Renewed options in use
A few weeks ago, I happily flew to NYC (with far less knee inflammation than previous trips) for a visit with friends and some lessons with John Nicholls. Previous to this trip, I had been struggling with the painful effects in knee and foot from even limited hill runs. Despite all the dedication of two and a half years in recovery from patella fracture, the long term impact of injury on desired activities continued.
After my lessons with John, I was much more elastically connected to the ground. I also had the marvelous experience of being breathed from my feet to the top of my head and beyond. There is no way to adequately describe this experience of breathing with the entire self, but trust me, it is utterly wonderful. Mind you, I have been taking lessons from John for over 20 years, teaching for 24 years, and dedicating myself to continued learning since I began teaching. This is not an overnight sensation, in other words!
Once I returned home with my newly refined elastic connection to the ground, my morning hill runs shifted into an entirely new gear. A springy response from foot strike to the top of my head became far more accessible. My perception of “enoughness” became more accurate, in that I knew quite quickly when to tone down vigor to avoid any injury. And my post hill-run condition was less aggravated and inflamed.
It’s the same old deal here, from an Alexander perspective: improve the entire use of self; then, vigorous activity strengthens the improved use of self.
I am only running a few hills, but I am learning a lot!
Balancing activity with current condition
Since injury well over two years ago, I have struggled to become more fully active without hurting myself. In other words, how do I use myself intelligently given my current condition of self?
My Osteopathic doctor recommended that I only run on softer surfaces. The beach in Kauai, where I can run barefoot with ease, is ideal, but since I don’t live in Kauai…. Although I respect, value and deeply appreciate my excellent Osteopathic doctor, and have every intention of using myself well in all circumstances, I just have to experience the exhilaration of a morning hill run with all the bird songs and fresh breezes from Puget Sound, as well as the resulting endorphins that inform the rest of my day.
So, what do I do? I go out for my morning run with a request for an overall elastic response to the ground. I intend for my breath and my use to be mutually supportive. As my breath proceeds through my entire length of spinal curves, my legs release into the ground, and all impact translates in a spiral up and out of my head. Running becomes an experience of invisible effort and spiraling ease. I pay attention to any pain signals and walk when running is not easy. I listen with joy to the morning bird songs, enjoy the breezes from Puget Sound, become a rhythm, and discover a new narrative beyond previous experience.
Balancing urgency for activity with current conditions of self is an ongoing exploration.
Metatarsal inflammation returns
During recent morning hill runs, I have begun to notice inflammation pain signals in my left foot again, after many months of reprieve from same. Past experience of this indicates a disruption in my overall elastic response to the ground, and a potential challenge with increased demand in activity. It is of interest that foot pain diminishes while I am teaching (when my use of self is at its hopeful best), but increases with vigorous walking or running. Thus, I will sadly hold off on morning runs until I can see my Osteopathic physician for assistance in structural integrity.
The ongoing consequences of patella fracture thus continue. The challenge for me is to not push beyond current limits of self (end-gain), to use my self with dynamic non-interference (attend to the whole picture rather than parts), and to allow time, once again, so that I can explore desired activities with good use and an elastic response. Do I like having to take time again? No, not in the least! But taking time is clearly necessary. More lessons to be learned!
Two years later..
Today marks two years since I fractured my patella in a sidewalk fall. The urgency in dedication required for my recovery has been balanced by the necessity for patience in progress.
The expert professional assistance that made recovery possible has been described in this blog. Suffice to say, I could not have come this far and this well without the help of deeply skilled professionals.
Key points in recovery:
*working with a Physical Therapist whose approach is creative, comprehensive and Alexander compatible
*removing the knee hardware! Huge difference!
*exploring activity within limits of pain via Gyrotonic exercise
*learning to rest (very difficult lesson for me)
*and to go slowly (torture!)
In Alexander parlance, I had to stick to the means-whereby, attend to the entire use of self, and seek assistance from others with a similar point of view. End-gaining was not only undesirable but completely unproductive. Pain was the clear and likely consequence of end-gaining toward a specific result in recovery. The entire condition of self had to improve for my knee to improve and pain to lessen.
And look at me now! I can run (with some frustrating imitations), pain is infrequent, kneeling is difficult but possible, and I can mount and dismount a horse again. Sleep is not disrupted by discomfort, I can descend stairs with ease, my legs are reasonably balanced in strength, and I can manage air travel without excruciating pain.
There is room for improvement, but I am grateful and pleased for how very far I have come!
And onward with recovery..
In the initial, very depressing months of recovery from patella fracture, I had little hopes of being able to resume daily activities beyond teaching and basic daily pursuits. Just walking was hard going, let alone dressing without assistance or descending stairs. It has been a long road of dedication requiring expert help on many levels, but current evidence indicates that hard work, expert help and application of Alexander principles has paid off.
I do still have limitations that may be ongoing, or may resolve with time and more dedication. My left (injured) knee cannot bend as my right (non-injured) knee can. Kneeling remains difficult. ”Child’s Pose” (resting back on folded knees and head on folded arms on the ground) is not, sadly, an option. Sprinting full out on level ground (other than on the wet, firm sand of a Kauai beach, barefoot) for any distance is very difficult. But, recalling that I couldn’t even sit comfortably for any length of time about 6 months ago reminds me of how far I have come.
Today, I deeply enjoyed a private Gyrotonic session with Magali Messac, my dear friend and Master Gyrotonic instructor. She challenged me to explore much more vigorous and refined movement in a whole person manner than I have attempted since injury. To say I was thrilled in the exploration barely states my exuberant response. After nearly two years of limitation in activity, I can now experience new movement learning and strength more fully again.
In fact, my use of self is probably better than previous to injury, as I have had the opportunity to re-examine habitual responses, old patterns, and long-held compensatory systems on all levels of self during this long, arduous recovery. My Alexander skills of pausing to allow a new response, refusing to narrow or shorten, allowing new experience, and insisting on a wider field of awareness were not only deepened but key to recovery.
I had to take the time that healing required, welcome expert assistance, and allow a bigger and unfamiliar coordination than previous experience and pain indicated. I am grateful, happy and relieved!
Tropical evidence of injury recovery
A year ago, with knee hardware still in place (thankfully removed subsequently), I experienced many frustrating limitations in mobility while visiting our beloved Kauai. At that time, I could not swim, walk on the soft sand, or ride a horse due to lack of function in my knee and painful inflammation.
Much has changed since then, thankfully. Although the long flight to Kauai with cabin pressure and imposed hours of sitting are not in any way comfortable for my knee, the discomfort is manageable now after hardware removal.
On my first pre-dawn barefoot walk on the beach in Kauai, with incredible stars overhead, I accelerated into a run, just to explore possibilities. Nearly two years after injury, I not only ran but sprinted full out on the wet sand with dawn tinged surf chasing my heels! Oh, delight, joy, relief and happy fulfillment of desire! I ran with ease and total absence of pain every morning for several miles!
I was also able to swim in the warm rhythmic ocean waters, and to ride my equine friend, Paddy, without any structural difficulty. Of course, riding a horse with even a minimum of skill requires many challenges to use of the self! My excellent riding instructor, Eileen, directed me with skill to attend to a larger view and to send my legs away from my torso. The guarding of my knee after injury, in addition to life long habits of use, potentially diminishes contact with the horse and the unified field of awareness that good riding requires. Still, there I was, happily on a smart and sensitive horse, viewing the tropical world from a different perspective and awareness. There were brief moments of unity with Paddy that yielded tremendous joy.
But back to running on the beach on my own two feet: I noticed a new coordination in running due to all of the work I have done since injury. There is a spiral relationship between pelvis and legs that feeds from the ground impact, up through my legs and torso in a manner that I have not previously experienced.
Recovery from injury has actually improved my use in running. Gifts arrive through unexpected (and not always welcome!) means!
Current morning run report
Having taken a break from my morning hill runs due to recent extreme weather, I was happy this morning to resume pre-dawn hill walk/run exploration. Not only did I run up various hill grades with ease, but also actually ran on level ground for over 5 blocks!!! This may not sound like much distance to non-injured people, but after nearly two years of recovery, during which I often struggled with merely walking, it was cause for celebration in my book!
My knee feels strange while running, in that the signals are unclear. There is likely some nerve damage due both to the emergency repair surgery and to the hardware removal surgery. I can’t describe the odd sensation as pain; more as of a lack of elastic response. The challenge thus becomes not pulling down with my attention to the weird knee sensations, and instead attending to a wider view of my self and the world beyond my self. If I pull down to the knee, my gait becomes clumsy and heavy. If I expand, instead, to the sights, sounds and potentially springy response of my whole self, my gait becomes more even, lighter, and happiness in running resumes. I don’t intend to ignore pain in any way, but to attend to the entire self and thus to cues for appropriate moderation in activity. The bigger view is more accurate than the specific view.
Now, of course, being the vigor-interested person that I am, I want to sprint! Have I learned patience? NO! Have I learned the consequences of impatience? YES!
I will await the experience of sprinting with a happy curiosity.
Vigor and exploration: post injury
It is 21 months today since emergency surgery to repair my fractured patella. What an unexpectedly long, hard road it has been! The journey thus far has required more determination and dedication than I thought was possible for me, skilled expert assistance, and every ounce of Alexander thinking that I could muster. Much has been learned, much loss has been digested. This serious injury changed my life in uncountable ways, and recovery has informed me beyond what I can as yet express.
Due to unseasonably inclement weather conditions, I have temporarily suspended my morning hill runs. There is no point in end-gaining beyond my current condition of self, nor beyond the external conditions over which I have absolutely no control. Despite this hiatus in learning to run again, my stamina, strength and range of movement have improved!
As well as walking with pre-injury speed and ease an average of 6 miles each day, I have also been guided in whole body strengthening by my superb Gyrotonic/Gyrokinesis instructor Lindsey. Her work, as in all Gryotonic/Gyrokinesis work, complements Alexander principles of thinking with the entire self in activity, and takes that thinking into vigorous exploration. Lindsey worked with me previous to injury, and thus knows my habits of response well. (She also takes Alexander lessons with me, and thus we can share a language of instruction.) Lindsey has assisted me not only in recovery from injury (addressing asymmetry in use, need to strengthen atrophied leg, and making the often painful and challenging process fun and interesting), but also helped me resolve patterns of use that were in place previous to injury. She has contributed hugely to my recovery to date, and no doubt will continue to do so in the future.
Currently, I am not only stronger, but experiencing strength from a newly comprehensive balance of use.
Physical therapy continues as I still experience limitations due to injury. Walking down steep hills remains scary and difficult as my knee does not yet have the elastic response to support me with confidence. My back still protests the asymmetry of leg function. And perhaps, most importantly, fear informs me more than I would prefer in some activities.
And yet, I have come an incredibly long way from the severe limitations in movement that I endured earlier in recovery. Pain is no longer a constant presence, more of a cue than a companion.
I am ever grateful for the expert guidance that has made my recovery possible, and for the Alexander principles which underpinned my psychic survival. Allowing time, requesting quiet, having a larger view, and refusing to end gain, as well as thinking with the entire self, are just a few of the skills that have helped me remain somewhat sane in this long and challenging recovery.
Running progress!
Big thrill this morning! After running up a series of hills, and feeling no pain in knee or foot, I ran on level grade for 2 blocks!! I resumed walking when I had the vaguest protest from my knee (end-gaining will do me no good, as evidenced by all my experience since injury). It has been 20 months and 12 days since I could run on level grade, a very long time for a person whose main speed is “go”.
And, I have a much more even gait in running up hill, instead of the rather lurching non-integrated gait of previous months. This indicates a more balanced elastic response through my whole self.
The condition of self improves in increments that add up, with time, patience and attention to overall use. Hope resumes that I can run on the beach in Kauai in December, at least a little distance, just for the overwhelming joy of running in the surf as the sun rises and stars begin to fade into dawn, with stars reflected in the black volcanic sands of Kauai and the ocean licking my happy feet.
Mobility progresses and hand pain as challenge
So, the good news: bipedal mobility proceeds joyfully, 20 months after injury! Although running on flat surfaces is still too much impact for my injured (patella fracture) knee, my morning hill runs go along with incrementally increasing ease.
I am also able to pursue vigorous exploration of Gyrotonic and Gyrokinesis exercise on a continuously challenging basis. Although I require knee pads for kneeling, I can now do most of a Gyrokinesis class without fear of knee pain.
The formerly inflamed metatarsal area has also quieted, and only signals when I am pushing beyond current elastic condition of self. Between my knee and my foot, I now have an excellent cueing system for end-gaining!
I have worked hard to get to this state of recovery, and with the assistance of wise experts in other modalities. 20 months after injury, I remain dedicated to achieving full function and mobility, and very happy to be making good progress!
Now, you would think after all the pain and frustration I have experienced that I would get a reprieve. But no, there is yet more to learn about pain and response to pain! Now my left thumb joint is hugely painful from an as yet undiagnosed cause. This means that even the simplest opposable digit action in my left hand causes a great wince of pain. Hand use being rather essential to being an upright primate, and especially for an Alexander teacher, this is both a concern and an opportunity for learning.
Pain in my hand/thumb causes me to narrow and shorten in an unproductive attempt to guard and protect. In activities other than teaching, I am having to quiet a fixed attention on a part, and instead expand to a larger view. As previously stated in this blog, I am not suggesting a repression of pain signals, but an expansion of attention to the wider, larger self.
I notice that while teaching, when my attention is large and my intention is global, my thumb joint rarely hurts. So, according to F.M. Alexander’s described experience of his own challenges with voicing, this indicates there is something I am not doing while teaching that diminishes cause of pain, and something I am doing that increases pain otherwise. Whether this is a structural imbalance, an arthritic condition or a perceptual inaccuracy is as yet unclear. The choice I have as a student and a teacher of the Alexander Technique is to apply principles of dynamic non-interference, and seek expert assistance beyond my skill set. I can refuse to narrow or shorten in response to pain. There are physical rules over which I have no control, but I can choose my response.