Every change shifts the entire Self
As I often tell my students, a change anywhere in the self changes the entire elastic Self. There is no isolation in structural change, as the entire self is continuously and elastically connected. This notion is evidenced by the foot pain I have experienced in the last month.
More clarity was revealed when I saw my Osteopathic doctor this week. Dr. Bensky determined that the forcible (and necessary) immobilization of my leg during hardware removal surgery had diminished the elastic response of that leg, so that the foot had few choices but to become painfully inflamed. The forcible fixing of my leg also instigated back spasms, as my entire self had to accommodate unnatural stabilization.
From an Alexander point of view, this makes great sense, as F.M. Alexander saw the entire self as integrated, and all responses interwoven and inseparable.
After Dr. Bensky’s work on me, my back became temporarily far more painful, then much better. I had the opportunity to visit with Walker the horse, a very handsome and sweet-natured animal. He was patient with my painful condition, and also a bit alarmed by my sudden needs to accommodate pain. Horses don’t miss any detail in human coordination!
My foot has improved significantly. I can walk now with only minor pain, and have hopes that even this discomfort will quiet with good use and expert intervention.
Hope returns for continued recovery to full and pain free mobility. It has been a very long journey, and possible in progress with assistance from skilled and like-minded professionals of several disciplines. The big lesson continues: attend to the entire self so that specific results occur from improvement of the whole condition of self, and the manner of use supporting the improvement of whole self condition.
The continuing subject of pain
Pain has been my informative companion, my constant feedback, and a rather primary sensation since I fractured my patella in February 2009. I have learned more than I really wanted to know about how much pain changes and challenges attention, and how daily life must be shifted to accommodate pain. There was a glorious month between hardware removal surgery and the onset of foot pain when I could move easily and comfortably. I am grateful for the reprieve, but also mourn that dream of pain-free living.
Applying Alexander principles of a wider attention and an intention for overall elastic response has made my pain-informed life tolerable. When I am teaching lessons or workshops, and thus very much attending to a larger view, without in any way repressing pain signals, pain takes a background seat.
There is also the pain, which is much more difficult for me, of not being able to move as I would prefer. How to apply Alexander principles to this emotional discomfort is still hit and miss for me. In the notion of whole self elastic coordination and choice in response, I can refuse to narrow or shorten, and quiet myself in reaction to emotional dismay. The strong intention to remain lengthened and widened, on the ground and springing up, increases respiratory freedom and quiets my mind chatter. I can see the larger view of recovery, in moments, and rejoice. Then, I struggle again and despair. When will I be able to run or even walk with ease again? The battle continues, with no known outcome that is yet clear.
The whole self in recovery from injury
The Alexander Technique is, to put it most simply, an education in the use of the self. The Alexander Technique does not diagnose or treat any specific symptom. We are teachers, not therapists, and have no medical education. Our job is to assist people in improving both manner of use, and thus, indirectly condition of use, by offering the complex skill of dynamic non-interference, and a choice in response to stimulus.
As an Alexander Teacher who has experienced a dramatic injury and an ensuing long term recovery, I can view the benefits of Alexander skills from a very personal viewpoint. My education as a teacher gives me a valuable perspective of the whole elastic response, whether ideal or disrupted by injury, as key in recovery from injury. The Alexander Technique could not in any way heal my knee directly, nor address compensatory muscle patterns in a direct manner. The Alexander Technique is always indirect in solutions. Improving the harmonious balance in response, and the manner of response with the entire self, has the potential to improve the condition of self. Even with my diminished and very challenged condition of self post injury, I was able to return to teaching in a short amount (two weeks!) of time. We can make the best of even very difficult coordination challenges with a wide attention to entire use, rather than specific attention to fixing of parts. Indeed, specific fixing of parts limits overall response, and thus overall recovery.
My recent experience of severe foot pain illustrated these principles. Although I could have attended primarily to the painful foot, I knew that the location of discomfort and the cause of discomfort are rarely the same. After I calmed my panic and distress, I realized that my foot was simply the weakest part of a system that had become unbalanced. Since I was born with an inwardly rotated leg, my pelvic support and leg-back coordination has always been compromised. After years of studying and teaching the Alexander Technique, this imbalance had improved to quite functional levels. The patella fracture, and the ensuing leg brace, had renewed my original imbalance to a marked degree. There are limits in what I can ask of my neuro-muscular system, even with best possible use. My foot expressed imbalance to a painful degree. Other assistance to re-establish a level of structural integrity was needed. Thus, I have sought intelligent Physical Therapy, osteopathy, and the integrated exercise approach of Gyrotonic.
The Alexander Technique cannot solve every physical difficulty, nor is it intended to do so. Compatible disciplines that assist in shifting structural interference, combined with Alexander skills, yield results that are comprehensive.
I might not be walking at all, whether my injury had occurred or not, but for Alexander skills of intention and attention with the whole self. And that being said, finding professionals with Alexander compatible awareness of the entire self in response have been necessary for continuance of recovery. In the big picture, all are interwoven, integrated and necessary. Attention to the whole self is key, and indirect solutions work best.
She walks! Back in action again..
My foot seemed to turn a corner toward increased function and lowered pain levels a few days ago, thankfully. All improved further after my friend and Gyrokinesis/Gyrotonic instructor, Lindsey, came to my office yesterday. Lindsey guided me through a seated series of Gyrokinesis exercises, all emphasizing whole self awareness, connection to the ground, and thinking into activity.
After our Gyrokinesis exploration, Lindsey and I walked to my home together. Just a few days ago, I could barely walk a few blocks without severe pain. Yesterday, I walked the uphill mile home at a decent pace with relative ease.
Given the whole elastic system of tonal response that we each maintain through use, habit, activity, belief and structure, no specific area of discomfort can be isolated in cause or resolution, unless a specific trauma (patella fracture, for instance) has occurred, and even then an overall response of choice and tone is necessary for renewed function. I knew, both intuitively and as an Alexander teacher, that my foot pain was due to overall structural and elastic rebalancing after the knee hardware was removed. Since the motions of Gyrotonic and Gyrokinesis so improved the comfort of my foot, and without directly addressing my foot, and since my foot rarely hurts when I teach (when my use is at its hopeful best), it seems obvious that a larger solution of improved elastic response would benefit my foot. My incredibly gifted PT Heidi agreed with my assessment. She observed many shifts and fixing of pelvic and back support that would potentially impact foot response, and helped me to unravel a bit, with subtle and skilled manual guidance, and without directly forcing any shape or postural mode.
The result? I walked a mile to friends’ home in lovely Summery weather and back again with only minor pain. I remained more aware of the ground as support for my upward response but forced nothing (dynamic non-interference). I delighted in walking, which was more than enough.
Landscape of recovery: renewed hope
Hope, post injury, is typically renewed for me by increased ease in exploring activity, and by experiencing some measure of pain free living. Both increased activity and decreased pain have been achieved in increments since patella fracture. Progress has not been in any way linear, but instead a spiral of set backs, re-learning, long plateaus and welcome improvements. This is the landscape of injury recovery. It is a journey without a map for me. I can choose to use myself well, no matter what my condition of self happens to be, and at whatever point in the landscape I happen to be traveling, and I can select professionals of other disciplines to assist me en route. Otherwise, my control seems to be nil. Indeed, relinquishing control seems to be my major (and very difficult) lesson in this ongoing journey.
Yesterday, I had the delightful experience of a private Gyrotonic session with Magali Messac, Master Gryotonic Trainer. Magali also takes Alexander lessons with me, and is thus aware of Alexander thinking about undoing into activity. Magali, as a former dancer of much renown, has experienced injury and recovery. She knows from personal experience the urgency I express to become active and strong in my participation in life. She also knows that I end-gain to achieve, and can spot this tendency with great perception and accuracy.
Magali expertly guided me through a challenging and joyous 90 minutes of exercise that did not stress my poor foot. I emerged invigorated, renewed, energized and thrilled.
I decided to direct myself after this very happy experience to walk and move as though my foot was not an issue. I am not suggesting that I ignored or suppressed pain. Instead, I refused to expect pain, or to compensate from that potential expectation, and to begin to welcome a more upright and widened overall response. I chose to believe in my graceful possibility, and to be willing to stop and re-direct if pain indicated doing so.
Then, this morning, I attended a Gyrokinesis class given by Kelly Reynolds. Kelly is a wonderful teacher. She and I know one another not only from her terrific Gyrokinesis classes, but as student and teacher in the Alexander Technique. Kelly has taken many Alexander lessons with me, and also was a trainee on my teacher certification course, until her life’s needs compelled her to pursue other activities.
Kelly’s class was, as usual, energetic, rhythmic, and really fun. Since the hardware removal from my knee, I can do much more of the class without discomfort. I had to accommodate my foot to some degree, but was joyously able to challenge myself with care and attention.
For any or all of the above reasons, or for reasons that are mysterious to me, my foot hurt far less today. I was able, with a much slower pace than I would prefer, to go downtown for various errands. A limp still informs my walking, but pain is quieter and movement is easier.
So, there is hope on the horizon of this up and down landscape. I may encounter more rocky bits, but will allow hope to inform me as I proceed onward, my use as a constant choice, and my chosen professionals as guides.
Recovery update and gratitudes
Many friends have assisted me in this hopefully temporary state of partial mobility. Darlene, Lindsey , Megan and Magali have all very kindly given me rides to work and home again. Numerous people, friends and students, have emailed or phoned with concern, support and offers of assistance. Several dear people have called or emailed to make me laugh in the midst of my deep despair. Carmella the cat has insisted that play is a big priority. Heidi, my wonderful PT, and Yoshiro, my incredible acupuncture guy, have assisted with skill and generosity. My gratitude to all of the above is deep, huge, and continuous!
My foot still hurts a lot with any extended walking, but less than in previous days. Today, I was able to walk to my local coffee shop, slowly and carefully. Then, I took a bus (I would have normally walked this distance with ease) to the Gryotonic studio. Although I was annoyed not to be able to walk there without pain, I was deeply thrilled to explore non-weight bearing activity, once I was there, and to move vigorously and consciously. I could think with my whole self, and experience rhythm and challenge in activity without compromising my foot.
Later, when I went for a walk in the lovely Summer day with my cane for help, I noticed that if I attended in a whole fashion to my length and width (requesting quiet, refusing to narrow or shorten, asking for width and length, refusing to check on results), my foot hurt far less, or at the least, I reacted to foot pain with minimal overall contraction.
At least I can walk a little bit. My slow and careful pace, and the required attention to whole self use, gives me an opportunity to notice the world at a reduced pace. Birds and foliage and clouds all register with more significance when I am forced to move with care and a very slow pace. It seems like I already learned this lesson earlier in my recovery, but I guess there must be more to learn.
Time Line: Injury and recovery and set backs to date
Let’s see the time line thus far for perspective on my very strained patience:
February 18 2009: fractured patella in a sidewalk fall
February 19 2009: emergency surgery to repair patella. Bone was stabilized for healing with two pins and figure 8 hardware. I was sent home with a full leg splint immobilizing leg into full extension.
March 4 2009: leg splint removed and replaced with a full leg Bledsoe brace; leg in full extension (no knee flexion whatsoever)
March 5 2009: returned to teaching private lessons and directing teacher training course with fully extended leg brace; cane required for any walking.
April 1 2009: 30 degrees flexion allowed in Bledsoe brace
April 15 2009: 60 degrees flexion allowed in Bledsoe brace; began PT
April 30 2009: Bledsoe brace removed; cane relinquished, careful walking resumes
May 8 2009: resumed Gyrotonic exercise with careful and expert guidance
August 12 2009: released from surgeon’s care
May 25 2010: hardware surgically removed from knee, resulting in far less pain and much increased mobility.
June 1 2010: resumed teaching post surgery, as well as walking to work and other destinations with great ease and joy
June 23 2010: excruciating foot pain begins to limit walking
July 2 2010: foot pain results in back spasms that make even simple mobility impossible
July 7 2010: metatarsalgia (extreme inflammation and pain in ball of the foot) diagnosed, likely due to increased mobility post hardware removal surgery. Cane required for even limited walking, even at home.
So, here I am a year and nearly 5 months after the original injury. Obviously, as evidenced by the above time line, recovery is not in any way linear in progression. This current set back is depressing and dismaying beyond tolerance. I had been hoping to resume my morning runs by Autumn; now, I am desperate just for walking capability.
Having endured so many levels of pain, and the deeper psychic pain of immobility (movement having been both my joy and my coping strategy), my patience and tolerance for discomfort is utterly spent.
Thankfully, I can teach, an activity I treasure and deeply enjoy. Now, if I can just (please!!) walk to work and home again, I will be gratefully overjoyed! Enough already! How much can a constitutionally active person endure?
Pain reduced with expert help
Thankfully, foot and back spasm were addressed and relieved to some degree via expert assistance from skilled professionals. Yoshiro, acupuncturist extraordinaire, helped reduce inflammation in my foot and spasm in my back. His work is mysterious, as in I can’t explain it, but very effective. I left his office with less of a limp and increased ease overall.
My excellent PT, Heidi, used various subtle hands-on manipulations to re-establish structural integrity and reduce the muscular guarding that had become quite fixed. In Alexander terms, my startle pattern had reached glacial proportions.
Heidi also guided me to allow the “wrong” thing while standing, sitting and walking, so that a new response to the ground could be allowed. By “wrong” thing, I mean it felt collapsed to me, but since I have been using the instrument of myself to stiffen away from my foot with great vigor, I have pretty skewed notions of what “right” or “wrong” might be. Faulty sensory perception, a basic notion of the Alexander Technique (“You can’t know a thing by an instrument that’s wrong” F.M. Alexander), becomes a more complex issue once high degrees of pain are involved. We naturally react to stop or avoid pain, and our habitual patterns, combined with heightened reactions to pain, can cost us our overall elastic balance and support. Even with all my years of studying and teaching the Alexander Technique, I need assistance in sorting out my choices in response once pain has become overwhelming. Intervention in areas of skill far beyond mine (Alexander Teachers teach, they don’t directly affect any condition) are needed when structural integration has been impacted dramatically.
So, as a result of Yoshiro and Heidi’s work, I can now think of other subjects besides pain avoidance. Although I am choosing my activities with care, I can sit, stand, and even walk with far less discomfort than yesterday.
I will return to teaching tomorrow, with the intention of best elastic self in that activity. My hope is to further improve in the dynamic quiet that hands-on Alexander teaching requires.
New diagnosis: metatarsalgia
After some days of very extreme foot pain, as well as severe and paralyzing back spasms (due to asymmetrical weight bearing and many compensations), it would be understating the case to say I have been hugely challenged in the use of myself. Good use has been close to impossible. I can’t stand, sit, walk or even lie down without nauseating pain in my back. The foot only hurts if I attempt to walk faster than a shuffle. I am not an inspiring example of grace or coordination currently!
Thus, I returned to my medical doctor today. She used a tuning fork to determine that no stress fracture exists, as the fork’s vibration would have made me scream if a fracture was indeed the issue. Instead, she diagnosed an inflammation of the metatarsal due to increased weight bearing demands after hardware removal from my knee, and my increased mobility after hardware removal.
Of course, this is a discouraging, depressing and disturbing set back, but I have some hopes of improving. I now have a little foot pad to assist my foot. The back spasm will hopefully quiet with some rest, ice and very conscious use.
You would think that after a year and 5 months of recovery that I would be accustomed to pain, but that’s not how it goes. I had enjoyed about a month of pain free mobility, and had delighted in that experience. The return of pain, and all the mobility and life limitations that pain brings, is incredibly dispiriting. Who’s in charge here anyway? Can I make an appeal for some relief? What more can I learn or relinquish? I just want to be able to live and move without pain, please.
Meanwhile, there are barn swallows swooping for bugs outside my window, and an eagle just flew past, pursued by a gang of crows. A local stellar jay is protesting a cat’s presence with vigor. I am reduced to observing, not acting, and active stillness is my only remaining option.
The challenge of further stillness
Diagnosis of stress fracture in my left foot was confirmed by both my doctor and my PT this past week. Stress fractures (hairline cracks in the bone) rarely show on x-rays, but my symptoms of localized pain, discoloration and slight swelling are consistent with a stress fracture diagnosis. Clearly, my foot was not elastically prepared for increased activity post knee hardware removal. My joyous enthusiasm for mobility backfired.
The primary treatment for stress fracture is rest, as well as minimization of pain causing activity (in my case, walking for more than a few blocks, as well as walking at more than a snail’s pace). I was so very happy to be able to walk with ease and speed after hardware removal surgery, and now I am reduced once again to dreary restriction.
I am very grateful that my knee has no pain whatsoever, and that I can teach Alexander lessons with ease. To say I am frustrated by rest requirements puts it very mildly. I am constitutionally restless, and despite nearly a year and a half of enforced limitation in mobility, I haven’t learned to like being physically stilled. I have defined my very being in life by an exploration of movement, and I wrestle mightily with being unable to walk, let alone being unable to run, dance, skip, or catch the next bus with ease and speed. Patience in healing and tolerance for immobility have been tested and worn to smithereens.
Quieting internal chatter, thinking with the whole self in stillness, and remaining dynamic without impeding healing is my current challenge. There are new skills to be learned, more identity with a constructed self to be relinquished, and more active stillness to be embraced. A sort of dynamic surrender is key now. I don’t like this experience one bit, but also trust, in my quieter moments, that larger learning is occurring, and I am hopeful that I can embody these hard lessons to assist my students in their mobility challenges, and the necessity of stillness as an internal skill.
The Alexander Technique offers a choice in response to stimulus. Although I struggle, my choice in response is to learn, find a new quiet, to go from undoing to doing without doing too much. Being happy with this necessity is not the question; learning is my only option. Fighting current conditions of self will get me nowhere. The battle becomes internal to a more extensive degree: quiet, refuse to narrow or shorten, request an overall elastic self, in an ongoing spiral of active stillness.