Constant change in recovery from injury
Recovery from injury is rarely linear in progress, as evidenced by my experience, and frequently noted in this blog. Recovery spirals and oscillates and quivers on the edge of personal use, activity levels, environmental shifts such as barometric pressure, genetic pre-disposition, and many factors often beyond comprehension. In the triangle of structure/function/use, the most effect we can have is upon use, which improves function and can potentially even affect structure.
I have been coming along pretty well in the past weeks. Reduced pain and improved function have cheered me. With the solid experience of nearly a year since injury, I have increased daily activity with incremental steps and with respectful attention. Nothing sudden or accelerated has been attempted. Yet, for no reason I can fathom, pain and reduction in injured knee mobility have returned with lazarine vigor. Add to this the fact that my non-injured knee is now loudly complaining after 11 months of asymmetrical weight-bearing.
How to use myself well with two acutely (but differently) painful knees is a challenge I will need to address. Living, thinking, even sleeping with good use becomes hugely important with these conditions of Self.
Given that change is constant, and that recovery goes along in unpredictable shifts, I will trust that attending to good use will result in a surprisingly new ease once again, and a pain free mobility after this weird interim of difficulty and challenged mobility. I intend to respond to the current conditions of Self with the best means I know: a dynamic non-interference that may reveal new solutions in overall coordination. As yet unknown lessons will be learned!
More victories in recovery: film viewing!
A serious injury and all the physical and psychological pains of recovery from injury impact life deeply. Pursuits of pleasure that were formerly easy and without thought become either challenging or impossible. Life narrows, and new coping strategies to maintain overall function and personal optimism must be found. The self-pity dance leads nowhere but down.
Previous to injury, I was not only physically active, but also active in viewing film on the big screen, as well as attending performances of music, dance and theatre. Since injury 10 months ago, it has been nearly impossible for me to sit comfortably for even a brief amount of time. This has limited my cultural pursuits and my social interactions. Even dinner with friends was difficult in terms of pain limits for sitting.
So, I was very pleased and encouraged this past week to be able to view some films on the big screen! I did have to carefully choose a seat that would allow me to wiggle and move and stretch out my leg without disrupting other viewers (usually the very back seat in the “disabled” section), but I can tolerate a few hours of (wiggly) viewing now. I am so very thrilled to be able to see films again! Although this may not sound like improved “mobility”, a level of visual mobility is now, once again, available to me.
The continuing application of Alexander principles figures in here. I could not, until now, push ahead of the condition of Self I found myself in, and had to wait (inhibit) until I could find a means of using myself well to pursue desired activities. The emotional and psychological consequences have been a struggle. Depression lurks like a shark in the shadows, but knowing I have a choice in response in my intention and attention has saved me from utter dismay. Noting each small step in recovery, celebrating the renewal of life activities, marking how far I have come is how I continue to defeat self-pity and depression.
Stair descent victory!
Today, I was able to walk down stairs (using both railings) like a normal person without pain or fear! This makes me incredibly happy and encouraged about continuing recovery!
I am slow and careful, but I can now accomplish this simple activity!
Hurray!
10 months since injury: still struggling
It has been an intolerably long journey since injury/surgery, and an excruciatingly slow recovery. As a person with previously boundless energetic reserves and resilience, I am now someone operating on the constant edge of pain exhaustion. I am at my best while teaching Alexander lessons. Otherwise, my reserves are completely spent, worn out and depleted.
Although I can walk some days without pain, I cannot count on pain-free movement, as discomfort returns without explanation. Remaining in the big picture, and also functioning well with pain, requires tremendous energy and intention. See above about resources being drained.
Recovery proceeds at a frustratingly slow pace. Applying Alexander principles of allowing time, pausing for a new response, and thinking with the whole Self has deeply assisted me in this very long and difficult recovery. Alexander thinking helps tremendously in using the Self well with physical limitations, as demonstrated by my experience. Healing can’t be rushed, however. The values that Alexander principles present are those of patience, tolerance and constructive waiting.
I attended a Gyrokinesis class today, with great happiness. Given my many limitations in movement, I was thrilled at what I could do with joyous exhilaration. I was also saddened, frustrated and depressed by all that I could not even attempt. Sitting back on my heels, kneeling with any comfort, and various other movements that impact my knee are painfully and functionally impossible. What was previously easy and accessible is currently difficult and inaccessible. There is no doubt that I am better, but not anywhere better enough for my liking.
Serious injury changes life on many levels and with myriad consequences. The person I assumed that I was cannot currently function. With Alexander principles, I can frame this as instruction, but what a hard lesson this continues to be.
Asymmetrical Use in Recovery
The Alexander Technique does not impose a form or a set means of function, but instead proposes using the entire Self well with any condition. A balanced elastic use of the entire person involves including asymmetry in structure with best possible use.
I am experiencing a condition of self that is dramatically asymmetrical. One leg is hugely strong, and the other remains atrophied, painful and less functional. This does not mean a diminished use of my entire self, just a need for more attention to a wider view of overall balance and elastic response.
My legs cannot respond equally to weight bearing, flexion needs or movement. Although I could attempt to create an equal response, this would involve end-gaining and a management of parts rather than a whole intention of self. My best intention has to be to the overall elastic condition of self, with my physical limitations as a consideration, not a total view.
If I indeed attend to a larger view, rise to my larger thinking potential, and see the wider world, then I limp less, experience reduced pain, and find surprising means of invisible and interior support. If, instead, I pay primary attention to my knee and to the asymmetry of support, I become more fearful, I twist physically to the injured knee, pain increases, and I limp with increasing urgency.
This is not in any way to suggest that attending to the big picture is easy. The tools of intention and attention that the Alexander Technique offers are simple, but also indirect, and thus different and less conceptually available than other more direct means of recovery. Experience, rather than concept, is required. The temptation of “making” myself symmetrical is huge, but the experience of allowing an overall elastic response provides evidence of value.
If I think largely, calmly and quietly, my experience improves. If I pull down to attempting an equal leg response, my experience narrows and shortens.
No amount of Alexander thinking will heal my knee more quickly, but I do have a choice in response to pain, mobility challenges, asymmetry of use and recovery impatience.
Recovery time line to date
February 18 2009: fractured left patella in a fall
February 19 2009: emergency surgery for repair of patella. Two titanium pins and a figure 8 wire installed for repair. Sent home with a full leg splint immobilizing leg into full extension
March 4 2009: Splint removed and full leg Bledsoe brace applied with full leg extension.
March 5 2009: Returned to teaching private lessons and to directing training course with leg brace/full extension.
April 1 2009: 30 degrees flexion allowed in Beldsoe brace
April 15 2009: 60 degrees flexion allowed in Beldsoe brace; began Physical Therapy
April 30 2009: Bledsoe brace removed
June 3 2009: gave presentation to Group Health Optimal Healing Group on the Alexander Technique.
May 8 2009; resumed Gyrotonic system exercise with expert care and supervision
July 18 2009: was able to travel to NYC for much needed Alexander lessons with John Nicholls
August 12 2009: released from care by surgeon
Since release from care by my surgeon, recovery has been a incrementally slow, non-linear, and often deeply discouraging process. If not for my Alexander skills and tremendous support from friends, family, and care professionals, I would have given up all hope. Physical Therapy continues, and will most likely continue for many months.
Alexander skills gave me the means to accommodate living with a leg in full or nearly full extension for a many weeks, and to move, despite crushing pain, without hurting myself further. A determination to both learn from this experience, and to deepen my teaching skills in the midst of a very challenging recovery, has increased my confidence in Alexander principles as a means of surviving injury, pain and all the dismay and potential depression that recovery involves. Being able to think with my entire self, to use the tools of intention and attention, has been key in this long process. The Alexander Technique does not in any way promise cure or even solution to injury, but does provide the skills to respond to current conditions with conscious choice. Although I may not be recovering with the speed that I would prefer, I know that I can make moment by moment decisions for the best use of myself, given that pain, limited mobility and ongoing frustration describe my current state of being. As previously stated, I have learned, reluctantly and with great resistance, that the pause, not the push, is essential to progress.
The pause that refreshes: recovery sequence
Putting a pause on exploring more than ordinary activities (see previous post) has had an overall good result. I can sense new support in my injured leg from my intention to allow new connections neurally and muscularly, as well as from simple PT exercises. Today, I could squat for the first time since injury in February! I also danced like a crazy person to music at home. The squat came quite naturally while refilling my cat Carmella’s food bowl. The dance was for sheer joy.
Walking with speed also came easily today. After 9 months of hobbling and limping and having my attention drawn ever downward to my all too painfully present knee, this was delight beyond belief! Limping may return, I know, but experiencing ease provides evidence of the value of inhibiting end-gaining, allowing quiet and a slower pace. Slow is not my favorite speed, of course. Habits of self are being addressed on myriad levels.
Now, I have to be sure not to end-gain beyond my current condition, to attend to the means-whereby, and to not challenge myself out of undue optimism. I have learned from my setbacks, and will, with cautious hope, progress from here onwards in a circular (not linear) fashion to the full recovery I so entirely seek.
The perils of optimism, the wisdom of waiting
A long recovery, and the patience required to resume desired activities, tempts end-gaining at many levels. What was previously “normal” in terms of simple daily pursuits becomes accessible at a frustratingly slow pace. Exertion at more challenging levels begins to seem a distant dream.
I so desperately want to resume my very active life that I often push ahead of my strength in an end-gaining pursuit of the many joys of vigorous exercise. This urgency has resulted in a cost of returning pain and immobility. It is a fine line to both respect current conditions of self and also strengthen for progress.
This morning, I had the joyous experience of walking to work with no knee pain whatsoever! None! I could even think of other subjects than my knee! According to my habit of self, I wanted to plunge into more vigorous movement by attending a Gyrokinesis class, despite the evidence of the past few weeks of pain and difficulty. Hey, I felt better now, why not go further?
Inhibition (quieting, refusing to narrow or shorten, requesting widening and lengthening) won, for a change. I may be crazy but I am not always stupid. I restrained my impulse to experience further vigor in a Gyrokinesis class, decided to enjoy the simplicity of pain-free walking, just taught my regular schedule of lessons, and relinquished challenge as a need for today.
The result for today (tomorrow or next week may be different) is that walking continued to be relatively easy. I bussed, rather than walked, the two miles to the Gyrotonic studio, and enjoyed a thoughtful, attentive time of gentle exercise supported by the weights and pulleys that the Gyrotonic system so intelligently provides. A few weeks ago, I tried to do it all (walking over 3 miles, a Gyrokinesis class and a Gyrotonic session) with excessive optimism.
I am learning that waiting is not going backward, but rather is respecting how I am now. Resuming previously enjoyed vigorous activities will only happen as I learn to wait. In the Alexander Technique, we allow a pause for the old habits to quiet and new neural connections to be made. Progress occurs with the pause, not the push.
Patience in Recovery, and Gratitude
9 months is an excruciatingly long time for a typically active person to be far less than fully mobile. The emotional, psychological and physical challenges of injury and long term recovery require a level of patience that is nearly beyond tolerance. A sense of personal identity, of safety and well-being, of confidence in life are all put to a test. End-gaining (pushing to an outcome) defeats and impedes recovery. Only the means-whereby (attending to the use of the Self) has any hope of success.
My own patience with rehabilitation and recovery frequently wears thin. My formerly easy mobility and joyous exploration of many activities seems a distant memory, a dream that I can’t fully recall. Now, I am just happy to be able to walk with a minimum of ease.
Daily gratitude is an essential component of my well-being. The dance of self pity, of focussing on limitation and pain tempts me with devilish attraction, but only diminishes my overall elastic response. If I pull down to the disturbing sensations of my knee, pain worsens. Although I don’t in any way ignore these sensations, which are often quite severe, if I instead bring a wider awareness of myself in the world to mind, pain is only a part of my picture, and pain is less overwhelming.
In that light, I make a daily list of gratitudes to keep my picture bigger than my own sensations. The friends, students and professionals who assist me in recovery by their belief that I will indeed resume being my formerly active self are a continuing source of inspiration. This has been a long road for them in supporting me, and I am deeply grateful.
So, my thanks to: my students, who teach me constantly; my friends, especially those who continue to provide humor and cheer without unwanted advice; my extraordinary PT, Heidi, who guides me with deep compassion and skill; Lindsey, my Gyrotonic instructor who helps me strengthen and explore movement in a very attuned and means-whereby fashion; the folks at Lighthouse Coffee who daily note both my progress and my setbacks with interest and empathy; Carmella the cat who insists upon daily play as a necessity; various valued canine friends, Oliver, Ella, Ruffles, Georgie, who express enthusiastic acceptance; Marty for his tolerance, patience and love; F.M. Alexander for providing a way of being, a skill in activity, that is expansive in possibility, and endless in process.
Another setback and more learning
It is now seeming like a given that if I experience exhilarating progress, I will also endure setback. Thus, for no explainable reason this week, no massage, no excessive activity of any sort, my knee swelled to a point of immobility, pain increased to a very high level, and simple activities became hugely challenging once again. After 9 months of recovery, my tolerance and patience for pain, immobility and dependence on others has thinned to a shred. Returning to needing a cane to walk and assistance to dress is nearly unendurable after some months of nearly normal mobility and independence.
I have to remind myself, with this renewal of pain and immobility, that this current condition is temporary. I can teach well and easily without pain because I attend to a bigger picture of self, use my entire elastic system, and focus far less on sensation when I am teaching. I don’t in any way suppress or diminish pain as information, but instead take that information as part of a wider field of input. I use myself as well as possible so that pain is not an issue.
Given my current level of frustration, anger and depression with this setback, you would think that I could bring the use of myself while teaching to daily non-teaching activities, like walking to work (currently using a cane, again). But I am a flawed and frustrated human, and I just can’t, don’t want to, and I rebel and protest instead, like a child who wants to run but can’t yet manage the coordination.
This setback provides an insight into the experience of people far more injured than I who have to endure even longer recovery patterns than mine. If I have run out of patience with all my Alexander tools and excellent professional resources, if I am battling depression and hopelessness, how do people without these tools even begin to cope?
Thus, I humbly continue with my refusal to shorten or narrow, with my request to widen and lengthen, and with a deep hope for reprieve from pain and immobility.