Travel as recovery progress
Negotiating travel while in long term recovery from a major injury (patella fracture, in my case) is a tricky business. The question of how much I can do with good use of myself informs decisions about travel. We all know that airline travel and being away from familiar circumstances imply challenges on many levels. Traveling with physical limitations amplifies these challenges.
Happily, I was able to handle airports and outgoing flight with surprising ease. And, while in my beloved city of New York, I walked an average of 9 miles (!!) daily with ease, speed and joy. I could pay attention to my surroundings beyond the walking surfaces, and even step down from lower curbs with my non-injured leg leading. This indicates that the injured knee has improved stability, strength and flexion for weight bearing.
While I was in NYC, I enjoyed lessons with John Nicholls, my primary Alexander teacher for the past 20 years. These lessons improved my overall use, resulting in increased confidence in my elastic condition of Self. Lessons with John enhanced respiratory support, improved connection with the ground, and decreased knee pain significantly, as my overall use shifted to a bigger picture. My brain state eased, anxieties and fears softened, and I enjoyed the experience of being larger than my sensations.
However, I overestimated my strength once I proceeded toward departure from NYC. Arrival involved going up stairs with luggage on public transport, which I could do easily as I can use both legs relatively equally in ascending stairs. Descending stairs with the weight of luggage was not so easy, and did not involve good use as a possibility, as I still have to go down stairs in a very asymmetrical fashion. Once I got to my flight gate, my lower back was in serious spasm. Sitting for 6 hours in a less than ideal seat (your typical airline seat, which is nearly diabolical) only increased discomfort. By the time I arrived in Seattle, I had to ask for assistance to get my carry-on bags off the plane. I hobbled off the plane with stiffness and disconcerting pain.
The spasms calmed with the activity of teaching (this activity requires good use), rest, acupuncture and careful exploration of monkey (elastic relationship of head/back/legs). The lesson in this is obvious: be conscious of what is possible with good use, and refuse to challenge myself with activities that make good use impossible. In other words, take a car to the airport if that involves better use of the Self!
Regardless of the back spasms resulting from over-challenging myself on the way home, I am thrilled to have managed travel mostly with ease, to have enjoyed increased mobility in my favorite city, and to have, until now, avoided back pain during my entire 8+ months of recovery from injury.
Possibilities and (as yet) impossibilities
Eight months of recovery has yielded many insights and instructive experiential information on applying Alexander principles to injury, rehabilitation and overall survival as a whole person, as well as a new knowledge of other disciplines that are effective in recovery from a major injury.
Tangible results as to my progress are clearly indicated by much reduced pain and far improved mobility. Eight months seems an awfully long time to be less than fully functional as a constitutionally active person, but recovery takes the time it takes. End-gaining has been clearly shown to impede my progress toward full recovery.
With my trusty pedometer, I can track my daily mileage in walking to an average of 5 miles! Much of this distance involves moving with near pre-injury speed and ease, which is a great joy for me. Sleep is no longer disrupted by excruciating pain. My knee is a bit stiff during my morning walk to work, but improves as I think my Alexander directions, and also attend to the wider world beyond my sensations and fears.
There are activities I look forward to experiencing, such as walking down stairs like a non-injured person, or going down hills with ease and confidence. Sitting for more than about 20 minutes results in stiffness and discomfort, so attending live performances or seeing films on the big screen are challenging. I can’t (yet) kneel for any length of time, sit cross-legged, or go back on my heels from kneeling into “child’s pose”. Forget about running. I may have to wait many months to even consider moving into my previously favorite activity. Mounting a horse, something I previously did with ease and joy, seems quite impossible for me just now.
My intention is to allow continuing refinement of the coordination of my entire self to reveal solutions that will make all of the above activities and hopes possible once again. Proceeding with patience and determination is a challenging mix, but I hope to learn that specific and general refinement as I carry onward with dynamic non-interference in mind.
The pain issue, revisited
Although daily pain is less and less of an issue for me, thankfully, the fear of pain as well as sudden unexpected pain continues. We strengthen the nerve fibers to pain by checking for pain. Ignoring or suppressing pain is not my intention, but allowing sensation to register from my larger picture is my intention. Fearing pain is a response post-injury that potentially limits exploring movement that may not indeed cause pain. There is a fine line that must be discovered by the whole self between fearing pain and reacting to that fear, and sensing with accuracy what is truly happening,
Most of us have what F.M. Alexander termed “faulty sensory appreciation” that is based on our habitual way of being. He emphasized that we cannot trust our interpretation of sensation, as our habitual responses have flawed our entire systems. We can’t know what has not been previously experienced with any accuracy. The instrument of our self is not reliable until we have the guidance of people more intelligently organized than ourselves.
So now, back to pain: I have accepted as a given that my knee hurts fairly constantly, with varying degrees of intensity. When I am afraid of pain’s increase, I narrow, shorten, and generally contract. If, instead, I allow my thoughts to rise up, see the bigger picture of myself, view with curiosity the world outside my sensations, fear diminishes, pain lessens, and I can see pain as a tool for response, rather than allowing pain to dominate my experience.
Although this may sound simple, it is not easy. People who endure continued pain struggle daily, hourly with finding a larger view than the sensation of pain. Life can so easily slip into pain as a dominating factor. Depression, despair, and helplessness are very possible life results. All the nerve connections for checking on potential pain become strong, and any accurate assessment shrinks.
Applying Alexander principles of attending to the whole self may bring hope and possibility. Pain may still continue, but may not be dominant as sensation. We learn, as Alexander students, to attend to a wider, deeper, more expanded view of ourselves, and to engage in daily activities with more choices in response, and an intention to dynamically allow the activity to do itself. We revel in exploring physicality in a conscious manner.
Continued learning in recovery
An intention to grow, change, learn and welcome new information is key for me in order to endure the difficulties and challenges of a lengthy recovery. Although I am still in the midst of this story, I can observe that some small changes have occurred in myself, and some lessons learned. As always, I write in hopes of learning for others.
I am continuously grateful for the kindness and patience of family, friends and students, and for the expertise of professionals who assist me in recovery. Accepting help is not easy for a fiercely independent person like myself, but I have learned to be appropriately dependent upon the kindness and skills of carefully selected humans.
A basic restlessness has been an aspect of my nature since birth. Impatience has often been a stumbling block to experiencing life in the moment. With the necessities imposed by injury, I have slowed, calmed and quieted. The surprise for me is that a slower, quieter pace can be both rich and dynamic. I miss moving with speed, and long for that option, but it is a hopeful future choice now rather than a habitual reaction.
The gifts of the Alexander Technique inform me in a totally new and deeper manner. Being able to think with my whole self, and to creatively cope with physical limitation has strengthened my confidence in Alexander principles. I am a much better teacher than previous to injury, and also humbled but much more I need to not know. Injury has required me to enthusiastically not know.
I can’t in any way say I am grateful for this life changing injury. No, I am not! I daily wish I had never fallen, and am wakened by nightmares of falling. Each morning, I come to consciousness wanting to go for a run in the new light, and to be informed by my morning run throughout the day. My restlessness is not gone, just reconfigured. Without the access of physical activity, I am forced to rest and quiet, and have had to learn to be at ease until I can be wildly active in a new way once again.
Limp and response
My limp had nearly disappeared prior to the recovery-disruption of recent massage. Now, my limp is once again often pronounced to the point of lurching when I am tired, in any pain, or (unconsciously) wanting surrounding humans to allow me a little more time and space.
Today, as I walked from my office to my Gyrotonic workout (a bit over 2 miles), I attended much more to my attention and intention in an Alexander fashion. Once again, I observe that my choices in response have an effect on overall experience and coordination.
When I focus on my (rather constant) knee discomfort, I pull down, and then experience more pain, fear, and fear of pain. (The fear of pain is probably the worst for my use) When I allow my thoughts to rise up, and I begin to see the lovely Autumnal world outside myself, fear and pain quiet, and the dreaded limp diminishes to a wisp of a limp. The soft tissue around my injured knee may suddenly spasm, which frightens me, but if I slow down in my thinking, allow my thoughts to rise, fear and even spasm quiet again.
Overall directions to widen are included in dynamically rising up in my attention. I include the ground as my source of support. Effort becomes much more invisible.
There is a difference between hurrying and moving quickly. If I hurry, I typically lose the bigger picture, as I am focussed on pace rather than process. Fixed determination only fixes me rather than frees me. If, instead, I intend to spring from the ground with a happy curiosity, I am much more free to move with speed and ease.
Acknowledging limits, however, becomes essential. Even with my best Alexander thinking, it is important to not push beyond pain. Respecting pain with a happy curiosity about choices in response is the balance I am exploring now.
Setback and then renewed progress
After a week of sometimes extreme physical and emotional discomfort post-massage, I have happily resumed mobility, experience far less pain, and have come to understand how and why the big setback occurred.
Although my intention in seeking massage (and the intention of the massage therapist) was inflammation reduction, I see now (with input from my excellent PT) that I have formed, over 7 months of recovery, a delicate balance of tensions and flexibilities to accommodate my injury. This was unintentionally disrupted by massage, so that my neuro-muscular system read the new imbalance as a need to protect the injured area with a vengeance.
As an Alexander teacher, I could/should have known better than to seek a specific result! Alexander principles are always indirect in application. We seek, in the Alexander Technique, to address a whole person response in balance, rather than to change any specific indication.
Setbacks may be a reality that have to be accepted in the non-linear progress of recovery. Hopefully, setbacks provide new information for what does and doesn’t work for continued recovery. Although I experienced great dismay, I am relieved and happy now to have recovered from my own backward direction with pre-massage mobility intact, and, I hope and believe, with more thorough recovery in my future.
Progress and then Setback
I have recently enjoyed great progress in recovery from my patella fracture. With delight and joy, I have been walking an average of 4 miles daily with ease and even occasional speed. Exploration of more vigorous activity in Gyrokinesis and Gyrotonic exercise has been great fun and has involved many fewer limitations than I had expected. I was becoming quite confident that recovery was proceeding easily and well. Then…
Several expert people had suggested that I seek further inflammation reduction through massage techniques. Since I have every interest in and full commitment to full recovery, I followed this suggestion, and received a lovely, subtle massage specifically aimed at reducing the lingering inflammation in my injured knee. My massage therapist warned that I might be a bit sore after the massage, as the tissues would interpret intervention as renewed injury. At her suggestion, I iced and elevated post-massage to calm any tissue reaction.
Extreme pain and huge inflammation ensued despite all the best intentions otherwise. For the past 5 days, pain and swelling have increased so that I am unable to walk with any ease, sleep without disruption, or even sit for longer than about 5 minutes. In other words, I am back to early post-injury levels of pain, inflammation, immobility and insomnia. My use of my entire self is challenged all over again.
Despair, discouragement and an overall sense of helplessness have begun to overwhelm me. A week ago, I could walk easily to work and to all desired locations. Now, I hobble to the bathroom and must think my Alexander directions with vigor to manage even simple activities like getting dressed or climbing stairs. I have to find daily reasons to remain optimistic, such as the sightings of scrub jays near my office, and the fact that I can still teach with some ease.
I know this stage will resolve and shift with my continued determination to not end-gain, to ask for quiet and for the bigger picture, to not pull down to the pain, but after 7 months of recovery, and with the joy of being more mobile suddenly removed, I am weary. I want so very much to progress, and struggle not to collapse or to end-gain with this temporary return of disturbing limitations.
Exploring more recovery: increased activity
For people intrigued by the challenge of new movement, new physical strengths, and daily exertion, serious injury changes all expectations. What was once easy and joyous becomes painful and impossible for weeks, months, even years. The reduced possibility of movement exploration can be a recipe for despair. Lengthy recovery affects every aspect of being. Patience, instead of pushing, becomes primary. Any end-gaining in movement is no longer an option. Proceeding intelligently in rebuilding strength in mobility requires support from expert professionals who view the whole self as an elastically responsive and integrated system.
Happily, in augmentation of my Alexander knowledge, I have found Physical Therapists whose approach to recovery and rehabilitation is compatible with Alexander thinking. Janette, a PT with certification as a Gyrotonic exercise instructor, worked with me this week to tweak, refine and clarify my Gyrotonic routine. With deeply preceptive attention to detail of the entire self, Janette showed me simple ways to not only strengthen the muscles supporting my injured knee, but to also address nervous system connections and feedback loops, so that I can exercise vigorously and consciously without increasing pain or inflammation. The work that she showed me also addressed lymphatic drainage, so that inflammation around the injury site clears as the whole body moves with ease and intelligence.
Today, I attended, for the first time since injury, a Gyrokinesis class given by Master Teacher Mia Munroe. Since I haven’t taken a class for 6 1/2 months, I was uncertain how much I could do with ease. Happily, I was able to move, with Mia’s skilled direction, with rhythm and strength. Obviously, I had some limitations. I can’t kneel, for instance, due to the hardware (pins and wires) in my knee, nor do “knee circles” with any comfort. Limitations aside, I deeply enjoyed the experience, once again, of exhilarating movement, of challenge, of learning, of thinking in motion with my entire self.
Feeling strong, being appropriately challenged, experiencing vigorous mobility reduces attention to the possibility of pain, and even reduces pain, if the whole self is attended. Enlivening the entire self with conscious thought, and taking conscious thought into activity, is what the Alexander Technique supports.
The dance of my Self in recovery continues!
Continuing Recovery Past Pain
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.
The nuances of whole person recovery
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!