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Making connections.

November 2, 2011

Before group classes start, I ask all new students if they have injuries or conditions I should know about. Not only is it a standard safety procedure, it also alerts me to changes I might make to the lesson on-the-fly and to particular observation I might make of that student during the class. Last week I had this response:
“No, no injuries. But I’ve had this pain in my right hip since having my baby, and it just won’t go away. I’ve had tests and MRIs but they can’t find anything wrong. So I’m hoping these classes might help.”
She actually rubbed her lower back on the right side as she said this, which gave me some clues, and after the usual preliminary cautions about taking it gently and NOT making movements if she found they aggravated her pain, we got into the lesson.
I observed her closely during the class, and afterwards I asked her a few questions.
“How old is your baby?”
It turned out this was her second baby, about 18 months old. To me, this means she’s still carrying her baby around quite a lot, so on to the next question:
“Which side do you carry your baby on?”
“This side” she responded quickly, demonstrating the action of holding her baby propped on her right hip. The muscles of her right lower back were contracted to lift the hip on that side and brace the imaginary weight.
I waited a couple of beats, to give her time to process the question and her response. Then, to flesh things out a bit more for her, I asked:
“Do you ever carry, would you consider carrying, your baby on the other side?”
“No. It’s too..difficult. Complicated. No.” Again, a rapid response, and again I paused for moment.
A flicker of realisation crossed her face, followed by a frown. Then she said:
“But it’s not, I don’t think it’s a trigger. Could it be that?”
Now this is an interesting dilemma. Because we have a generally mechanistic view of the body, our inclination is to look at cause and effect like this:

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And that works very well for trauma based injuries like breaking a leg in a fall or tearing a muscle in a football match, but it doesn’t help much when it comes to overuse injuries. Often the ‘trigger’ of pain in overuse injuries (that is, the action which immediately precedes the onset of pain) is something utterly innocuous. “I was just washing my hair in the shower” or “I was just putting a cup in the bottom of the dishwasher” are common, baffled answers to questions about when pain started. In fact, these are the proverbial straw/camel’s back actions in which the body, albeit under no or little load, is for the umpteenthousandth and crucial time, moving in precisely that organisation.

Giving someone the time to reflect on their own statements/actions and come to realisations by themselves plants far more fertile seeds for change. But you have to ask useful questions and be very, very patient. A colleague (an excellent Pilates teacher) recently recounted a story to me of one of her students.
This chap was a postie, suffering from back pain on one side. He’d been to doctors, a variety of practitioners, had all the scans and diagnostics, but still nobody had been able to help. He’d come to my colleague hoping that some strengthening exercises might work. She quizzed him about his everyday life far, far, more thoroughly than previous practitioners had. Between the two of them, they realized that, under specific instruction from his workplace, he was delivering mail leaning across his motorbike, always on the same side. It wouldn’t be enough to simply to do some Pilates work in the hopes it would counteract the movement habits of his daily rounds. If he wanted to seriously address his pain, he would also have to disobey operational orders and vary his routine by delivering from both sides of his motorbike.

So we don’t join the dots in a simple cause-effect relationship. We have to look at the whole person, their environment, and their interactions in the enviroment to make a picture.

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3 Comments leave one →
  1. November 2, 2011 7:22 pm

    Nice piece! I was never much good at joining the dots myself. 🙂

    Which is where a good practitioner comes into the picture.

Trackbacks

  1. Dots and the story « lab, acturally.
  2. In which the Festive Turkey imparts some wisdom despite being dead. And cooked. « lab, acturally.

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