Some Problems with Movement "Correction"

Moshe Feldenkrais said that to "correct is incorrect." He was referring to efforts to correct someone's movement patterns. Which is kind of a strange thing to say for a guy whose method was largely about making people's movement more efficient. What did he mean and what does this say about efforts to correct movement? I think his message is that it is preferable to show clients different options or choices for how to move, than to tell them their current movements are wrong and require correction.

Here is a brief discussion of three ways in which offering choices might be preferable to prescribing corrections.

1. "Right" for one person is "wrong" for another  

The first problem is that we may be wrong about what movements we think are correct or incorrect.

When we look at someone's movement patterns and see that they appear uncoordinated or awkward in some way, it remains possible that we are actually looking at the optimal motor solution for that person's particular structure.

I recall watching a runner recently who was extremely bowlegged. Of course he had an unusual gait, but there was something about his running that made me think that he was moving about as smoothly as possible for a guy with his structure. So I was impressed.

But what if he had some obstacles to a more technically correct running form that were invisible to my eye? Such as lesions or disease processes in the joints, muscles or nervous system? Perhaps then I would have thought he really needed to work on his coordination. But that would've been a mistake!

I definitely believe that most people have significant room for improvement in their movement. I wouldn't be writing this blog if I didn't! But I realize it's hard to know whether a particular movement is improvable if we don't know all the relevant variables.

For example, certain movements may look restricted or awkward, not because of bad movements skills, but because of an intelligent decision on the part of the nervous system to protect against potential tissue damage. Barrett Dorko coined a great phrase that illustrates the problem of labeling unusual movements as being pathological - are we seeing "defense or defect"? It can be hard to know.

Give these uncertainties, I think a good solution (and the one advocated by Feldenkrais) is to have an approach that is more about offering options and alternatives and testing how they work, rather than ordering corrections and assuming they will work. If the new movement option is truly an improvement over the previous one, then the client's nervous system will show some sign it likes them, regardless of what the therapist says is right or wrong.

2. Identifying "dysfunction" can create fear of movement and nocebos

Another pitfall with identifying "dysfunctions" and prescribing corrections is that it can contribute to an unreasonable fear of an otherwise useful movement pattern.

Kinesophobia (fear of movement) predicts poor outcomes in chronic pain. It is easy to see why. Pain results from the perception of threat, and one of the inputs the brain considers to analyze threat is cognitive - thoughts and beliefs about whether a particular movement is safe. If a client receives a message from an expert that a particular movement is unsafe, it can contribute to fear of that movement, which could increase the probability that the movement will cause pain.

Keep in mind that it's not just the intelligent, conscious, rational part of the brain that decides what to be afraid of. It's also the stupid, unconscious, primitive part. Therefore, if you suggest to a client that a certain movement is pathological, remember that the stupid part of that client's brain might get the wrong idea and take it to extremes.

I will confess that I developed a mild but unhealthy fear of low back flexion after reading Stu McGill's books. I have talked to at least a few other therapists who reported the same thing. The point is not that there is a problem with the books, which are excellent, but that fear of movement can develop unexpectedly from well meaning advice intended to offer protection.

I think we can avoid this problem by being very careful before telling a client that a particular movement is wrong or pathological. The emphasis can instead be on suggesting options and alternatives, and seeing if they create improvements.

3. Inauthenticity

Another pitfall with trying to correct movement is that the corrected movement pattern might feel forced, unnatural, and inauthentic. For example, a client might try to implement a therapist's advice to arrange their posture differently, but the new arrangement feels awkward and requires conscious attention to maintain. The problem is that the conscious brain of the client is on board, but the deep unconscious part which actually controls movement is not sold.

Most clients will simply abandon any recommended movement pattern if it doesn't feel natural, or if it cannot be maintained without conscious attention. But some people with a tremendous amount of willpower will persist in adopting the unnatural movement pattern for long enough that it becomes a pathological habit. A connection to authentic movement is lost.

In either case, the attempted correction fails if the deep unconscious part of the client's nervous system is not convinced that the new movement pattern is beneficial. Therefore, once again I think this militates in favor of an approach which is oriented towards giving the client resources or information that they can use to their own benefit, as opposed to telling them what to do.

So is it incorrect to correct? I think it's a great thing to help your clients move better and that's what I try to do. But the style of how that is done is important. I like to think in terms of offering options, as opposed to dictating corrections and risk demonizing current patterns.

One the other hand, if you only have time for about a five minute session, the approach below is quick and affordable: