Post Surgery report: Whispered Ah
One of the biggest challenges for me in the entire long sequence of recovery from injury has been enforced inactivity. The initial emergency surgery for patella repair required me to live with huge daily pain and a fully extended leg for months, as well as re-learning to walk with a severely atrophied leg and very unbalanced use of my entire self. The recent surgery recovery is much simpler, as pain is quite minimal, and I can bend my knee, within limits for incision healing, and can walk with relative ease. Still, my surgeon recommended a week off to reduce inflammation and allow healing. Restlessness, boredom and frustration ensue. Without pain to stop me, I am likely to push myself beyond recommended notions of activity.
Inhibiting the urge to move and to return to teaching and full activity is a constant project. Anesthesia and post-surgery pain meds have made me very cranky, and my typical crankiness solution is physical activity. The internal landscape of noise has thus become louder and more insistent. The only “activity” that assists me is Whispered Ah, an Alexander procedure that requires dynamic non-interference and overall quieting. Whispered Ah reveals more layers of internal noise, and a necessity for further quieting. I don’t want to be quiet, but I have to just now. I want to run around the block, see to the garden, clean the house, go see some art, find external distractions galore. Instead, I will breathe. Damn, but this is hard!
So, I sit with my leg iced and elevated, allow reflexive respiration, watch the crows play in the wind, swallows swoop for insects, rain clouds gather and disperse. I reflect, with gratitude, on the great care given to me by surgery nurses and doctors, the kindness of loved humans and animals. Perhaps I can allow a drift from movement urgency to momentary being, and return to cherished full activity with new skills and awareness.
Metal free knee!!
Surgery for removal of pins and wire from my patella went well yesterday, according to my surgeon. (As I was in the land of general anesthesia, my awareness of proceedings was nonexistent.) Once in the recovery room, pain became a thundering crescendo. The skilled and kindly medical team thus gave me a combination of big-time pain drugs until discomfort became manageable. Upon release to home, I was wobbly and a little goofy, but only in minimal pain.
Any pharmaceutical intervention has its side effects, however. Pain was reduced, but my stomach went wild. A night of extreme nausea and vomiting ensued. Since the prescribed anti-nausea medication wouldn’t stay down, I ceased fighting and just rolled with the punches, so to speak. No good use of myself was really possible except choosing productive areas of battle.
Today, surprisingly, my knee hurts less than it did prior to surgery, with only a slight incision pain. The ache that I associated with the hardware is gone. Of course, knee movement is limited by the dressing that protects the wound and stitches, and by the tenderness of the area. Nausea is gone, thankfully! I can’t say I have a voracious appetite, but at least the idea of food is no longer repugnant.
The temptation for me, of course, is to push back to full activity. I will apply inhibition and pursue rest instead, with ice on my knee, and sleep as my sport.
Hardware removal surgery
Although there are few projects less appealing to me than surgery, the potential future ease of living without metal pins and wires in my knee, and the possibility of being able to kneel with ease (gardening, Gyrokinesis, looking for cat toys under the furniture) trumps surgery and recovery distress. Thus, surgery to remove the pins and figure 8 wires on my fractured patella (all initially necessary for bone healing) has been scheduled for May 25.
In contrast to zero preparation for emergency surgery post injury, I have time now to prepare in organizational fashions (loose pants for surgery day, food prepared at home, a planned week off from teaching), and also to un-prepare. The temptation is to end-gain by pushing strength limits prior to surgery, increasing activity levels, and an overall attitude of pre-figuring a condition of self. However, since I can’t possibly know how I will be after surgery (the prediction is that mobility will only be affected by attention to incision healing), I am choosing to dynamically un-prepare. The condition of self, and my manner of use in that condition of self, will benefit most from more indirect means and approaches. Instead of working out more, walking further, and attending to strengthening in any specific fashion, I am calming, quieting and attending with happy curiosity to the use of myself. I am doing the time tested and effective Alexander procedures of Hands on the Back of the Chair (to increase an overall balance of tone and connection to the ground, as well as a brain state condition of dynamic non-interference) and Whispered Ah (to re-set respiratory support for invisible effort in breathing and co-ordination) so that I am hopefully in a good condition of self for surgery and recovery.
And, I am going for my morning faux-runs with a bittersweet awareness that this experience might not be available, temporarily, after surgery. Thus, the morning Spring light, the myriad birdsongs, are sweeter, the rhythms of walking with relative ease more precious.
I may go backward in recovery after surgery, but hope for further future possibilities in movement and ease.
NYC as recovery sequence
When I fractured my patella in February 2009, I would never have imagined how lengthy recovery would be. Now, of course, I know differently than the relatively immediate recoveries I experienced with previous injuries and surgical hernia repair. A patella fracture and necessary surgery for patella fracture has involved over a year of dedicated rehabilitation, a new use of self, and patience that has challenged my entire being.
I recently travelled to NYC, my very favorite city on the planet. Flights impact my knee in a very painful manner; I book extra leg room (so I can wiggle and extend the injured leg). I endure the cabin pressure and the long hours of sitting with great discomfort, even with extra leg room.
However, once I can walk and move upon arrival, the pain diminishes. I am far more able to ascend and descend stairs and walking distances with near to my pre-injury ease. Movement in a symmetrical fashion has become more accessible, and weight bearing of luggage is no longer such a huge challenge as even a few months ago.
I walked on an average of 9 miles every day, according to my trusty pedometer. This mileage was easy for me in NYC, as walking there includes so many views and experiences, and the city is primarily level in footing. Attending to the larger view than my challenged knee improves use. I could joyfully attend to the rhythm of the city and be part of the flow of the city from a global sense of my entire self in a wider attention.
The result was that I returned home with far greater strength in my injured leg, much less inflammation, and a renewed confidence in my mobility.
Of course, I had booked lessons with John Nicholls while in NYC with the intention of improving my entire condition of self. The lessons expanded my respiratory support, enhanced connection to the ground, and generally reduced my interference in overall response.
All we can do, truly, is reduce interference. This may sound passive, but is truly the most active means of improving use in recovery from injury. We go from undoing to doing without doing too much. Undoing becomes an active state that can inform all activities. It is simple, but not easy, and a joyfully lifelong pursuit.
Going from undoing to doing (without doing too much)
In the continuous spiral of recovery from injury, there is a constant balance between not pushing beyond current strength, yet still increasing demands so that strength can be improved. How do we go from dynamic non-interference (a very active state of quieting, refusing to narrow or shorten, not checking on results, allowing the activity to do itself) to demanding actvities that require specific muscle activation?
The emotional urgency of recovery makes this subtle sequence even more demanding, as the temptation of end-gaining (relinquishing process for results) becomes larger, noisier, and more compelling.
As I experience the necessities for strengthening my atrophied leg via Physical Therapy and Gyrotonic exercises, I face the challenge of allowing a timeless pause between intention for activity and doing the activity. Waiting with thinking will only go so far for actually strengthening muscle groups that require activation. With Alexander principles in mind, I go forward with activation, back off to re-direct my entire self, go forward again, in a continuing sequence of activation and waiting, requesting and pausing, refusing to hurry yet allowing the intention for activity to be accomplished. Beliefs in what I should do have to give way constantly to what I can do with a good condition of self. Refusing to diminish an overall elastic response, even while I attend to specific strengthening, is both challenging and productive. If I attend to the whole self, I can accomplish my assigned exercises with a larger picture awareness. If I focus on a part, my whole self becomes contracted, and the results are less than ideal. Even my emotional dismay must be seen as an entire response; I can pull down and into pain, urgency, impatience, or I can ask for a wider response of the global condition of self. The second choice requires a larger intention and an active refusal to interfere for the sake of specific results, and always brings less pain. Attending to the integrated whole self is challenging but more successful. Focussing on the part is easy and familiar and drearily less productive.
And, even with these skills in mind, I continue to experience pain, mobility limitations, dismay and frustration. The learning presented by a major injury continues. It is a spiral of lessons in a continuum of intention.
There’s always more
The continuing challenge of recovering to full function after a serious injury presents numerous opportunities to shift old habits of response. As a former student of mine told me, after enduring many illnesses, injuries and tragedies, “it’s not what happens, it’s what you do with it”.
Injury typically exacerbates imbalances in elastic tone with all the accommodations and compensations required in moving with partial mobility toward full function. In addition, the signals for pain usually become overactive, so that necessary strengthening is short circuited by anxiety. Fear of further pain interferes with recovery modes.
My condition of self was far from ideal previous to injury. From birth, an internal rotation of one hip made my leg/torso relationship distinctly asymmetrical. Clumsy medical attempts to change my condition by force (braces, casts, orthopedic shoes) and in a direct manner only increased overall distortions. Only by approaching change through the indirect means of the Alexander Technique, addressing the whole rather than fixing the parts, was I able to learn to function well with a compromised condition of self. Still, injury and resulting accommodations brought all the original imbalance back into dramatic play.
The injury has continuously offered me the opportunity to address old patterns of response in a new manner of more conscious choice. Yesterday, my Gyrotonic instructor, Lindsey, and Gyrotonic instructor and Physical Therapist Janette guided me through very refined exercises to strengthen the balance of leg/torso relationship. It was a huge brain challenge for me to shift how I was connecting to the ground and thus initiating movement. My current strength is in a very twisted form that prevents my knee from becoming stable, and results in pain, thus signaling fear and a reduction in confidence for moving through daily activities. Lindsey and Janette helped me to think about support differently, in a very Alexander-consistent whole person fashion. I was able to challenge knee and leg strength with safety, and to experience means of strengthening that were difficult but not scary or painful. This required me to think with my whole self, to have a clear intention, and to refuse to force (interfere) and yet still activate very dynamically. Going from undoing to doing without doing too much is how I describe this in Alexander terms.
I found myself exhausted, thrilled, weepy, and happy after this refined workout. As signaling and response changes, the sense of self allowing rather than controlling shifts. Dynamic non-interference is key. The work becomes more about relinquishing effort in a familiar sense and allowing new solutions in a wholly balanced experience. Refining response to what seems like dangerous pain is an aspect of allowing more, pushing less, remaining active, and being open to a new experience.
As a result of this work, my knee felt much more stable, stronger and far less painful this morning as I enjoyed my morning “faux run”. Learning continues, and the self finds a continuing new balance in response that is hopefully even better than previous to injury. There is always more!
A newly informed gratitude
Although I would not wish a devastating injury like mine upon anyone, I have come, at last, to a sense of deep gratitude for the learning and opportunity offered by this unexpected, unwelcome and often hellish life changing injury. Adversity is never welcome. Who wants to break their knee, for god’s sake? Not any sane person. And while my sanity has often been questionable, I don’t seek pain as a means of learning. But, pain arrived, life happened, and all I could do was learn. The Alexander Technique offers the possibility of using the Self consciously, whatever the conditions of the Self might be.
As I have frequently stated, this injury changed my life, and thus changed me. I have had to endure and survive the deep dismay of not being who I defined myself to be (a mobile and active person), and to embrace the not-knowing of how to be without previous definition. My edges have softened. In being forced to stillness and slowness, in enduring my own noise, in accepting, after much struggle, my limitations, I have found a freedom in less defined being that is a great surprise and a deep gift. Of course, I want to recover fully, but I have relinquished the urgency of ever being the same person as my pre-injury self. I would never give away all that I have learned for the predictability of being my pre-injury self. My comprehension of pain, immobility and long recovery, and my understanding of that process, could only be informed by experience. Conceptual recovery is an illusion and a set of assumptions. Applying Alexander principles to the many-layered sequence of injury recovery is a reality that I live and can convey to my students with hard won experience.
Without this experience, I would not have worked so deeply and attentively with professionals of other disciplines, and thus understood how Physical Therapy, Osteopathy, Gyrotonics can assist in effective whole person recovery. I have learned of the kindness and skill of professionals that is available once intention is clear and end-gaining is set aside. The struggle of continuing means-where-by in recovery has taken on entirely new meaning.
I have relinquished the tiller a bit, learned to allow the boat’s drift, become more open to currents, and let wisdom be other than mine.
The Faux Run Idea
As has been frequently expressed in these blog posts, I miss my morning runs with a passion. The stillness I found in movement, the morning sounds, scents, views, light, the rhythm of timelessness, and the ensuing balance of self in the world all provided many joys previous to immobilizing injury.
So, I can’t run yet, but I can walk. I decided to experience “running” from whatever condition of self is available to me. Perhaps my neural and muscular self would recognize new options from a partial re-enactment.
I donned my running gear and simply walked my running route of several miles through the neighborhood. The morning air, with breezes from Puget Sound, the Spring foliage, and the many songs of migrating birds, as well as seagull calls and crow chatter, drifted happily through me. Expanding my picture beyond what I can’t do brought the joys of what I can do to awareness. I can attend to my use without fear of pain or potential falls, and experience the possibility of running again. Quieting myself, hearing my own noise and not reacting to that incessant noise, refusing to narrow or shorten, and welcoming the wide world resulted in a very happy faux run.
The only detail missing was actually running, which may well occur in time, with faux runs as my new means-whereby. Attend to overall use and the thing will do itself is my constant theme. Progress toward full recovery proceeds incrementally, but it does proceed.
Quiet and Height
Although I can’t yet admit to being grateful in any way for the serious injury that has required so much attention, time, endurance and resilience, I am recognizing positive outcomes. Being forced to relative stillness has resulted in hearing my own internal noise, and thus to a new skill-set in requesting quiet in an Alexander fashion.
Before injury, I ran most mornings to hear my own noise and to disperse that chatter into motion. I also ran to hear the morning birdsongs, to view trees and foliage through the seasons, and to allow a creative approach to my teaching day. Running balanced my emotional levels and resulted in a calm sense of well-being. Movement provided stillness.
It has been a deeply challenging adjustment to remain emotionally balanced during a year of high pain levels and dramatically reduced mobility. All of my previous coping skills were removed, and I was left with my own noise, as well as with extreme pain and frustrating mobility limitations.
Now I am seeing how this experience has presented an incredible opportunity to respond to my internal chatter with a newly urgent and continuous request for quiet. This has not only augmented my teaching skills, but also made me far more patient and tolerant of students who struggle with doing too much, chattering internally, and coping with the challenges that pain and injury bring to daily life. I know the struggle experientially now, and have a hard won compassion.
I went for my annual physical exam this week. I was thrilled and surprised that my height had increased by half an inch! My PT, Heidi, says that this height increase is due to an expansion and lengthening in my back. So, with all the good work I am doing to recover, old habits existent previous to injury have relinquished their grip. Recovery work has resulted in an overall improvement in springing up from the ground, allowing lengthening and widening.
I have been forced into quieting and learned new coping skills. Recovery from injury has resulted in old structural patterns shifting to a more elastic mode. With the help of many people, and the skills of the Alexander Technique, I have made the best of a deeply difficult year. I can’t run (yet) , but I can walk, and I have new tools to quiet for further possibilities.
One Year Later
A year ago today, I was recovering from surgery to repair my fractured left patella, injured in a sidewalk fall. Two metal pins and a figure 8 wire were installed on my broken patella. I was sent home the same day with a full length splint, crutches, and heavy-duty pain medication. My surgeon told me that it would be “at least a year” before my knee wasn’t a constant problem, and that I shouldn’t expect to walk without a limp, let alone run, ever again.
I have come a very long way in a year, through much travail, dismay and difficulty. I can walk without a limp on a good day, and I fully intend to be able to run sometime in the future. I learned to live life with, initially, a fully extended leg, then with incremental increases in knee flexion. I managed to teach private lessons and to run a teacher training course with a full leg brace for 12 very long weeks just two weeks after surgery. Daily life was challenging in ways that were previously unimaginable. The experience of serious injury changes entire perspective about possibilities.
The lessons of injury have been life-changing, terrifying, informative and deep. My very definition of self, and of my self in the world, have been shaken, questioned and renewed into a form that is still unrecognizable to me. But I survived, which at some points was questionable this past year.
My stubborn determination was not sufficient for recovery, however, nor was my impatience helpful. Assistance was required. The Alexander Technique gave me a means for framing my recovery with dynamic non-interference, direction and inhibition, and the skills of allowing a bigger picture than the distressing sensations of huge pain and limited mobility. The skills of other professionals were essential to proceed toward full recovery.
What has helped me most, thus far in the journey, in renewing mobility independence are the following, all equal in importance: Alexander lessons with John Nicholls for an overall reorganization of self with respiratory support as a key note; Osteopathy to nudge me gently toward a structural balance; Physical Therapy with very attuned and big-picture PT’s, Heidi and Janette to provide intelligently active means of recovery; Gyrotonic exercise guidance with Lindsey for strength in a deep sense; acupuncture to reduce inflammation from Yoshiro; and just teaching Alexander lessons daily, which required me to use myself well, despite physical limitations.
Friends and family have been patient and kind, as well as tolerant of my occasional meltdowns. My cat Carmella, dog friends Ella, Georgie, Oliver, Ruffles have all insisted that I am fine however I am, and can we play now? These critters have also conveyed affection and acceptance that was vital on days when I was deeply discouraged. Paddy the horse and equestrian teacher Eileen gave me hope for intention in recovery. And my dear, dedicated, patient students, who have had the confidence in me to continue learning in tandem with my recovery, have made many levels of recovery possible.
There are many gratitudes implied in the lists above. My recovery to this point is due in huge part to the skills, guidance, kindness, patience, acceptance and confidence of many people and animals.
There is still a long road ahead. Although pain is not such a constant presence, it is still a daily possibility. My mobility is not anywhere near where I hope it will be. The many athletic pursuits that I enjoyed previous to injury, the ease of daily life activities, are currently either impossible or only partially available to me. I still struggle with accepting limitations in movement, still mourn what I can’t do with ease or at all. But, a year has brought progress, much learning and the news of more to also not know.
Thank you to all who have so generously contributed to my recovery this year!! The story continues…