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Mobilization Through Bodywork
 
(This section is always under development. If you are an expert in any of the topics below, please contact me to contribute!)
 
Keep moving. This is the key to a free joint. This section describes many of the modalities we can use to keep our bodies vibrant and more limber. Most of us have explored many of these options prior to seeking hip replacement surgery as we sought to prolong our careers and the longevity of our failing joint(s). Many of these same modalities will serve to help us in our recovery post-operatively. There are many to choose from and, as with supplements, the variety can be confusing. As an attempt to help the reader make an informed choice of therapy, this section attempts to examine some of the bodywork options.

I have divided the mobilization modalities into three areas: structural work, energetic work and work through movement. While there is much overlap with each approach in theory and practice, the following is what I mean in general:

Structural work:
This work, achieved through physical manipulation of the body by a skilled practitioner, helps us to keep the optimal anatomical alignment of muscles and bones. Modalities include massage, chiropractic, physical therapy, osteopathy, etc. Most dancers and athletes are familiar with these and I will not be describing them further at this point in time.

Energetic work:
Acupuncture and Chinese Medicine
As opposed to work that involves our physical body, energetic work addresses the body’s underlying life force energy (“Qi” in Chinese medicine)and its patterns of disharmony. When the underlying Qi is in balance, it is easier for the anatomy to be properly aligned. Even in situations where we have bony joint deterioration, helping the Qi to flow smoothly through the affected area may decrease the pain and improve movement. This underlying Qi can be balanced using the Traditional Chinese Medical tools of acupuncture, Chinese herbal formulas, TuiNa (Chinese massage) and through the practice of Qi Gong and/or Tai Qi.
 
By the time my hip was diagnosed with osteoarthritis, intervention with acupuncture and Chinese Medicine did little to ameilorate my pain. However there was an encouraging study published in 2005 that showed that acupuncture decreases pain and increases mobility in patients with osteoarthritis of the knee.

In The Annals of Internal Medicine study (Dec 2004; 141:901-911), 570 patients with arthritis of the knee were randomly divided into three groups: one group received real acupuncture weekly, a control group received “sham” needle treatment that mimicked real acupuncture, while a third group received education and counseling. All were allowed to continue taking whatever medications they were using.

Interestingly, the patients in the "sham group" did report a reduction in pain, but significantly less than the group getting true acupuncture. The group receiving the genuine treatment reported 40% improvement in symptoms. These patients showed an improvement in function by week 8 and a decrease in pain by week 14. Both the placebo and real needle treatments were more effective in relieving symptoms than education.

A significant finding of this study, in light of the news about NSAIDs, was the absence of side effects from the treatment. Acupuncture was found to be safe as well as effective.

At Turning Point we have some very good outcomes treating arthritis with acupuncture, especially arthritis of the knee. One such success story is of a famous ballroom dancer, then in his 50s, who I treated for debilitating knee pain.  He was able to avoid knee replacement surgery for another decade - dancing all the while.
 
For further information about acupuncture and Chinese medicine please visit the Turning Point Acupuncture website.

Other Energetic Modalities: Osteopathic medicine and many other healing bodywork modalities acknowledge and treat the underlying life force and thus aid in freeing the joints. Energy can also be balanced via hands on work, such as the energy balancing technique of Reiki.

Work through movement:
Some movement practices have been developed, or have been adapted to address the healthy integrity of the moving body. These include:

Water therapy, Alexander Technique, Feldenkrais work, Pilates, Gyrotonic®, Body-Mind Centering® and Yoga therapy.
 
In pursuing any of these modalities it is essential to work with an experienced instructor who has a good anatomical understanding of the joint and the surrounding muscles.
 
Below are a few notes about some movement modalities I have researched. I am in the process of asking experts in each of these fields to contribute to this website to help each reader chose what the right approach is for him/her. In the meanwhile helpful links are included for the reader to learn more.

Water therapy
It is widely agreed that the safest place to exercise for protecting the joints is in the water since water provides support for no-impact work. Water therapy is ideal to protect your hip joint prior to surgery, as well as for post surgical rehab.

 
The best resource I have found for water therapy for the hips is this book:
"Heal Your Hips : How to Prevent Hip Surgery—and What to Do If You Need It"
by Robert Klapper, MD and Lynda Huey
It is available here at Amazon:

The Los Angeles based orthopedist  Robert C. Klapper, MD, Director of the Cedars-Sinai Institute for Joint Replacement provides good advise about when THR is indicated.
Lynda Huey, is a leading authority on water rehab for athletes and dancers.
(I’d like to thank Leslie Kaminoff of The Breathing Project, Inc. in New York City for bringing Huey’s work to my attention.)
 
The co-authors have a helpful website that all THR candidates with pool access should visit.
On the excellent page describing the water exercises and water based gait training, Huey sums up the benefits of water work:
"This pool program is based on the elimination of gravity for increased pain-free range of motion."

Another fun resource is Allegra Kent's "Water Beauty Book".
Unfortunately this book is now out of print and virtually unavailable last I checked.

Alexander Technique
The theory behind this technique is that by changing your posture you can move more easily.

alexander technique

Starting in the fourth months of my rehab I studied Alexander technique at the urging of my physical therapist who thought that it would improve my gait and address my lingering back pain. I studied with the former Paul Taylor dancer, Jane Kosminsky, who herself had a recent knee replacement. (Read her joint replacement story here.) The technique involves the examination and correction of everyday activities like sitting and rising from a chair, gait training, head placement, lifting (using "the Monkey" position), etc. There is also table work which involves the teacher placing the student in an anatomically correct rest position to teach the body to be at ease by gentle suggestion.
 
Jane has made wonderful introductory video tape with the actor William Hurt:
The Alexander Technique: First Lesson (1998)
It is available at Amazon.com

Quoting from the introduction to the tape, Jane sums it up best:
Developed by an actor who lost his voice due to improper posture, the Alexander Technique involves a series of subtle changes in stance and movement that, once learned, are to be incorporated into everyday life.”.
 
Here is a helpful link:
http://www.alexandertechnique.com/
 
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Feldenkrais
As part of my own post-rehab physical therapy I learned to do the “pelvic clock”, but otherwise I was pretty ignorant about the method. Soon after dancerhips.com went online I got an email from Deborah Page, a former dancer and massage therapist awaiting her own THR, who is also a Feldenkrais teacher. She wrote:
“I wanted to invite you to research the Feldenkrais Method. Many times Awareness Through Movement (ATM) Lessons have saved the day for me, and a Functional Integration Lesson from a practitioner has the ability to really shift the body's habitual organization for movement. It has surprised me that so few people recovering from a THR know about it. Feldenkrais teaches the brain about improved coordination, something no other method does quite as elegantly. It would be a great resource for anyone recovering from hip surgery. ATM is what you can do for yourself; FI is the hands-on version, received from a practitioner. (Pelvic Clock is an example of ATM)”
 
 “I'd like to recommend Elizabeth Beringer's ATM series Embodied Learning: Focus on the Hips and Low Back. (Audiotapes). This has been the single most significant set I've worked with for my hips. You can order it from Feldenkrais-resources.com. She is a very good teacher and the lessons are quite clear.”
--Personal communication: Deborah Page, LMT, GCFP
Integrative Somatic Therapy & Movement Education

 
Deborah Page recommends:
http://www.feldenkrais-resources.com/
 
This is the website of the renowned teachers David Bersin and Elizabeth Beringer. The site is also one of the best sources of books, tapes, and other learning material both for practitioners and general public. Here are two quotes from that site:
 
“Movement is life.  Life is a process.  Improve the quality of the process and you improve the quality of life itself." --Dr. Moshe Feldenkrais
 
The Feldenkrais Method is an unusual melding of motor development, bio-mechanics, psychology and martial arts.  It is recognized for its demonstrated ability to improve posture, flexibility, coordination, self-image and to alleviate muscular tension and pain.  It consists of two compelling and versatile applications: Awareness Through Movement® and Functional Integration® modalities harness the nervous system's ability to self-organize towards more effective and intelligent action. Integration® modalities harness the nervous system's ability to self-organize towards more effective and intelligent action.
 
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Body-Mind Centering®
Much of my sanity and preservation of my body in the year prior to my THR surgery can be attributed to my work with Roxlyn Moret, a yoga therapist who is certified in Body-Mind Centering®.
 
Based on the work of Bonnie Bainbridge Cohen, this movement therapy is informed by her observations of neonatal movement, the study of embryological development, of cellular and gross anatomy, as well as yoga and dance. I found the work profound in its deep wisdom of the body’s innate knowledge and intelligence. The work itself is gentle and supportive in both the movement component and the hands on work.
 Here is how it is described on the official website:
Body-Mind Centering® (BMCtm) is an integrated approach to transformative experience through movement re-education and hands-on repatterning.  Developed by Bonnie Bainbridge Cohen, it is an experiential study based on the embodiment and application of anatomical, physiological, psychophysical and developmental principles, utilizing movement, touch, voice and mind.  This study leads to an understanding of how the mind is expressed through the body and the body through the mind.
 
Pilates
Now very popular in health clubs across the nation, Pilates is very familiar to dancers as a movement modality to develop core strength. I found, however, that as my hip joint deteriorated, it was very hard for me to do the mat work without gripping my hip flexors. Also, since as compensation for my bad hip my back was also very stiff, it was hard for me to do all the spine rolling exercises.
 
Pilates was developed by Joe Pilates (1880-1968). He was a boxer and a gymnast and had studied many exercise training programs including ancient Greco Roman exercises, as well as Eastern traditions and European physical rehabilitation styles. In the 40’s, 50’s and 60’s in NYC, Pilates worked with the most famous dancers of his time including members of the New York City Ballet and the Martha Graham company.
 
The Pilates Method consists of exercises done on different pieces of equipment (the “reformer”, the “tower”, etc) and on the mat. It is designed to develop core strength by targeting the abdominal muscles and the paraspinal muscles. It addresses alignment issues by balancing the body’s musculature. Practitioners report increased strength, flexibility and coordination.
 
Gyrotonic®
Hilary Cartwright, the former Royal Ballet dancer and master Gyrotonic® teacher, had a THR in 2003. It is through her that I have learned how valuable a modality Gyrotonic® can be. Hilary has worked with many dancers both before and after THR with excellent results. (You can read her THR story here.)
 
Handle unit The Gyrotonic® system was developed by Juliu Horvath. Like Joe Pilates, Juliu combined his personal training and interests into a coherent system of movement. In this case, Juliu was a ballet dancer and a gymnast who had studied yoga, tai chi and Chinese medicine. Through the latter he understood the tremendous value of breath work. Using his understanding of the human body he developed unique pulley and resistance based equipment that permitted the body to do spherical movement. Full circular movement could mobilize the joints while strengthening the body’s core. He synchronized the exercises with the breath to enhance the cardiovascular benefits of the movement.
 
Hilary describes the work in this way:
"The Gyrotonic pulley tower works like the perfect dance partner, giving resistance where necessary, yet assisting particularly with rotational movements; facilitating the joints by engaging the correct supporting muscles without stressing or tensing other ligaments and tendons. The resulting sensation is to bring the dancers mind and body into a state of harmony."

 
Yoga therapy
Yoga, in my mind, is in a class by itself since it is essentially a spiritual practice with a movement component. Done as therapy, however, there is an emphasis on using the postures to promote physical healing.
For more about Yoga and THR, consult the Yoga page.
 
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(Written 5/21/04 and updated 7/15/05)