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]