The Trager® Approach in a Medical Setting
I worked for eleven and half years in and through a holistic health center under the auspice of St. Joseph Medical Center in Towson Maryland doing Trager® in a medical setting. The Center was called the Center for Health Enhancement (CHE) and was an operational entity from February 1997 to June 2008. For three years, it was an off-campus center with 21 practitioners and administrative support, under the care of Sister Anne P. Hefner, Vice-President of Missions and Ministry. In 2000, the Center moved on campus and in that same year, six massage and two yoga therapists began to provide services to inpatients. All the non-inpatient services and bricks and motar center ceased in 2003. The inpatient services and the CHE therapist support staff continued until June 2008. Some individually contracted therapist services have continued in a small way to the present. My contracted services at St. Joseph’s ended June 2008. This seems like a time of expansion for alternative and complementary medicine in hospitals, but payment for these services has been a low priorty in recent years at this hospital.
When I was a practitioner at CHE, I wrote the following description of Trager services at the Center. A description of the inpatient post-operative services that I provided would be different from the description below.
Links to the Other Trager Pages on this Site
What is the Trager® Approach?
More About the Trager® Approach
List of Trager® Resources
About Trager® Introductory Workshops
List of the Chesapeake Trager® Association Practitioners
The Trager® Approach in a Holistic Health Setting
Practitioner — Robert Clark
Modality — Trager® Bodywork or Trager® Psychophysical Integration
1. Describe your discipline as if you were talking to a layperson new to wellness: (Include a description of its benefits.)
The Trager® Approach uses gentle rhythmic movement to pleasurably connect you to your body and stimulate deep relaxation, improved physical mobility, and mental calm. As a result you let go of physical and mental blocks, release unneeded tension, move more easily and effectively, and feel better. This educational process, developed by Milton Trager, M.D., reaches below your conscious awareness to the levels that operate your body for you. The Trager® Approach is an advanced form of bodywork, accomplishing all the goals of therapeutic massage gently and to a great depth.
A Trager® bodywork session takes about an hour and a half. No oils or lotions are used. Relaxing on a bodywork table in a safe environment, clad in underwear or other non-restrictive clothing, you are moved, rocked and stretched gently and non-intrusively through acceptable ranges of motion. This gentle process communicates the experience of pain-free, unrestricted movement. Mobility may increase dramatically during a session. Also included in each session is instruction in Mentastics®, a Trager-coined word referring to light, playful, mentally-directed, self-care movements that are incorporated into everyday activities to recall and enhance the effects of the Trager® tablework. Each session involves work with the whole body and is complete in itself. Although there is no set regimen, positive effects are cumulative and you may find that you benefit from a series of sessions tailored to your needs.
The Trager® Approach often achieves excellent results for people with everyday problems of aches, pains, muscle spasm, poor posture or balance, limited movement, and the normal aging processes. It has proven useful in enhancing athletic performance and in helping individuals who have suffered trauma become more comfortable in their bodies. The Trager® Approach has helped with neuromuscular conditions including back pain, multiple sclerosis, cerebral palsy, post-polio syndrome and Parkinson's disease, as well as, with sports or work injuries. The benefits are: flexibility, ease of movement, mental calm, releasing chronic stress, expanding limits after being hurt, learning to accept beneficial touch, and a pleasurable awareness of one’s self as whole and integrated.
2. Describe your discipline as if you were talking to a physician new to wellness: (Include a description of its benefits.)
The Trager® Approach is the innovative learning system of movement re-education and relaxation training created and developed over 70 years by Milton Trager, M. D. It is an approach to psychophysical integration using light, gentle, non-intrusive movements to facilitate the release of deep-seated physical and mental patterns; patterns such as those that develop through poor posture, injuries, emotional traumas, stresses of daily living and poor movement habits. Trager® is performed in two different modes. One mode, called tablework, involves the client lying relaxed upon a massage table and being gently moved, rocked, stretched, compressed, and being taken through comfortable ranges of motion. The second mode is Mentastics® exercises. This involves teaching the client to creatively explore self-care through movements that are initially demonstrated and practiced with the client and which later can be expanded upon on their own. Both modes facilitate lasting neuromuscular re-education, increasing ease and responsiveness in movement.
The following conditions have been successfully treated with the Trager® approach:
• Musculoskeletal injuries from athletics, motor vehicle accidents, surgery, poor posture and musculoskeletal back pain;
• the secondary effects of spasm, rigidity, spasticity, and stiffness from neuromuscular disorders such as polio, cerebral palsy, Parkinson’s disease, muscular dystrophy,multiple sclerosis, and rehabilitation after stroke;
• conditions that have a stress component such as tension headaches and irritable bowel syndrome.
It has also been useful in helping improve athletic performance in world-class athletes in numerous sports and in treatment of sexual and physical abuse to decrease pain and help the clients become more comfortable in their body once again.
3. Describe your personal philosophy as a practitioner of this discipline:
I present the following to my clients by way of introducing myself and my philosophy:
I am privileged to be of service to you and to be a part of your health care support system.
I respect the uniqueness of each individual, and tailor my work by listening to your spoken needs as well as to the feedback that your body provides. I offer an opportunity to relax and focus upon the lightness, freedom and peacefulness you can experience in your body, mind and spirit.
The Trager® Approach and bodywork techniques which I use are non-intrusive and serve to help you unwind and release body tension and trauma, offering you relief from pain and reminding you of what deep well-being is.
It is my sincere intention that through this work you will discover an inner connection to your source of healing and wholeness which will empower your continued efforts toward wise self-care and happiness.
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When I personally think about my deep connection with the Trager® work and the personal development possible through sharing with my clients, there is a philosophy of self- awareness that is the thread upon which each client session is strung. And the movement of this inquiry is as follows:
The initial movement is to hook-up within and around myself to the ocean of wholeness that is my instinctive, full-feeling, alive source. This is the centered feeling-state of listening aliveness often referred to in meditation instruction. A conversation is begun with my client — the questioning of how it is for them; the listening to the response from their whole being: their words, gestures, and body language. This does not result in knowing what is wrong or how to fix it. There is a guiding of the client’s inquiring attention into the feelings of weight and lightness in their body and their life. Through this process of inquiry and listening, they, too, hook-up. Next, perhaps through some Mentastics® explorations, we find a hint — or a handle to help them to live in a lighter, freer way.
In the tablework, I take the attitude and trust that were created in our introductory time together and open a deeper exploration of how self-awareness and free motion of the body might be for my client. I ask with my hands and an open mind — “How might it be?” I converse with the limitation I sense, weighing it, letting it be what it is, revealing its nature and disposition, asking if change is possible and interesting. I do not transgress the limit by moving into resistance and pain.
Together with my client, I help awaken their awareness of themselves, of how they can feel and enjoy their lightness, mobility and wholeness. Once experienced and known, new territory becomes accessible to the client’s recall, and they learn the path to greater freedom for themselves. Mentastics® and recall after tablework give the client tools of self-inquiry to reawaken the feeling-state experienced on the table at a later time. Milton Trager said, when asked the goal his work, “World peace, one body at a time.”
4. What is the typical age range of your clients? gender breakdown?
25 to 80 years old;
75% female in my general practice.
With individuals coming for more serious health or emotional adjustment problems, the gender breakdown is equal.
5. Respond to as many as are appropriate by describing
a) Typical conditions of your clients:
b) Typical benefits of your modality for each condition:
The Trager® practitioner does not set out to treat or fix a medically diagnosed ailment or condition; the whole person and whole body are the medium of the work. A deep feeling experience is conveyed by touch and movement to the client and temporary or lasting changes may occur relating to many of the below listed conditions:
* acute pain: tension or stress pain can be relieved by Trager®, including tension headaches and myofascial tension and pain.
* chronic pain and * lower back pain: chronic pain of neuromuscular origin can often be relieved by a series of sessions.
* joint pain, * rheumatoid arthritis, * osteoarthritis: conditions when not actively inflamed or overly weakened that benefit from acceptable movement are improved by Trager®.
* migraine: as an adjunct therapy Trager® has helped with the severity and recurrence of many types of migraines
* chronic fatigue and * fibromyalgia: the light and gentle touch of Trager® work has been found helpful. Trager® is recommended by Dr. Jacob Teitelbaum of Annapolis who specializes in treating these conditions.
* gastrointestinal illness: stress related conditions of the gastrointestinal system are relieved by Trager® work.
* asthma: stress related constriction of the airways can be helped by Trager®.
* stress management: Trager® can be a great aid in stress management; the tablework, the homework, and the Trager® self-inquiry into the possibility of an easier approach to movement and life would help.
* eating disorder: where body image and health feelings about one’s body are at issue, Trager® can assist in making a change.
* anxiety: stress related anxiety can be helped.
* depression: Trager® has helped depressed individuals feel better, lighter both physically and emotionally as an adjunct to psychotherapy and medication.
* support for healthy lifestyle change: bodywork, generally, and specifically the Trager® approach are very supportive.
* pre or post-op outpatient support, * chronic illness pre or post-op inpatient support, and * end-stage disease/hospice: touch therapy and the light touch of Trager® on areas that are not overly tender or compromised can assist in recovery from surgery or injury and help maintain movement possibility and flexibility in those who have difficulty in moving themselves either in shorter term recovery or longer term nursing care.
*the secondary effects of spasm, rigidity, spasticity, and stiffness from neuromuscular disorders such as polio, cerebral palsy, Parkinson’s disease, muscular dystrophy, ALS, rehabilitation after stroke and multiple sclerosis. Feelings of heaviness and immobility can be released; and subtle awarenesses of increased sensation and muscular control can be encouraged; and spasticity and painful muscular contractures can be relaxed.
* other: The emphasis of Trager® work on moving efficiently and freely helps high-level athletic performance, and Trager® tablework and Mentastics® promote recovery from sports related injury.
6. List any medical contraindications of your discipline:
In general, Trager® and Mentastics® as taught by Trager International are so gentle that they poses very little risk even to the most fragile client. If the Trager® practitioner has a question about safety in a particular case, this is a matter for medical clearance from the client’s physician, even if the client was medically referred. Written informed consent by the client which includes an understanding of the risks and benefits of this service is needed before preceding with the delivery of services.
Contraindications to Trager® include fresh injuries such as torn muscles, ligaments, tendons and fractures. Active thrombophlebitis (e.g., blood clots) is also an absolute contraindication. During the time of high fever or when a patient is extremely debilitated from injury, surgery, or infectious disease, bodywork should not be performed.
Relative contraindications and precautions include metastatic cancer and nerve impingements such as ruptured discs, with the exception of the patient being cleared by his physician and working with an experienced practitioner. Care must be taken when a client is on anticoagulation medication but in the absence of severe carotid artery disease, even neck movements are not necessarily contraindicated. Certain Trager® movements are contraindicated in pregnancy and pregnant women are recommended to work with a practitioner experienced in this area. There are certain movements contraindicated for particular joint replacement and bone repairs. Degenerative conditions of bone and joints call for careful monitoring of the client’s comfort with movement. Avoiding direct work on open sores, areas of active inflammation and of joint pain are common sense cautions. If a client is on narcotics or pain medications that might mask the warnings of painful movement, the Trager® practitioner should consider not initiating a session or terminating it.
7. List any contraindications based on client temperament or experience:
Severe mental illness is a contraindication, unless referred and supervised with a medical professional present.
People who have pain from or aversion to being touched for either physical or psychological reasons would have to be open and able to move beyond these feelings. It is possible to introduce comfortable movement and touch with this population with a minimum of contact. If physical or psychological abuse is unconsciously at the root of their aversion, counseling may be a prerequisite for any kind of touch therapy.
People with a lack of personal boundaries need to work with Trager® practitioners who have skills in working with these individuals.
Trager® is less likely to be effective when clients are not comfortable with this modality or if they is not interested in taking responsibility for their own health. This is problematic as Mentastics® exercises are very important to helping persons to maintain and improve their health on their own and between visits.
8. Describe what takes place in a typical session from the time the client walks into the practice room to the time the client leaves the practice room:
A Trager® session lasts about 1 1/2 hours with the initial session being a little longer because of the intake process. A typical session includes about 10 to 20 minutes of assessment and instruction in self-care movements and about 70 minutes of table work.
If I have had the opportunity to speak with a client when she made the appointment, I will go over her reason for seeking Trager® bodywork and generally assess if she has any contraindications to the work. I have every client fill out a health and lifestyle history to assist me in providing for her appropriate care; this I have her do preceding the session and have it ready for me when we first meet at the beginning of the session. I would go over the client’s reason(s) for the visit, introduce her to the approach if it is new, and go over her history and her expectations for the day’s work.
As part of my assessment of the client’s needs and present condition, I would have her show me any movement limitations she is experiencing and would suggest some self-care movements that might offer the feeling of freer movement within the present restrictions. I would limit my instruction to a few simple movements in each session.
I would explain the office layout, disrobing options and draping on the table. I have her privately disrobe to her briefs or whatever clothing she finds comfortable and arrange herself on the table and covered with a sheet. At that point I would enter the workspace and ask about room temperature, covering, and music to facilitate the client feeling relaxed and comfortable.
Each Trager® session addresses the whole body. I usually work on the front of body, then the back, and finish with the client relaxing on her back and doing a little neck work to release any tensions incurred from lying on her stomach with the head turned to the side. I try to avoid using a face rest because it limits freedom of movement.
At the outset of the bodywork, I would encourage my client to give me feedback about any discomfort she is experiencing from my touch, the movement, or the environment. I want my work to be experienced as comfortable and pain-free and I need client feedback to assure that outcome. I would instruct her that when I pause in the bodywork, it has a two-fold purpose to give me a chance to recover my own body comfort and meditative hook-up and to give her a chance to savor the residual feeling of the Trager® work in her body and deepen her hook-up. The bodywork consists of gently weighing, rocking, stretching, swinging of all the various parts of the body and integrating them through movement. I intent the client to receive a feeling of relaxed, easy, free motion through all her tissues, and I do this by how I touch and move them. The touch needs to be soft and non- intrusive, harmoniously rhythmic to the weights and elasticity of her body at that moment.
After completing the tablework, I help the client come to vertical: sitting on the table and then standing by the table and finally moving around. At each stage, I suggest the client sense the new feeling in her body and how it moves. I sometimes give additional instruction in self-care movements or do this after she is fully dressed. I remind the client about payment and schedule another appointment if she so desire. And finally, I check with the client before she departs whether her state of relaxation is disorienting and whether she is grounded enough to face the world and drive safely.
9. What do you tell prospective clients about insurance coverage for your modality? What impact does that have on your practice?
Presently in Maryland, insurance coverage for Trager® or therapeutic bodywork or massage is unlikely. A few insurance companies may reimburse the client for Trager® or massage, particularly if prescribed by a doctor; but not direct billing by the practitioner to the company. At this time Trager® is covered under Western Life Insurance Company and Oxford Health Plan as “alternative medicine.” It can also be covered if a practitioner works in a doctor’s or chiropractor’s office and is billed by the doctor under “neuromuscular re-education.” Insurance companies are beginning to look at alternative modalities; but here in Maryland even with state certification for therapeutic massage fully implemented, there is little possibility for automatic reimbursement if a claim were submitted by the massage practitioner. I offer clients receipts for payment for services, and I will write brief reports with relevant insurance codes for this type of work which they can try to submit to their insurance companies.
I personally do not look forward to the paperwork involved in working with insurance companies. I like the direct payment by clients. I don’t know how insurance coverage or lack of it impacts my practice. Most prospective clients don’t expect coverage. This may change however as I work in a hospital connected wellness center with modalities that are becoming increasingly viewed as health services.
10. When would you find it useful to confer with a referring physician or the physician of a self-referring client?
Generally, if a client can walk into my office and the gentle initial Trager® work is acceptable, medical consultation is unnecessary. If I do not understand the limitations to movement for particular medical conditions before I commence bodywork, I would need to consult with the referring physician about that client. A self-referring client with any serious contraindication to bodywork requires clearance by the client’s doctor. Usually I would ask the client to seek such clearance and provide them with explanatory material about Trager® for their doctor. I like to confer with a referring physician or psychotherapist if I am finding resistance to my work that cannot be accounted for by physical assessment or discussion with the client, given that the client is motivated to work with me.
11. What other modalities do you use regularly to complement your primary discipline? How do you introduce them to your clients?
If movement is contraindicated for some part or the body as a whole, I use Reiki to facilitate relaxation and healing. I am a Reiki II practitioner. I would, in the course of my assessment or bodywork, suggest that the still touch of Reiki would be helpful and ask the client’s permission to proceed in that way. I generally use the Trager® approach without the introduction of other modalities, not breaking the rhythm and flow of the session.
I also have a background in various forms of breathwork, used to facilitate the release of psychophysical restrictions. Within a session I might direct a client’s awareness to the movement of breath within some part of his body or suggest some self-care breath awareness exercises he might do at home. I do not initiate breathwork sessions within bodywork sessions and would be reticent even to recommend psycho-emotional release breathwork unless this inquiry came from the client. This is not a modality that I do at the Center for Health Enhancement and I do not self-refer off of site.
Beyond modalities that I personally do with clients, I make referrals and recommendations for counseling, guided imagery and expressive arts therapy, including dance, physical exercise, yoga, Chinese movement arts, swimming, and playing. I also recommend the continued exploration of how clients might make their daily life a moving meditation, taking the Trager® questions of “What could be lighter?, What could be easier? into their daily activity.
12. Please attach any citations of studies or professional journal articles documenting the benefits of your discipline. Extracts of studies are preferable as this is the form we would like to provide to physicians. Also helpful will be organizations that may be sources to obtain this information.
Articles:
Blackburn, Jack, A series of four Trager® Articles published in the Journal of Bodywork and Movement Therapies, "Trager® pyschophysical intergration - an overview," JBMT (2003) 7, pp 233-239. "Trager® - 2: hooking up: the power of presence in bodywork, JBMT (2004) 8 (2). pp 114-121. "Trager®: at the table - Part 3," JBMT (2004) 8, pp 178-188. "Trager®: Mentastics® - presence in motion - part 4," JBMT (2004) 8, pp 265-277. At: http://www.presencingsource.com/
Griffin, Joe Lee, PhD. “Trager®: Improving Physical Limitation;” “Healing with an Essential Life Signal: How do Bodywork and Meditation Help Pain?” published on the Internet; also a second article, “How Trager® Movement Education Improves Athletic Performance,” How Anybody Can Learn to Swill Well, self-published, 1989, 217-222; Internet address for these three articles and more Trager information: http://www.joeleegriffin.com/
Juhan, Deane, “Multiple Sclerosis: The Trager® Approach,” 1993 self-published, available through The United States Trager Association.
Juhan, Deane, MA. “The Trager® Approach: A Comprehensive Introduction,” 1993, self-published, available through The United States Trager Association.
Molatore, Tom; England, Jeanne, “Trager Applied to Muscular Dystrophy,” The Trager Journal, vol. 1: 4, Fall, 1983.
Partridge, Martha, “The Trager Approach as an Adjunct Therapy to Parkinson’s Disease,” a paper with two case studies, presented to the Dept. of Movement Disorders, Mount Sinai Hospital, New York, February 12, 1997, available on the Internet address: http//members.aol.com/jsteele486/private/trager/park01.htm.
Walrous, Ilene Shunfethal, MA, RPT, “The Trager® Approach: An Effective Tool for Physical Therapy,” Physical Therapy Forum, April 10, 1992, 22-25.
Witt, Phillip L. “Trager Psychophysical Integration: An additional Tool in the Treatment of Chronic Spinal Pain and Dysfunction,” Whirlpool, Summer, 1986, 24-26.
Witt, Phil, PT.; MacKinnon, J. “Trager Psychophysical Integration: A Method to Improve Chest Mobility of Patients with Chronic Lung Disease,” Physical Therapy 66(2): February, 1996, 214-217.
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.” Physical and Occupational Therapy in Pediatrics 8(4): 1988, 76-94.
Books as Reference:
Claire, Thomas, Bodywork: What Type of Massage to Get and How to Make the Most of It, New York, William Morrow, 1995, ISBN 0-688-12581-6.
Liskin, Jack, Moving Medicine: The Life and Work of Milton Trager, MD.., Barrytown, NY., Station Hill Press, 1996, ISBN 0-88268-196-6.
Savage, Fred L. Osteoarthritis: A Step-by-Step Success Story to Show Others They Can Help Themselves, Station Hill Press, Barrytown, NY, 1989, ISBN 0-88268-086-2.
Trager, Milton, MD, with Cathy Hammond, Movement as a Way to Agelessness: A Guide to Trager Mentastics, Barrytown, NY., Station Hill Press, 1987,1995, ISBN 0-88268-167-2.
Trager Information about Practitioners and Trainings:
Trager International: current training list at http:// www.trager.com
United States office and information:
United States Trager Association
13801 W. Center St Suite C
P.O. Box 1009 Burton, Ohio 44021
1-440-834-0308 www.tragerus.org
“TRAGER” and “MENTASTICS” are registered service marks of Trager® International
NOTE: The TRAGER Approach does not involve treating or diagnosing any disease, nor is it a substitute for medical attention. The TRAGER Approach uses the feeling of comfortable, rhythmic movement to educate your functional mind to release unneeded tension and balance needed muscle tone. When there is any indication of physical or mental disease, we recommend that a physician be consulted before you receive TRAGER sessions.
