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More Turkey Wisdom.

December 30, 2011

In my last post, I described how I went head-to-head with a dead turkey, and the turkey won. Using basic principles of Physics.

Even though I knew on Christmas morning that I was in pretty serious trouble, it did not occur to me to say to my beloved “Here, you take the cooked turkey to the family shindig, please give them my apologies but I really need to lie down horizontally because a two hour car trip followed by a three hour sit down lunch is only going to increase the damage I’ve done to myself.”

If I had said that, I wouldn’t be writing this post. A day’s rest on the back, and I would have been back to business as usual.

But no. Instead, I gritted my teeth and taxed that little group of postural muscles further by sitting, standing, and generally struggling to maintain my torso upright with respect to gravity. For 5 hours. Over which time various other muscles came under unusually heavy load (lumbar extensors, diaphragm) in an attempt to compensate. I became profoundly aware of postural sway – millimeter deviations from a pain-free organisation was accompanied by a screaming spasm of muscular pain.  Acute pain, which I foolishly chose to suffer through in order to satisfy my socio-cultural obligations.

By acute, I mean short term pain with a pathology (aka injury). Pain of this kind is an incredibly useful (albeit unpleasant) product of evolution. Its purpose is to make an organism stop doing something harmful to itself. Like take-your-hand-out-of-the-fire, or don’t-bear-weight-on-that-broken-leg, or in my case: don’t-load-kaput-extensor-muscles. Ignore or use painkillers to dampen acute pain at your peril.

I’m not against painkillers per se – they’re incredibly useful in certain situations. I’m just not a fan of painkillers as a blanket first resort for the reason I just raised: acute pain has a purpose. If you can identify the harmful thing to stop doing, and be confident that your conscious willpower (or some external device like a sling or cast) can prevent you from doing that harmful thing, then go ahead, gobble those aspirin, spray on the anesthetic, smear on the Deep Heat or whatever your choice of painkiller is.

The thing is, what most of us use painkillers for is to mask acute pain signals so that we can keep on doing whatever harmful thing our body has just red-carded. This is pretty much a sure-fire recipe for further injury and prolonging recovery time. I’m no fan of suffering, but I turned down the various pills and potions offered (with the very kindest of intentions) on and since Christmas Day.

Instead, I chose bedrest: commonly considered a bad idea because we all “know” that “the best cure for back problems is to keep moving” .

Rest. Is. Good. The important thing is to rest relative to the kind of injury you have. This article from SaveYourself.ca has my vote for the all-time, best-ever advice on relative resting. Because my injury involved the postural muscle system, being upright ran the risk of making the damage worse, and of establishing compensatory muscular habits that would, in the long run, lead to other damage.

That’s not to say I did nothing while lying on my back. I employed my skills as a Feldenkrais Practitioner to keep moving, to stay within the boundaries of comfort, to explore what I could do, to take things slowly, and to discern and appreciate the smallest of changes. I set myself little challenges, and listened to when my body told me to rest. I only experienced pain when I engaged the damaged muscles – which told me they weren’t ready to take load yet. Using painkillers would have blurred and confused that critical feedback.

So let me be crystal clear here: there are definitely situations where using painkillers to dampen acute pain is beneficial. But you need to be aware that the flip side of the coin is the potential to prolong recovery time.

More Wisdom of the Festive Turkey:

1. Just about everybody will hurt themselves at one time or another by doing something foolish. Even movement ‘experts’.

2. Pay attention to acute pain, and stop doing whatever is causing it. Regardless of the social situation. Do not ‘soldier through’ – you’ll regret it.

In which the Festive Turkey imparts some wisdom despite being dead. And cooked.

December 30, 2011

If Physics bored you to sleep in school, here’s a really good reason to have stayed awake: the principles of levers and forces. I’ve just spent the last four days lying on my back, unable to sit or stand, because in the Festive Roasting Rush I forgot those fundamental principles. I’ve also spent that time reflecting on pain, culture, folk wisdom, and the appalling state of Australian telly. Now that I can have my torso upright without excruciating  pain, I want to share some of my thoughts with you (not about Oz telly – it’s beyond redemption) over a series of posts.

First, to Physics, and how I hurt myself: with a 5 kilo turkey. A piffling weight to lift, you say – provided one keeps it close to one’s body. But what with the general cooking kerfuffle, the only clear space to baste the bastard was on top of the stove, which meant standing an open-oven-door’s-depth away from the stove, and lifting the turkey from below onto the stove top at pretty much full horizontal arm extension. I did that 6 times over the course of Christmas Eve day. A rough and dirty calculation makes that turkey a bit over 90 kilos of force – almost twice my entire body weight – each time I lifted it up, and each time I put it back in the oven. This is where remembering that Force = (Weight x Length-from-fulcrum) / Length-to-fulcrum BEFORE cooking would have come in handy and suggested clearing some bench space prior to basting so that the whole procedure avoided long lever action….

Now, the lifting-the-turkey fulcrum point is not at the shoulder joints – it’s in the area where a variety of muscles attach the arms to the spine. These include the muscles we’re all familiar with from gym weights training: traps, lats, rhomboids. It’s important to remember here that despite the pretty coloured diagrams you find on weights machines and in anatomy books, muscles do not work in isolation. Remember also that the spine is articuated (and therefore bendy) so to provide a stable fulcrum for lifting turkey-type loads, all of the extensor/postural muscles of the back have to participate, and to a certain extent, the diaphragm.

In an ideal body, each muscle in the whole ‘orchestra’ contributes its fair share, distributing load proportionately. There may be ideal bodies out there somewhere (although I think it’s pretty unlikely) – but mine is not one of them. So some of my muscles didn’t participate as much as they should have, and other muscles had to compensate by doing more than they’re capable of. It’s important not to interpret this as some muscles being weak, in need of some jolly-hockey-sticks strengthening discipline. What it means is that my nervous system didn’t coordinate muscular activation properly – a bit like the conductor forgetting to cue in the second violas.

In my case, the muscles which got hammered with overwork were a few small sections of the postural muscles close to the spine. As I’ve written before, this kind of injury doesn’t always present itself immediately as a pain experience, and in fact I didn’t notice a thing until the following day. I lifted my arms to pin my hair up, and, whammo. But more on acute pain in the next post.

Now, the reason I’ve painstaking detailed this fairly mundane sequence of events is because this sequence is exactly that: mundane. Long lever lifting is something that lots of folk do quite a lot of the time without thinking, and the injuries it can cause are the reasons why safe lifting practice is a standard part of OHS education. But I have never seen lever force equations or diagrams used to elucidate just WHY safe lifting techniques are important (eg that a light weight at the end of outstretched arms requires nearly 20 times force at the back). What seems to happen is that documentation like our National Code of Practice for the Prevention of Musculoskeletal Disorders from Performing Manual Tasks at Work (2007) simply lists ‘hazardous’ actions and postures. If one were to apply the term ‘hazardous’ to these actions in everyday life, it would pretty much rule out sport, housework, cooking, playing a musical instrument, gardening, having a pet, having children…. The problem with teaching people WHAT rather than HOW is that you end up with a whopping great list (over 7 pages in the Code, with diagrams) in the hope that all possibilities will be covered. They won’t, and people won’t remember the whole list either.

The Wisdom of the Festive Turkey: remember your high school Physics.

Practical Neuroscience

December 2, 2011

It’s official: I have blog envy. Sometimes you come across a blog which is so elegant, clear, and engaging there’s absolutely nothing you can say which will add to it. But it’s so compelling you just HAVE to share it. I found one such this week: at better movement.

First, watch this marvellous TEDtalk by Daniel Wolpert on The Real Reason for Brains. Then read this post at better movement.

Dots and the story

November 22, 2011

In Making Connections I wrote about the importance of the bigger picture: the person, their environment, and their interactions with their environment, when considering how to approach overuse injuries. My colleague N. has asked me to elaborate a bit on this (not sure whether to thank you or curse you, N., as it’s led to a few weeks of intense thinking work) – so here it is.

For my last post I used a couple of ‘join the dots’ images to emphasise the complexity of human movement and experience versus the simplicity of a cause-effect, mechanistic approach. I’m going to stick with that analogy, and expand its application beyond overuse injuries to reflect on a broader theme – and invite you all to enter a fun competition!

One of the most common beliefs I encounter is that there’s a ‘right’ way to sit, stand, walk, etc etc. This ‘right’ way is considered immutable – that is, a body organisation which is perfect for all bodies in all environments and, frequently, for all interactions. (Insert your own “Pull back your shoulders”, “Engage the core”, “Tuck your tailbone under” posture mantra here.) The problem is, bodies, environments, and interactions are highly variable. This is why we have brains in the first place. Having said that, however, there are some constants – which is why we can talk about there being more and less efficient body organisations for specific actions in specific environments. Let’s take the arrangement of blue dots below as representing ‘constants’:

Examples of ‘constants’ (extended conceptually to include rules) might be: gravity; Newton’s laws of motion; trigonometry (for adding vector forces); the mechanics of hinge, ball-and-socket, and sliding joints; the laws of physics around energy conservation; momentum; friction; the mean tensile and compressive strength of human bone and muscle tissues; the generic anatomical structure of humans (ie bipedal vertebrates); etc etc. Note that some of these ‘constants’ apply to the person, some to the environment, and some to both. And notice how few of the ‘constants’ actually are constant: most are rules-of-behaviour or averages. People, although anatomically similar, are not identical. Environments are not static either (unless you remain absolutely still inside a sealed box, not something I recommend), although we often conceptualise them as being so. Just walking across a room may bring you onto a variety of sufaces (hard and slippery polished timber, then a slight change in level to a soft and grippy rug) which trigger minute adjustments in movement. Outside buildings, our environment is even more variable: wind, kerbs, oncoming cars, ice, broken glass and so on.

So if we take our dots now, and include as lines the interconnections between them as a picture of a more efficient body organisation for the function ‘walking’, it might look like this for an anatomically average human, on a clear day, on level ground, with a couple of kerbs to traverse, and a doorway to walk through (remember this is an analogy, not a representation):

But of course we are not naked robots, simply traversing terrain. We carry bags, wear restrictive clothing, limit our anatomical functionality with shoes, talk on the mobile, drink a take-away juice, hold an umbrella. We walk with purpose: to get to a meeting; softly, so we won’t wake a sleeping child; to find a particular address; to avoid unwanted attention on a dark street in a dangerous area; to take a tray of coffees back to the office without spilling any; to meet a lover. We walk with our personal histories and futures: remembering that argument with your children; reciting facts to be recalled in your upcoming exam; imagining your friends’ reaction when you tell them you’ve gotten engaged; worrying that you’ll be late to the meeting and lose your job. Add any one or more of these variables, or allow for a change in the environment (say ice on the road) and the picture might look like this:

Same dots. Different story.

Do I need to labour the point about the fallacy of the ‘right’ way? I didn’t think so.

You might also like this post about ‘posture’ from a fellow Feldenkrais practitioner in the USA.

Competition: for fun, why not make your own drawing using the dots from the top picture in this post. Send it to me, and I’ll give a prize to the best one!

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:

20111102-115541.jpg

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.

20111102-130847.jpg

Recycle three (edited) …Avoiding awareness

October 27, 2011

  It’s extraordinary how uncomfortable modern human beings are with awareness. We’ll go to all sorts of lengths to avoid it, in case it turns out to be every bit as unpleasant as poor Linus and Lucy’s experience.
All too often awareness is strongly associated with pain or frustration. We become aware of poor movement patterns through backache, stiffness, strain, or worse: injury. Equally, we deliberately suppress awareness to achieve social goals. Imagine being aware of the constant sensation of your clothes on your skin,  or the muscular effort involved in keeping your knees pressed together while sitting.
However, lack of awareness is exactly the state required for the dark side of neuroplasticity to strengthen poor movement habits and develop compulsions through repetition. Nobody intends to make life hard for themselves – it happens by stealth precisely because we have become so skilled at avoiding awareness.
Awareness is the first step in co-opting neuroplasticity to your advantage.

The lovely Peanuts cartoon above highlights what happens when we encounter a new awareness without some kind of  functional framework – the unfamiliar is experienced as discomfort. Yet imagine the added richness of experience in store for Linus and Lucy if they were to take their awakened tongues to an encounter with an ice cream cone or to a singing class!

Recycle two… Blind spots

October 27, 2011

We all have them. I don’t mean that you might actually believe that you don’t have a left shoulder or a right knee, but rather that your sense of some parts of your body can be anywhere from vague to non-existent. Take, for example, your toes. Without looking at or touching them, can you sense each individual toe to the same degree as each of your fingers? Missing parts of our body image often limit efficient movement and can also contribute to pain. It works like this: if some part of you doesn’t contribute to an action, then other parts have to take up the slack. Overworked muscles and joints are more vulnerable to damage and fatigue – hello lower back pain!