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

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.

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.

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.

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.

This 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.

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.  From 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.  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

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 business.  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.  Allowing 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.

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.

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.  

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.

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

-Amy Mayer OTD, OTR/L, RYT 200

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