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.

 

 

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).