An Alexander Technique Teacher’s Back Goes Out

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An Alexander Technique Teacher’s Back Goes Out

I was sitting for morning meditation and I reached diagonally to pet my cat. “Ouch!” the left side of my back said. A few minutes later, I was in the narrow area of my house where the laundry machines are lodged, performing the complicated diagonal high/low reach to move clothes from the washer to the dryer. “Owe, Owe, Owie!” my back said. “Sh*t, Fwck, D@mn!” I replied. An hour later I was on Zoom teaching the 15th and last session of the Summer Somatics Course. I had planned to lead them through a little yoga, and reached diagonally on my desk for some water, and my body froze. “Ouch, ouch, ouch!” Sorry students, no yoga for you, no dance for me. My back had gone out in that classic, vague way that people always say. As someone who never has back pain, but helps people with back pain all the time, it is a bit hard to spasm, I mean fathom (bad pun).

Actually, I did have a back spasm once six years ago. I was taking an Afro Haitian dance class and we had been practicing one of the key steps in Petwo*. According to Wikipedia, “The Petwo spirits are considered to be volatile and hot-tempered, exhibiting bitter, aggressive, and forceful characteristics.” Certainly, the dance and the music is fiery and percussive. We had been going across the floor for 20 minutes jumping into back lunges while flipping our backs into deep arches and curves. Suddenly, I felt like someone kicked me in the sacrum, probably one of the Lwa gods, and then I could not move. My back went out.

My understanding of back spasms is that the brain judges that the movement is unsafe (or life circumstances are unsafe), and does what it is needed to take the person out, before actual injury (or illness) ensues. The spasm felt like an injury but I was not injured. The pain and stiffness came from my brain protecting me from further action.

This is not to say that percussive forceful movement might not cause a muscle or ligament to tear, a fracture or an arthritic flareup. Injuries are real.

This time, the preceding events were attending a dance class and doing Pilates V-ups. “Ouch!” said my low back. “Oh, keep going,” said my brain. Later in the class, I stubbed my toe trying to beat a petite jete, a movement that I had no business attempting given 30 years absence from ballet class. Then, I went home and did some weight training because it was on my exercise calendar. Then I spent the rest of the afternoon socializing, even though I was tired.

I woke up on Monday, and my back and toe ached. I decided to skip dance for Monday and Tuesday, planning to return on Wednesday. My schedule was brimming with dance classes, a tight 4 day timeline to get grades in for the Summer Session, an onslaught of final papers to grade, four all-day tango workshops with a master from Argentina, four new students, and the 1-week turnover to the Fall Semester. Some part of me thought it was going to be hard to get everything done, the other part of me really wanted to do it all, “Life happens now! You can rest when you are dead!”

On Wednesday, I cancelled all my private students and began the lifestyle that I would repeat for the next seven days with increasing pain. Creeping around the house, taking hot baths, moving in bizarre ways to not trigger the pain, and feeling afraid and depressed. I worried that I had torn a ligament or a muscle, pinched a nerve, fractured a vertebrae, slipped a disc, or had arthritic inflammation. After many emails, my doctor ordered an X-ray and referred me to a PT.

The $450 X-ray showed mild hypertrophy (overgrowth) of the facet joints between my sacrum and lumber spine.

My doctor emailed me the next morning saying that it was likely that I was experiencing an arthritic flareup in the facet joints of my lumbar spine. As soon as I read this, I could feel how right she was. Although the pain had been moving all over my body, from my sacrum, to my left hip, to my left psoas, to my left obliques, to my left QL, to my right QL, now I could feel with total precision how the pain was centered and burning in the facet joints of my lower spine. The more I felt into the area, the more the pain increased. I could feel it so clearly, hot, red and throbbing.

But at 8:45 am, I had a video appointment with a Kaiser PT. How could a video appointment help? Screw my crappy plebian health insurance. I needed someone to see me and touch my back, but I logged in anyway.

“Did you see my X-ray I said? “Mild facet hypertrophy at L5-S1?” I quoted the radiology report. It feels like most of the pain is localized now to my left QL.”

“We don’t diagnose that way anymore,” she said. “We don’t go by anatomy. The research doesn’t support it.” My heart warmed slightly, since I knew of what she spoke. Then she went full on biopsychosocial pain model on me. “We diagnose by asking the patient a series of questions.” And then she proceeded to do with me exactly what I do with my own students.

“Does it hurt more in the morning or evening?”
“Evening.”
“Does it hurt all the time or only during specific movements?
“Only certain movements”
“Which movements does it hurt?” She had me lean forward (ouch, ouch, ouch), she had me bend back, (ahh!).
She watched the way I was moving: Super stiff like an android, holding my back straight and descending and rising in sharp vectors using only my leg joints.

She determined that it was not an arthritic flare-up, or a tendon tear or other injury.

“Your X-ray is totally normal, and the facet joints looked exactly the same 3 weeks ago when there was no pain. The reason you are in pain is that you are moving stiffly, and you are over-focusing on the pain. You need to go back to work and start living normally, and try to move as fluidly as possible. The pain is due to tight muscles, and the reason it’s moving around is that you are moving in odd ways in anticipation of pain. Try to move fluidly.”

Who’s the Alexander Technique teacher now?

My understanding is that even with arthritic pain this is true. I see this all the time in my students. The way there are bracing to avoid putting pain into an arthritic knee actually twists the bones in a way that counters how the knee is “designed” to bend, and causes more compression and pain. Often, I can help them direct their bones in such a way that they have no pain in the inflamed joint. None of this is to say that you should ignore pain and push through it, but what you do for an injury depends on the type of injury – and the way you move with that injury will matter long term.

Ah, I said. Yes, I am very familiar with the biopsychosocial model of back-pain. This is the first time I have lived it.

I mentioned my schedule and commented that I wondered if the back spasm was related to overscheduling myself and my body acting drastically to protect me.

“Well, yes,” she said. “There’s a lot of research on that.”

Huh, I said. Huh.

I mentioned that I had taken a page from John Sarno and started journaling to see if my pain was due to blocking anger.

Huh, she said, Huh.

We set up a follow up appointment. My game plan was to move fluidly, to not brace for movements that I expected to hurt, and try to return to normal life.

Within one day the intensity of the pain was down about 50%, within two days, about 90%. Teaching Alexander Technique lessons helped a lot (who can forget that Alexander Technique is good for chronic low back pain ). At three days out, I’m still hovering at 90% and waiting for my body to decide that it’s safe enough to release those muscles.

Back pain, commented my friend Nik, is a self-fulfilling prophecy. You get pain, and your brain goes, “Danger!” and causes muscles to clench, which hurts, so your brain concludes, “I was right! Danger!” and so the pain escalates.

The next day, I decided to step up on a chair with my left leg and noticed I had almost no strength. It seemed like my left psoas was not firing. Then I remembered that this Spring I hurt my left hip in a dance class doing contemporary floor work. For about a month, flexion hurt, especially those movements you never noticed before, like lifting your leg to put on your underwear on. Owe! Then the pain went away.

I always wonder how people’s bodies can get so twisted and tensed, off-center, rigid and wooden and imbalanced, but I think I just got the personal view. Without conscious knowing, our brain changes our movement path to avoid pain, and then those accommodations never go away, and cause more problems, and so more accommodations are made, and more necessary muscles are no longer firing, and more compensations are made, until after so many years the body is rigid and twisted, with muscles physically shortened, connective tissues bunched and stiff, and the brain patterning that controls smooth coordination forgotten.

I looked at how I was stepping up on that chair with my left leg compared to my right and did what I knew to coordinate my left side. The psoas fired, the step was easy and powerful. My left leg was not weak, it was just offline. I think that my brain, unbeknownst to me, had been steering me away from using my left leg.

It’s been two weeks since I’ve dared dancing. I hope to get back to class on Monday.

As awful as this experience is, and I can say that constant pain is bloody awful, totally exhausting, souring of the mood and isolating, I have no doubt that this first-hand experience of my first full on mysterious “back-going-out” episode will be helpful for me as I help others. And hopefully, I will be more attuned to the signs of over-doing that probably got me here.

I’ll conclude with a note to myself. Dear Elyse, you have a habit of always wanting a more spacious schedule, but you book up your life to the hilt and only rest on an emergency basis. What if you tried to schedule your time more spaciously?

____
*here’s a video of the incredible Portsha Jefferson teaching Petwo. It gives me chills to watch:

Some Sitting Help

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By Bjoertvedt - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27198216

By Bjoertvedt – Own work, CC BY-SA 3.0

Stand up. Find your hip joints. Locate your “bikini” line, and find the place where, if you press into it, your pelvis will shoot back in space. That’s where your hip joint is. Note that this is just the frontal plane. Your hip joint is a 3D structure, and exists on the side and backplane of your pelvis also.

Place your thumbs in your hips joints and your hands around your leg bones, so that you can feel for the rotation of your thighs (femurs) as you flex and extend your pelvis. When you send your pelvis back in space, notice that your femurs internally rotate. You might be able to feel a slight widening in the sit bones. When you extend your hip joints, you will feel external rotation of the femurs, coupled with a narrowing of the sit bones.

You can also practice sitting in a chair. Explore a gentle motion of rocking forwards and backwards on your sit bones. Sense the widening of your sit bones as your rock forward, coupled with internal rotation of the femurs. Sense the narrowing of your sit bones as you rock backwards, coupled with external rotation of the thighs. Find a balance point with the pelvis slightly tilted forward (sit bones widening). This helps to establish the lumbar curve of your back and will make sitting upright feel much easier. The slight lumbar curve will also help to release the shoulders as the fascia of the back will tend to tug the shoulder blades down a bit.

How does this differ from how you ordinarily sit?

Most people have a hard time finding and moving from the hip joints. Do you bend your head forward or extend your chest instead of moving at the hip joint? To isolate the movement to your hip joints, it’s helpful to imagine a marble sliding down the chute of the spine. When it reaches the tailbone, that’s the moment to lean forward.

As a final note, this type of mechanical guidance does not sum up the Alexander technique, which I would frame as a holistic method for enhancing our conscious lived experience of being embodied. I offer this mechanical exploration, because so many of my students have discomfort sitting.

Knowing a little bit about the geometry of your bones can make a tiresome daily activity easier.

Response to NYT article “Alternatives to Drugs for Treating Pain”, by Jane Brody

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Body Project Blog ~
Where Thought is the Active Ingredient

Regarding the Sept 11, 2017 NYT Well article: Alternatives to Drugs for Treating Pain

I applaud Jane Brody for presenting a great list of non invasive treatments for back pain – missing from this list is the Alexander Technique, one of the few methods that has been subjected to a large  (n = 579) randomized controlled trial. Alexander Technique was effective for mitigating low back pain, both after treatment and at a 1-year follow up, as compared to both massage therapy and a no treatment educational control condition, See: Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain for details. More recently Alexander Technique has been shown to lower neck pain, and mitigate pain in knee osteoarthritis possibly due to improved gait mechanics, although admittedly the latter study has a small sample size, limiting the reliability of results.

Alexander Technique, in my opinion, is a superior intervention because it teaches mindful awareness AND a way of moving that is arguably far more efficient, that will prevent and heal the wear and tear on your body from poor movement habits, and encourage you to move more, because the act of moving has suddenly become pleasurable. To the extent that pain and muscle tension is caused by moving in an inefficient manner, Alexander Technique provides a solution. To the extent that pain and muscle tension results from mental stress, Alexander Technique also provides a solution.

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Stiff Lower back?

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Tight Jaw? Tension between your shoulder blades? Landing heavily on your heels when walking?

Make sure your rib cage is not lifted up! The cue I use in Alexander Technique lesson is to drop the xiphoid process, which is the little bony point at the end of the sternum. If you look at the image to the left, the xiphoid process is highlighted in gold. You can imagine it like a pendant hanging straight down, or joke with yourself that it’s rude to point your xiphoid process at someone.

If the xiphoid process is sticking out, it will cause you to lean back. If it is dropped towards the ground, you will find your weight centered on your feet, and that your arms and shoulders are freer to swing when walking.

If the xiphoid process is sticking out, it will prevent you from exhaling fully, and of course, inhaling fully. Observe how letting the xiphoid process hang affects your breathing. It’s a very tender spot in the body. It lives in front of the heart, lungs and diaphragm. You might even experiment with feeling a bit like you are burying it inside your body on the exhale.

Even though you feel more relaxed, you might suddenly start to worry that you are slumping! Go ahead, lift your xiphoid process back up to see what your habit of good posture is.  Does this feel super stiff and tense? Go back and forth until you can feel the difference between your idea of good posture and the reality of efficient body mechanics.  If the head drops when you drop your xiphoid process, that’s just information that you’ve been lifting your chest to keep your head up. Instead, imagine a tiny laser pointer on the crown of your head pointing to the ceiling. Use imagery, not your ribcage to lift your head.

In lessons, I work with my students to understand how correcting a local “part” of the body affects the whole to create better posture, balance and breath.

Body Project Blog ~ Where Thought is the Active Ingredient, by Elyse Shafarman

 

According to Jane Brody, the NY Times Well Columnist, Posture Affects Standing, and Not Just the Physical Kind

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Body Project Blog ~ Where thought is the active ingredient, by Elyse Shafarman

“A distraught wife begged me to write about the importance of good posture…” So begins Jane Brody’s most recent NY Times Well column, Posture Affects Standing, and Not Just the Physical Kind.

Brody outlines the usual problems that lead to poor posture, i.e. stress and bad furniture (car seats, iPhones and heavy bags), and she runs through the usual solutions, don’t slouch, tuck or over straighten the natural curves of your spine, and if this is difficult, sign up for a course of core training to strengthen all those tired muscles that have forgotten how to do their natural job. But Brody misses the one technique that solves it all, that ties together our modern thirst for mindful awareness and our basic human desire to live without pain, i.e. The Alexander Technique.

I encourage everyone who wants to learn how to stand effortlessly, with good posture and zero fatigue or pain to run to their nearest Alexander Technique teacher. Don’t hesitate. Now is the time to sign up for a course of lessons. To find a teacher in your area, visit The American Society for the Alexander Technique website.

Alexander Technique is a set of skills that helps all people, regardless of age, health status or physical fitness, be comfortable in their bodies. All the basic movements of life – sitting, standing, walking and sleeping become easy again.

Even better, the Alexander Technique does not require that you set aside extra time in your busy life. It’s a handy form of mindfulness that can be practiced in the midst of everything – while standing in line, idling in traffic, making lunch for your kids, sitting in meetings, riding your bike, or even reading this blog.

And, the Alexander Technique is not purely physical. It will help you understand the link between your thoughts, emotions and muscle tensions. You will grow in self awareness.

While we can’t always have perfect furniture or perfectly amenable circumstances, once we learn the Alexander Technique we always have the power to be comfortable and at peace in our own skin.

To learn more about the Alexander Technique feel free to contact me for a complimentary 15 minute phone consultation 415-342-6255

 

Why Study Alexander Technique?

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10487410_10204190998279179_5402076236014725919_nJoy!

Many people come to the Alexander Technique because of pain. The Alexander Technique is an effective tool for overcoming pain. You learn how to align your body and reduce pressure on inflamed tissues and joints. You learn how to move efficiently and avoid further damage. You learn how to calm your nervous system and exit the positive feedback cycle of pain, stress and more pain. Alexander Technique is one of the few alternative health modalities whose beneficial effects on back pain have been verified by a large-scale randomized controlled trial (BMJ 2008;337:a884).

But, I never came to Alexander Technique for pain.

I studied Alexander Technique, because like FM Alexander, I was passionate about an art form. He wanted to act. I wanted to dance. After an Alexander lesson my dance technique was infinitely better in ways that no amount of stretching or diligent work in dance class ever approached. Through Alexander Technique, the chronic tension in my neck, shoulders and spine released. My hip joints were magically free. My balance was effortless. My jumps floated. My turns never stopped. My creativity flowed.

I was also always very curious about psychology and the relationship between what you think, how you feel, and how you move. Alexander Technique was the key to that invisible link between thought, impulse and action.

Why study Alexander Technique?

  • To perform at your peak
  • To perfect your art
  • To discover Joy in your body

Body Project Blog: Where Thought is the Active Ingredient!

 

*Photo by Holly Glenn Whitaker

Practice tip: sitting at work

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How many different ways can you sit? How many different ways can you stand?

The top row of this poster, “Think Outside the Chair“* might give you some ideas for ways to vary sitting and standing poses. If you have the latitude at work, don’t limit yourself to chairs. Stand up, sit on the floor or even lie down for some of the time.

Are you practicing sitting in a chair without back support? It’s easiest if you’re sitting quite high up (on a bar stool for example). The greater the angle between your legs and torso (approximately 120 degrees might be ideal), the easier it is to sit upright. The closer your legs and torso are to making a right angle, the more strain it puts on the back. Sitting on the corner of a chair (pointy edge between the legs) is an easy way of getting on top of your sit bones. This also helps your back.

Chose about 4 different sitting positions and 4 different standing positions and consciously rotate through them during your day. It’s really hard on the body to hold the same position for 8 hours, but not so bad to sit and stand in a bunch of different ways.

Slumping is not so bad if you do it CONSCIOUSLY as a rest for a minute or two, versus hours at a time. You can also rest your back muscles by rolling your spine forward over your legs, hanging your head and breathing into your back. Even better, take a break and lie on your back in Constructive Rest for 5 to 15 minutes.

Leaning back on the chair is fine if you feel tired. It helps if the chair back does not also lean back, because then you will be likely to push your head forward to see what you are doing. You can prop yourself up against the chair back by placing a pillow under your shoulder blades and upper back (vs. supporting the lumber spine). This also helps create a little traction between the top of the pelvis and the lower ribs, which stretches out the low back.

In any position, it always helps to give your AT directions: “Let my neck be free, to let my head float up so that the back of my neck is long, to let my spine lengthen and my back widen, to let my knees direct away from my hips, to let my heels go down, to let my shoulders expand to the sides…”

For further help, contact your local Alexander Technique teacher!

Body Project Blog: Where Thought is the Active Ingredient.

*Credit to biomechanist Katy Bowman for popularizing this image taken from, “World Distribution of Certain Postural Habits, Gordon W. Hewes, American Anthropologist, New Series, Vol. 57, No. 2, Part 1 (Apr., 1955), pp. 231-244

Why does 3-D breathing help back pain?

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“For some reason, my lower back was giving me hell, and then I remembered the 3-D technique. I did that for a few minutes, and it’s really amazing how quickly it relieved my back pain.”

If your back pain is due to poor posture, freeing up the breath will automatically support better postural coordination in the torso. Breathing is a movement akin to an internal massage. Observing and expanding your breath will help the muscles of your belly, back, and chest loosen. Your spine will have room to expand.

If your back pain is due to ischemia, which is a lack of blood flow, deeper breathing will support the autonomic responses that increase blood flow to tissues.

If your back pain is caused by psychological or emotional triggers, slower, deeper breathing will circumvent stress reactivity, and help you get off the stress/pain feedback loop. By regulating the breath, you automatically regulate the physiological aspects of stress. Your heart rate will slow. Your blood pressure will drop.  The flow of adrenaline will dial down, and within moments or minutes, the agitated mind catches on to the calmer physiology.

Although this video is in French, the images need no translation. It’s easy to see how breathing is a 3D body experience.

 

 

 

 

Practice tip: 3-D Breathing for Back Pain

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A student emailed me this morning to say, “I just wanted to let you know that the three-dimensional breathing technique you taught me saved my back yesterday.”

3-D breathing, adapted from Betsy Polatin’s wonderful new book, The Actors Secret, helps you experience optimal movement of the ribs and torso during breath.

Try 3-D breathing:

1. Front to back dimension: Place a hand on your belly and a hand on your low back. You will naturally feel your belly expand and deflate as you breathe. You can also feel more subtle movement in your low back. Visualize more of the breath movement happening in your back. This will help widen and relax the back muscles. Do you feel more movement in your back after visualizing?

Next, bring a hand on your sternum and a hand on your back near your shoulder blades. If your shoulders are too tight to easily reach your back, you can place a hand on a friend’s back to feel their breath movement. Yours will be similar.  Remove your hands and sense your own breath movement. Did you know that most of your lung tissue is in the back of your body?

2. Side to side dimension: Place your hands as comfortably as you can on your side ribs. Feel the horizontal expansion of your ribs as you inhale. Feel the deflation of your ribs as you exhale. Stay for a few breaths. Remove your hands and sense your rib motion.

3. Bottom to top dimension: Place a hand above your collar bone on your uppermost rib (yes, there’s a rib above your collar bone!). Place a hand below your sit bone or at your perineum. Feel the rise of the upper ribs, and the fall of your pelvic floor as you inhale. As you exhale, you may feel the pelvic floor rise and the spine lengthen upwards. If you can’t sense anything at first, take a few big breaths as if you were at the doctor’s office. Once you get the feeling, breathe normally. Then remove your hands and sense the movement.

Which dimensions of breathing are familiar to you? Which do you use rarely?

Does the act of noticing your breathing automatically improve the quality? Is your breath smoother, deeper, or easier in any way?

In your day-to-day life, start by sensing one breath dimension at a time. Can you sense your breath while talking on the phone, eating, or texting?

 

Body Project Blog: Where Thought is the Active Ingredient.