After any serious injury and resulting pain, the habit of checking for pain becomes yet another challenge. Extreme pain due to injury and/or surgery requires, initially, some degree of self-monitoring. Then, over-checking for pain becomes an interference for further recovery. The nerve sequences for pain physically strengthen and thicken if we use them with frequency to check pain. Even a note of pain plays the entire orchestra of original pain even though this full pain sequence may not be actual at the moment. Teasing out what is “real”pain and what is a re-play of previous pain is what my PT, Heidi, is assisting me with assessing and with responding to appropriately.
In the Alexander Technique, we take as a given that our sensory feedback is faulty as it is based upon habitual use of the senses. What is familiar, as in neural pathways most habitually stimulated, is judged as “right”. The unfamiliar neural connections are assessed as “wrong”. But often, the “wrong” is actually “right”, if not always familiar.
I am learning, with expert guidance, to know when pain is dangerous, or is just a “ghost” sequence from past pain. This is difficult to describe, as it is very experiential in nature, and also individual in interpretation.
Meanwhile, I am deeply grateful to be able to walk, to dance in my weird one-legged fashion, to teach well, and to explore new means of response from the condition of Self that I am currently experiencing.
How we move defines our Self, whether we are conscious of it or not. Our co-ordination of the entire Self in daily activity registers on our brains as an identity of Self. When we change our motor response to stimuli, for instance in an Alexander lesson, we typically don’t recognize our Self until that new response becomes familiar. Habits of response are usually invisible to us, and yet they are how we define who we are.
My self-definition and identity had been constructed by my activity enthusiasm involving my pre-injury mobility. Experiencing dramatically reduced activity and very challenged mobility has shifted my identity to a mysterious and murkily defined mode. I am not who I was previous to injury. And, who am I without my former movement explorations? I can’t yet say.
Six months of incremental recovery yield moments of joyous celebration and many days of frustration and dismay. New coping skills have been developed out of necessity. My former means of handling stress was by running joyfully every morning, to hear morning birds and to experience rhythm and exhilaration, and by walking speedily to all my locations. Both of these activities helped me observe how my mind was working, and to resolve any problems through an entire experience of Self in motion. Movement was my source of joy in many respects. Now, I have to find new ways to process any daily stress (with the added stress of not moving vigorously!). This is not at all to my liking! I have to be fine with a slow pace, to accept a stationery bike as my means of exhilaration, and to find quiet in just quieting myself. These are no doubt new skills. Patience is the new mode.
Do I like this new mode? No, I do not! I miss running like an addict misses drugs. My injured leg looks like an alien limb to me, especially in comparison to my Tarzan non-injured leg. Although my overall strength is remarkable, and my use is pretty good, considering my injury, I get depressed about the jelly-like wobbliness of my injured leg. I wake up every day wanting to go for a run.
I am forced to be quiet in a new way, and may, with this experience, find new skills and a new identity. But I haven’t become happy or grateful about forced quiet yet. Stay tuned!
The psychological and emotional aspects of recovery go in tandem with physical recovery. F.M. Alexander proposed and deeply believed that the mental, physical and emotional aspects of the Self are integrated and inseparable. Although some activities may be described as primarily “mental” (problem solving, for example) or “physical” (e.g. athletic pursuits) or “emotional” ( distress, joyous participation), the entire Self is involved in any activity. We don’t as animals know we are feeling an emotion, for instance, unless we have an indicating physical and mental set of cues. All animals have this integrated response; humans have emphasized the mental priority with sad consequences.
Experiencing ongoing physical pain and immobility has myriad psychological consequences. The Self that has been recognizable by daily physical activity is no longer on line. New means of accomplishing simple tasks must be found, and the familiar Self, as cued by previous experience, changes and morphs. The danger of a Self as identified by “disabled” lurks and haunts emotional stability. We can sink into a notion of disability as a constant, or rise to a concept of the whole Self, with choices in response to stimuli, whether internal or external. This is what F.M. Alexander proposed as the next step in human evolution.
My current means of responding to my (temporarily) reduced condition of Self is to, once again, dance! I watch videos of Michael Jackson, who was one of our generation’s greatest movers. The mirror neurons in my wee brain take great delight in viewing his ease and skill in motion. So, I dance in my mind and instruct my whole Self accordingly, despite my less than functional leg. And, I put on music and dance like a crazy person, so my injured leg can learn to respond again. I look pretty silly, but I have fun, feel joy, renew hope and also re-connect neural sequences that have been temporarily lost with 6 months of arduous recovery. My whole Self feels better and more on line.
That’s the spirit! Just dance, despite limitations!
It has been nearly six months since I fell and fractured my patella. I had no idea when I injured myself of what a long road of recovery would be required, and of how many challenges I would face. Six months of being less than fully mobile is a very long time for anyone, but a dramatically long time for a person (me, for instance) who is typically active in a vigorous, daily fashion. My emotional survival has often come under question, and my physical recovery has been challenging far beyond any expectation.
My surgeon “graduated” me from his care this week. Until our final meeting, he had never seen me move. He had seen me in a wheelchair, on the operating table, and on an examination table. Given his limited observation of me, I dismissed his dire predictions that I would never walk without a limp nor ever run again.
On our last visit, my surgeon (who, by the way, did repair my patella with great skill) asked me to stand and “walk” in a very small space. I literally walked in a very small circle. He pronounced that to be “good”. He did not ask if I can walk down stairs, run, do Gyrotonics, teach a full schedule or ride a horse.
My point is that the surgeon doesn’t see the patient in a full-time function fashion. The full function recovery is up to the patient.
What has worked well, thus far, in my recovery is ignoring dire predictions, diving into as much activity as I can manage, with Alexander principles applied, finding PT’s who think beyond mechanics, and trusting that the resources available from my extensive professional contacts will yield far more than the standard recovery protocol.
Alexander lessons, osteopathic treatments, acupuncture and Gyrotonic exercise, in addition to intelligent Physical Therapy, have assisted me. I have no idea where I am on the spectrum of standard recovery from a patella fracture. I am walking an average of 3 miles every day, teaching a full schedule of Alexander lessons, and vigorously exploring Gyrotonic routines. I cannot yet run, walk down stairs in a normal way, sleep comfortably or claim that I am pain-free. Pain continues in a random and frequent fashion. I still don’t recognize myself in my current level of challenged mobility.
Still, I am recovering, not stuck, and will continue to improve with intelligent PT, Gyrtotonic exercise, acupuncture, osteopathy and, most enduringly, Alexander principles, until I am functional and mobile to the degree that I consider full and acceptable.
I am much better than I have been and hope to be better than I am, with the expert support of all the good people who guide me, and with continuing thoughts of dynamic non-interference, and of up, forward and wide!
From an Alexander perspective, we can all go up a little more and pull down a little less. This applies throughout life, and especially for Alexander teachers, who have been applying Alexander principles to activity on a daily basis for many years. The Alexander Technique is not a quick fix. The habits of a lifetime are addressed by continuous attention to overall use of the self, and an intention in response that is elastic and whole-person attentive. More and more layers of potentially pulling down in response to stimuli need to be kindly and gently addressed, so that thinking with the whole self becomes a continuously developing skill.
I can walk with much more ease and speed now, much to my joy. But I must apply the directive of “going up more, pulling down less” to daily mundane activity to continue with recovery. When I find myself limping and lurching, I have to calm and quiet my mind, refuse to pull down in my attention, and decide on the priority of springing up from the ground with my entire neuro-muscular response. This results in a more balanced means of walking, less pain and fear of pain, and a wider attention to the wonderful world that surrounds me. I can enjoy the views and the experience involved in walking without pulling my attention down to my injured knee.
This is not to suggest that I ignore or suppress any discomfort, whether physical or emotional. Instead, I choose to notice my intention and attention, and decide to welcome a freedom of self in whatever condition of self might be current, and to dynamically spring up from the ground with joy and ease.
I saw a hawk today in the city and heard the hawk’s chirps because I had a wider view than possible knee pain. Evidence of embracing a wider view!
This continuing journey of recovery from serious injury has led me into unexpected paths of exploration and connection. Previous to enduring an injury, I had minimal experience with Physical Therapy. Now, I am building a matrix of sources and connections, so that I can have the best possible expert support for my eventual full recovery.
This past week, I was delighted to exchange work with another PT referred to me by my Gyrotonic instructor, Lindsey. Janette Arhndt is a PT with refined skills in Gyrotonic, myofacial release, and lymphatic drainage therapy. Janette kindly came to my office for our work together. I gave Janette her first Alexander lesson, and she gave my injured knee much needed hands on soft tissue work. Her intent was to relieve the inflammation (and the resulting pain and immobility) in my knee, as well as to encourage lymphatic drainage. As an Alexander teacher, I am quite selective about hands on me. Janette’s hands reflected her overall superb use. I experienced an immediate increase in flexion, reduction in discomfort, and a deep sense of well-being.
Janette was very optimistic about my recovery, as she observed my movement with care and attention. Her calm, kind and professional presence, as well as her intelligent recommendations for pursuit of simple recovery approaches, was hugely reassuring.
The day after my delightful exchange of work with Janette, I enjoyed a Gyrotonic session with Lindsey. I was able to happily explore much more vigorous movement, and all without pain or fear of pain. I also walked most of the way from my office to the Gyrotonic studio (about 1 and 1/2 miles), a greater distance than I have walked with any ease since injury!
Our current health care system (please, can we just change it?) outlines a “productivity model” for injury recovery that is deeply end-gaining. PT’s are typically expected to advise specific muscle strengthening exercises (focussing on the part more than the whole) and present a standardized list of exercises for an injury. There is often little time or attention allowed in our current system for the PT to notice how the recovering person is motivated to think or believe about the process of recovery. The weight falls upon the recovering person to find a means of rehabilitation that best suits their hopes and personal goals. Due to my Alexander skills, and connections I have made through my long term interest in intelligent activity, I am blessed to have found PT’s who are compatible in their approaches with Alexander principles, and who support me in my insistent belief that I will recover fully.
I have never, previous to fracturing my patella in a fall, required the skills of a Physical Therapist, so my expectations were relatively uninformed. After injury, I’ve had two Physical Therapists through my co-operative health group, and they did their expert best for me. Although I have been very appreciative of their work, my pain levels and mobility had not improved significantly from the exercises they had assigned to me. Thus, I took it upon myself to find further, less mechanically oriented PT guidance.
My Gyrotonic instructor, Lindsey, referred me to a PT who is a former dancer and Gyrotonic instructor. Heidi spent a considerable amount of time in listening to how I am now, how I have been since injury, and then observing how I walk. She gave me new ways to think about walking that helped me tremendously. And, happily from an Alexander perspective, the “exercises” she gave me were far less about strengthening specific muscles than concerned with overall awareness of co-ordination. Although she didn’t employ the term “use” in an Alexander fashion, she attended to use and the big picture of personal co-ordination choices.
The result is that my mobility and pain levels have improved. I walked home from work today at my pre-injury speed and ease.
There is more recovery in my future, I hope. I can’t walk down stairs like a normally co-ordinated person, walking downhill is very challenging and often painful, and running, riding a horse, or doing many of the activities I did previously with confidence are currently far beyond my capability. I am grateful to be able to teach well. I have renewed hope that with the skilled guidance of a PT who thinks less mechanically and more widely, combined with Alexander lessons, I will be able, in time, to enjoy all the activities I love, and more, once again.