Are Your Clavicles Where They Should Be For Pain Free Movement?

How You Think About and Refer to Your Body Matters

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? 20180929_184037Just 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.

20180930_135605Place 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. 20180929_183928

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.

 

Break the cycle. Redesign life.  What does it mean?

Maybe you have noticed this tagline on my website. Perhaps not. I thought long and hard about a motto, slogan or catchphrase for my business and this is the result. I did not put it through a rigorous focus group evaluation process, so I’m not sure if the public understands what I mean. Hence, my next blog post.

What does it mean?

Break the cycle. This portion of the phrase is referring to the pain cycle. Over the past 27 years, I have seen many clients and completed countless ergonomic evaluations.

I was almost always called in to do an ergonomic evaluation because someone was experiencing pain. Unfortunately, it was quite rare that I was asked to complete an assessment to prevent a problem, but that is the way our healthcare system works. As I would talk with the person and evaluate how they use their equipment, I could get a clear sense of how much their work equipment and work habits have contributed to the pain they are experiencing. I could also get a pretty good feel for how willing they were to change their work habits. All this information, combined with years of experience helped me make a recommendation on whether they should seek out additional therapy or not.

For many people, a few tweaks of their workstation set-up and some changes in their posture, they are good to go. Their pain should settle down quickly. These are the folks that notice a pattern between their work and their pain and aren’t afraid to speak up. They notice they hurt while working, and they feel better over the weekend or while on vacation. They also notice this pattern early in the process and don’t just wait to see if it goes away. It might be their neck, back or hands that hurt. It doesn’t matter much where the pain is located. These people probably don’t need any therapeutic intervention such as occupational or physical therapy. Improved work habits will settle things down.neck pain

The next group is similar, but perhaps they need more changes to their workstation or work habits. They have also let things go longer. This may be because they didn’t want to make a fuss at work or they are just too busy to make the time for an evaluation. They are generally very fast paced folks who are a little more ingrained in their work habits. These folks will likely struggle a bit more to make the necessary habit changes which will, in turn, take more time for the pain to subside. I will often give them a little more support by offering some stretches they can do to help them to break the pain cycle.

Then there are those folks that have been experiencing pain for many months or even years. They may have also seen their physician and been prescribed pain medications or a splint. Their work habits may not have even been on their radar screen as a cause of the pain. Or, maybe it did, but they didn’t know they had the option to change. These folks need more help and support breaking the cycle. In addition to recommending changes to their habit and workstation, I also suggest they seek out therapy. The pain they are experiencing will probably not go away with changes in the work they do, at least not for a long time. Breaking the cycle takes more. Seeking out help from an occupational or physical therapist will help break the cycle and support hem through making changes at work.

I actually see all four categories of people in my practice now. People who are seeking myofascial release to prevent pain and primarily want to be sure their bodies are functioning optimally do occassionally find their way to Mayer Wellness, LLC. These folks are rare, but there is a shift happening. More people are thinking preventatively. It does take time, energy and resources but it is possible to design your life to focus on prevention.

The majority of my clients fall into the other categories. They are experiencing pain somewhere in their body and want help breaking the cycle. I may be their first stop in this process, or I may be one more therapy in a long line of traditional treatments, alternative medicines, and medications. There are so many people with pain and almost as many options for managing it. Most of the people that end up in my office are seeking not just to break the pain cycle but also figure out why the pain is there in the first place.

Although I hate to admit it, my skills are limited (tongue in cheek). My skills and my scope of practice are certainly limited. I can’t diagnose medical conditions. What I can do is help people work backwards through old injuries and surgeries, evaluate their posture and body alignment, evaluate their holding and body tensing patterns, evaluate their habits of movement during work, leisure and exercise, evaluate their stress and how they manage it, and finally evaluate the tension in their muscular and fascial system. Through this process, we connect the dots and create a hypothesis about where the pain may stem from. From there we begin to redesign their life.

The redesign process may be limited to reducing the tension in their tissues through myofascial release (MFR) techniques. For others, the redesign process may mean changing postural habits. Others may need a lifestyle make-over adding new methods for stretching their bodies or managing stress. For one client it was as simple as changing the way she sat on the couch with her family in the evening to watch movies. This simple redesign and a few MFR sessions broke her cycle of back pain and had her back on track.

Many people don’t know they have control and options beyond medication to manage and even eliminate their pain. And, these people aren’t unaware because they aren’t intelligent. While working at Creighton University and providing ergonomic evaluations, I helped heads of departments, physicians, attorneys and even exercise science faculty sort out their ergonomics and get rid of their pain. These folks most certainly have plenty of smarts. What they don’t have is my skill set. They have their own area of expertise. The attorney I helped undoubtedly wouldn’t expect me to be able to represent myself in court (should the need arise). I call on her to help me with that aspect of life.

Sometimes my clients, past and present, feel “dumb” that they didn’t recognize their poor posture or a movement habit I point out. I remind them of their own area of expertise, and they aren’t expected to know it all. They have me. And, when the time comes that I need something in their area of experise, I may call on them. In fact, I have. I have served technology professionals, physicians, nurses, physician’s assistants, architects, engineers, massage therapists, teachers, spiritual directors, teachers, moms, grandmas, plumbers, receptionists, delivery drivers, coders, executives, business owners, marketing professionals, caregivers, students, office managers, therapists, security professionals, athletes, stylists, dog walkers, optometrists, and many more.

Each person brings a perspective that consists only partially of their professional knowledge. Every individual has a set of beliefs about what it means to be healthy and well and what will help them achieve it. I learn so much from hearing their ideas and perspectives on wellness. Most are very open to my recommendations and whole-heartedly implement them to the best of their ability. The clients I am blessed to work with are very enthusiastic about simple lifestyle redesign ideas that will empower them to take control over their pain. It is exciting when they report back… wow, I feel better.

So my goal and the goal of Mayer Wellness, LLC is to help people…

Break the cycle.

And…

Redesign life.

Does Your Pillow Affect Your Fascial System? Yes, and I Don’t Use One.

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.

beautiful-beauty-bed-914905

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.  adorable-baby-beautiful-1172937I’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.  attractive-beautiful-beauty-179737If 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. bed-bedroom-carpet-90317They 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. simon-matzinger-633741-unsplash

 

Sleep well!

 

Muscle or Fascia: Which is tight and how do I know?

A client recently asked me when she should see Pam, whose practice is primarily myotherapy versus me and receive myofascial release (MFR).  A follow-up question was how she would know if she has tight muscles or tight fascia or both.  What a great blog post discussion!

I share office space with my long-time friend Pam O’Connor LMT (licensed massage therapist).  She owns Myotherapy and Massage, LLC and has practiced for over twelve years.  We have several clients who see us both.  Some alternate their visits seeing me one week and Pam the next.  They feel this rhythm keeps them feeling their best.  Others may start their bodywork journey with Pam, and she sends them to me if she suspects fascial involvement.  Others begin with me, and I send them to Pam for follow-up.  Some schedule us back to back seeing me first to open the fascia and them Pam to dig into the muscles.  We encourage our clients to experiment with the bodywork they receive and determine which intervention and what intervals keep them feeling great. We have clients that come in many different intervals and some that settle in with either Pam or myself on a regular basis.  We encourage them to choose which suites their body best and assure them we are okay with whatever they decide. Depending on lifestyle, history of injury, or diagnosis, the frequency of visits can vary widely.  Then there are the clients who just pop in when they have a flare-up then disappear till the next.  Everyone is different.  While we, of course, encourage regular wellness visits, we understand this doesn’t always fit into everyone’s busy lifestyle.

I asked Pam to explain myotherapy in her own words.  Here it is. Applying pressure to specific trigger points in the muscles to fatigue tight muscles which are often the cause of pain.  The force also helps to elongate the muscles to release the spasms.  Treatment decisions are made based on the cause of the flare-up and the location of the pain.

Myotherapy was developed by Bonnie Prudden, a fitness expert, and rock climber, in 1976.  Pam had the good fortune of attending a workshop led by her before Ms. Prudden passed away in 2011. I have received myotherapy from Pam many times, and it is NOT a fluff and buff massage, as Pam calls it.  It does get deep into the muscles.  She holds each pressure point for a few seconds then lifts off and moves to the next.  If there is a particularly tender area, she may revisit it a few times throughout the session.  I find it very effective as do her many other fans, I mean, clients.

Pam has sent clients to me for many years. She  says she decides to recommend MFR to her clients if there is very little “give” in the muscles or if there is greater than normal discomfort with pressure. That is her indication there is likely significant fascial involvement. Another indicator is when the client reports they felt better for a while, but the pain snuck right back up on them after a day or two.  If they continue to report this trend after several visits, she will recommend MFR or a combination of MFR and myotherapy.

I asked Pam how she explains MFR to her clients.  She has received MFR from me many times so has first-hand knowledge of the experience.  She likes to describe it as a full-body stretch right where you need it.  She will explain how fascia is much like the white stuff around a chicken breast.  Imagine if that was very tight around the muscle rather than just encasing it.  This explanation helps them get a general idea.  She will then give them my card and direct them to my website, my brochure, or me for more information.

Once a client has decided to try MFR, they are often surprised at the differences in the process and the sensations.  After we go through the evaluation process and the client climbs on the treatment table they are often surprised when I ask them to lay face-up with their clothing on. Right away they are noticing this is entirely different from myotherapy or massage. (I do ask them to bring a sleeveless top and loose shorts or sweats.)

I like to introduce MFR through an arm pull.  I will pick up their arm and hold at the wrist and elbow. I explain that I will gently pull until I feel all the slack taken up, but I’m not dragging them across the table. I ask them to feel into that sensation and identify where they feel the tension. They are often surprised when they notice tension somewhere other than where they expected.  Occasionally, clients report feeling the tension in their chest, back or even further from their arm.  As I continue to pull, I ask them to notice how the tension softens or changes.  As they tune in, they often report they feel the tension go away or shift to a new place in their arm or body. This “tuning in” process helps the client feel tight places in their body that may be contributing to the pain they are feeling. It helps them understand the interconnectedness of the fascial system and their pain may be a whole-body issue and not just a localized problem.  I also use this information to inform where I work on the body and which technique I will use. Barnes calls this the “fascial voice”.  I often move from one area of the body to another depending on what the client is feeling in their fascia.  Where in myotherapy there are patterns that are followed based on the location of the pain or the original cause.

An additional difference between myotherapy and MFR is the time the technique is held. In MFR, once the “just right” tension is placed on the tissues it is held for several minutes. As a release occurs, the therapist follows the tissue and maintains the tension waiting for additional releases.  In some cases a release can be very linear but in many cases the release can move in a very non-linear pattern.  So, in both myotherapy and MFR the therapist must be very present in order to feel into the tissues and provide the appropriate depth of pressure for the technique.

To answer the original question, this is an excellent way to differentiate tight fascia versus a tight muscle or muscles.  When the fascia is tight, pressure or tension in one area often results in sensations that do not fall in line with the muscles. Clients are often amazed when they feel this in their bodies.

Another clue that the problem may be in the fascia is when clients also report the pain they feel is vague and it is hard for them to say exactly where they feel it.  They may also indicate that the pain or sensations seem to shift around or don’t seem consistent from day to day, yet it is always there. The web-like structure of the fascia will pull and compress differently depending on the tension and positioning in the rest of the body.

Another indicator that the problem is in the fascia is not getting results from traditional stretching or exercise. The fascia doesn’t respond to conventional stretching. You may get temporary muscle lengthening, but if the fascia is tight, it will be pulled right back where it was.  If you hold your stretches for a few seconds, you are not getting into the fascia.  The fascia responds best to a long slow stretch.  The stretch must also be at just the right tension.  While I’m working on my clients, I ask them to pay attention to how much pressure I’m putting into their bodies so they can learn to feel what the just right amount of tension is so they can transfer the sensation to their home stretching program.  I have clients who tell me they stretch all the time but still feel tight.  Once they learn how to stretch their fascia, they get much better results.

I would be remiss if I left out a critical consideration in understanding the tightness in your body and how to improve how you feel.  How you hold your body and how you move your body throughout the day (and night) will make or break your success with any form of bodywork.  If you don’t understand how to improve your body alignment during rest, work and play no matter what you do, you’ll be back.  If you are chronically holding and moving your body out of alignment, you may start with tight muscles, but your fascia will quickly follow.  To break the cycle of tightness and pain, you must learn to use your body the way it was designed to move.

Myofascial Release and the Forces of Life: Stand-Up Workstations

Should I have a stand-up workstation?  I get this question ALL the time.   My answer… it depends.  Side note: My first-year students at Creighton really dislike that answer, but it is soooo true. Humans are pretty darn complicated. The students eventually get it and use the same phrase when explaining how occupational therapy works to their clients, families, and their own students.

What does it depend on? Your alignment, my friend.  And, your understanding of what your body needs related to movement. So, it depends on your knowledge of ideal body alignment combined with the body’s need for movement. This blog is NOT about treadmill workstations.  Although there is some research that says they may be good for you, most of us either can’t afford them, or our cubicle is way too small.

Why do you need proper alignment?  If you take a body that is not in proper alignment, then move it from sitting to standing, you add a host of additional forces on that body.  Imagine toes that point outward and ankles that turn inward?  Then the knees almost face one another and are slightly bent or hyperextended.  Maybe one of each! Of course, we must add the butt tuck.  Think this alignment is uncommon?  Nope.  I see it quite regularly in my practice and places like the grocery store. Yes.  I’m looking.  I can’t help it.

When a body is out of alignment and then asked to perform daily tasks such as standing at a desk for hours at a time or walking the dog, we experience forces our bodies were not designed to handle on a regular basis. Now is when your fascia steps in and saves the day, sort of. When your fascial system detects trouble, such as repeated forces on a misaligned joint, it will tighten up to protect the joint. Thank you, fascial system, for helping me function even though I’m out of alignment!  Yeah!  But, there is a cost.  Your fascia is connected from head to toe and fingertips to fingertips. When it is tight in one area, it affects the entire system. You may not even feel anything unusual in your misaligned ankle, but you have a tugging sensation in your lower rib cage.  This is how fascia works. It really is all connected.

This person may seek treatment for pain in the rib cage.  Traditional therapy and logical thinking based on our current textbooks would lead you to treat the rib cage. First, we must make sure they have seen the appropriate health professional to rule out any medical causes such as a tumor, of course.  With so much research coming out on the fascial system, we must look beyond the rib cage.  We can start at the ribs and probably make them feel a lot better very quickly.  But, they’ll be back.  Why?  We haven’t addressed alignment and the tightness around the misaligned ankle.  So, no one gets out of my office without a clear understanding of where they can improve their alignment and how.

So, back to the stand-up workstation. If you are going to sit or stand at your workstation for many hours per day, you must understand and practice proper alignment.  But, a huge but, you can’t stay static in that perfect alignment all day long.  You must consider your best alignment posture your home base. Hang out there.  Learn to feel comfortable there but vary from it regularly.  The more comfortable you are in proper alignment, the safer you will be in other positions. I suggest exploring as many different positions as possible that you can get away with at your workplace.  If you have a door that closes and people don’t come to visit you often, that can be a lot of positions.  But, if you greet the public all day long in a professional work environment, you are likely to be pretty limited if you want to keep your job.

Even if you are limited, there are some easy things to do to keep moving but first let’s discuss ideal body alignment in a stand-up workstation. Your feet should be pointing straight ahead. Reach down and find the long bones in your feet.  Point the middle ones straight ahead. Now place them directly under your hip bones.  Feel the bones.  Most people overestimate the width of their hips. If you feel pigeon-toed in this position, you have work to do.

While we’re working with the feet, let’s discuss shoes.  Choose the lowest heeled shoes possible.  This applies to men and women.  A heel, any heel, will tip you forward.  You will compensate all the way up the chain of joints in your body.  The compensation may be small, but we are talking about a lot of time.  Small misalignments over long periods of time can cause problems.  Let’s skip up to the knees. If we get them in proper alignment, we’ll likely pull the ankles right along.  Make sure your knees are pointed in the same direction as your feet, straight ahead.  For some people, this takes a lot of effort and coordinating muscles they haven’t used in a long time.  You must use the muscles in your thighs and hips to pull them into alignment.

Next, check your hips and your pelvic tilt. Finding the correct angle can be challenging to do yourself if you have been out of alignment for a long time.  Most people tuck their tailbone.  Reach around and feel your low back. You should feel a gentle curve in your spine.  Your tailbone should angle away from you, not under you. Before we move up any further, shift your weight to your heels.  Stack your knees and hips over your heels.  Avoid putting too much pressure in the front of your foot for too long.  The large bone in the heel can bear this pressure.  The smaller bones in the front cannot.

Now that your weight is in the heels stack your shoulders on top of your hips, knees, and ankles.  Pull your head back, too.  Your ears should be over your shoulders. Be careful that you are not just tilting your ribcage back.  Keep your ribs still and bring your head back.   Next, reach and feel the base of your skull.  Tip your chin until your eyes are level with this point.  If you are straining about now, think like you must look weird or feel like you might lose your balance backward, you have more work to do.  Stand up workstation

Finally, the shoulders and arms. In sitting or standing, they tend to be the source of quite a bit of trouble.  To get them in best alignment I’m going to walk you through a few movements.  First, be sure the rest of your body is in best alignment from your feet to your head. Gently squeeze your shoulder blades together and keep them as far down away from your ears as you can. Turn your palms up, bend your elbows to about 90 degrees.  Keep your elbows at your side and rotate your shoulders, so your hands are out to the sides. You are now externally rotating your shoulders. Feel that position in your shoulder joints.  See if you can maintain as much of that feeling as possible and while keeping your elbows close to your side, slowly move your hands as if you are going to type on a keyboard. That my friends is proper arm alignment.  As you slowly release the effort of holding your shoulder in that perfect position, notice where your shoulders gravitate.  If they round forward, you have more work to do. If you found this confusing, you can watch my short video on the shoulder alignment stretch.

As we said earlier, this alignment is your home base.  Vary from it regularly.  Step away from your desk and sneak in a brisk walk with a lot of arm swing as often as you can even if it is just to the water cooler and back.  Stretch your arms above your head and rotate your wrists.  If you can paint the bubble without attracting too much attention, paint it as often as you can.  If you are not sure what that means, see my short video. Painting the bubble is easy to do if you are reading from your monitor.  It feels amazing.

Have something under your desk to step one foot on occasionally. Use a yoga block, an old book or binder or a fancy ergonomic footrest. I like to have something I can move around easily so I can either step on it or use it to stretch my calves. I have another video on calf stretching that is great to do while at your standing workstation or any other time of day.  Stretching your calves qualifies as movement at your workstation.  Do it!  Shift your weight, slouch a little, cross your ankles. It is all good as long as you’ve worked on proper alignment enough that it comes naturally to you and feels as comfortable as any other position you can contort your body into.  If you can achieve and hold proper alignment easily, get going on that stand-up desk. They are awesome.  If you can’t figure out or easily hold proper alignment, get some help.  Your investment in proper alignment will serve you well beyond your stand-up workstation time.

Mayer Wellness, LLC Introduction to Alignment Workshop Series

Myofascial Release and the Forces of Life: Mental, Emotional and Spiritual

We are shaped by the forces we experience: physical, mental, emotional and spiritual.

A while back I wrote a little about some of the physical forces shaping our lives. Those are generally the more obvious, but I would argue they are not the most significant. Let’s reflect on the less physical forces that shape our bodies and our lives.

This article is about meditation, but it will take us just a bit to get there. Please read on.

As an occupational therapist, I am trained to observe people’s habits and routines. As an ergonomist and skilled observer of activity and alignment, I am continually watching how people move. But, I’m not just observing their bodies for proper alignment. Their postures also give away their mood, their attitude and their sense of self. Their facial expressions and hand gestures (or lack of) speak volumes. And, (here’s where I hope I don’t lose some of you) often we just feel it. People are energetic. They give off a vibration, a vibe. I would presume that many of you, especially my occupational therapy friends, can tell instantly when your client comes in the door (or you walk in theirs) how they are feeling. You pick up the vibe. Whether you believe that a picking up a vibe means a sense of another’s energy or just a skilled observation and snap decision of many visual clues, please keep going.

In my classes I teach the concept of matching, pacing, leading to build rapport with clients. It is a common management strategy. I teach students to not just barge into a client’s room on full blast with their 100-watt smile and a chipper attitude. It may not at all be what the client needs. I ask them to enter with empathy and notice how the client is feeling. If they are also vibe-ing (yes this is a made-up word; I’m blogging not writing a scientific article) high then let that 100-watt smile loose. If they are not, settle in and adjust your vibe more in line with theirs. This is matching.

From here on out, you can begin changing the pace. As occupational therapists, we have many strategies to do this, but our most powerful is our therapeutic use of self. We listen. We engage with the client. We help them find meaning and create priorities. This is pacing.

As we engage the client and being to notice their vibe (attitude, mood, willingness to make eye contact, facial expressions, the tone of voice, etc.) changing, we can continue to pace the interaction in a more positive direction skillfully. This is leading.

The goal is to lead them to a place where they feel empowered and are willing to participate in therapy and in life. It may just be for this moment or this 30-minute visit, but it is a start. Sometimes a little traction is all that is needed to move forward. After all, life is about moving forward. When we are burdened by mental, emotional and spiritual issues, this can be very challenging. We end up being still and closed in on ourselves. Our postures change, and we don’t move. Our muscles and fascia become stiff. We feel yucky. Lifting our vibe enables movement which is critical to health.

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In this scenario, when a client doesn’t want to participate or are vibe-ing low, we are often dealing with mental, emotional or spiritual issues. They may be frustrated due to pain or because the stroke they experienced has changed the way they look and feel. They may be fearful they will not be able to engage in life the same way. They fear the loss of a meaningful life. These issues are often much more significant barriers to participation than the physical ones.

As occupational therapists, we have our own barriers. How do we handle this? We are not only dealing with our client’s issues, but we also have our own. We are people too. We can’t always separate our life from our work. We bring our family issues, financial concerns and our own aches and pains to work with us every day. They don’t go away when we walk in our client’s room. Some of us are better than others at putting our own issues aside and putting on that 100-watt smile mask no matter how we really feel. That is not, however, the best answer. What is the answer? Meditation.

Learning to meditate may be the best decision you’ve made in a very long time. And, sharing that skill with your clients may be the best intervention you’ve provided, maybe ever. It doesn’t take much of a deep dive into the literature to see the benefits are being studied and the outcomes are positive. Here is a short article in Psychology Today that links to specific articles if you want to dig in. Or, you can always go to the National Institute for Health.They share several studies for meditation with specific diagnoses such as pain, blood pressure, and anxiety.

When I work with my clients, every new client, every time, the first thing I teach them is diaphragmatic breathing. And, I check in with them regularly if I don’t see diaphragmatic breathing being used during our follow-up visits. I emphasize how diaphragmatic breathing will make the treatment more effective. I show them that this is the foundation to meditation and focusing on your breath helps to calm the body and the mind. Every client I work with also has stress. Shock. I have never had a client that was not open to learning to breathe better.

Why should you learn to meditate? It is good for you. And, you can more effectively teach your clients. You are a role model, and they will ask you if you meditate. If you can honestly say yes, they will be more likely to trust you and be willing learn from you.

girl-praying-hands-eyelashes-41942 meditate

Learning to center or ground yourself before walking into a client’s room can change everything. You will be more receptive to your client’s vibe. You will notice more. You will listen more intently. You will make better decisions. What does it mean to center yourself? Basically, it means being completely in the present moment. Letting go of the past and future concerns. Calming your emotions. Noticing and physically feeling what is around you such as the ground beneath your feet.

Letting go of past and future concerns is probably the most challenging part of centering yourself. But, it is only for a short period of time. Never fear. You can go back to worrying when you step out of the client’s room. Learning to meditate is what gives you the power to turn it off and the power to focus on the here and now. When you learn to focus on the present for short periods of time, you can learn to do it longer and longer.

How can you use it with your clients? First, teach them to breathe. When they aren’t up to much of anything, they still need to breathe. Educate them about the benefits of diaphragmatic breathing. Evaluate how they are breathing. Are they using their diaphragm or their chest muscles? Once they are focusing on their breath, you can tell them they are already meditating! They are being fully present and in the moment. Hearing they are already meditating is often very surprising to my clients and it may be to yours too. If they are already using prayer or reflection, they may be surprised to hear those can also be considered forms of meditation. These baby steps open the door to a willingness to learn more.

The next step is educating your clients about using breathing and meditation to manage stress. It is helpful to begin dispelling the many myths about meditation. You don’t have to sit cross-legged. You don’t have to wear a robe. You don’t have to chant. You don’t have to meditate for hours upon hours to get the benefits. And so on and so on. You can also let them know there are many forms and styles of meditation and it is very likely they can find one to suit them and their lifestyle. Of course, you should always be respectful of any religious or cultural beliefs.

Do your homework or attend a class on meditation to learn the many options you can offer your clients. There are many forms of breath work. Some meditation practices focus on our different senses such as vision, hearing, taste, and smell. There are body focused meditations. Additional meditation styles us imagery, gratitude, and even movement. As you may offer your client many different options for exercise, you can provide just as many options for meditation.

It just so happens, I offer a short workshop designed to expose you to a variety of meditation options. The workshop also covers how to prepare the body for meditation and how to develop your own personal practice. For therapists, we’ll also discuss how to use meditation as an intervention in occupational therapy practice in any setting.

pexels-photo-344102 friendsThis article used the scenario of an occupational therapist and a client. However, you can substitute many different situations here. A parent and child. A manager and an employee. A teacher and a student. Friends. We are all connected and learning to be fully present for ourselves, and each other is indeed the best gift we can ever give anyone.

Myofascial Release and the Forces of Life: Physical Forces

We are shaped by the forces we experience: physical, mental, emotional and spiritual.

Whether you view this statement from a neuroscience perspective or good old-fashioned logic, it can spur a significant amount of reflection should one allow themselves time to do so. Let’s begin our reflection with the physical forces.

What physical forces shape your body? Start with a reflection on how you spend your time. There are some primary categories I consider as an occupational therapist.  Many of us divide most of our time between some combination of caring for ourselves and others, work, and sleep. These days, if we are generous with ourselves we also squeeze in leisure, play, and social participation.  I’ll toss in one more category that is often left out, travel.  We spend a lot of time in our cars driving to work, running errands, and getting family members where they need to be.  With all those categories, where do we start?  With furniture, obviously!  We may all divide our activities differently between the categories of life, but a common denominator among us and our activities is furniture.  We use it at work, in our homes, in the community. Furniture is a massive physical force in how our bodies are shaped. How?

Let’s start at home.  Almost every American home has a couch.  Some call it a sofa, a davenport (yes, I just heard someone use that the other day), a lounger or futon if you still have your college furniture.  The softer and cozier the couch, the better, right?  Reflect for a moment on how your body is shaped when you sit on your couch.  Or, better yet, look at your friends or family members who are on the couch next to you.  What shape is their body when they are sinking comfortably into the couch for a binge session of Netflix? My guess is the letter “C.”  Their feet are up on the footrest. Their tailbones are tucked under pulling their lower spine flat.  Their heads and shoulders are rounded forward occasionally looking down to check their phone.  couchFrom an ergonomics perspective, this is categorized as an awkward posture.  Awkward postures are a risk factor for potential injury.  Having one risk factor doesn’t necessarily lead to an injury.  The likelihood of injury increases when you layer one risk factor on top of another.  With our love of couches in this country, the risk factor we layer on with our awkward couch postures is time. How many hours do you spend on your couch?  If you have more than two or three favorite T.V. shows, the answer is probably too much.

Let’s reflect further on our furniture and our sitting habits.  The next most common place we sit for many of us is work (paid employment).  If you are lucky and have a job that allows you to move for a large portion of the day, sitting may not be an issue unless when you do sit, it is not in good alignment.  You may have access to ergonomic chairs in your workspace, but do you know how to adjust them for you?  In my experience, many people either do not know how or do not take the time to adjust their chairs to their individual needs.  As a result, there is less than ideal positioning for many hours at work, day after day. Even in the best possible alignment, prolonged sitting is shaping your body in a manner that makes movement more challenging.

Next, let’s reflect on travel.  How well does the seat of your car (your car furniture) support you in proper alignment?   I’m not asking if you are comfortable.  Are you in proper alignment? There is a big difference sometimes.  Sitting in a car, especially if you are in the driver’s seat, there is a lot of asymmetrical action going on.  There is rarely adjustable lumbar support unless you can afford a car that has that fancy option.  Even then, most cars are made with the average man in mind, so car seats are not always adjustable enough to meet everyone’s needs. Next time you are driving, evaluate your sitting position.  Are you able to achieve a nice curve in your lumbar spine and stack your head on your spine appropriately? Is your weight evenly distributed through your hips?  Or, are you spending your travel time in an awkward posture with your tailbone tucked and your head and shoulders rounded forward?

Let’s briefly touch on leisure and community sitting options.  Most restaurants, movie theaters, church pews, coffee shops, etc. do not supply furniture that supports and promotes proper alignment. seats It is up to us to notice this and do the best we can with what we have.  I’m not suggesting you don’t enjoy these wonderful establishments, just be aware how they may be contributing to your posture habits.

Finally, let’s look at our sleep habits.  Finding a pillow that fits is like finding a good pair of jeans.  They are tough to find, but once you do, it’s magic.  Mattresses are tough, too.  If we are all essentially built the same, then why do we prefer different mattresses and pillows?  I hypothesize it is how tight our muscles and fascia are that guides our mattress choices. Little children can fall asleep anywhere and wake up ready to move and play.  When adults fall asleep on the floor, we wake up in pain and hardly able to walk. What are your sleep habits? Do you curl up into the same “C” shape you sit in at work and on the couch?  Is that the most comfortable position?  Hmm…

I recently worked with a man who came in with shoulder pain from an accident over a year old.  He was frustrated that it was still not healed.  His posture in both sitting and standing was a “C” shape.  He had very rounded shoulders and a tucked tailbone.  When I asked him about his sleep habits he said he was having problems, but he bought an adjustable bed, and it was much better.  He explained how he adjusted the head of the bed up about 30 degrees and adjusted the knee area up so his knees were bent too.  This creates a… say it together… a “C” shape.  So, no wonder this position felt better to him than lying flat.  Fortunately, he was in my office to improve his overall wellness in addition to addressing his shoulder pain, so he was very open to any suggestions I had for him. Once I explained to him that it may make him feel better in the short-term, it is likely contributing to his problems and may make matters worse in the long-term.

How does this “C” shape affect your body beyond the obvious? Constant sitting, especially sitting with the pelvis tilted back, or the tailbone tucked under leads to tight hips, thighs, knees, and ankles.  Everything above your hips is affected as well.  Constant sitting with the body out of ideal alignment leads to the shortening of muscles and reorganization of your fascial system. The facial system is designed to support and protect you. It functions best in the alignment our bodies we designed for which includes a neutral pelvis, a nice low back curve and the head stacked on top of the spine. When the fascial system detects constant deviation from the norm, it will reorganize to support this less than ideal position. To do this it must become more rigid.  If your fascial system is stiff in places, you will feel it. Soon it will start to feel normal to you and will adopt this position in all your activities. Moving your body in poor alignment creates tremendous wear and tear on your body’s moving parts, especially when you ask it to do heavy or repetitive work.

Remember the client with the sleep number bed?  His shoulders were so rounded forward that when I asked him to stand comfortably with his arms at his sides, the backs of hands were facing me. This position was his normal standing position. In proper relaxed alignment, the thumbs should face forward, not the backs of the hands.  He was injured doing bench presses. Imagine asking a shoulder in this misalignment to do heavy work?  Remember, multiple risk factors increase the likelihood of injury.  In this case, we have three risk factors: awkward posture, heavy weights, and repetition.

Am I advocating for you to get rid of your couch?  I’m not getting rid of mine, and I’d never ask you to do anything I’m not willing to do myself.  So, what is the answer?  Analyze your risk factors and make choices to minimize them.  If you don’t want to give up your T.V. time, then vary your postures. Give yourself and your family members options. Minimize your time in any one position. Provide large pillows to sit or lay on the floor.  Getting up and down from the floor and sitting cross-legged are great ways to move and stretch the hips.  Try sitting on the floor and leaning against the couch.  You can find meditation pillows that provide a comfortable option for sitting on the floor with or without leaning on the wall or couch. You can continue to sit on your couch but find as many different sitting positions as possible. Use different shapes and densities of couch pillows to support you. Regardless of the position you choose, always try to honor the curve in the low back.

If you are bending your body into a “C” shape when you are on the couch and flattening the low back curve, then find ways to counter or do the opposite of the “C” position.  If it is uncomfortable to sit or stand with a low back curve, then you likely have some work to do.  If you feel pinching sensations the low back and hips, the muscles are probably overstretched in your back and tight in your front, and your fascia has reshaped itself to support a flatter back.  What can you do?  It’s never too late to start moving differently and changing the physical forces your body experiences throughout the day and night.

Moving differently in your daily life is the best option, but it is not always realistic to change your entire home and work environment.  Start slowly.  Even small changes like putting your coffee cups on a higher shelf can integrate shoulder movement you would not normally get in an average day.  Mobilizing your shoulders can help with neck and upper back pain.  Another idea is to put your towels on a lower shelf in your bathroom or linen closet.  This change encourages you to squat to reach your towels.  Squatting strengthens your legs and stretches your hips. It is better to move more all day long then to cram all your movement into a thirty-minute exercise session.

Choose an exercise program that focuses on proper postures such as yoga or tai chi.  Avoid exercise such as cycling as this creates a “C” shape in the body.  If you love cycling, work hard to counter that posture with back, and hip extension stretches.  An important note here is that you can’t spend your home, work, travel and leisure time in awkward postures and expect that a few hours of exercise a week will keep you in great shape.  It is much more likely that your muscles and fascia have adapted to the awkward posture and you are creating extra wear and tear on your body when you are exercising. Move more, all day long in good alignment and you’ll get more from your workout.

Finally, getting bodywork, especially myofascial release, can help you open your fascial system after years of poor posture and help you move into better habits with ease. Having an expert observe your posture while still and during functional tasks can help you better understand your habits.  The connection between your body and your brain is powerful and we can’t always identify our own postural issues. What feels comfortable or normal to you may not actually be the best alignment. An expert can help you analyze your physical forces and support you as you move into the best possible movement and postural habits.

Our furniture is one very powerful physical force that shapes our lives.  The key is awareness and continually making small choices that shape the body and the life we desire.

Amy Mayer OTD, OTR/L, RYT 200

Myofascial Release, Movement and Foot Pain

Almost everyone I work with has had pain in their feet. It doesn’t seem to matter how young or how old they are.  It doesn’t seem to matter if they have a job that is more sedentary or if they have a job that requires being on their feet all day.  It is also interesting that it is almost never the primary complaint and it frequently comes up after the evaluation is over and we are well into treatment.  Clients often report that it is an old issue that has never gone away. People just expect to have pain in their feet.

The traditional approach to foot pain is to add support.  Inserts and shoes with highly developed technology to mold to, support and protect your feet and ankles are big ortho insertbusiness.  What if the opposite were true?  What if less was more when it comes to your feet?

There are 52 bones, 107 ligaments (the tissue that connects bone to bone), and 19 muscles. There are 33 joints in the foot making the number of possible positions of the foot amazingly high. (I asked my son to do the math and assume each joint can be at neutral, up or down.  The answer is over five quadrillion possible combinations in just one foot!) If there are so many potential positions, why do we intentionally limit them with sturdy shoes? When we think about the rest of the body, we know that strong and flexible creates a healthy body.  Why not the feet, too?

Keeping our feet bound up in shoes and supportive inserts keep our feet immobile making them weaker and less flexible.  Think about your foot health and your footwear habits.  Does this make sense?  We have not even talked about high heels yet!  Any heel, even low heels, can lead to foot and whole-body pain, but that is another discussion. Let’s stick to shoes in general.

When did you start wearing shoes?  I treated a baby recently.  He was nine months old and starting to pull himself up and cruise the furniture. After the treatment was over, his mom began to dress him.  She pulled out an adorable little pair of shoes. When I saw they had thick solid soles, I asked her if it was ok if I made a comment on his shoes and she was very open.  I explained to her about all the muscles and bones in the feet and that his feet were still developing.  I also described how all the possible motions of the joints and muscles were providing his brain and body with feedback helping him learn balance.  Baby FeetAllowing him to wear no shoes or socks is best.  If you are afraid of him slipping or stepping on something use socks with grippers or shoes with flexible leather soles.  Allowing his feet to become strong and flexible as a baby will help him with coordination and balance as he grows older.  She put the shoes back in the bag and put two pairs of socks on him instead.  She asked if she should have her older kids go without shoes sometimes too.  The answer was yes. It is never too late to develop healthy feet.

I worked with a teen who was complaining to his mom that his feet hurt when he wore his new football shoes. They had tried several brands, and they all hurt his feet. The shoe issue came up in conversation and was not the reason I was seeing him. Mom said he hated to wear any shoes other than his high-top sneakers and always complained his feet would hurt in other shoes.  He also told me he wears them all the time except sleep and showering and likes to lace them up super tight because that feels best.  I gave them my “free your feet” talk and added more information about the fascia.

The fascia connects everything throughout the body.  So, if the fascia in your feet is tight, it can pull into the entire body, sometimes in very unexpected places.  The fascia is also a communication system. It helps you know where your body is in space so you can move smoothly and accurately.  When one part of the fascia is pulled or stretched, the rest of the body knows this and reacts due to the interconnectedness of the system.  This is called tensegrity.

tensegrity
A Tensegrity Model

So, if you are out walking and step on a rock with the left front part of your right foot your whole body can immediately adjust to keep you upright. This information is sent throughout your nervous system and your fascial system.  If your fascia is tight and inflexible, communication may be limited. Weak and rigid feet can lead to poor balance, as well as tightness and pain in the feet and other parts of the body.

Ok, one more story.  I decided to try reflexology.  A reflexologist is a person who applies pressure to points in your feet with the intention of addressing issues throughout the body.  They believe the foot is a map of the entire body and pain in your body will mirror throughout your feet.

Reflexology
Reflexology Map

My friend told me she had tried it and it was a very painful experience. I loved it.  I felt no pain.  I did experience some tenderness that mapped to places in my body that were tender.  Interesting.  Why was my experience pain-free and my friends was not?  She loves shoes.  I don’t.  Well, I do love a cute shoe when I must wear them, but that is not the point.  I am out of shoes every chance I get. I rarely wear shoes in the house. I regularly take walks in my backyard without shoes.  I exercise without shoes. I take my grandson to the park, and we take our shoes off when climbing the equipment together. (Yes, the area gets a thorough scan to be sure there is no broken glass or sharp objects. Stepping on rocks and twigs is welcome.)  When I hike, I wear flexible hiking sandals instead of sturdy hiking boots. Plantar fasciitis used to plague me.  Now, when it rears its ugly head, I go for a barefoot walk instead of pulling out my old shoe inserts.  Yes, it helps a lot.

So, what about adults and older adults? Don’t throw out your shoes just yet!  Assess your shoes and how often you wear them.  Do your feet ever get any no shoe time?  If not or not much, move in that direction slowly.  Your feet see a lot of action so you must go easy.  If your feet don’t typically work for you outside a shoe, they will be sore if you do too much too soon, just as any other part of your body would be if you started a rigorous exercise program.  Let me be clear! Shoes are a necessity of life and often a safety requirement.  I’m not advocating for no shoes all the time.  Safety is always number one. Give some serious thought to your footwear and try to balance safety with flexibility and strength as much as possible.  Teen Feet

If you have foot pain that will not resolve, you may want to get checked out to be sure there is not a medical problem. Then, you may want to try myofascial release and slowly begin working on the flexibility and strength in your feet, legs and hips. Myofascial release can give you a jump start on your flexibility and bring your feet into the best possible alignment as you begin your no shoe adventures. Opening the fascial system and aligning your tissues, allows all your systems (muscles, nerves, ligaments, etc.) to work even better.  Alignment is critical!

You can start your home program by just not wearing shoes for short periods of time in your home. If this sounds unappealing, find slippers or shoes with flexible soles. If you have access to a yard, try walking barefoot in your yard and feeling the lumps and bumps under your feet. Notice how your feet move and where you feel the responses in the rest of your body.  If your feet get sore, adjust your program but don’t give up. If you need help designing a plan for yourself or your family, contact me.  You may consider choosing exercise opportunities where shoes are optional, such as yoga. Your feet were designed to be free and support you in all your daily activities. Give them the chance to support you and are likely to be pleasantly surprised.

Feet with smiley toes

 

Be patient. Your feet work hard for you.  Treat them with care!

-Amy Mayer OTD, OTR/L, RYT 200

 

Yoga and Your Health Savings Account

Did you know that with a physician’s letter of necessity you may be able to use your health savings account to pay for yoga? Yes, it is true, but you’ll want to check with your plan first.  What is a letter of necessity?  It is a written statement from your physician stating you would benefit from yoga due to a specific medical diagnosis.  The evidence is growing that yoga is beneficial for a wide variety of diagnoses including back pain, anxiety, depression and high blood pressure (National Institutes of Health, 2016). The National Institutes of Health (NIH) is also funding research to study how yoga may affect many additional diagnoses and health problems such as diabetes, HIV, immune issues, arthritis, menopause, multiple sclerosis, posttraumatic stress disorder and smoking cessation.

While at Creighton University, I co-led a study researching yoga for smoking cessation.  Unfortunately, our study did not have balanced participation, and we cannot claim any statistically significant results.  However, what we did find is that people were very attracted to the idea of using yoga to help them quit.  Many reported they were not actively planning to quit smoking, but when they saw the idea of using yoga they were motivated to try and joined our study.  Many of our participants had no yoga experience at all. When we followed up with our participants, many reported they were still doing some form of yoga and most frequently used the relaxation and breathing practices they learned in the study. It is exciting that the NIH has seen enough value in this idea that they are continuing to fund studies!

Is yoga right for your health problem?  You should talk to your physician.  Then, find someone who knows yoga and has knowledge about your health concern. Some movements are unsafe for specific conditions. There are many styles of yoga available. Some types are very intense requiring a high level of fitness while others are very mild and appropriate for even the most inflexible and out of shape among us. Some styles are very fast moving and fitness based while others focus heavily on meditation and slow movement. The key to improving your health is to find the right match.

In the field of occupational therapy, we have a saying to describe our goal in designing therapy for our clients.   Our clients should be successful yet challenged with all their therapeutic tasks. Finding this balance helps our clients challenge their skills without over frustrating them.  This is precisely the balance you should strive to achieve with your yoga practice.  Finding a level and type of yoga practice where you feel successful leads to a sense of satisfaction.  If you feel challenged, you are more likely feel the task is doing something positive for you and you are likely to be motivated to continue. When you find the right match, you will be able to see your progress and seeing progress feels great.

As an occupational therapist and yoga instructor, I love teaching yoga to people with all fitness and experience levels.  It is important to me to know why someone is attending my yoga class.  Is it for fitness, a specific problem, weight loss or management, stress management or something else? Knowing this information helps me make sure class has a little something for everyone.  Doing a one to one yoga session allows me to tailor the entire session to that individual, matching their needs and fitness level to each pose and the flow of session to create the just right challenge.

I have worked with people who have extreme difficulty getting down to the floor and back up again. They feel they can’t attend a regular yoga class because of the frequent transitions.  Designing a yoga class where we do all standing poses or all floor poses was ideal for this person.  We also built in the process of going to the floor and up as part of the session.  This movement is an essential skill as we age.  I have also worked with people with specific injuries they thought prevented them from doing yoga.  A woman with a chronic toe problem was ready to give up, but we were able to find a way for her to transition her poses without putting undue pressure on her right big toe.  She was thrilled to regain her yoga practice reaping the benefits without the fear of re-injury.

So, does it make sense to spend your healthcare dollars on yoga?  That is up to you.  You are in charge of your health. If you decide the answer is yes, find a yoga teacher and style of yoga that matches your needs.  Talk to your healthcare practitioners, your friends, explore websites and call yoga studios.  Take the time to find the right match.  When you find the right match you’ll feel the just right challenge.

 

 

Reference:

National Institutes of Health (2013). Yoga: In Depth. Retrieved from NIH National Center for Complementary and Integrative Health https://nccih.nih.gov/health/yoga/introduction.htm

Explaining the Fascial System and Myofascial Release

How do I explain the fascial system and myofascial release to my clients?  More or less something like this…

The fascial system is not extremely well understood but the research is starting to emerge.  You will not see this system have its own chapter in a textbook as you do other systems such as the muscular, circulatory or nervous systems. However, with all the research being done in recent years I will predict that within the next decade it will be better understood and deemed worthy enough to be granted its own chapter.

Part of the reason for fascia being poorly understood is that our primary understanding of it has been developed through autopsy and dissection.  It is the stuff that has to be cut through to get to the good stuff.  Many of our tissues look and function very differently when they are in a living being versus a non-living being. Fascia is also difficult to see on our typical imaging systems. Therefore, medical professionals make judgments on what can be seen and pay less attention to what cannot.

With our current technology, we are better able to study fascia in a living being and are better able to understand its many roles.  We know its primary role is to support. Imagine the fascial system as filling in space in the body between the muscles, bones, organs, etc.  Imagine a nerve running from the neck down into the arm. When it is moving from one muscle to another is it not just hanging out unprotected in open space inside the body.  The fascial system supports it.  It is the same idea with the circulatory system.  Arteries and veins are supported as they move from one are of the body to the next by the fascial system. Imagine the fascial system as being loose and having open space like wet gauze fabric but three dimensional.  This three-dimensional system spans the entire body from head to toe supporting everything.  It is very fluid when healthy so our structures can glide freely within it.  We are also learning another role is to support the body during functional movement.  There are layers of fascia connecting muscle groups that work together to help us move fluidly and hold us together are we do fast, heavy, large movements.  This is an important protective feature.

This protective role is important in everyday activities but becomes crucial during an impact such as a motor vehicle accident or a fall. During an impact, the fascia’s role is to contract and hold tissues together and resist separation of the tissues. Normally the fascia is a hydrated fluid system that allows other tissues to glide within it.  During impact, it tightens up to hold structures together.  A helpful analogy is the game of Red Rover. In this game, kids form two lines by holding hands.  A kid from the opposing team runs toward the line and tries to break through.  The kids holding hands are like fascia.  They tighten up, contracting their bodies to prepare for impact and prevent the line from breaking apart.  If the force is too great, the line breaks. Our bodies, like the Red Rover line, can take a significant impact without breaking apart thanks to our fascial system.

So, if the fascia tightens to support us when there is an impact, why doesn’t it go back to normal after the injury? In a healthy system, it does. During an impact, this normally fluid system contracts and squeezes out the fluid then becomes very rigid. Over time in a healthy system, the fascia slowly regains its fluidity as the surrounding tissues heal allowing everything to glide normally again. The problem is that most of us are not living the ideal healthy lifestyle. We are far too sedentary.  We don’t get great nutrition.  We don’t drink enough water. We don’t get enough sleep. After injuries we are told to rest.  We assume protective postures. We take medications that numb us. We are fearful of returning to our regular activities. In the worst case scenario we undergo surgical interventions which also cut through the fascial system triggering more tightening of the system.

When the system is unable to return to its more fluid state it continues to tighten.  There is a slow pull through this three dimensional system. This can cause pain and discomfort in areas that are far from the original injury.  Pull on the bottom of your t-shirt and notice the tension at each shoulder.  The angles are different but there in tension in each.  This is another useful analogy to understand the pull in this system. The tightening also reduces the space for tissues such as nerves and blood vessels to glide through causing pain and decreased blood flow which is crucial for the health of all our tissues and normal functioning of the body.

What can be done? The fascia must be coaxed back to its more normal state. Through the technique of myofascial release (MFR), a slow sustained stretch is applied to the restricted area of the body.  This low load stretch encourages the fascia to open up, pull fluid back in and return to its normal state.  Yet another analogy.  Imagine a sponge. When you wring it out, all the water is forced out.  If you hold it that way it will eventually dry out and hold the twisted shape. If you set it in shallow water, some of the sponge will soak up water but much will remain dry and twisted.  If you gently untwist the sponge and slowly pull it as open as possible it will absorb more water.  The job of the therapist is to gently untwist the fascia and encourage it to soak up as much fluid as possible.

The client has an important role both during the MFR treatment and after.  During the treatment, their primary job is to breathe.  I teach every client to breathe with their diaphragm.  It continually surprises me how little movement of the diaphragm is present when I evaluate breathing in my clients. I explain to them how important it is for them to practice this method of breathing both during treatment and in their everyday life.  Along with breathing, I ask them to focus. They need to focus in on what they are feeling and stay present with what is happening in their body.  Some clients prefer to chat during a session.  This is ok as long as they can also feel.  If I sense they are not, I ask them to focus in during at least part of the session. I don’t want to change who they are but I do want them to learn to feel.  Learning to feel a restriction and a release helps them learn to manage their bodies outside of a session.

Outside of the session, the client’s role is to maintain the progress made in therapy.  They must maximize their wellness behaviors.  This includes making sure they are drinking plenty of water, eating healthy food, working on their posture, and integrating more movement and stretching into their daily activities. These changes don’t need to be made all at once.  Even small changes can make a huge difference during the healing process.  For example, if the client usually does some simple stretching to help the aching in their neck, they can learn to hold stretches longer to mimic the MFR technique.  They can adjust their stretches to choose stretches that maximize what their body needs. Ideally, the therapist helps the client identify opportunities for change that will maximize their healing process.  I try to ask them to make a small change or add a new stretch after each session.  Layering on a new strategy or stretch a little at a time helps clients see the benefits of each.  When the benefits are seen the change is more likely to become permanent. I will often have clients come back and ask what else they can do at home. These changes help to hold the gains made in therapy and continue with more forward progress during additional MFR sessions.

I try to gauge their interest and provide more or less depending on how they are responding to the information.  I always let them know they can ask questions anytime.  I want them to fully understand what is we are doing and why.