Let’s take a moment and leave the world of judgment and enter the world of curiosity. In this article, I will address how proprioception, the unconscious perception of how the body moves in relation to space, can be utilized in the treatment of patients suffering from eating disorders.
A natural judgment would be to assume that movement is antithetical to eating disorder treatment. Those suffering from eating disorders often have poor or toxic relationships with movement itself and use movement as a means to increase caloric deficits, thus exacerbating their illnesses.
The question I would like to raise is this:
How can patients hope to rebuild a relationship with movement while in a treatment setting if movement is absent from their treatment plans?
I contend that the use of movement is instrumental in the recovery process. I will be discussing how environmental stimuli are catalysts for achieving self-awareness within movement. Rebuilding these connections can revitalize patients’ relationships with themselves and their bodies.
What is movement?
Movement is academically defined as general activity or an act that changes physical location or position. However, movement is so much more than that. In a group setting, I use basic body-weighted movement and lightly weighted movement to evaluate and encourage my patients’ relationships with movement and space. I challenge each patient to focus solely on themselves while moving in a set environment (usually defined by an exercise mat). “Be selfish with your movement.” I say this because comparison to others in a group setting could be deleterious.
This may seem counterintuitive as eating disorders are seemingly self-centered diseases; however, eating disorders are actually very complex. The general population normally thinks of these disorders this way because we believe that it is always about modifying their bodies for aesthetics; but, as an example, it can sometimes be about someone wanting to be able to fade into the back and not be seen. It can also be a form of self-harm; it could be about someone wanting to gain attention because they feel unheard or unseen: “no one knew I was depressed or struggling, so I starved myself so they would notice”. Knowing this, there could be a chance that their disorder might not be indicative of their relationship with movement at all.
For the clients who do have a disordered or toxic relationship with movement, I observe the following behaviors to appraise a patient’s connectivity with movement and their progression through treatment.
- Is the patient mimicking the person next to/in front of them?
- Is the movement or movement pattern correct?
- Is the tempo consistent or erratic?
- Is the movement spasmodic, or is it smooth and fluid?
- Is the patient having a visceral reaction to the movement and is this reaction positive or negative?
My observations allow me to categorize three behavior types to look out for and correct over time. Something important to remember; clients who are weight restoring may feel like they are in a foreign body while in motion in this group. So, any behavior type can go from one to another.
The three behaviors I’m going to talk about are, Compulsiveness, Avoidance and Excessive. It’s good to remember that these behavioral types are not the only ways to categorize relationships with movement, but rather the ones I tend to use most frequently.
Normally seen counting every repetition without exception to maintain control of the situation, these clients can’t allow themselves to do an uneven number of reps on each side because they fear asymmetrical body development. Additionally, any disruption to an exercise or changes in tempo will cause anxiety.
This type of client has difficulty allowing themself to enjoy movement. These clients do very well with positive reinforcement and notice improvement, however small. These types of clients do very well with checking in before group to see how they are doing and setting goals or intentions before the group starts.
One of the most effective goals for this type of client might be something along the lines of allowing themself to just be present and enjoy the group while trusting the process. They also do well with mid-group check-ins like “how do you feel, where do you feel the exercise at/ what muscle do you feel activating while in motion?”
A client inclined to avoid movement is reluctant to participate in directed movement at first. This may be because they have abused movement in the past or do not believe they have progressed far enough in treatment to allow themself to participate. etc. The movement-avoidant client may see movement class as a reward they are not deserving of.
This client does very well with setting small weekly goals, it could be as small as being able to do 3 out of the 10 stretches. They also respond very well after seeing progress in different aspects. For example, a client who could not touch their toes 2 weeks prior and now has the ability to, or the client coming from doing 1 push-up and now being able to do 5. This also builds a lot of self-confidence and gives a lot of validation.
This type of seen behavior is when a client moves at a very fast pace while in group. Movement may act as an emotional catalyst that elicits a physical response. Their relationship with movement is driven by obsession and overexertion.
For this client, I have them sync all movements up with belly breathing with a rhythm. One example is 4-1-4 breathing. A four-second inhale on the eccentric phase, a one-second pause, and a four-second exhale on the concentric phase. This allows the client to slow down every movement and really focus on connecting with their bodies and learning how to truly active the working muscle groups.
Changing over time
Sometimes patients shift from one behavior type/category to another during treatment. For example, someone who has been shown to have Compulsive behaviors surrounding movement may start to show some level of avoidance or even excessiveness as the original behavior is being worked on. For each of the observed behaviors, there are many different skills or cues I use to rein clients back in.
Realistically, movement isn’t just about “movement”, it’s also about building confidence, setting and reaching goals, and taking small steps to increase overall awareness of oneself—physically and mentally. It is about building better relationships with oneself and overcoming past trauma. Building love and appreciation for the body you’re in and the way it moves in different spaces and situations.
There are many dynamic relationships clients can have with their body and movement. Movement is a vital part of eating disorder treatment, as all clients will leave treatment and be active in some way. With movement groups as a regular part of the treatment process, we can get them ready for anything.
Eli McCary is a movement specialist at Galen Hope, where he runs the corrective exercise, strength, and condition movement group for bone and joint health. He is a vibrant health and wellness professional with diverse knowledge in periodization movement programming. One of the things he is most passionate about is helping others regain their ability to enjoy the freedom that comes with doing movement and helping rebuild a positive relationship between the movement and the person doing it. Eli is a kind and exuberant person who will try his hardest to make sure you feel both welcome and always heard. The one thing that he is most certain about is that no matter what, you will have fun in his group.