I’ve Fallen and I Can’t Get Up!

This was a line made famous by a commercial for senior alert necklaces over a decade ago. According to the CDC our risk of falls is continuing to rise and by 2030 we’ll have 7 fall related deaths per HOUR if the trend continues.If you are in your 50s and up or have loved ones in their 50s and up, you MUST read this.

I chose this as my article this month because in the past two weeks I worked with two clients, both in their 80s and very active. They walk, exercise, mow the lawn and lead fun productive lives. Both fell unexpectedly and could not get up. It was a scary several hour ordeal of being on the ground until help arrived. They were amazed and confused because once someone helped them to a chair they could instantly stand up and walk. WHY?

First let’s address the falls themselves. The circumstances were quite typical and could send any of us off balance: a wet floor and wet grass. Why do seniors fall more than younger folks in these instances? Having good joint range of motion and the muscle strength to react quickly are extremely important. If we’re not continually challenging ourselves with activities or exercise that helps to maintain these as well as challenging our balance, we put ourselves at risk. Often, we don’t know it is gone until we need it. However, this is NOT enough.

Over time, lots of sitting can reduce the range of motion and strength in our lower body.

Let’s examine why someone who can mow their entire lawn with a push mower can’t get up from the ground. He has plenty of strength but only within a small range of motion of his hip joints. He has functional hip and leg strength from a sitting position to a standing position (meaning it isn’t great, but he can get up) and great strength in a walking range of motion (meaning he can walk a long time comfortably). He has poor or no strength at a greater range of motion than a seated position such as what it takes to get up from a low chair/couch or the floor.

How does this loss happen without us even realizing it? We sit and sit and sit. All this sitting leads to loss of motion and strength. This leads to poor postural habits and tight fascia. It creates a downward spiral of problems with balance and overall health. To make matters worse, when older adults start to have trouble getting up from chairs we buy them lift chairs, raised toilets and install grab bars. Now they can get up independently. Yeah! These tools are fine, but we avoid the underlying problem. We cannot just apply these band-aides. We must address the greater issue of loss of motion! How do we do this?

Progressive exercise for increasing leg range of motion and strength.

Here are some ideas. In the photos you see Dwight and Pam (both provided their permission to share their photos). It is important not to just dive into a big exercise routine. It is important to grade the movements in a safe progression for each person. Occupational therapists (OT) are trained to expertly grade activities to the individual based on their skills and health history. OTs also put exercise in context, so the developing skills directly apply to the desired activity.
I’ll explain the photos and add some detail.

In the first photo, Dwight is positioned in a chair that is lower than he typically sits in at home. When trying to rise, he cannot get himself up without the assistance of his arms pulling him up. This was surprising to him. My suggestion was that he position a chair about this height at his kitchen sink and practice getting up and down slowly without “plopping”. Plopping happens when there is not quite enough strength throughout the full motion to control the lowering motion into the chair. At the lower end, strength gives out and we plop into the chair. I instructed him to use less and less assistance from his arms as his legs gain strength in this new range of motion.

In photo number two, I asked Dwight to change his leg position in the chair. Dropping one leg back begins to mimic the position he’ll eventually need to get up from the floor. He found this position even more challenging. He should start with assistance from his arms and gradually reduce this assistance as he gains strength in this new range of motion.

In the third photo we see Pam, who admits getting up from the floor is not easy for her and anyone who has seen Pam for a massage knows she is STRONG! Pam is positioned in a low stool with the split stance. Dwight isn’t ready for this position, but it is what he’ll transition to next. Pam is using her arms to assist as she moves through the lowest part of the motion. She reduces her arm pull as she finds the strength in her legs. The stool provides a sense of safety while practicing challenging movements and provides a safe place to land and rest if she fatigues too quickly.

The next phase (photo four) is switching to a lower target. Lower the knee to touch the target and come back up. The target might be three pillows or the stool at first, then gradually lower the target as strength throughout the range builds. You may also notice Pam is doing the movement at a door. This is another good option for grading the support. Starting at the kitchen sink provides excellent stability and support. A door offers support but not as much stability.

In the fifth photo, you see Pam touching her knee all the way to the floor. Excellent! She’s built enough strength to get down and back up again. However, she’s not done yet.
In photo five she is learning not to rely on any external support to get up. This increases stability and balance in this lower range of motion. You may not fall in a place where you will have an external support to assist you in getting up. Continue to do the exercise in a place where support is available if needed. You should do the movements until your muscles fatigue or you will not get stronger.

In the final photo, we see Pam’s foot. As we age, we also tend to lose range of motion in our feet ankles and calves. This is NOT simply due to aging. It is due to lack of use. When adults have foot pain, we are often offered immobilization as an option to protect them. This creates a spiral of decreased motion and strength. Our feet must also be strong and flexible and are a key element to being able to get up and down easily as well as maintain our balance in an upright position. My other client who was very active but couldn’t get up was completely lacking in this motion which prevented her from being able to get up from the floor. She’s currently working on this skill. Pam’s motion is excellent! Yeah Pam!

Finally, we have not addressed going from the position of being completely flat on the floor. This is another important progression I’ll address in another article. Just remember that if you fall, you are not guaranteed to fall in a place that will be easy to wiggle out of. Many falls happen in the bathroom where you might be on your back, front or side with very little room to maneuver. It is important to have strength available at all ranges of motion to get yourself safe.

The key points: • Get up and down regularly as part of your exercise plan at every age. If you have hip or back pain, you may be lacking in strength and motion. This is an early sign! • Grade your exercise with the help of an expert if you are very weak or have other health conditions. • Don’t forget your feet, ankles and calves. • Provide older adults with assistive devices as needed but don’t be fooled that they are the answer to the problem. Your loved one is still at risk if they can’t get up. Connect them with a health professional that can get them moving safely. • Create a body that is prepared to get up from any position.

Dwight’s next challenge!

UPDATE! At his last wellness session, Dwight reported he was able to do about 15 get ups from the chair without the use of his hands and was ready for the next challenge. In the photo you can see that we’ve given him a bolster as a target to futher increase his range of motion. He could not get to the bolster without using his hands to lower himself down and pull himself up. However, this was true with his last challenge of getting up from the chair with split stance. He was able to improve with significantly in just a few weeks! We’ll see how he does with this challenge. His plan is to do the exercise at his kitchen sink with a couple pillows as his target. The pillows will also keep him safe if he does need to rest. The goals is to use less and less arm strength as the legs gain strength in this range of motion. Go Dwight!

Need help getting started?  Make an appointment for a New Client: Natural Movement Evaluation and Consultation.  Or Join a MovNat class on Schedulicity.

Practical Meditation Tips to Get Started Right Now

Many of our lives have been turned upside down resulting in high levels of stress.  It is unclear when our lives will be back to “normal” and this uncertainty results in even more stress. All this stress results in a physical outcome as tension builds in our muslces and fascia. Meditation is a well researched option for effectively reducing stress and anxiety.  So why aren’t we all meditating?  
Many people don’t meditate because they don’t really understand how to do it and they get crazy frustrated when they can’t empty their mind or achieve the appropriate cross-legged posture.  The good news is that you don’t have to do either of those things.  The bad news is that is does take some effort but if you really understand the basics, it can be quite enjoyable and helpful.  The other good news is that it doesn’t just help with stress and anxiety. Meditation can improve focus, improve your mood, give you more energy and help you be more creative.  Those are some great reasons to meditate. 
The true purpose of meditation is two-fold. In the moment, meditation shifts the brain and body into a more relaxed and calm state resulting in an immediate positive change in physiology. Over time, meditation can change your brain and help you respond to stressful situations in a more positive manner.

Photo by Kelvin Valerio on Pexels.com

Here are some practical tips to get started. 
First, you can meditate anywhere and in any position.  You can sit on a pillow cross legged or you can spread out on your lazy boy recliner, what truly matters is what is happening in your head.  As you get started, if your body is more comfortable, you will be less distracted.  You can even meditate standing in line at the grocery store!  Again, what is happening inside is what is most important. 
You can meditate for very short periods of time and get positive outcomes. Even just a few minutes can begin to shift your physiology and start you on the path to shifting your brain. Start with just a couple minutes at a time and slowly add a minute here and there as you gain skill and confidence. Also, time of day doesn’t matter.  Fit it in anywhere you can as you get started.  There are no rules.

Well, there are rules in some styles of meditation and there are many styles out there.  Once you get going you may want to explore what is out there and go down a more specific meditation path, but for now let’s just get over the hurdle of getting started. In ALL meditation styles there are several common ingredients and I’ll cover them all briefly here. I have a video you can watch that explains them as well.  

1. Breathe.  Learn to breath with your diaphragm.  Learn to breathe deeply and slowly.  This one skill can help you make profound shifts in your health and well-being.  The video above also covers diaphragmatic breathing.  You ALWAYS have your breath available as a focus point  Breath well and bring your attention to it often. 
2. Focus.  Your brain must have something to focus on.  We are wired for awareness.  Emptying the mind completely is nearly impossible.  The goals is to bring your attention to the breath, an object or a sensation depending on your choice of meditation style. You can be aware of other thoughts and sensations.  The goal is to learn to let them go and keep returning your attention where you want it and not get pulled down the rabbit hole of your wandering thoughts. 
3. Judgement .  Just let it go.  As thoughts enter your mind or as you notice sensations during meditation, do not judge them as good or bad. Experience them and let them go.  You will find yourself not only judging what is happening externally such as the sound of someone firing up their lawn mover just as you decide to try some meditation, but also internally.  You will get frustrated with yourself when you can’t control those pesky thoughts about what you’ll have for dinner later. Do not judge yourself and your ability to meditate. Rather congratulate yourself each time you notice your attention has wandered and you have decided to bring it back to your object of focus.  Treat yourself gently in the process of learning much like you’d teach a puppy or small child a new skill.  You are gentle, patient and encouraging with them, be so with yourself. This is probably the number one issue most of us struggle with when practicing meditation. 
4. Calm. Learn to soften your body.  Learning to spot tension in your body and continually let it go will help you be more comfortable as you meditate. Soon, this will cross over into daily life. 
5. Mindfulness.  Keep your attention in the present.  Stress and anxiety are typically past or future oriented.  We can’t change the past and can plan appropriately for the future but can’t control it.  Staying in the present is generally much less stressful.  Use your five senses (sight, sound, touch, smell and taste) to pull your mind in to the present. 
6. Process. Let go of any outcomes you are trying to achieve and simply focus on the process of meditation.  It is called a meditation practice.  Practice regularly and focus on the process of continually bringing your mind back to the object of focus.  In a five minute meditation you may have to do this fifty times.  That is OK.  Next time it might only be thirty or it might be fifty-one. If you stick with it, it will get easier.  

There are many strategies you can use to help yourself let go of those pesky intrusive thoughts that will continue to interrupt your meditation process.  I will share those in the next post.  For now, you may want to watch the introductory videoPractical Meditation.  This will also introduce you to a simple meditation.  My follow up video cleverly titled Practical Meditation #2 will introduce you to a few other styles of both sitting and standing meditations.  Happy meditating! 

Are your clavicles where they should be for pain free movement?

woman-red-and-pink-off-shoulder-dress-standing-near-wall-3195986-2We commonly refer to clavicles as collar bones. The clavicle bones are the two long thin bones beneath your shoulders on the front of your body. You can easily feel them with your fingertips. The clavicles connect the sternum (breastbone) to each scapula (shoulder blade). They are far more important than you might think. Five muscles (pectoralis major, sternocleidomastoid, subclavius, deltoid and trapezius) attach to each clavicle supporting complex three-dimensional motion. The clavicles and the attached muscles supply the support and motion required for complex shoulder and arm function. If one or both of your clavicles are not in proper alignment, your shoulders and arms are likely unable to achieve their full range of motion. This misalignment is very likely to lead to an injury or pain that seems to come out of nowhere.

 

Why might one or both clavicles be out of alignment? This is most likely due to tight muscles or fascia. Tightness is often a result of past injuries, repetitive awkward movements, chronic poor posture, or a combination. So, how do you know if you are at risk? Look in a mirror or have someone take a photo of you with your clavicles in full view. If your clavicles don’t appear to be horizontal or near parallel with the ground, you likely have some tightness pulling your clavicles out of alignment. The more angled one or more clavicle is, the more out of alignment it is. It is far more common for the slope of the clavicle to be lower toward the center of your body and higher on the shoulder side. You may also have one or both clavicles out of alignment from front to back as well. If your shoulders are slouched the shoulder end of the clavicle may be farther forward than the other side.

In the photo above, the model has very horizontal well-aligned clavicles.  The model below has very angled clavicles.  This position may indicate an imbalance of tension in her muscles and fascia.  The third model at the end of this article has her shoulders pulled up and forward creating both a slope and a forward position of the clavicle.  This is a very unhealthy position.  Hopefully this was just a pose for the camera and not a permanent position of her clavicles!  

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Another clue when you look in the mirror is noticing where your arms hang in relation to your body. When everything is in good alignment, the tip of your middle finger should be able to feel the side seam of your pants. (This may also be affected by lower body alignment but we’ll stick with the clavicles for now.) If your arms are hanging forward from your body, the muscles and fascia around your clavicles are probably very tight.

 

Here’s what can you do if your clavicles are not in the best possible alignment. Notice what muscles you need to engage to exaggerate the angle of your clavicles. The upper trapezius muscles pull the shoulder end of the clavicle up and the pectoralis pulls it forward. Lengthening these two muscles is a great place to start. You can start by doing the shoulder stretch on my website.  mayerwellness.com/stretch-and-mobilize-your-fascia They key to stretching with the intent to address tightness in the fascia is to go slow , be gentle, and hold the stretch for at least a minute or two.

Taking your muscles and joints through their full range of motion on a regular basis is another way to keep your body healthy. This helps to maintain range of motion, muscle balance, and good blood supply to the area of the body you are moving. A wonderful simple and fun exercise you can do anywhere is the Paint the Bubble exercise. Look for it on my website. mayerwellness.com/stretch-and-mobilize-your-fascia This will take your shoulders through their full range of motion. Notice how your shoulders feel before and after this exercise. You will be amazed that you can actually feel a difference!

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Now go look in the mirror and check out your clavicles!

Adult Tummy Time: Why you should be doing it every day.

We’ve all heard babies should have time on their tummies. Tummy time is not about their    bellies. It is about their back and helps them develop a spine strong enough to help them lift their heads, sit up and prepare to stand and walk. Imagine a toddler trying to walk with their spine and hips still in the fetal position. The prone or tummy position stretches out the front of the body and strengthens the hips and back. This creates the strength and balance necessary for continued development and healthy alignment. If you’ve been around babies who are just starting tummy time, you know that it isn’t always welcome at first. But, as the baby gets stronger, it becomes another fun way of exploring and interacting with their environment. Adults need tummy time too, but for entirely different reasons. 

When I recommend tummy time to my teen and adult clients, I often get “the look.” That “what you talkin’ about Willis?” face. I laugh, then explain. 

Adults (let’s include kids and teen in this conversation too) rarely spend time laying on their stomachs. Some health professionals also recommend not sleeping on your stomach, which in my opinion, only makes sense when there is a medical issue, injury, or significantly limited range of motion in the neck. For many of us, it is just fine and actually a good idea. It promotes neck range of motion and helps us get back what we lose during the day from looking forward constantly. Sleeping positions could take up another entire article. If you are interested, you may want to check out my blog on pillows.

Back to getting prone during the day…

Our culture is set up so that we are almost always sitting. Toileting, eating, working, driving, relaxing, etc. all involve chairs of varying structure and   comfort. Chairs didn’t become common until the 16th century. Since then, we’ve kept making them more and more cozy and   comfortable. Our bodies have become very accustomed to chair sitting. Chair sitting isn’t necessarily bad, but most of us are using them irresponsibly. We collapse into the chair, letting the chair do the work of keeping us upright. We allow our tailbones to tuck under and our head to sink forward. What does this look like? The fetal position!

The fetal position.

Our bodies become sticky in the positions we are in most, especially if we don’t move them regularly through a full range of motion in different planes (think yoga, tai chi, dancing or similar). Add up the hours you sit in a day. For many of us that will be 12 plus hours. Ouch! Not only does our fascia thicken and tighten with lack of movement. This habitual positioning creates muscle imbalances. Some are far longer than they are intended to be, and others are short. Both are probably tight. What to do? The good news is that our bodies are very resilient.

To get on the path to tummy time, the first thing you should know is proper pelvic positioning. There are a variety of landmarks, but this is probably the easiest for most people to find. Stand sideways in a mirror. Feel the bones that stick out the furthest in front on both sides of your hips. These are known as the anterior superior iliac spine or ASIS. Now, find the pubic bone. Put your fingers just under your belly button. Press in and slide down until you feel a bone. That is the top of your pubic bone, which is also part of your pelvis. These three bony landmarks are all connected. Now try this movement that will remind you of The Rocky Horror Picture Show. Tilt your hips, so the pubic bone is further forward than the ASIS landmarks. Now try tipping the ASIS points back and your pubic bone forward. The goal is to line them up in the same plane as shown in the picture. This is the position where your lower back is the strongest. It is also the best position for diaphragmatic breathing and pelvic floor function!  This position also  allows the upper body to stack up in best alignment. So if you can’t get rid of your neck or shoulder pain, check your hips!

You may be able to feel the landmarks better if you get on the floor on your tummy. A floor is best to try this. A bed is too soft and will skew your results. Make sure to have your chest and shoulders close to the floor also. Can you feel those three points touching the floor? If not, reach your hand to feel the landmarks.  What isn’t touching? Can you tilt your pelvis back and forth to get there? If you can’t your fascia, muscles or joints are probably sticky. Don’t force it. Instead, stay there and see if your body will slowly adjust. Give it time. It may take a few minutes or a few months. But moving toward proper pelvic alignment is a huge step to better overall health and less pain. If you have trouble achieving this position with gravity helping you, you will have a tough time working against gravity while standing. 

If this is too hard, start on the bed, but move to the floor when you can. You can take your tummy time further by adding a ball to stretch your abdominal fascia and muscles. See more in my video Belly Stretch.

While in tummy time, you probably won’t have anyone entertaining you or cheering you on like you may have had as a baby during tummy time. But you can entertain yourself. Read, play a game, listen to a book or music, watch the news or some Netflix or better yet, meditate. Get your family and friends doing it too!

If you need help finding proper alignment and deciding how to get there, make an appointment. I’m happy to help!

Ice or Heat? Which is best for pain?

This is a common question with a complicated answer.

I taught at Creighton University for 20 years.  Before my students asked almost any question, they already knew the  answer I would give them. It became a running joke.  The answer to almost every question about how to treat an injury or a diagnosis is…

…it depends.

A good healthcare practitioner (Western or Eastern medicine) knows they are not treating a diagnosis or an injury.  They are treating a person. We are all very similar, but we are all extremely different. There are no clear answers.  There is good solid research out there for many issues we face, but what we have is really a drop in the bucket.  And, the answers often change as new knowledge is always emerging.

Dr. Gabe Mirkin coined R.I.C.E. in 1978. This stands for rest, ice, compression and elevation. It has been a commonly accepted practice for treating injuries but there has never been great evidence to support it.  It has also led to many common misconceptions about what to do for all types of pain.

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In this short article, Dr. Mirkin discusses how icing or cooling actually delays recovery. Our natural response to injury is inflammation.  It is a natural part of the healing process.  Icing constricts blood vessels and prevents healing. However, he does say that icing may help prevent pain, but we should only do it for short ten minute periods immediately following an injury.

The Cochran Library provides us with a systematic review of heat and cold for low back pain. There is moderate evidence for heat and very little evidence for cold.

What about the R. or the rest in the R.I.C.E. protocol? The NIH provides a fact sheet on low back pain. There is strong  evidence that you should not stop moving. You should move gently within a safe range of motion respecting your body’s pain limits.  This movement pumps the muscles pulling healing blood deep into the tissues.  This pumping also mobilizes the lymph which is critical for healing. If you are not sure how much you should move based on your injury, talk to your healthcare practitioner.

What should YOU do?

  • Discuss your options with your healthcare provider. There may be other variables you should consider when deciding how to treat your pain. For example, if you have a condition that decreases your ability to feel, it may not be safe to use either heat or cold.
  • If you are not experiencing an acute injury, the evidence points to heat. But, heat doesn’t mean hot.  Gentle warmth is best.blaze-bonfire-burn-672636
  • Everyone is different. Even though the evidence might point to heat, if you are in pain and ice enables you to decrease your pain enough to move and complete your daily tasks, ice may be the better option for you.  Life keeps on going despite our pain but use it sparingly.  Keep in mind that cold decreases your ability to feel so move with caution after using cold.
  • If your goal is to move or stretch your muscles and fascia, the evidence points to warmth.
  • You can do both. Alternate heat and cold.
  • Remember that both should be used with caution. Don’t put either directly on the skin. Place a layer between the modality and your skin such as a bath towel.
  • The American Chronic Pain Association provides a Resource Guide addresses many options including heat and cold.

 

How to Protect Your Back (and other important body parts) When Gardening

 

woman standing beside purple flowers
Photo by Malcolm Garret on Pexels.com

Gardening is full of risks, especially when you are going from being very sedentary during the winter to all the bending, squatting, lifting and walking on uneven ground yard work and gardening require.

I created a short video to provide several tips for transitioning safely into this wonderful activity that is so good for your whole body and soul.

Find the video at: https://www.youtube.com/watch?v=qG9pvygvrBY or search Gardening Tips to Reduce your Risk Factors on YouTube.

Here is a quick summary.

Gardening with Plumb Line

  • Stretch your feet, calves and hamstrings before you head outside.
  • Practice squatting to prepare your joints. Use a door handle for balance until your legs are ready to support you.
  • Regardless of your body position (standing, bending from the hips, squatting, kneeling, sitting), always maintain a good low back curve.
  • When bending over build a bridge with your hand or elbow to take some strain off your low back. (see photo)
  • Balance your body from front to back from a plumb line that begins at your ankle. Keeping the weight in your heels will help. (see photo)
  • Switch hands frequently when weeding.
  • Wear well fitting gloves with a non-skid surface on the palms to reduce the grip forces required for grasping.
  • Keep your tools in good working order.

Legs Up the Wall: A Simple Pose with Huge Benefits

Legs Up the Wall pose is wonderful for so many reasons. I frequently recommend it to my clients who have low back pain, tight hamstrings, tight calves, leg cramps or foot pain. This pose is also great for calming your nervous system and pairs well with a short meditation.  It is such a simple looking pose but offers the body and mind so many benefits.

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Below are some additional benefits this position offers:

  • Stretches the hamstrings (back of the thighs)
  • Stretches the calves
  • Stretches and retrains the low back curve
    • It stretches all these areas (legs and back) in combination which is important in functional movements such as walking, bending and reaching.
  • Facilitates blood circulation
  • Facilitates lymphatic circulation
  • Relaxes the pelvic floor
  • Stretches the shoulders

But, what if I can’t get on the floor (and back up again)?

I encourage all my clients to practice getting up and down from the floor. Doing Legs Up the Wall Pose is a very purposeful reason to practice this skill.  Getting up and down from the floor uses many muscles and joints in a way we generally don’t during the day (and night). It is a skill we all need, especially as we age.

If you can’t get up and down without assistance, place a chair beside you to help with getting up and down. Take your time and do it mindfully. But, work toward being able to do it without a chair.  You never know when you might need this skill.  If you drop something important and it ends up bouncing a few inches under the couch, you may need to get on the floor.  If you have grandkids who are begging you to play picnic with them, you may need to get on the floor. Hopefully, you never need this skill because you fell, but if you do and there is no one around to help, you will be glad you have this skill. The process of getting down on the floor and up again is a good movement for your body.

Tools You’ll Need

Technically, you don’t need anything to do the pose, but there are a few items that can make your experience more comfortable and help you get the most from the pose.

  • A yoga mat can soften the surface you are laying on and encourage you to stay longer. You must be patient when stretching the back of the legs.
  • A towel can be folded or rolled up to support the low back curve. You should always maintain a healthy low back curve when doing the pose, so you are stretching with the back in a functional position.  If you can’t tolerate the towel, even with just one fold, you are too close to the wall. Work towards a combination of adding folds in the towel to increase the curve and getting your tush closer to the wall.  Be patient.
  • A yoga strap can be placed around the thighs or the calves to keep your legs and feet in line. If you find your feet tend to roll out or in, the strap will keep them pointing in the right direction and allow you to soften into the pose fully.
  • Therapy balls can be an excellent addition to the pose. You can place them under your back or shoulders for a little added release during the pose.
  • Thick socks may be helpful if your heels are tender. The added cushioning may make it more comfortable.
  • A book, music or a podcast can help you be more patient with your pose. Try just breathing for five to ten minutes, but if you’re not there yet and need some entertainment to get the physical benefit from the pose, that is absolutely fine.

You may want to visit my Self-care Products page to find the items you may need.  You’ll find helpful links to the tools. Let’s get started.

Doing Legs Up the Wall Correctly

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  • Start with your hips 10-12 inches (or more as needed) from the wall, so you are not placing too much tension on the back of your legs. Wiggle yourself closer or further from the wall until you feel a mild to moderate tension in the back of your legs. You may feel the tension in your calves, your thighs, your hips, back or all. There is not a right or wrong. You will feel it where you are the tightest first.  The sensation may shift around. You are stretching fascia as well as muscle. 20190226_132330
  • Keep your legs hip-distance apart and your toes pointing forward. If you have trouble keeping your legs and toes in this position, use a strap around your calves. This allows for even deeper relaxation.
  • Place a rolled-up towel under your low back to keep your low back curve from flattening. Start with a small roll and increase it to stretch this area.
  • Once you have the legs and low back in place, breathe deeply using your diaphragm. Be very patient. Continually scan your body from head to toe and soften any part of your body that has tensed up.
  • If you noticed that you are no longer feeling mild tension in the back of your legs, hips or low back, you might be ready to move closer to the wall. Try gently pressing the bottom of your tailbone closer to the floor. If this creates a pulling sensation, you’re ready to move a little closer. If the feeling was intense, just move a little closer, maybe half an inch.  20190226_132059If it wasn’t very intense, you could try moving an inch or more toward the wall. You can do this by placing your feet on the floor and walking your hips toward the wall.

Additional steps to add more benefit.

  • With your arms on the floor and your palms up, begin to slide your arms up to 90 degrees or more. This adds a nice shoulder stretch to your pose.
  • Use deep diaphragmatic breathing to calm your muscles and promote lymph circulation.20190226_132302
  • Make the pose even more beneficial by adding a therapy ball under your upper back. Allowing the ball to sink into your fascia during the pose can relieve tension in this area as well.

Your long-term goal is to be able to easily get down on the floor and do the pose with your bottom against the wall.  This may be in the near future for some of you but pretty far off for others. The short-term goal is to begin.  The benefits are worth the effort.

Thank you to Gessica Stovall, OTS for posing for the photos.

By Amy Mayer OTD, OTR/L, RYT

Are Teens Experiencing More Body Pain and Injuries?

This fall I have seen a surprising number of teenagers in my practice.  I think most people will say this is not surprising with all the phones and video games teens are using.  I agree.  boys-cellphones-children-159395But, let’s dissect this a bit more because teens are NOT going to stop using technology and devices are getting into the hands of younger and younger children all the time.  As a mom, grandma, and occupational therapist I must implore parents to do the best they can to balance tech time with lots of outdoor and indoor free whole-body play.

The teens I worked with last fall all were injured during exercise.  It was awesome that they were exercising.   I’m sure they and everyone around them most likely thought what they were doing was going to keep them healthy and protect them from injury.

Some of the teens were injured during exercise they were doing on their own, and two believed they were injured during training that was part of a school activities.  In two cases the activity was weight lifting, and one was following a DVD program. In all the cases the students said they had some instruction about how to do the exercise safely.  active-adult-athlete-703012When I asked them to describe how to do the tasks safely, it was quite superficial and, in most cases, included how to protect your back.  This is good, but it assumes the exerciser is starting with a body in proper alignment and know how to keep their back safe.

The Nebraska Department of Health Education standard related to the use of technology states, “Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors”.  This standard is becoming more and more critical as generations of people including kids, parents, and grandparents are using technology.  Our children are observing us.  This is how they learn how to react to stress, grammar and speech patterns, gait (walking) patterns, gestures, posture, how to spend time and energy, etc.  It is not just about how technology affects health behaviors but how our family and culture is using technology. It is much bigger than what I am going to focus on in this short article.

This health education standard is incredibly important.  To my knowledge, there is no direct description related to how this standard must be implemented in a school’s curriculum.  Use of technology affects health in so many ways including mental, emotional, and physical health.  Just in the category of physical health, it can affect eyesight, attention skills, coordination, posture, body weight, etc. With so much to teach related to health education, it would be easy to miss the details of posture and body alignment.

Kids are using technology with rounded backs, tilted hips, rounded shoulders, and flexed necks. They are sitting for longer and longer periods. They are less likely to spend long periods in activities where they are jumping, climbing and running with recess and gym classes being shortened.  All this creates tighter muscles and fascia.  All this tightness continues to pull their bodies out of alignment.  When the human body is chronically out of alignment, meaning the muscles that surround the joints are either overstretched and tight or shortened and tight, the fascia’s job is to thicken up to protect joints. The fascia is trying to protect us and support the function we are asking our bodies to do most.  The problem comes when we ask our bodies to do something very different such as lifting free weights or doing burpees.

You may have heard your teen (or younger) complain of aches and pains, and you know they aren’t lifting weights or doing burpees. If our bodies are chronically out of alignment and stuck, even simple activities can be problematic such as lifting a heavy trash bag, pulling a box out from under the bed, or catching the dog who got out of the yard. It can even be as simple as reaching for the shampoo in the shower.  We should worry if we hear kids complaining of pain from these simple daily tasks.  We should really pay attention when we know our teens are starting to participate in more demanding exercise type activities.

athlete-exercise-female-163330Typically, if our bodies were in proper alignment, it would be no big deal to grab a couple of 5-pound weights and start pressing them to the ceiling. But, if our shoulders are stuck in a rounded forward position with muscles that are tightened in either a short or elongated position (even just a few millimeters), and we lift those weights, we are asking for trouble.  Our complex shoulder joints are designed for complex movement and need to be moved through their full range of motion regularly to function best.  Regularly doesn’t mean 3 times per week for 20 minutes.  Regularly means daily, several times per day. Instead, the position our neck and shoulders see most is rounded forward grasping a phone or typing on a computer.  This idea applies to our feet, ankles, knees, hips, ribs, neck, elbows, wrists and fingers, too.

We must educate our kids on what proper posture is, and that is it not just standing or sitting up straight.  It starts at the feet and goes to the top of the head with many important details in between. We must take responsibility for our children to help be sure their bodies don’t slowly get stuck in a poor position. We must watch over them, and if we allow lots of sitting time, we demand lots of whole-body movement time.  We must watch to be sure their bodies are not slowly rounding forward at the neck, shoulders, and hips. We are setting them up for injury when they are old enough to decide on their own it is time to move and get fit.  They must understand that body alignment is perhaps the most crucial part of a fitness routine.  They will experience more success and fewer injuries if they pay attention to the details of alignment first.

tomas-salas-81163-unsplashEvery fitness program, regardless of age, should begin with an assessment of your body alignment no matter how young (or old) you are.  If you find details of alignment that need to be corrected, every program should begin with exercises that focus on bringing the body back into alignment.  Once proper alignment is achieved, full-speed ahead.

For details on correct body-alignment visit https://mayerwellness.com/.

Pain Management Self-Care Products: How do I choose? And, do they make good gifts?

One of the goals of Mayer Wellness, LLC is to help people design a life where they can reduce, eliminate and manage their pain to create a satisfying life. So, it is important to me that I teach my clients self-care. As all therapists know, what the client does between appointments is far more critical in making progress than the appointment itself. Receiving bodywork regularly is a wonderful part of a wellness routine. However, good movement habits and regular self-care is a must to keep pain and stiffness at bay.

I know from personal experience that my old shoulder injury will rear its ugly head if I don’t keep up my regular stretching and exercise routine. My regular activities include lots of shoulder movement, but when I’m at the computer more, I know I can’t skimp on my routine or I will pay for it. Most of the time some light stretching and weight bearing through the shoulders with some yoga keeps my shoulder in check. However, when it decides to flare up, I need more. That is when I turn to my self-care tools.

I have always been a lover of gadgets. Kitchen gadgets, yard gadgets, technology, and of course self-care gadgets. There are many tools on the market now. A search on amazon.com for self-care products resulted in over 8000 products. How do you choose?! One option is just to keep purchasing them, trying them out for a while, and see what you feel. This is what I have done over the years. I don’t believe I’ve ever returned an item. Not because they were all effective. Far from it. I didn’t feel right returning something after using it for a couple weeks, which I think is a fair trial period. So, I kept them and let them pile up.

After a couple decades of buying and trying I’ve landed on several self-care products, I can’t live without. I’m sharing this because I’m hoping to save you time, energy and expense. And, help you with your own self-care. 20181024_142634I use many of the products in my workshops and with my clients. I don’t sell any of them in my practice, but I have often been asked. I’ve considered it, but the retail business is entirely different from the therapy business, and I’m just not ready to go there yet.

Becuase I have been asked so many times if I sell the product or where they can be purchased, I created is a page on my website dedicated to the products I use in workshops, with clients, and recommend for self-care.  You can continue reading of just go right to my Recommdended Products page and poke around.

Amazon.com has a wonderful program (Amazon Affiliates) that actually pays me a small (very, very small) portion of any sale from a link to my website. So, full disclosure: If you buy something I recommend after clicking on my site link to amazon.com, I profit. It does support my private practice, so I very much appreciate it!

Another thought before I begin unveiling my favorites is gift giving. Those that know me, know I’m weirdly crazy practical. Many years ago for Christmas, I gave everyone in my family and extended family a TheraCane. If you are not sure what this is, it is a self-care tool shaped like a cane with handles that helps you get at the knots in your back. Everyone was a little confused at first now knowing what it was. After a few lessons, they loved it. It ended up being one of those gifts that kept on giving. So, if you need a present for someone you care about, you are sure to find something on my list. Unfortunately, we all have pain or stiffness now and then so if you are practical like me, then these products make great gifts. And, no, the TheraCane is no longer on my favorites list, but I may pull it out on an infrequent occasion.  Here is a link if you do want to check it out. Thera Cane Massager (Black)

You can choose to keep reading or I show and explain the tools in this video.

I am never without my number one favorite tool, the therapy ball. They literally travel with me everywhere. I have used them in the car, hotel rooms, planes, my office, during meetings. I have lent them out and given them as gifts. They are versatile and get can into tight spots almost anywhere in the body. Therapy balls are the primary tool I use in my workshops. There are many tips and tricks to getting in those areas deep in the hip shoulders you can never quite seem to hit.

The best therapy balls are dense but have some give when you press into them. They also have a “sticky” opposed to a slippery surface, so they do not easily slip away from you when you lean into them. Using balls that are too hard is not safe for many people and can damage tissues. Balls that are too soft such as tennis balls are not as effective and more difficult to use. It is also best to find a set of therapy balls that come in a pair and includes a bag or pouch to be used together or individually. This offers more options in your stretching routine.

The Acupoint ball is my personal favorite and the size and density I use in my Myofascial Stretching Workshop. It is excellent for most people, especially women, as they are slightly smaller than other therapy balls (about 2.5 inches). Acupoint Massage Balls PicA smaller ball easily gets in between muscles to reach deeper into the fascial system.

On my Recommended Products page, I have a link to a slightly larger set of therapy balls, a set of therapy balls of various sizes for targeting smaller areas, and a larger four-inch ball for the abdominal area. Yes, I own them all and use them all. They are all wonderful when used correctly.

You can use the therapy balls alone, but to really increase the effectiveness it is helpful to have a yoga strap and a set of yoga blocks. You can substitute a book for the block and a scarf for the strap, but the right tools make a significant difference.

A yoga strap is an excellent adjunct to your yoga practice or your myofascial stretching routine. Yoga beginners who are just diving into improving their flexibility appreciate the extra reach they get from using a strap. In your myofascial stretching routine, a strap allows you to move your extremities in an unlimited amount of directions to change the angle of your pressure with the therapy balls. While you can use a belt or a scarf, yoga straps come in different lengths and provide more options. My favorite yoga strap, the Therapist Choice Stretch Strap, has elastic loops you can slip your hands through to decrease the amount of grip needed to hold the strap. This allows you to relax your body more as you stretch. The downside of this strap is that it cannot be made into a circle for bound poses in more traditional yoga practices.

You may also choose a traditional yoga D-ring strap. This brand comes in lots of colors and lengths (6, 8 or 10 feet). Why different lengths? The longer your legs or the reach of your arms, the longer your strap should be. A very tall person might want the longest strap length to provide the most options for using the strap. A shorter person may do just fine with a shorter strap. I have an 8-foot strap which serves me well. I’m 5’7″. The D-ring also allows the strap to be made into a circle for binding or securing the body in certain positions.

Yoga blocks are essential for someone just starting yoga. Blocks allow you to ease into poses and support you when you can’t quite reach the floor or need extra space when moving through many poses. Blocks can also dramatically increase the effectiveness of your myofascial stretching practice when using the therapy balls. Yoga blocks come in different sizes and densities. Depending on your intention for use and your experience you may choose different blocks.

If you are purchasing blocks to use with your therapy balls, it is a great idea to have a set with two different sizes of blocks. This provides options with how far you can lift or tilt your body areas to angle into the therapy balls. The link on my Product Recommendation page offers a 3 inch and a 4-inch wide block.

If you are purchasing blocks to support you as you ease into a yoga practice, I recommend a broader 4-inch set of blocks. This width is often more stable and comfortable on your hands as you lean into them. If you want an even greater sense of stability with your blocks, choose a cork option. They are heavier but offer some give when leaning into them. I love my cork blocks. They are pricier, but when I’m doing a lot of sun salutations, they are helpful to provide a little extra room and stability with pulling my legs through from down dog. The brand I recommend offers both foam (in lots of pretty colors) and cork options in a 3 or 4-inch block set at a reasonable price.

One of my most used props in my toolkit is the half-roll. The calf stretch is the hands-down most crucial stretch you can do for keeping your fascial system relaxed and open. While you can use a rolled yoga mat or a book to do the calf stretch, having a half-roll is convenient and can be used for many other stretches or balance exercises. It also looks nice if you want to use it at your standing work-station (which I highly recommend). I keep one at work and one at home. I often use it while in the kitchen prepping supper.

I’m generally not a fan of foam rollers and almost never recommend them to my clients or use them in my workshops. However, many people do use them. If you do roll, I suggest you use a roller with texture. Smooth rollers may press into the tissues and loosen tight areas, but they smash everything else in the process. I recommend you roll to locate tight spots then press and hold to release them. A roller with texture gets in between the tissues and provides points of pressure deeper than a smooth roller can.

The hand-held single ball roller is excellent for when you don’t have time to get down on the floor and use a therapy ball. Using them in the car or at work is excellent. It is also an easy way to help out a loved one when they ask you to rub their shoulders. It feels great, and they make lovely gifts.

When you need to get in a little deeper a roller with two handles can really do the trick. This tool is pricey but by far the best hand-held roller. Great to use when a loved one asks for some TLC.

Many of us have pain and tension in our necks periodically. Getting into those muscles is tricky. Massaging and lengthening them is helpful and feels good. I own and use the following two products when my neck needs some TLC.

The Cranio Cradle gently presses into the muscles at the base of the skull.  It can also be used in the upper and lower back area. It is soft and flexible, but sturdy enough to support the weight of your body. You can also change the angles for your best stretch. It can be used anywhere you can lay down.

20181024_150235This neck hammock is easy to set up and provides a very gentle stretch. It is also suprisingly comfortable with little cushion in the neck and ear areas. You can control the amont of stretch by moving your body further from the connection to the wall/door.  The connectors are sturdy elastic so you feel well supported. Using a hammock can help train your neck to relax. To up the effectiveness while in the hammock, meditate.

While all these tools are great, there is nothing like an expert practitioner to help you find the tight areas and teach you how to use them to their maximum effectiveness. You can also purchase gift certificates for a workshop, a stretching consultation or a one on one myofascial session by contacting me directly.

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.