Trager Approach

Health Tips / Trager Approach

What Is It?

Also known as Trager work or Trager psychophysical integration, the Trager approach is a unique method of “body education” that involves extremely gentle and painless hands-on manipulation of the limbs, joints, and muscles by a trained practitioner. It also includes the teaching of free-form movement sequences to increase body awareness and enhance agility.

The aim of this therapy is to impart a physical message to the unconscious mind that movement can be effortless. The Trager approach has been found to be particularly useful for chronic neuromuscular ailments, such as back and neck pain, as well as stress-related conditions, such as headache.

The Trager approach was developed almost by chance in the 1920s by Dr. Milton Trager (1908-1997). As a young man growing up in Miami, Trager dabbled in gymnastics and dance, and eventually began boxing. After a workout, he often received a sports massages from his coach. One day Trager offered to give the tired-looking coach a rub down in return. The man was amazed at how rejuvenated he felt afterward. Trager then tried the same thing on his father, who suffered from chronic sciatica; the sciatica cleared up after two sessions.

These experiences encouraged Trager to begin experimenting widely with massage, treating people with ailments that ranged from back pain to polio. His work eventually led him to become a physical therapist, and he continued to improve and refine his technique. In his fifties, Trager became an M.D., and when he was almost 70 he began to teach his approach to others. In 1980 the Trager Institute was founded in Mill, Valley, California, and Trager continued to teach there and throughout the United States and Europe until his death in 1997.

Today the Trager Institute is the only international organization providing certification in Dr. Trager’s method. There are currently some 2,000 Trager practitioners in the United States, Canada, Europe, Israel, Africa, Australia, and Japan.

How Does It Work?

The therapy is based on the premise that discomfort, pain, and a reduced range of movement are physical symptoms caused by accumulated tension. This may be the result of trauma, weak posture, fear, emotional blockages, and/or stress. The feelings of lightness, openness, and peace that the technique induces are believed to resonate through the nervous system. Not only does this ease tension but it also changes the unconscious mental and physical experience of movement to one of pleasure rather than pain.

There are two components to the Trager approach. In the first, known as tablework (because the work is done on a special table), the practitioner gently and rhythmically rocks, shakes, and stretches various parts of a client’s body, loosening tight muscles and painful joints. This rhythmic movement also gradually induces a state of deep relaxation. Once relaxed, the person experiences just how pleasurable it is to move freely–a key step in learning to break free of restrictive muscle patterns associated with physical tightness and pain.

During the second part of a session, the practitioner teaches the client simple sequences of movements, which can later be done at home. Called Mentastics by Trager (short for mental gymnastics), these movements are designed to reduce tension and increase physical mobility. Unlike most exercises, which are done to improve strength or endurance, the goal of Mentastics is to achieve a relaxed, meditative state.

What You Can Expect

At the first visit, a Trager practitioner will typically take your health history and explore any physical problems you are currently experiencing. The practitioner may then discuss how you’re feeling emotionally, since part of the treatment will involve helping you make connections between your state of mind and your physical problems.

For the tablework portion of the session, you will lie on a padded table, dressed in loose-fitting clothing that allows you to move freely. To better concentrate on you, the Trager practitioner then enters a meditative state (in Trager parlance called the “hook-up”). This allows the practitioner to more easily find areas of tension in your body and to feel your response to the treatment.

According to Dr. Trager’s principles, the calm, peaceful manner of the practitioner’s “approach” is just as important as the technique itself. No oils or lotions are used. The practitioner moves your muscles rhythmically and lightly, lengthening and shortening, sliding, rolling, and flexing them. The movements are never forced and you should feel no pain. You should also begin to experience an invigorating sense of deep relaxation.

After the tablework, the practitioner will teach you some simple Mentastics movements in order to improve your awareness of your own body. Depending on your ailment, you may be asked to dangle or swing your arms or legs, shift your weight from foot to foot, or do big, dancelike movements. You will be encouraged not to resist or control these motions, but to “let go” completely.

The practitioner may also suggest that you ask yourself some key questions while you’re doing the movements, such as “What can be freer, lighter, or softer in this movement?” or “What could make it more beautiful?” And though it may seem as if you are hardly doing anything physical, each movement is carefully designed to integrate mind and body and thus develop the power of your unconscious.

A typical Trager session lasts from 60 to 90 minutes. The number of sessions required will depend on your ailment. Some people feel better after just one session, but most people benefit from the cumulative effects of five or six once-a-week sessions. You will also be encouraged to do the Mentastics movements on your own. Two or three 10 to 15 minute sessions of Mentastics a day are recommend to start.

Health Benefits

The Trager approach is particularly useful for relieving the everyday stress that can build up in the muscles and joints. With its emphasis on self-awareness skills, the method is especially good for situations in which the physical patterns of stress recur due to an ongoing emotional cause. In addition, the particular hands-on technique used by Trager therapists can be especially beneficial for difficult nerve and muscle problems that have not responded to other body-centered approaches, such as chiropractic, massage, or traditional physical therapy.

To date, no major controlled clinical research has been done on the Trager approach, although a few small studies have appeared in physical therapy journals. As with other “alternative” body treatments, scientific studies are difficult to conduct due to the small numbers of practitioners who are available to work in clinical research situations.

Nevertheless, those who have benefited from the Trager therapy report that sessions can ease tight muscles and joints, while providing a simultaneous feeling of relaxation and vitality. Some athletes credit the Trager approach with helping them focus, improving their stamina, boosting their speed, and making their movements more graceful. Because the therapy can also improve flexibility, it may help prevent injuries.

In addition, the Trager approach appears to be beneficial for those with chronic neuromuscular pain, such as sciatica or back pain. It also has been used to treat hypertension, migraine, and anxiety disorders.

Some practitioners also report success in treating people with carpal tunnel syndrome, polio, muscular dystrophy, Parkinson’s disease, and other disorders that cause weakness or paralysis.

How To Choose a Practitioner

As with all body-centered therapies, the success of Trager work is dependent on the skills of the practitioner. The therapist must be able to guide you into a deeper awareness of your body’s chronic tension habits and their relationship to your current and past stresses. Indeed, this can be as important as the bodywork itself.

Most practitioners come to the Trager approach with a background in massage or other bodywork techniques, but some have health-care or mental health backgrounds or practice Trager work as part of conventional physiotherapy. You may be able to get references to a Trager therapist from your current health practitioner or from prior clients of a particular Trager therapist. When you find a practitioner, be sure to start with a get acquainted visit to determine if the therapist’s approach is right for your needs.

It is also important to look for a practitioner certified by the Trager Institute, which maintains a database of certified practitioners worldwide. In order to achieve the degree of Certified Trager Practitioner (CTP), a trainee must first undergo Trager therapy sessions themselves, and then complete more than 250 hours of training. This typically takes one to two years. Once certified, a practitioner must participate in continuing education. Your insurance company may cover part of the cost of Trager treatments if the Trager practitioner is also a licensed health-care practitioner, or if your plan has a “by physician referral” option that allows for nontraditional rehabilitative procedures.


Under the guidance of a qualified professional, the Trager approach is considered safe for most individuals. It’s always advisable to consult your doctor for a diagnosis of your condition before seeking treatment.

Women in their first trimester of pregnancy should avoid Trager sessions.

If you have a history of thromboembolism (blood clots), do not undergo Trager sessions.

Do not use the Trager approach if you have had joint surgery within the last three months.

If you have rheumatoid arthritis, be sure to tell the practitioner to avoid inflamed joints.

Some patients with a history of psychological trauma may become anxious as relaxation deepens. Be sure to tell the therapist if you experience anxiety during the therapy session. It is possible that you may need the care of a mental-health professional for treatment of anxiety related to physical symptoms.

Individuals with continuous muscle tension may experience mild muscle soreness for up to 24 hours after a session.

Be well,
David Edelberg, MD