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?”
“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: