Newly Found Inner Quiet
I am restless by nature and wired for speed. Although I have experienced injury and recovery previously (fractured ankle, hernia surgery), I have always recovered with astonishing speed and resumption of function and mobility. A combination of my Alexander skills and a strong motivation to move well again powered my previous recoveries.
This injury, requiring a long term rehabilitation, cannot be hurried. My Alexander skills have certainly helped me in reducing compensation and unnecessary accommodations, as well as assisting me in managing the emotional consequences of being temporarily less mobile than I prefer to be. Strong motivation to recover serves me to a point and then becomes an end-gaining urgency that does not serve recovery. Impatience thwarts progress when I push too hard.
There is a subtle balance required of me now that reflects the conscious response to stimuli that that Alexander Technique embodies. I must have a clear intention, and then do from undoing, activate without doing too much. This is a total response, integrating emotional, physical and mental aspects on a continuous basis.
Given that I am currently unable to be physically active in my familiar manner, all aspects of my sense of self are impacted. My means of processing emotional and mental information has had to change, as my previous means-whereby has involved movement, exertion, and an exploration of activity on many daily levels. Exertion in the physical manner is not currently available. And thus, I am exploring a new experience of being quiet and stilled, yet remaining dynamic. How to remain dynamic in stillness is what Alexander students and teachers learn to embrace, willingly and joyfully. My current relative immobility puts this learning at an entirely new importance, and not one that is always comfortable.
I multi-task far less because I can’t be attentive to potential pain and also multi-task. One task at a time is what I can reasonably do. I am beginning, reluctantly, to welcome internal quiet, learning to wait for the bus without pacing, embracing the sadness of not running daily, welcoming the winds of stillness in an active fashion.
Increments in recovery: patience
Patience is not one of my virtues, at least in terms of patience with myself. I can be endlessly patient with my students as they learn the skills of dynamic non-interference, thinking with the whole self, and new co-ordination. With my own self, and particularly with a long and arduous recovery, my impatience tempts end-gaining, frustration and despair. I am wired for speed and mobility, not for the slug-paced slog of recovery from a serious injury.
My daily graphs of pain, mobility, flexion, mood and sleep are indicating, despite my rattling impatience, that the trends spell progress. Evidence in being able to walk to work, with a frustratingly slow pace and much care, also indicates progress. Previous to injury, I walked to work easily in 12 minutes. Currently, the walk plods along requiring about 40 minutes. Impatience demonstrates itself with a sense of narrowing myself and a general pulling down. Thinking my Alexander directions changes my experience to one of appreciating that I couldn’t walk at all a few months ago. For some moments, I even enjoy my experience, which is a rare gift these days.
Incremental progress in recovery does add up eventually (hear my impatience?) and tips over into the proverbial corner to increased function and mobility. Learning the Alexander Technique involves incremental progress that also tips over into a new sense of conscious control of the self. After 22 years of teaching the Alexander Technique, I guess I should know about patience.
The Big View with Recovery Set Backs
Over the past several weeks, I have experienced set-backs in pain levels and mobility that have dismayed, disturbed and depressed me. Just when I seemed to have achieved more comfort and flexion, my experience changed, without discernible explanation, to challenging pain and nearly non-existent flexion (which spells minimal mobility).
One of my wise and dedicated students, a professor at the University of Washington, suggested that I begin keeping a graph of my experience so that I can see trends in a larger fashion. And so, with her expert support, I began noting levels of pain, sleep. flexion, mood and activity. It is so tempting, and so very human, to become over-involved with today’s pain/activity/flexion and believe that current levels are permanent.
The larger view applies to learning the Alexander Technique also. As you become more keenly aware of your habitual reactions, they become louder, so that you may believe that you are regressing, when actually ease, calm, and overall co-ordination may be improving. These qualities may be much more difficult to chart; a graph is too mechanical for such qualities. The point is that progress in use of the self and in recovery is not linear, and may involve perceived regressions, experienced set-backs, and inexplicable leaps. The self needs to organize on many levels that are integrated and inseparable, especially in recovery. A long term view that is in balance with present awareness is a continuing balance of perception.
Pain is deeply discouraging; trust in the spiral process of recovery is conceptually appealing but realistically shaky. If I can recall my 25 years of Alexander study and all the spirals, set-backs, plateaus and breakthroughs I have experienced in that journey, perhaps I can bring a wee bit of patience and trust in process to this more acutely painful and urgent recovery.
I will see what the big picture reveals.
End-gaining in Recovery
Although it is embarrassing to admit to end-gaining in my recovery as an injured Alexander teacher, I am experiencing the results of pushing too hard to recover.
I got very excited that I could walk with more ease, and so began walking to my office and home again. Combined with my daily PT exercises, it became clear that I was end-gaining, as my knee became so painfully inflamed that I couldn’t do the necessary daily flexion stretching or PT strengthening, and was also unable to sleep due to tremendous pain.
Slow and steady is my new theme. Although I desperately want to resume daily activities that previous to injury were a given, I have to prioritize a balance of rest and activity in a conscious fashion.
No matter how intensely I want to improve my strength, knee flexion and mobility, I cannot rush it with my will. I need to rest, and to consider the overall use of my self. I am so accustomed to being a very active and strong person that I have mistaken activity for recovery. Resulting pain, and the huge, debilitating despair from pain, teaches me about my confusion; respect the pain, go slowly, allow process, and trust in eventual recovery.
Further progress, increased activity
Recovery from a major injury such as I have had requires persistence, awareness, and a willingness to actively apply intelligence in the use of the self to activity. Every resource of my Alexander principles, as well as seeking expert help from other disciplines, has been necessary and instrumental in continuing recovery toward full function and overall strength.
Alexander thinking has been essential in coping with the myriad challenges of serious injury. It is the underpinning and the context for me to pursue necessary rehabilitation activities so that I can resume life as I prefer it to be.
My excellent PT, Heather, suggested that I get a stationery bike, not only for increased knee flexion and leg strength, but also to feel active and challenged on a cardio-vascular level. I admit to being previously suspicious of any stationery exercise equipment, as it generally tends to use the same muscle groups repetitively and without thought. However, given that I can only walk a limited distance without fear or pain, and that I am missing the emotional balance I normally find through activity, an exercise bike is an ideal choice for now.
Marty found an exercise bike for $7 at Goodwill and delivered it to my office. With Alexander thinking of head up and forward, back long and wide, legs out of back, I pedal madly to nowhere like Miss Gultch, otherwise known as the Wicked Witch. This loosens and moves my injured knee through flexion, strengthens my injured leg, inspires a respiratory response, and perhaps, most importantly, gives me the exhilarating experience that I so miss from my daily run. Taking Alexander principles into movement and daily activity has been a joy for me for many years. If a stationery bike provides a dynamic opportunity, then I will take it, with gratitude and joy. So far, I can manage about 5 minutes before my knee hurts, but am building incrementally to 6 minutes and onward.
My wise and creative Gyrotonic instructor, Lindsey, also provided opportunity for me to explore my limits in motion and activity today. With care and attention, I was able to to explore further spinal movement and leg co-ordination. I was able to do much more than a week ago, which gives me great hope for ongoing progress in strength and function recovery.
I can walk without a limp if I think with my entire self with dedication. I see myself striding confidently and easily (head up, knees forward of back) and then it happens, as long as I am not scared. Fear of falling remains a factor in my co-ordination, especially since my injured leg doesn’t always respond with balanced muscular tone. The knee may suddenly buckle and I wobble uncontrollably. I can respond to the fear only by slowing down, quieting and and re-thinking an elastic response. Rushing and end-gaining just won’t work.
This is the best I can do, and so far seems effective! I an grateful for professional support from experts such as Heather and Lindsey, and deeply thankful for over 20 years of Alexander expertise.
Losing the lurch and the limp
As my mobility increases, much to my joy, the habits of limping and lurching when I walk, climb stairs or come up from a chair linger. These habits had become very deeply ingrained by my formerly very limited mobility, as well as by constant pain.
Now, I have to consciously refuse to limp and lurch. This means I need to direct myself with great dedication and determination to come up from the ground from both feet, and to trust my injured leg to support me as I put my weight into it. I also have to ask my non-injured, overly strong leg to participate a little less, so that the left leg can learn to bear weight again.
Widening is a constant directional challenge for me. If I am uneasy about support or balance, I notice an immediate narrowing through my shoulders that results in a very pronounced limp, as I have pulled myself off the ground, and thus disrupted the entire elastic balance of tone. My fear of falling remains huge. Trusting that my thought of widening onto the ground to spring up will be sufficient for support becomes a rather noisy internal dialogue. If I am understanding, accepting and patient with myself (this often means literally going more slowly), the battle quiets, anxiety decreases, and what do you know, I can walk with some semblance of ease and grace!
After nearly 3 months of requiring rides to and from my office, I am now walking to the bus and getting to work on my own slow steam! Independent mobility has always been a great delight for me. I am very happy to be, step by step, resuming mobile independence with consciously applied Alexander principles.
Finding Strength/Accepting Limitations
As a formerly strong and fit person, the challenges of being currently wobbly and weak are dismaying to say the least. Thus, I was eager to return to some sort of exercise beyond my extensive daily PT assignments. The use of the entire self interests and motivates me, with respect to, but not total focus upon, my injury.
I returned to Gyrotonic Seattle studio today, after an absence of nearly 3 months, with the careful and attentive guidance of my wise instructor Lindsey. Together, we explored what I can do to strengthen my overall self, and to renew a balance of elastic response, with good use always in mind.
The Gyrotonic approach is very Alexander compatible as it takes thinking with the entire self into active form. Lindsey guided me through a series of spinal movements to renew a fluid response through my entire torso. All of my former habits of shortening through one side are much more apparent with the guarding habits resulting from injury. I have the opportunity now to address these long held habits of shortening because I have to in order to recover a balanced condition of self once again.
As compared to my workout prior to injury, I could do very little, but even minimal motion was a wonderful experience, especially with attentive guidance to overall awareness. The inherent imbalance implied by one very weakened leg affects the entire muscular response. We are, after all, designed to be mobile with two legs. My entire self wanted to distort to protect the injured leg, but this reaction is no longer useful. I had to work very diligently not to distort, and to allow an overall response even when this felt wrong and scary.
The PT exercises address the specifics of needed strength and flexion. The Alexander Technique and the Gyrotonic approach include the entire tone of muscular balance, and of intention and attention. All are necessary, I am finding, in the journey toward total recovery.
I am learning to go from undoing to doing without doing too much, and to activate from thinking in an entirely new manner. I can’t (yet!) do what I could some months ago, but I can use available tools to resume full strength in activity eventually.
The Pain Issue in Rehabilitation
Pain has been a rather constant companion and source of information for me since mid February. My reactions to pain have become habitual, just like most humans’ reactions to pain. I guard, stiffen, compensate, and generally pull myself down.
I could describe and differentiate the many nuances of pain resulting from a fractured patella and repair surgery, but that process would most likely contract me further. Pain is undeniable with a serious injury. The question is one’s conscious choice in response to pain.
Today, my skilled PT, Heather, gave me exercises, both passive and active, to increase the flexion of my injured knee. These exercises hurt, but I must do them to regain desired function of the knee. Heather advises, “Respect your pain”, meaning that on a scale of 1-10, don’t push myself beyond 4. I can go to the the edge of tolerable pain, but can I do it with good use of myself? Can I use myself elastically while I push my knee beyond where it seems safe to go? If my question becomes my entire use rather than my knee pain, I can actually bend my knee further! If I am not interfering in an overall response, the injured area has the room to move, even incrementally.
Heather also manually pushed my flexion to a degree of nearly fainting pain. The pain was balanced by the resulting increase in knee flexion. Meanwhile, I had to use every molecule of “big picture” thinking to dynamically allow her expert work.
What Heather identified most clearly is that I have indeed been moving as though I am still wearing a leg brace, and that my fear of pain is impeding progress more than actual pain. Faulty sensory awareness strikes again!
I see now that I have to endure pain with good use for my functioning to improve. I have to refuse to end-gain through pain also, and to respect tolerable limits, yet still explore the territory of pain with an overall elastic response. This is a constantly changing territory, and thus my dynamic response needs to be quietly attentive. Recovery as a process includes pain. I can view pain as an ingredient of my experience to which I can respond with conscious direction of the entire self. Not easy, but occasionally possible.
Whole Person Recovery
As noted previously in my posts, recovery is not a linear experience. Habits of accommodating to each new stage of recovery need to be relinquished so that a new condition of self can inform the entire means of response in movement. Change is continuous, and progress is not always obvious, as an injury implies necessarily protective responses until those responses are no longer necessary.
My injured knee seems to have turned a corner toward increased functional response this week. Partially, this was due to having less fear about moving, and more confidence in my skills in direction from an Alexander perspective. Another large influence has been simply using the knee and my entire self with more ease without the leg brace. Strength in overall response benefits the injured area far more than focussing solely upon the area of discomfort.
In light of a whole person response, my skilled and expert Gyrokinesis/Gyrotonic instructor, Lindsey, came to assist me with my PT exercises today. Although my Physical Therapist, Heather, is excellent, Lindsey adds the dimension of knowing how I moved previous to injury, and of seeing the entire elastic thinking self for any activity, due to her Gyrotonic and Gyrokinesis training. (Both approaches very Alexander Technique compatible!)
Lindsey gave me ways of thinking through my PT routine that included my entire response. She also gave me very refined and subtle exercises that directed my injured leg to “learn” from my non-injured leg. This is very consistent with current neuroscience information about the motor and pre-motor areas of the brain, and with how the brain manages overall co-ordination.
A major challenge of serious injury is resulting inactivity. Not only does inactivity have emotional/psychological consequences (witness the despair and depression that I have experienced), but the brain takes inactive areas “off-line”. If there is no stimulation to a muscle group for any period of time, the area in the brain that directs that muscle group shrinks. With respect for pain, it is important to stimulate an entire elastic muscle response as soon as is possible after an injury, so that whole person function can resume with balance of tone.
Because Lindsey knows my work as an Alexander Teacher (she has had lessons, and i have worked with her in Gyrotonic for many years), she could direct me in a whole person manner. The exercises and procedures that she taught me renewed my sense of an overall dynamic response in a way that both energized and calmed me. I could proceed from non-doing to doing without doing too much. Increased activity did not result in interference with the primary control (head-neck-back relationship), nor did it increase anxiety about possible pain.
Activating the entire self on all levels is key to a thorough recovery. If we take Alexander principles into dynamic activity, we can renew a sense of being functional and present in ourselves. The brain response improves, muscles, tendons, ligaments get a new message of functionality, and the nerves have new connections for continued mobility. Plus, emotional calm resumes from an overall balance in tone of the self.
Without the Alexander Technique and the guidance of intelligent experts such as Lindsey and Heather, I would not likely be doing as well as I am. The despair and depression that I have experienced on this journey are diminished by the dynamic participation that I can currently experience.
Brace free lessons: Recovery steps
In each stage of recovery from injury, one learns to accommodate the conditions that are necessary for healing. Casts, splints, braces, crutches, canes, stitches, medications and more may all be part of the return journey to mobility and health. Hopefully, one has intelligent co-ordination of self and expert guidance so that the temporary necessity of artificial support does not mutate to a creation of ongoing need.
Since February 18 (10 weeks, 70 days), my left leg has been confined in either a post-surgery full leg splint, or in a Bledsoe Simple leg brace. I have used a cane for balance, as well as a signal to people about my injured status.
I accustomed myself to full leg extension, then learned that my skills no longer applied once I had been allowed partial flexion. Then I learned to move with allowed partial flexion in the brace. I adapted my life (with generous human help) to both the splint and the brace so that I could continue to function as well as possible, within a specific set of activity limitations.
After the previously mentioned 10 weeks, I removed the brace, on recommendation of my surgeon, and according to recovery protocol. Fear and relief held a continuing discussion. Relief in sleep quality, overall physical comfort, clothing choices confronted large anxieties about falling down, severe muscle atrophy, and new demands on the injured knee. All the sensory signals for safety that I had developed had become associated with the weight, feel, and constriction of the leg brace. Without the leg brace, my vulnerability seemed overwhelming.
But, as any Alexander student (and since I am an Alexander teacher, I am always a student), I learned through experience. After sleeping without the brace (and being unnecessarily fearful about bending my knee in the night), I bravely dared to stand up in the morning. Nothing terrible happened. The knee was as stiff as ever, but I didn’t fall down. I walked up the stairs to my office with two legs (both hands on the railings) almost like a normally mobile person, just with a wince and a lurch. It was scary and my knee ached, but I could do it. (I still can’t descend stairs like a normally mobile person, as my knee won’t yet bend enough.)
And the cane? I remain uneasy about going outdoors without it, but I see now how I have been delaying a level of recovery of balance and confidence by relying on my lovely cane. We need assistance, then continue the assistance even when the need has changed. This seems the essence of habit as related to injury recovery.
I am not mobile in any larger way. I am slow and often scared of falling. I walk with a very noticeable limp. My knee aches more and differently now that the demands upon my knee have changed. The knee ache doesn’t alarm me, but it does remind me that I can’t end-gain this recovery nor speed it with my will.
I still can’t just “run” to the store, “jump” on a bus, board a flight, squat to pick up dropped keys. “Walk” signs remain far too briefly timed for my street crossing pace. I can sleep more comfortably, bathe easily, wear my regular clothes (not just brace-adaptive pants) and get to know my leg again with continuously changing use.