Heel Pain – Mystery Solved!

My friend, a one-time avid tango dancer and current expat in Germany, has been staying with me for a few weeks. She burst into the living room one evening and said she was having persistent heel pain. She thought she was landing harder on her left (non-dominant) heel because every time she took a step on her left foot, the heel hurt. Worse, every morning her feet froze into stiffness. The morning walk to the bathroom was closer to the arthritic shuffle of an elder than a fit 42-year old. “Can you help me Ms. Alexander Technique Reembody Expert?” she asked.

“Why yes,” I thought, “I probably can.”

Usually we tend to be a bit ginger with our non-dominant leg*, so I was curious to watch her walk.

By Connexions – http://cnx.org, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=29624326

I observed that she was not landing harder on her left heel. Instead, she had a habit that almost everyone has with their non-dominant ankle: weak plantar flexion. Plantar flexion looks like pointing the foot, but the movement happens at the ankle joint, not the forefoot or toes. The result of weak plantar flexion is that you end up pushing down on the ground with your forefoot, the same way you push down on a gas pedal. This pushing action can cause hammer toes, which she was starting to develop, and tight plantar fascia.

Dare I say the terrible word that we all fear…plantar fasciitis? In a way, my friend was lucky that she hadn’t diagnosed herself with a case of this. There is little doubt that if she had thought she had something as dreaded as plantar fasciitis, the pain, the inflammation and the physical compensation patterns would have all multiplied due to a sense of bodily threat.

I had her sit down on the carpet and we compared her ability to plantar flex the right and left ankles. Sure enough, the movement was smooth as butter on the right side, but feeble and hard to organize on the left. After some trial and error, and a little Alexander Technique hands-on  help, the left side got the hang of it.

She got up and walked. The left leg was behaving differently.

“I don’t want to give you too much cueing,” I said. “Too much thinking will interfere with coordination.”** But then I gave her one cue. I couldn’t resist. “Notice if you are pushing down with your left forefoot. Don’t do that. No gas pedal foot.”

Two days later she came in, excitedly waving her shoes. “I have a story to tell,” she said. “See! Look,” and she pointed at the shoe wear. The right sole had a dark indent from hard heel strikes, the left none at all. She reported that in just two day of practicing plantar flexion, the heel pain was gone, and she was no longer waking up with stiff feet. The absence of the morning hobble felt strange. She had grown so used to it.

How is it possible to change a habit and come out of pain so quickly? We are taught in all disciplines that changing habits takes repetition, practice, attention and a lot of time.

Sometimes, when we discover efficient ways of moving, it’s as if the new pattern already existed, perhaps as something we did when we were children, before tight shoes or tango shoes and life’s pressures caused us to grip. Perhaps this is an issue of neuroplasticity, which turns out to be faster, more flexible and more adaptive than one could ever imagine.

“Plasticity happens rapidly…too fast for the brain to grow new connections. It’s more likely that unused pathways are unmasked when sensory inputs are changed, as from wearing a blindfold for five days. Over time, such plasticity changes can become permanent.”
(p.86, The Body Has a Mind of It’s Own, Blakeslee & Blakeslee, 2007)

Still, how could two years of chronic pain dissipate in two days? Researchers know that pain can diminish long before tissues fully heal, and debilitating pain can occur in the absence of injury due to an over sensitized nervous system (p. 71 Explain Pain, Bulter & Mosely, 2013). Reduction in threat mediates both the experience of pain and tissue inflammation. If the new way of moving provided more security than the old way, a feeling of safety may have been enough to reduce the pain and inflammation. Maybe.

I admit that the above paragraphs are speculative, but instant sticky change has been my experience learning and now teaching aspects of the Reembody Method alongside Alexander Technique. Admittedly, quick lasting change doesn’t always happen. This is not a problem. The slow method, which include mindful awareness, steady practice, concentrated thinking about causes and conditions, and artful contingency plans when triggers trigger, well, that’s great stuff. It works. As a teacher, I like to have a variety of tools in my box

 

*Imagine having to step up on to a high a ledge. What if you were also carrying a bag of groceries? Which leg would you use to step up? Most people would choose their dominant leg because it feels stronger and more secure. We tend to push with our dominant leg and baby our non-dominant leg.

 

**If you try and swing your arms in opposition to your legs as should happen naturally when walking, you will probably find that you have no idea how to walk.

 

 

Just call me a body nerd

Dancing in SF Carnivale 2018

I crossed some boundary in minimalist footwear yesterday. I clambered over Bernal hill in my flimsy sandals, whilst purposefully stepping on rocks to massage the stiffness out of my overtaxed dancer feet. Back when foot reflexology was in fad, I remember reading advice to hike barefoot. The rocks and gravel were supposed to stimulate key meridians. I thought this was nuts, but now, I’m not far behind the trend. My feet felt fantastic this morning, and body nicely tuned up for dancing. Obviously, the Body Nerd meridian was stimulated

Noticing that my Central Nervous System (CNS) finally stopped throttling my movement range. For months, hip pain and low level depression stiffened every part of me. I couldn’t get low in plies or high in jumps. I thought my age was catching up to me. But the brake is off. Elasticity is back.

Picking up my handstand play a year after elbow injury. If I include a tiny pelvic pendulum as I kick up into handstand I have much better balance and control. The pelvic pendulum is the figure eight motion the hips make in gait. My hips felt free to adjust to the balance vs locked and rigid, as they do when I, on purpose or due to stress, employ the more common handstand cue to, “Squeeze the butt.”

Yes, injury and pain is somewhat a theme in this post. As I dance, I am in constant conversation with my body. I use the Alexander Technique, and everything else I know to keep learning and moving.

Helping a Dancer with Foot Pain

Blond woman smiling over her shoulder at the camera.Today I helped a dancer with foot pain using Reembody Method. She had pain in the balls of her feet from dancing in heels. The pain was more intense in her left foot, which was her non-dominant (ND) side. As she described her situation, I was forming a picture in my mind about what her steps might look like, and how her ankles and feet moved.

Frequently, dancers are instructed to push the back foot into the floor, almost like the foot is an oar in the ocean. This has the counter-intuitive result of stalling forward momentum, while dispersing unwanted force into the tiny bones in the balls of the feet.

We were working online[i]. I observed her walking. Then she lay on her back with pillows under her knees. She followed my instructions to plantar flex her left ND ankle. Plantar flexion looks like pointing the toes, but the action is isolated to the ankle joint while the toes remain completely relaxed. It can be surprisingly difficult to uncouple these movements.

I could see where she was having problems. To create the pointed shape, she was pushing her forefoot down as though pressing on a gas pedal, with minimal movement in the ankle. The action I was looking for requires sliding the heel bone along the floor towards the body by shortening the Achilles tendon. The Reembody method predicts that people will have a harder time organizing this movement on the non-dominant leg, which seemed to be the case. So, I had her switch legs, and try it on her right dominant leg.

Piece of cake.

Next, she practiced a sequence of upper and lower leg rotations on her right D leg that I thought she would need to improve the launching[ii]capability of her left ND leg. According to the Reembody Method, we tend to stop using our ND leg as an effective launcher, and the bones spiral in directions that make this leg trend towards bending and weak force production. It gets a bit soggy. Over time, the ND side grows dormant, and we end up doing almost all the work of locomotion and support on the D side of the body. You can observe this by watching people walk. Since most people are right legged, watch how people post over the left leg. Observe how the left leg tends to rotate out and doesn’t land under the center of mass.

Then I had her rest. Rest is an important part of learning new skills.

Then I asked her to visualize the movement sequence on her right leg, followed by visualizing the sequence on her left leg, followed by performing the movements on her left leg.

Piece of cake.

The two sides the body learn from each other, due to the chiastic nature of the nervous system – stay tuned, that’s another blog.

Next, she stood up and commented that the left leg felt longer, more stable and easier. I could see that she was allowing it to bear more of her body weight.

Then we translated the actions of the leg on the floor to the way the leg moved during gait. I had her position the left leg behind in the “pushing off phase” (but please don’t push off the foot, remember we don’t have oars). As she drew her heel bone up away from the floor and shortened her Achilles tendon, she allowed her shin, thigh and pelvic bones to spiral as we had practices. “I feel less pressure in the ball of my foot.”

Bingo!

True, she’s got a bit of homework to integrate this new way of moving into dancing in heels, but the beauty of Reembody Method is that newly learned movement sequences are “sticky,” meaning, the body adopts them quickly and unconsciously. This is surprising and different from most training models. Usually repetition, reward and effort are needed to build a new habit. We think, but don’t know for sure, that Reembody works more quickly because the movement sequences provide the central nervous system (CNS) with an immediate feeling of safety, hence we gravitate towards the new movement. It’s only under heightened stress, that we are likely to revert to the old inefficient patterns and will need to again practice the optimal joint rotations.

This is a small example of how the Reembody method can be used to solve pain, and fine-tune our movement for better living, sports performance and artistic expression.

I’m teaching an introductory class at Berkeley Rep starting July 10, where as a bonus you will also learn methods from the Alexander Technique.

Join me!

 

[i]Many Alexander Teachers do teach online but it is still quite controversial in our community. It takes many years of training to get the special quality of directive touch that marks an AT teacher’s hands. That touch is an art from, and many feel that without it, the technique loses its integrity and heart. I remain neutral on the topic, but for now chose to teach Alexander Technique in person, and use an online platform for other forms of mindful movement training.

[ii]Launching is the moment the back foot leaves the ground and springs forward. In the arms, you might think of it as expressing or releasing force, for example the moment an arm explodes forward in a punch or to throw a ball (to be discussed in a future blog).

Shoe talk

Getting minimalist shoes is something to think about – but certainly not a requirement.

I wrote this for a student with osteoarthritic knees. We’ve been working on correcting the way her leg bones spiral when bending and straightening. The correct direction of spiral removes the pain completely. This has been going well, so I felt it was time to address the subject of her so called “healthy shoes”, ultra padded running shoes replete with motion control, arch support and a hidden 1.5-inch heel lift.

To get the knees to work better, it’s going to help if the feet and ankles can do their job in the most unfettered manner possible. When we go barefoot, the foot can change shape and adapt more flexibly to different surfaces and different physical demands. The intrinsic muscles of the foot get strong and flexible. The forefoot and rear foot have the freedom to counter twists appropriately between inversion/pronation and eversion/supination, depending on the stage of the gait cycle. This means that ground reaction force moves up through the body in a way that creates powerful stored elastic tension and spares the joints from pain and wear. Restrictive shoes might jack up the heel, limit foot motion via arch support, control pronation, squeeze the toes, among a few of the  impositions on natural movement.

We tend to think of our hands as sensitive intelligent instruments and our feet as bricks that we shove into padded casing. Your foot has 26 bones and 33 joints. The sole of the foot is a rich landscape of sensory receptors. Our feet have evolved to move in a myriad of directions and relay a rich schema of environmental data to our brain. In shoes with very padded soles, our sensory feedback is diminished. In the absence of good data, the brain protects the body by tensing the feet, ankles, knees, and everything above.

You can test this out. Wear only one sock and have one barefoot foot. Walk around your house. Notice the difference in how your two legs move. Which leg is freer and more fluid? Which foot feels secure? Which leg do you trust? Which limb feels pleasurable to use? If your answer is the side that’s barefoot, you have just discovered the impact of better proprioceptive data on physical movement.

You can assist this process by using a foot roller or other implement to wake up the sensory receptors in the skin of your feet. If you google wooden foot roller, you’ll get dozen’s of results.

Minimalist shoes offer less support and protection to the foot, and can take a while to get used to. I recommend starting with only an hour or two at a time to help the intrinsic muscles of the foot adapt to the new level of work demand.

Personally, I like
Vivobarefoot
Earthrunners
Softstarshoes
Xero

Flip flops, although they appear minimal, can be a problem because it’s necessary to squeeze the toes to keep the shoe on. Same thing with clogs. You want your toes to only have to do the work they were meant to do.

And hey, summer is coming. Time to go to the beach and feel the sand between your toes.

P.S. As a final note, it is possible to use your feet well, or at least better, while wearing fashionable shoes. This is the sort of thing that I help my acting students work with. It’s reasonable to choose aesthetics over function to survive in our culture from time to time. I tend to save my fashionable shoe time for tango or the occasional date night. The rest of my life, I like to let my feet roam free.

Photo by Jordan Whitt on Unsplash