You know you should exercise more: Study after study shows that it's important for people with joint and muscle diseases to keep moving.

But that's not easy to do when everyday activities - typing on a computer keyboard, reaching to get a book, bending down to pick up a baby - hurt. Or when just moving hurts so much the very thought of exercise makes you wince.

No wonder they call it dis-ease.

Chances are that your arthritis isn't responsible for all of this discomfort. It's likely that some of your pain is being made worse by habits of poor posture or improper body use that you've picked up trying to avoid pain or maneuvering to work around a stiff joint.

These faulty movement patterns may be stressing and irritating other joints and muscles, setting up an escalating cycle of pain and function loss. In fact, movement specialists even think some cases of osteoarthritis may be caused by poor patterns of movement that wear out joints which would otherwise be healthy.

A course of movement education might help get you moving again. Three of the best known programs are the Alexander Technique, the Feldenkrais Method and the Trager Approach, each named for its developer.

Each is based on developing mind-body awareness to help you recognize habits that create tension and learn new ways of moving. Each has a unique approach and attitude and teaches people how to discover and relieve tension; improve posture, range of motion and breathing; and how to correct patterns of misuse that can cause pain.

The techniques also teach more efficient ways to use damaged joints or achy muscles so that movement and balance take less effort. They teach ways to relieve joint stress by distributing weight more evenly, and they help people feel empowered by showing them ways to relieve their pain.

"When the body is used efficiently, there's less wear and tear on the joints - and less pain in movement," says Deborah Caplan, a New York City physical therapist and certified Alexander teacher who has osteoarthritis.

These programs have long been popular with athletes and performers, and have been gaining a small following among physical therapists. But there are few scientific studies demonstrating their effectiveness. Alexander is the best documented: A new study in the Journal of Gerontology showed it improved functional reach and balance for a group of older women, and participants in another study reported that it helped more with chronic pain than relaxation or other techniques.

Practitioners of each method have written about the benefits for arthritis and related diseases. Physical therapists and medical doctors familiar with the techniques often recommend them for many ailments, from stroke to multiple sclerosis to chronic pain. Kaiser Permanente, a major California health organization, offers low-cost Feldenkrais classes for patients with chronic pain.

The techniques are also recommended to help people learn to move correctly after joint replacement, for those who haven't responded well to physical therapy and for those who need more intensive work.

Less Pain, More Gain
All three of these programs are no sweat - literally. They require minimal exertion, and can be done by anyone at any age or fitness level - from those who are barely mobile to those who are athletically elite. They require no special clothes or equipment, and can be practiced just about anywhere on your own.

But these are not quick fixes. While most people feel an improvement after one session, that usually isn't enough to make a lasting change. It takes a number of sessions over time to change lifelong habits and to retrain your mind, muscles and nervous system to move your body more easily.

It's difficult to fully describe these methods, because they are subtle and results depend on the quality of interaction between teacher and student. Because these therapies are considered safe, the best way to find out if one might help is to try it.

But don't expect complete relief.

"These practices won't rebuild cartilage, but they can decrease your need for medication," says Mark Hoch, MD, a Trager practitioner who makes use of the method in his Stamford, Conn., practice. "They can help you feel better and give you tools to reduce your pain and increase your mobility and self-image."

What you can expect is to feel more comfortable in your body, to be more stable and to move more freely. You may even find that these therapies open up a whole new world of activity for you. After a few weeks of these classes, you may be ready to do yoga, Tai Chi, dance, or some other exercise with much less pain.

The Techniques

Alexander Technique: Aligning the Spine
The Alexander Technique emphasizes aligning the head, neck and spine and releasing tension to allow the body to move more efficiently. It is most effectively taught in private lessons lasting 30-45 minutes, but is sometimes taught in group sessions.

Using a guiding touch and verbal instructions, the instructor brings a student's awareness to imbalances and "habits of misuse" that lead to inefficient and even harmful patterns of holding and moving the body. While some work may take place with a student lying on a padded table, most of the lessons involve showing students how to improve everyday functions. Students learn to walk, stand and sit without strain, and to correct poor work habits.

"Alexander Technique has an immediate practical application - and people who hate exercise love Alexander, because there are no exercises," says Caplan. The technique is intended to be absorbed into daily awareness and activities.

Cost: Rates vary from $40 to $80 per private lesson; costs for group workshops vary. The number of lessons required depends on individual cases and goals, but a typical course is 30 private sessions, usually taken twice a week. Some students return every year or so for a "tune-up."

Finding a teacher: There are some 1,000 practitioners in the United States. certified by the North American Society of Teachers of the Alexander Technique

Phone: 800/473-0620 or 888/321-0856
E-mail: nastat@ix.netcom.com
Web site: www.alexandertech.com.

The Feldenkrais Method: Awareness Through Movement
The Feldenkrais method uses subtle exercises to help students discover poor habits and explore new movement skills.

The method is taught both one-on-one and in classes. In the classes called "Awareness Through Movement," a practitioner verbally guides a group through a sequence of small, non-stressful movements meant to increase body awareness, flexibility and range of motion. These sessions usually begin with students lying on floor mats, but exercises are also done standing and sitting as students discover more comfortable ways to move.

During the individual lessons, called "Functional Integration," the student sits or lies on a table and the practitioner gently guides the body through a series of movements, discovering the range of motion and allowing the student to experience free movement on a conscious and unconscious level. Sessions usually last about an hour.

"You're not taking away the disease, but you can greatly reduce your pain," says Meena Narula, a Rochester, Mich., physical therapist and Feldenkrais instructor who has had severe rheumatoid arthritis for 20 years. She credits Feldenkrais with keeping her moving well enough to operate her own physical therapy clinic, and says it is equally effective for other rheumatic diseases. She's even developed a special Feldenkrais course for fibromyalgia.

Students can do exercises on their own at home. Because Feldenkrais classes are given at different levels of difficulty, some continue to attend classes.

Cost: Private sessions cost $50 to $80; group lessons $10 or less. A private session followed by a six-week series of twice weekly classes is recommended, with an occasional tune-up or workshop after that.

Finding a teacher: Some 1,500 practitioners are certified through the Feldenkrais Guild of North American (FGNA).

Phone: 800/775-2118
E-mail: feldngld@peak.org
Web site: www.feldenkrais.com.

The Trager Approach: Contacting the Unconscious
Trager practitioners believe pain and stress begin in the mind, and work on the body as a way to change both physical and mental patterns. They work in a meditative state using touch to communicate with the client's unconscious.

In Trager table work, the client lies, loosely clothed or in underwear, on a padded table. The practitioner gently moves the body, rhythmically rocking, stretching or taking the joints through range of motion, helping the client experience what it feels like to relax and let go of tension and stress. The gentle, manipulative movements enter both the conscious and unconscious mind, changing the mental and physical experience of movement to that of relaxation and pleasure rather than pain.

A system of free-form movement sequences called "Mentastics" (for mental gymnastics) is used to increase body/mind awareness and range of motion. Some sequences are as small as shifting weight from one side of the body to the other, others involve full body, dance-like movements.

Dr. Hoch says Trager work can benefit people in chronic pain, particularly those with fibromyalgia. "Trager gives the experience of feeling better, and shows that there is something you can do for yourself about pain," he says. "When you know you can feel better, it is very powerful."

Cost: Private sessions usually last an hour and a half and cost $60 to $90. Group classes cost about $10.

Finding a practitioner: In the U.S. there are some 570 practitioners certified by the Trager Institute.

Phone: 415/388-2688.
E-mail: admin@trager.com
Web site: www.trager.com.

Good Advice
These gentle movement therapies are generally safe for almost everyone, but use common sense.

• As always, seek your doctor's or physical therapist's advice about any therapy you plan to try.
• While the costs per private session are comparable to physical therapy, these therapies are not usually covered by insurance unless given or supervised by a physical therapist or a doctor.
• Keep in mind that these therapies are not considered medical therapies, nor do they replace your current medical therapies.
• These techniques may not replace the need for physical therapy.
• Because little scientific research has been conducted on these therapies, most medical doctors and physical therapists don't recognize them as effective. (In fact, few doctors and physical therapists are even aware they exist.)
• Seek a qualified practitioner who has been trained and certified by the appropriate professional organization, and be sure he is experienced in working with your condition.
• If you have severe joint or muscle disease, you may want to choose a practitioner who is also a physical therapist, or who works closely with one.
• Don't do anything that hurts. If you are having a flare, take particular care to move carefully.
• Expect to commit to regular sessions and practice to get the benefit from these programs. New movement habits take time to learn.
• These techniques are not exercise and do not replace the need for you to take part in exercise.

Judith Horstman writes regularly about alternative and complementary therapies for Arthritis Today.