, BS. Articular Neurology and Manipulative Therapy. In Glasgow, E.F.; Twomey, L.T.; Scull, E.R.; Kleynhaws, A.M; Idczak, R.M., Aspects of Manipulative Therapy, 2nd Edition. Churchill Livingstone, New York, 1985. Pages 72-77.
[From Physical Therapy Forum; April 1992]

Wake Up Your Feet

By Ilene S. Watrous, P.T., M.A

Frequently, after working with multiple sclerosis (MS) patients using the Trager® Approach on their feet, I hear the comment, “I can feel my feet again.” By making the feet more flexible, my goal is to improve the patient’s sense of balance and timing, standing and shifting, and muscle strength. When you have MS, the signals coming to the brain are impaired. Thus, it is critical to awaken the sensory system so that it will start responding more normally, eliciting change in the muscles and reducing rigidity.

Because MS is a neurological condition that affects movement patterns—the very process of how people walk and move---therapy seeks to address their functioning and mobilization. While it is true that individuals have different kinds of MS and each person displays unique symptoms, the majority of patients do have balance problems. Most people are helped by releasing their habitual patterns of movement, which affect their balance or gait.

The more you can feel in your toes and in your feet, the better you will move and walk. Even people in braces can benefit from increased awareness to their feet. Feet that are mobilized and awakened with enhanced feeling may also delay progressive weakness.

What we refer to as the foot is a complex, mechanical structure of both the foot and ankle, including 26 bones, 33 joints and over a hundred muscles, tendons and ligaments. This amazingly designed foot not only bears the weight of the body, but allows all of the interlocking parts to work together with one primary purpose—to let us stand, balance and walk.

What then do I do, as a physical therapist trained in the Trager Approach, to awaken the feet with enhanced feeling? I provide gentle, rhythmic, oscillating motions of touch that increase the sensations and mobility to the whole foot. Using light, non-threatening movements to the joints and muscles, I create a positive, relaxed feeling that feeds into the nervous system to effect change in the tissues and to increase one’s range of motion. Through this communication, I also engage the unconscious mind to be more aware and to enhance feedback from body to brain. In essence, by using this approach, I am stimulating the sensory-motor feedback loop and subtly giving suggestions to the nervous system about what movements are possible.

In the words of Dr. Milton Trager, the originator of this work, “It is the manner in which I work, not necessarily the movements I do, that brings about the change. Every move, every pressure of my hands, every thought is directed toward bringing new feeling experience to the unconscious mind of how the affected areas should feel.”

This Trager Approach gives the body options so it has freedom to explore movement in those affected areas and to break out of the set, habitual patterns. As Dr. Trager explains, “The purpose of my [body] work is to break up those sensory and mental patterns which inhibit free movement that cause pain and disruption of normal function.”

Sensory feedback, then, is the key to breaking out of the limited, habitual movement patterns which hold us prisoners of rigidity and stiffness. It is recognized that feedback receptors which sit in the joints get degraded and decrease in number with the normal aging process. A neuromuscular problem like MS causes further degeneration of these receptors. If we can increase the range of motion in these tight and weakened areas, we are improving the receptor input into the brain.

One of the most susceptible areas for decreased receptor input is the joints of the feet, often times leading to numbness in the feet. Through small accessory motions and passive range of motion, patients will experience a more complete repertoire of movement. The receptors will be stimulated and enhance movement awareness. In addition, there will be improved circulation of blood through arteries and nerve flow. As a result, patients will feel more relaxed, use more of their feet, and move their muscles more effectively.

The Trager Approach increases sensory feedback in the constrained areas. This encourages the weak or sedentary muscles, nerves, and arteries to participate in the foot in a new way. When the foot is stiff and continually held in the same position (when standing or walking), it is not capable of the numerous adjustments that have to take place to walk effectively.

While sensation to the feet is critical, painful feelings in the feet created by an over-stimulated nervous system can impact negatively on mobilizing. Desensitizing these sources of pain is essential before trying to improve the overall functioning of the feet. Innately, the Trager Approach works for de-sensitizing hyper-stimulated areas.

In addition, osteopathic techniques can be employed to further reduce spasticity and sensitivity in the feet. Spasticity here is defined as resistance to stretch with varying degrees of intensity. In many cases, prolonged stretching of the heel cord and tight calf muscles in the back of the feet helps the weak muscles in raising the toes and feet. This enables the muscles to participate more fully in the gait cycle.

For the MS patient, of equal importance to sensation is balance. Signals coming to the balance center are impaired, so people with MS not only have problems with sensation, they also have problems knowing what they are doing with their feet--with timing their movement. When do they push off? Do they push off with their toes? How do they land? When do they put their foot down? How are they sequencing their movements?

Balance primarily depends on three operating systems: sight (eyes), the vestibular system (inner ear) and proprioception (the ability to identify where the foot is in space). It is very difficult to compensate for balance if more than one of these systems is impaired. Balance exercises, such as standing on one foot, are useful in themselves, but are especially beneficial if used as an adjunct to the hands-on work. Balance exercises, identified below, that increase proprioceptive input are particularly important for people with MS. These exercises activate the receptors that respond to movement and stretching in the joint. They give constant input to the brain as to where the limbs are in space.

Dr. Trager encourages performing simple exercises, which he termed Mentastics®. These activities help to recreate the positive feelings of relaxation experienced on the therapist’s table. They also develop increased body awareness. This is part of re-education and relearning the natural way the body can move. Ideally, these exercises are integrated into a person’s daily life.

Some of these exercises are based on replicating the developmental sequence of a child learning to walk. Babies first crawl to a stationary object like a chair or table, hold on to it and gently rock back and forth. This is part of awakening receptors which tell them where they are in space. Then, they begin to let go occasionally while they continue to rock back and forth. Once babies master these skills, they begin to take steps and, eventually, walk naturally. In essence, my therapy work with MS patients starts at a level where we can begin to stimulate the inherent plasticity of the nervous system. New pathways can be formed to carry sensation to the brain.

Below are simple, everyday exercises to relax, stimulate, and strengthen muscles and to enhance proprioception. The exercises are not meant to be part of a formal program, but can be performed anywhere, at anytime, by yourself. I encourage patients to hold on to something when first trying to do the exercises below.

--Shifting your weight from side to side or rocking back and forth;
--Using your mind and focusing on your toes, feel each toe on both feet;
--Shaking your leg gently as if you are brushing off snow from your boot.

Can MS patients improve their walking? The answer is most likely “yes.” However, because MS is variable, the support needed may differ from time to time. When the gait is compromised, the individual may require an assistive device. At some other time, different fitting shoes may be necessary. But working around those variables, as a physical therapist, I believe that people with MS can improve their ambulation through increased sensory feedback, balance exercises to increase proprioceptive input, and Trager Mentastics.

There are other familiar ways of exercising that assist individuals to better manage their MS symptoms. These exercises also help the person to get grounded and increase focus, balance and freedom of movement. I recommend tai chi, yoga, and dance because they allow people to explore more options in movement. Of course, one chooses the activity which is most rewarding and provides the most pleasure. In conclusion, the goal is freedom and ease of motion—leading to regaining the joy of movement through the feet.

Simply put, the key is to wake up and feel your feet.


I have Complex Regional Pain Syndrome (CRPS) and just felt my first Trager session

Testimonial by client TC, New Jersey

History of my injury. I had a work injury in 2007 and suffered extensive nerve damage in my arm. When the pain wouldn't go away I was diagnosed with Complex Regional Pain Syndrome (CRPS) and told that I would be on multiple pain medications for the rest of my life. In 2010 I had a spinal cord stimulator implanted to help with the pain and cut down the amount of medication that I had been taking. Unfortunately, there were complications with the surgery and I wound up worse than I was before the surgery. I had a bleed in my spinal cord, sciatic pain from the battery that was implanted in my buttocks, constant muscle spasms and aches in my neck and shoulder and balance issues from the spinal cord bleed. After recuperating for a month, my wife and I went on a cruise because we needed to relax. At this point, I was still in bad shape from the surgery and needed a cane to walk because of the drop foot I had developed as a result of the spinal bleed. On the ship, a fellow passenger came up to me and explained that she had suffered a drop foot for several years from injuries she sustained in a car accident. We compared stories and how there isn't much that can be done with spinal and nerve injuries. She then proceeded to tell me how Trager “cured” her drop foot and gave her back her life. She gave me a brief description of what the Trager practitioner does during a session and told me that even though it sounds crazy it really works. I had never heard about Trager prior to this. Once we got home, I went online and looked up Trager. I watched videos and did some research and determined that the bones in my neck were too fragile to even think about trying it. and put it out of my mind. 

Fast forward to 2015. After extensive self-­administered physical therapy in the gym and therapeutic pool, my balance is much improved. The drop foot has been resolved, although I still can not run more than a few steps and never put any weight on my right leg because it can give out at any time causing me to fall. In addition to the old aches and pains, the sciatic pain had worsened and both of my hands would freeze up and cramp on a regular basis. My neck and shoulders are so tight and painful that I still wear a neck brace for long car rides and mowing the lawn. I started thinking about Trager again and wondered if it would help me now that my bones were fully healed. 

I found my Trager practitioner through, and had my first session with her on Sunday. Because the first session is complimentary, I had nothing to lose. She explained Trager to me and I watched a video explaining the origin of Trager and a sample session. I was nervous when I saw the neck part of the session, because although it was gentle, my neck wasn't able to move in the positions that the video showed. She then showed me several Mentastics moves that I can do.

No pain, complete relaxation. Finally it was time for the table work. She explained how she would work. and told me to just relax and enjoy it. She worked on me for about and hour and a half and was able to relax every muscle in my body without ever causing me any pain. My sore arm and neck were relaxed for the first time since my injury. At the end of the session while still laying on the table, NOTHING hurt me. It was amazing!

No sciatic pain. It's now 3 days after my initial session and although most of my body has tensed up again (as my practitioner said it would) I have had NO sciatic pain, my right leg is more stable, and my hands and fingers have not had any spasms. Most amazing of all, I did not need to take any pain medication for 2 days following my Trager session. My practitioner explained to me that my muscles have been so tense or so long it will take several sessions to relax them enough that they can stay relaxed for a longer period of time. I can't wait to go back!

T.C., New Jersey