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I have had a very small private practice for many years and never processed insurance. I have also practiced within larger institutions who did process insurance.  Since I have formalized my private practice into a limited liability company, I have waivered back and forth regarding whether I should become a provider and process insurance, or not. I am in my 6th month of full-time practice, and I still do not process insurance.  Despite this, my practice continues to grow.

Occasionally something happens that makes me rethink my stance on processing insurance.  A client might ask about insurance or tell me they’d come more often if I took it.  They might say to me they have passed my name on to someone who could use my skills, but they won’t come because I don’t take insurance.  It may be because they can’t afford it, or merely because they think I should take it because I’m an occupational therapist. I have talked with people that are baffled by this choice, some that are irritated by it, and others that applaud me.

On the topic of not being able to afford “out of pocket” services… I know there are some who think that only the elite can afford to pay out of pocket for the services I offer.  I was a little concerned about this too. However, I have found that it is less about income and more about where people place their value. I don’t use a sliding scale or ask about salary when I intake a new client, but I do ask about the type of work they do to get a feel for how they use their body. Their job may or may not tell me about their financial status.  I don’t know about their spouse, if they have one, or their savings account, or if they have a health savings account.  (I do make sure to tell them if they have a health savings account, they can use it since I am an occupational therapist.) With high deductible plans becoming common, more clients are expecting to pay out of pocket. Most of my clients don’t question this arrangement.  It is on my website, and I don’t proceed with my evaluation until it is clear that I don’t process insurance. I don’t want any suprises. I also never pressure clients to return.  It is up to them if they find value in my services and want to continue.  If they do, they decide when and how often. I also volunteer my services to be sure I am helping people who can use my skills but can’t afford them.  I do think it is essential to give back to the community and I am working with a local non-profit to do this regularly.

I continually reflect on how I want to grow my practice and how I want to shape my life.  When you own a business, it becomes your life.  I crave a simple life, and processing insurance is NOT simple. There are many rules to follow and tasks to complete that extend far beyond client care. I want as much of my energy, creativity, time, and problem solving as possible to go into client care.  On the flip side, I could charge more and make more if I took insurance.  In the state of Nebraska, if I accepted Medicare, I could make about 40% more per visit.  If I accepted other commercial insurance products, that number would go up. However, with others, it may go down. Some pay based on the service description (CPT codes) and others pay a flat rate often based on their determination of an average treatment time (usually 30 minutes). I have also compared my hourly rate to other practitioners around the country who have the specialized skills I use in my practice. Some practitioners charge more than triple what I charge.  The practitioners are not just on the coasts where the cost of living is higher — many practice in the Midwest.  I recently had a client who found an MFR practitioner in Oklahoma for her mother.  This practitioner has much less experience and charges double my rate. Ultimately, even though I could make more money, I want do not want any insurance company dictating how I interact with my clients, provide therapy and operate my business.

Recently I had an experience that made me reflect on my decision not to process insurance.  Usually, these experiences push me to reconsider processing insurance. Many times, I have reopened my provider application to Medicare, but something always stops me. This recent experience made me dig in my heels and affirmed why I don’t.  I don’t want to share too many details about what was going on with my client, but we had a great discussion about insurance, evaluation, and documentation.

The bottom line, not processing insurance allows me to practice how I want to practice. It allows me to spend 100% of my time with a client addressing their needs exactly how I think is best (in collaboration with them of course).  The insurance company does not dictate how long each visit lasts and how frequently we meet. It cannot cap how many sessions we can work together. It cannot stop therapy if progress is slow or they deem therapy to be medically unnecessary Many clients begin with several visits, trail off, then come back intermittently as they need help.  Each client’s frequency and duration of visits varies widely.  Again, the client decides rather than the insurance company.

Insurance companies want objective information.  They want proof that a person has pain.  They demand objective reproducible, measurable information to prove a person actually has pain, and proof that the therapy being provided is making progress toward an objective, measurable goal. There is not always a clear measurable deficit that accompanies pain.  Most of my clients can do all their daily tasks.  They go to work every day. They take care of their families.  They are happy and interesting people. They have normal range of motion and functional strength. Many have had imaging tests that do not show a problem.  …and yet they have pain. Sometimes the pain is mild and intermittent and sometimes it is severe and chronic. But, they are still functional.  They must be.  Life won’t allow less.  It is the quality of their experience that brings them to therapy.  My therapist friends might ask, “don’t you use a pain scale?”.  I used to.  It just doesn’t work for many of my clients.

A pain rating is a snapshot in time. There are times when a client walks in, and they tell me they are doing great right now, but they had pain during the weekend when working in their garden or while at work lifting boxes or it wakes them up at night.  The nature of fascial pain is that it does change.  It is not always in the same place or the same intensity.  It can increase and decrease depending on the overall tension in the body.  Tension can change with changes in activities and stress.  Both activities and stress change every moment of every day.  Pain can get a little better, then worse, then better again.  The path to healing is NOT always linear. And, some of my clients say they don’t really have pain.  They describe it as tension or tightness in their bodies. So, the pain scale doesn’t really work in my practice, and I no longer use it.

I also don’t typically take measurements or use assessments of any kind.  I may do some testing to pin down an issue, or take a measurement if a client has a specific concern about loss of stretgth or motion.  I do complete an evaluation with every new client.  I get a full history, and I evaluate their body alignment in great depth. We discuss their activities, work and wellness habits. This process helps me determine if there may be a connection between their experience of pain and their life habits. When it comes to them telling me about their pain, where it is, when it hurts and how bad, I simply believe them. I don’t have to have objective evidence (which often doesn’t exist) to prove they need therapy.  If they are spending their own money to get help, I don’t need proof.  I don’t waste any time collecting information I don’t need to help them. I spend 100% of my time collecting data that will help me help them.  The information I collect is often subjective, and part of the person’s lived experience and not a standardized assessment. Each follow-up session is 100% problem solving and treatment.  I don’t need to spend time repeating assessments to prove change is happening. I simply ask my clients how they are doing, and we go from there.

Note: I am not trying to state that health insurance for therapy services is not a wonderful benefit. It absolutely is. However, it comes with many requirements that shape both the business and the services offered.  It is far better suited for diagnoses that come with measurable effects and result in clear funcional deficits.  I want to offer something different for my clients who don’t always demonstrate clear measurable impairments or have functional loss.  The common thread in both groups is loss of quality of life.  That is very difficult to measure.

As we move through the holiday season, we may be super excited about all the wonderful foods that are part of all the different traditions and celebrations occurring this time of year. We may also be cringing just a bit about all the extra calories we’ll be consuming and the additional pounds we may add before year end. Some of us may already be thinking about our new year’s resolution to exercise more. Ugh.

Many American adults make one or more resolutions. Two of the most common are weight loss and exercise. Other resolutions include managing time better, saving more, to stop smoking, spending wisely, more time with family, learning something new, etc. The downside of resolutions is that many fail within just a few weeks of making them. Why? Behavior change is hard. Really hard. We are creatures of habit and familiarity is comfortable, even if it isn’t good for us.

Let’s be more specific and discuss exercise. Why do we fail after starting a new exercise program? There are as many reasons as there are people. Some of the most common are, we try to do too much too quickly, we don’t see results fast enough, or it hurts.

It makes good sense to ease into an exercise program. It is very hard on a body to go from minimal movement to intense bouts of exercise sprinkled in with minimal movement. For example, a person who has a job sitting at a computer most of the day and then sits on a couch for much of the evening leads a very sedentary lifestyle. Even though they may be good at getting up several times a day to take a walk to the break room for coffee and spend part of the evening preparing supper and completing household chores this is still minimal movement. This movement is also very limited in intensity and type of movement. The muscles, circulatory system, joints, etc. are not being challenged. When this person decides to start going to the gym and using the elliptical machine for 45 minutes, three times a week, this is an improvement, but this person still leads a mostly sedentary lifestyle.

Going from the sitting 6 to 8 hours at the office, then jumping on the elliptical is a bit of a shock to the system. A body that is stiff from little movement can be easily injured. Sprinkling in these intense bouts of exercise into a mostly sedentary lifestyle can make success challenging. Less intense activity for shorter periods more frequently is a better way to start an exercise program. Our office worker would likely experience more success by spreading the exercise throughout the day. For instance, they may start the day by getting up early and doing 15 minutes of yoga. Then they might reserve 10 minutes of a lunch break for taking a brisk walk. Finally, they might find 20 minutes in the evening for weight training. This variety of movement and intensity will begin to create a body that is both strong and flexible throughout a wide range of motion of the joints. Only then is a body ready for intense bouts of exercise.

For many people, there is another critical step necessary before engaging in any exercise program, even a gentle program full of variety. This step is essential to the success of any exercise program to prevent pain and injury. A body that is out of alignment will break down eventually. I usually cringe when people compare the human body to a machine, but I’m about to do it. Much like our cars require proper alignment to function, our bodies do too. If a vehicle is out of alignment the tires wear faster and unevenly, belts break, we hear rattling, and it may even become more difficult to steer. When we are out of alignment, our joints wear faster and unevenly, our fascia becomes thick and we hear popping and clicking, some muscles are short and tight, and others are long and weak, our balance can be poor, and movement can feel uncomfortable.

So, what do we do? It is not as simple as just standing up straight. Each of our major joints must be examined to determine if they are in or out of alignment. The first step is knowing what proper alignment is and what it is not. The next step is knowing what to do to bring joints that are out of alignment, into alignment. Unfortunately, this process is not as simple as it is for your car. You can’t pull into the body shop, let the technician make the appropriate adjustments, pay your bill and leave in perfect alignment. It is a little more complicated but still very achievable. We have two hurdles to jump. One, of course, is our body. The second is our brain. Changing both takes time and effort. Our brain is so used to feeling our bodies being in a specific position that even the most out of alignment body can feel very normal. Even when we know what better alignment is, our brain easily settles into what feels the most familiar. This is true even when misalignment may be contributing to the pain we feel. Our brain and our body need repetition and deliberate practice to change.

Before I provide you with the best exercise for reshaping your alignment, I will first cover what proper alignment looks like. You may want to stand in front of a long mirror and play along.

1. The feet should be positioned directly under the hip bones.
2. The weight should be felt primarily in the heels of each foot and balanced evenly between the feet.
3. The middle long bones of feet should point straight forward.
4. The knees should point straight ahead and hinge in line with feet when bent.
5. The hips should be level.
6. The clavicles (collar bones) should be almost parallel to ground.
7. The sternum (breastbone) should be perpendicular to the ground.
8. Both arms should hang in line with the body with thumbs forward. The middle finger should be able to feel the seam of the pants.
9. The eyes should be level.
10. The chin should be down. From the side view, an imaginary line from the eye to the base of the skull should be parallel with the ground.
11. From the side view, the ankle joint, knee joint, hip joint, shoulder joint and the ear should fall in a plumb line.
12. From the side view, the tailbone should tilt away from the body. There should be a low back curve that allows the top of the tailbone to tilt towards the body and the bottom of the tailbone to slope away from the body.

These are some of the major body points you can actively work on to improve your body alignment. Just to be clear, you don’t want to find perfect alignment and stay in it always. Your body should be comfortable in and naturally fall into ideal alignment as much as any other posture.
Since you are probably in front of a mirror right now, see if you can identify any of these common issues I see in many of my clients.

• Feet are positioned wider than the hip bones
• One or both feet turned out.
• One or both knees are turned inwards.
• The tailbone is positioned vertically with a flat low back curve.
• One or both clavicles are angled.
• One or both arms hang in front of the legs.
• The back of the hands face forward.
• The head is forward from the shoulders.
• The head is tilted back with the chin up.

So, what is the exercise that can improve your alignment, as well as a host of other great benefits? With a few modifications, the squat. Here’s how:

• Start by finding your best possible standing alignment from head to toes.
• Stand with your feet directly below your hips and pointing straight forward. Keep the weight in your heels and balanced evenly between both feet.
• Engage your thigh muscles as necessary, so your knees also point straightforward as they bend.
• Find your low back curve.
• Start the squat by moving your tailbone backward. The motion should feel like you are aiming to sit down in a chair that is just a little too far away (without actually sitting).
• Your knees should never move forward past your toes. Keep your shins as vertical as possible.
• Keep your head and chest upright.
• You can use your arms as needed to maintain your balance at first.
• Go slow and only go as low as you can comfortably manage your balance and knee alignment on the way down and the way up.
• Stand all the way up each time aiming for the best possible alignment in your entire body.
• Make every movement mindfully. Never compromise alignment for speed.

Here are a few more ideas if you are having trouble.

• Place your hands on a table, counter or back of a chair for balance.
• Place your hands on your thighs and slide them down your legs as you squat slowly and purposefully. Feel your knees pointing straight forward. Stand in front of a mirror if needed.
• Start by dipping down just a few inches trying to go a little bit lower each time.
• Sit down onto a chair and stand back up in proper alignment and without using your hands.

Here is a short video to help you see what a well-alligned squat looks like.

Most people want to know exactly how many they should do each day. My answer is as many as you can. If they still have a questioning look on their face, I say to shoot for 100. The look on their face usually changes to shock or surprise. If you are only squatting down a few inches and coming back up, you can easily do 30 in a couple of minutes. The better you get a keeping your knees in the right place, the faster you can go. The focus should ALWAYS be on alignment and not on depth or speed. Once you have the alignment perfect, go deeper. Once you can go down as far as possible without having to shift the knees forward increase your speed. Then, increase your repetitions.

I always make one more VERY IMPORTANT recommendation. The 100+ squats should be spread out over the entire day. A few here and a few there. The brain and the body learn better with spaced practice. I have clients who do squats while on phone calls, while their coffee is brewing in the morning, while they brush their teeth, before and during walks, and many other creative bits of the day. The key is to sneak them in where you can and while doing something else. Then you don’t have to carve out particular time to work on your alignment.

We can make this exercise even better by working on the shoulder and head alignment at the same time. I recommend you don’t add these until you have the legs perfect. When you’re ready, add the shoulder stretch. When you come to the standing part of the squat turn your palms up and move your hands behind you, leading with the thumbs. Gently pull the shoulder blades together keeping the shoulders down away from your ears. Bring your thumbs and fingers as close together as possible behind you. Be sure not to thrust the bottom of your ribs forward. The breastbone should remain perpendicular to the ground. Don’t compromise this alignment trying to reach your hands together. When you move back into the squat, let the arms move into a relaxed position or a position to help you balance always trying to keep the palms facing forward or up. Once you have this perfected, add the head. As you come up to standing, gently tuck the chin and lift the ears straight up while noticing the weight in your heels.

Many people who have a flat back or tucked tailbone experience a pinching sensation when doing the squat exercise. This is part of retraining the low back curve. Never push into this sensation. Instead, think about extending the body up and elongating the space between the tailbone and head as you come up. As you do this explore how far you can go before you feel the pinch. Continually move into the curve as much as you can without the pinch.  Apply this same thinking to any discomfort you feel in your hips or knees.

This exercise will do much more for you then just realign your muscles, fascia, joints and all your other tissues. It retrains your brain as mentioned earlier. The more your brain feels this proper alignment, the more your body will naturally fall into this alignment.
Other great benefits of the squat exercise include:

• The repeated contraction and relaxation of the muscles act like a sponge, pulling more blood into the capillaries. The more blood you have flowing through your muscles, the healthier they will be.
• You’ll build muscle. Improving your strength will prepare you for other modes of exercise as well as burn more calories.
• You will balance the tension of the pelvic floor muscles which are important in urinary health nad function.
• Your heart and circulatory system will be challenged in a different way than walking. The contraction and relaxation of the muscles move the lymph. Your lymphatic system rids your body of wastes and relies on pressure changes in the body to push the fluids through. There are many lymph nodes in the groin and abdominal area, so squats are ideal for promoting lymph flow.
• It is excellent for improving balance. Try the exercise without shoes as much as you can to create more flexibility in the feet. Our feet are designed to be flexible and help us know where our body is at all times. This is critical for good balance.

To wrap up…
Do as many squats as you can throughout December, and you’ll be much more prepared to begin any exercise program you want in January!

If you feel like your body has extra challenges and you need help finding your best alignment, contact me.  As an occupational therapist I am familiar with all types of abilities and disabilities.  I can help design a movement program that meets your abilities and provides the just right challenge for you.

Happy squatting!
Amy
Mayer Wellness & Myofascial Release, LLC

How you think about your body shapes you.  Our bodies are not inherently weak with a need for protection.  They are inherently strong with a need for movement.

This blog post isn’t about loving yourself in the way you might think, although that is important.  I will not ask you to stand in front of a mirror and repeat how much you love yourself or your body.  But, I am going to ask you to reflect on how you think about your body and movement, and how you refer to your body.

I hear many people, not just my clients, but also friends, relatives, and people I run into at the store talk about how their bodies are failing them or how they need to be careful of their delicate neck, back, etc.  They reference their bad leg or their bad shoulder.  They refer to their bodies as weak, failing, old, bad, injured, frail, broken, fragile, hurt, delicate, deteriorating, etc. They refer to the damaged or painful area as “my bad leg” or “the bad side of my neck.”  It isn’t really their fault.  The media uses this language, but the biggest culprit is the retail system.  Skillful marketing tells us to protect our fragile necks with this new pillow, our aching back with this mattress, or buy these shoe inserts to protect your deteriorating feet. Our healthcare system even uses this language, but it is slowly shifting to person first language. Person first language shifts a statement about a person to place the person first and the issue second and removes labels such as victim.  Rather than stroke victim, we say a person who had a stroke.  A person shouldn’t be defined by or labeled as their illness, injury or disability. We shouldn’t define ourselves or our body parts by our illness, injury disability or pain.

I will make gentle suggestions that they try to be kinder to themselves.  It is ok to say, “the arm that hurts,” but it would be even better to refer to it as my left arm or my right knee. I might even get really over the top with some clients and encourage them to use language such as “the area that needs more love today.”  Words matter.  We should be as gentle and patient with ourselves as we would be with a small child.  On the other hand, we should also have high yet realistic expectations of ourselves and our bodies.  We should expect them to function well if we are treating them well.

I am asked very frequently about the best pillow to protect their fragile neck, the best mattress to protect their bad back or the best shoes to protect their injured feet. My response is never a product.  My clients are rarely prepared for the long-winded answer they receive. I usually begin with the statement that your (insert body part here which may be the neck, back, feet, etc.) should be flexible and strong.  If it were, you wouldn’t need to protect it with (insert product here which may be a pillow, mattress or shoe insert). You may want the (insert product) now, but if you work on increasing the strength and flexibility of your (insert body part), you won’t want or need it.

Our bodies do a heck of a lot for us.  We need to refer to our bodies kindly and feed them with not just kind words and thoughts but also proper nutrition and hydration. We also need to feed our bodies a variety of movement.

Our bodies are meant to move.  Our bodies are designed for an amazing amount of motion.  Our shoulders, hips, knees, neck, etc. can move through ranges of motion that support all sorts of activity.  We are made to be able to reach above our head by extending our arms and lifting up on our toes.  We can squat to the ground by bending our feet, ankles, knees, and hips.  We can twist our spine in diagonal patterns to reach across our bodies.

However, for most of us, this tremendous range goes unused for hours, days, weeks or even months.  But, we fully expect that when we do decide we need to reach way over our heads for the rarely used serving bowl, or stoop down and look under the couch for the dog toy everything will work as expected. Unfortunately, when we do need to move into these extremes our bodies protest, and something often goes awry.

Keep reading because I am not going to ask you to add a regular exercise program of CrossFit or gymnastics to start moving and strengthening all your joints. But, I am going to suggest that you become more aware of how you are moving (or NOT moving) your body each day. I’m also going to suggest that you have realistic expectations of your body.

Take a few moments and think about the last time you reached over your head.  Can you identify at least one instance of reaching high enough you had to lift your hands over your head in the past 24 hours?  The past week? Recent modern history? Just kidding.  This may include placing your coffee on the roof of your car while you opened the door and tossed in your handbag or reaching for your heavy sweater on the top shelf of the closet since the weather has turned chilly.  Or, maybe it was several times in the yoga class you attended twice last month.  In any case, for many of us, it is not a regular part of our day.  So, the fantastic mobility of our shoulders goes unused and begins to take on the shape of what we are doing most of the time.  How many times did you reach out in front of you to type on a computer or check your phone?  How many times did you reach forward to prepare food or steer your car?  This has become the predominant motion of our shoulders.  As a result, they become stuck in this position. The shoulder blades spread across and up the back and the humerus, or upper arm bones, rotate forward. When stuck in this position, the mechanics of this joint are completely thrown off.  If you look in the mirror and see one or both arms hanging in front of your hips and you see mostly the back of your hands, your shoulder joint is probably stuck in this unnatural position.  The fascia thickens to support the joint in this position and support the activities you do most of the time.  But, when you need to reach the sweater on the top shelf, you feel the pinch and the tweak in the joint.

This same story can be told about the hips, the feet, the spine or the neck.  Our typical day to day movements are minimal, but our expectations of these muscles and joints are high when we need them.  I’m not just speaking to people with the so-called sedentary lifestyle.  Many people in our culture with the 8 to 5 desk jockey jobs do go to the gym and get in the recommended 3-4 times per week, 30 minutes of moderate exercise. But, what type of exercise?  Much of gym-based exercise is very linear, repetitive and limited in range of motion: treadmill, elliptical, bicycle, stair climber, rower. These machines keep our bodies moving in a limited range, not even close to the variety we have available to us and occasionally need to use.

So, what can you do?  Reflect on your daily ranges of motion.  When are you reaching?  When can you squat? Can you set up your life, so you ask your body to make these motions daily or even multiple times per day?  Here are some simple ideas.

Place your coffee cups and towels on a high shelf.  Then you’ll have to reach above your head at least twice each morning.  Put the toothpaste and your pajamas in a lower drawer.  Then you will need to squat at least twice each evening.  Think about how you can integrate a twist into your day.  Can you reach across your body to reach for the soap in the shower every day?  Maybe use your left hand to adjust the rearview mirror before you back out of the garage.  Notice your patterns and mix it up.  Ask more of your body but keep it simple and part of daily life. 

I have a chin up bar in the doorway between my kitchen and dining room.  While I am pretty far from being able to do a chin up, I stretch or hang on the bar several times a day. I use my arms a lot during the day doing sometimes intense pushes and pulls.  It is great for me, but I also need to move the joint in other ranges as well. The bar keeps my shoulders limber and strong in all directions.

If you are a person who has the opportunity to move all day as part of your job, you are fortunate.  This movement will keep you healthy.  My only caution is that you be sure you are moving in proper alignment and using your body in the manner in which it was designed.  If you move a lot but still have aches and pains, check your alignment. Small changes can make a huge difference. If you are the person who sits during most of the workday, can you organize your space for more reaching and squatting throughout the day? Small changes can make a big difference.

Again. Our bodies are not inherently weak with a need for protection.  They are inherently strong with a need for movement.

Side note: As an occupational therapist, I understand there are many people who do have illnesses or injuries that have left them disabled and make the suggestions I have in this blog entirely more difficult.  My basic suggestion stands that we should all, regardless of our ability or disability challenge ourselves daily to maintain as much motion and health as we have available to us. This suggestions also extends into mental challenges, but that is another blog. Namaste.

Pillows are a frequent topic brought up by clients who see me for myofascial release (MFR).  They are often concerned if the pillow they are using is helping or hurting their bodies, specifically their neck.  Most of my clients also report they have been on a never-ending quest for the perfect pillow that will relieve their stiffness and pain.  They have tried endless pillows of varying thicknesses, fillings and price points.  They often end up purchasing an expensive pillow with dips and curves that hold their head in perfect alignment.  When it doesn’t relieve their discomfort, they are then concerned if they purchased it in the correct size.  Should they have bought the small when they chose the medium???  I frequently hear they paid so much for it, they feel the need to keep using it anyway.

A quick search on Amazon of “pillows for sleeping” resulted in over 8000 results. The most expensive pillow I could find on amazon.com was $906.00. Don’t believe me? Do a search.  The least expensive was on sale for $8.84. Pillows are big business.

There were many pillows with a full five-star review.  There are pillows directed at all ages and many different problems from allergies to migraines.  There was even a pillow for infants if you want to get started early on a stiff neck. Now, granted, I know there are some issues people have where a pillow can be very helpful and even necessary.  So, I’m not saying everyone should toss their pillow.  I’m not saying anyone should throw out their pillow.  My goal with this post is to get you thinking about your neck, how stiff the muslces and fascia are in your neck, and what you are trying to accomplish with a pillow.

The goal of most people is to get a good night’s rest and to wake up ready to greet the day feeling great and full of energy. That is certainly mine.  I will admit that I too have gone on the quest for the perfect pillow, but I never found it.  I did find a pillow I really liked after I modified it by removing about a third of the stuffing. Even then, it didn’t take away the stiffness I often felt and the occasional headache I’d have in the morning. But, it was better than anything else I’d tried, so I stuck with it until…

I was listening to a podcast by one of my favorite author and podcaster, Katy Bowman.  She mentioned that she had weaned herself off a pillow in 18 months.  Katy is very into natural movement and also has no living room furniture.  She explained how we didn’t evolve with pillows and not using one leads to more natural movements at night.  Katy reported how she gradually went from a very thick pillow to a much thinner pillow then eventually a folded towel.  At the time of the podcast, she was using an old t-shirt when she wanted something under her head. It sounded risky and uncomfortable, but I love Katy Bowman, so I thought I’d give it a try. It made sense to me from a natural movement perspective and a myofascial perspective.  It took me two weeks.

What?!  Two weeks?! How did you do it, Amy?  Well, let me tell you.  I have one of those 10” x 10” bean bags you can warm up in the microwave.  I have been warming it up for years and taking it to bed with me.  I find it very soothing regardless of the season.  I will put it where I have a little ache or pain or just let it sit on my chest and soothe me to sleep. Occasionally I’ll put it under my neck if it feels stiff.  When I decided to try not using my pillow, I put that under my neck curve while laying on my back and quickly fell asleep. The problem came when I rolled onto my side.  That just wasn’t going to work.  I had my regular pillow nearby and switched to it when I turned to my side.  That pattern continued until one night I rolled to my side, switched to my regular pillow then moved back on my back with my regular pillow and then woke with a blazing headache. It felt like my regular pillow was pushing my head forward and it was. So, the next night I decided to stick with the bean bag when I rolled to my side.  I wadded it up as much as I could and eventually fell asleep.  When I turned to my back again, it was right there for my neck curve.  I’m a very active sleeper and will sometimes roll to my stomach as well.  Nothing works well now for that position so, I use nothing.  …and it works well.  I still use my little bean bag most nights, but many nights I prefer it on a shoulder or elbow if I have a little ache or pain, so I have nothing under my head or neck.  And, it works just fine.

So, the big question… how is my neck? Is it less stiff?  Do I have fewer headaches? The answer to both is yes.  The reason I decided to try this experiment is that it made sense to me.  I am a big believer that our bodies need to be both flexible and strong, and that includes the neck.  For some reason, we are taught that our neck is so much more fragile than the rest of our body.  We need to be super careful with it. Well it if is weak, tight and out of alignment, that is true. It is more likely to cause problems and be very painful when it is tight.  If we are placing it carefully on a pillow for 6 to 8 hours each night, no matter how perfect the alignment we are creating an even stiffer neck.  We are training it to prefer one position.  That is not good.  During the day many of us go to work and end up looking a screen much of the day again, keeping our necks in one primary position.  Again, not good. The problem comes when we ask our neck to suddenly turn and look over our shoulder when we hear the dog tipping over the plant or our friendly co-worker sneaks up behind us with a surprise “boo.”  We’re not flexible enough to handle these “extreme” motions.  Extreme is in quotes because they are actually normal motions but not to a neck that is very stiff.

According to Katy Bowman, biomechanist, academic and author of Move Your DNA and Alignment Matters, when you laterally flex your neck or let your ear drop to your shoulder, they should touch.  When I Googled the normal neck range of motion, I found 45 degrees to be the most common, but I did see 60 degrees. In our culture, it is so typical to lack range that we now expect less from our bodies.  No, I can’t touch my ear to my shoulder unless I shrug my shoulder up. I’m working on it. The motion should be measured with the shoulder at rest and in its normal alignment.  If you are not sure if your shoulders are in alignment, check your clavicles or collar bones. They should be level or parallel to the ground.  If they aren’t or one is level, and one isn’t, you’ve got some tightness to work on.

Another common neck problem is the head forward position.  If you stand most people next to a plumb line, the ear will not be in line with the ankle as it should.  The ear will likely be much further forward.  There are many reasons for this common posture, but one is our use of thick pillows.  Big fluffy thick pillows are a symbol of luxury, and they look beautiful on the bed, but they are not great for our necks. They push the head forward and limit head movement at night.  Again, our bodies need lots of movement and positions to be strong, flexible and healthy.

When sleeping with a tiny pillow or no pillow your head and neck will move more.  They will not only move more, but they will also stay in different positions longer allowing the muscles, joints, and fascia to lengthen.  In addition to lengthening, you also have gentle compression forces into your shoulders when you are sleeping on your side.  Your tissues respond best to long slow stretches and why not get them when you are sleeping?  When your neck tissues are suppler, they will have better blood and lymph flow to your neck, head, and brain.  It will take more tension away from your thyroid, your vocal chords, your ears and your jaw.

It definitely takes time and effort to make lasting change in your body but making an effort to have greater neck flexibility and strength can make a huge difference in your health and well-being.  This may be from changing your sleeping habits or changing your movement habits, either way, it is worth it. If you can’t seem to make the change, get some help.  A neck that is chronically stiff may mean your fascia is tight.  If you’ve tried regular massage and haven’t had lasting change, try myofascial release.  The gentle sustained pressure will open the fascia, increase blood flow and make it easier to loosen the muscles.  This combined with regular neck movement through its full range of motion both at night and during the day will keep your neck well. 

Sleep well!