Yes, we are connected

skeletons

Though I’ve been focusing on the feet these last few weeks, if you’re having problems with your feet you may also want to make some other connections. Yes, similar to what we’ve been exploring there are things you can do physically that will help. But our feet are connected to our leg bones, our leg bones are connected to our hip joint. Our hips are connected to our spine and further it goes, up the whole body.

We tend to look where pain expresses itself… and think we will find the solution there.

Some people may have knee problems and look to ‘fix’ the knee when really what’s happening (or not happening) is at the hips or at the feet. Or elsewhere.

Imagine you have a cast on your ankle and how it might feel when you walk. How your body might compensate. You may end up with a sore back or shoulder muscles as you try to move as best you can with a stiff, unable to bend, ankle. We’re not usually walking around with a cast on, but many people don’t really use a lot of their ankle flexion for a whole host of reasons. Shoes, patterns of movement, previous injury, etc. Pain may be expressed in your back or shoulders when what’s really going on is down at your feet.

People will often say, “yes but I had an x-ray or ultrasound and they found this (insert condition here) is wrong with my feet”. Yes, I’ve been there too. Diagnosed with chronic plantar fasciitis in both feet, osteoarthritis in both big toes. Basically, I was told to wear rocker shoes, orthotics, and live with it.

Orthotics absolutely serve a purpose in many cases but I’m not sure of any other body part we are willing to cast or brace for a lifetime. We might need a collar brace, but not forever. We may need to wear a special boot to help with a foot injury or after surgery. The point is we work hard, physiotherapists and others work hard with us, to remove these external or artificial supports. Our feet and some orthotics, in my opinion, should be no different.

After my own diagnosis and subsequently learning that our body will most often adapt to what’s asked of it, I figured there must be another way. I have put some effort and focus on my feet in many of the ways shown last month but what was happening in my hips (lack of strength and stability) also played a part.

There are often many pieces to the puzzle of long-term, persistent or chronic pain.

For instance, why was it my feet didn’t always hurt? Why only sometimes? Some days?

Paying close attention I came to notice that when under stress, under too much ‘load’, my pain was likely to arise or increase.  If I was out enjoying myself, not a care in the world, doing something fun or even necessary perhaps, I didn’t seem to have pain. But at other times, it most definitely kicked in.

The biggest a-ha for me now is to realize that structural degeneration or tissue damage is likely to show up for me and everyone else at some point (Note: Brinjijki et al 2014 study as shown in the table below). Particularly by the time you’re my age (56). I need not ‘fear’ this, or fear making things worse, but rather utilize all the things I know I can do, that might help with the pain I sometimes experience in my feet.

  • Strengthening
  • Stretching
  • Keeping my feet soft, supple, agile
  • Adding load, good stress, to keep the bones healthy
  • Wearing appropriate footwear; allowing for space, mobility, flexibility
  • Keeping my overall ‘weight’ in a manageable range
  • Knowing that my levels of stress, fatigue, diet and a range of other factors may also play a part.

degenerative spine issues

In the month of November, we’ll explore our HIPS (Yes, I switched my focus this month from shoulders to hips. We’ll get to shoulders in December). This is where load and/or gravitational forces are primarily distributed through the body so how well we manage this, matters.

Along the way, I’ll throw in a few morsels about chronic pain that might help you make sense of your own personal experience with persistent pain in the hips, or elsewhere.

I hope you’ll join me.

 

The Evolution of a Practice

SimplifyWhen I used to write about yoga for a local magazine, the numbers of Americans practicing yoga was about 20 million. Today, about 6 years later, that number has nearly doubled, edging up towards to 40 million. Globally, the estimate is about 300 million and the number of over 50s practicing yoga has tripled over the last four years.

People often wonder what this thing called yoga actually is. Difficult to answer in just a sentence but to me YOGA is the exploration, awareness, and response that informs how I (might best) relate to the world inside myself and to the larger world around me.

A large part of this doesn’t involve the physical yoga postures or asana practice, but that’s usually where people begin. It is a good way into the wider exploration. Most, practice on a mat and typically in a group class. Certainly, it’s where I began.

Not knowing anything about yoga when starting out, I first practiced Ashtanga yoga and then when I began teaching it was a somewhat modified Vinyasa practice. Both involve strong, physical, almost gymnastic-like movements linked with the breath. Ashtanga, in particular, is meant to be practiced for 1.5hrs each day, 6 days of the week.

My practice today no longer resembles this in the least. Today, my physical yoga practice is interweaved throughout the day, with broader concepts in the background.

  • Most often it does not take place on my mat.
  • Most often it is less than 30 minutes at a time.
  • Most often it’s a response to whatever I feel might best serve me, at any given time.
  • No special place, clothing, or time.

Which I think might be a helpful way to practice for many who don’t have the time, money, or perhaps ability to get to a studio or gym.

What does this practice look like?

Join me over the next few months and we’ll look at little snippets of yoga, movement, breath practices that can be done in a couple of minutes or combined to make your own personal practice. On your own time, in your own space, that fits into whatever your life demands of you.

Most important to me is to teach people what they can do for themselves. Provide agency. The ability for you to have the tools and the freedom to make choices that enhance your wellbeing and your life.

  • In October we’ll focus on the feet.
  • November will be all about the shoulder joint.
  • In December, we’ll get into the hip joint.

I’ve chosen these particular areas to focus on as they tend to be where problems, pains, issues show up for most people I talk and work with.

You can find me talking about this on Facebook, and Instagram, if you want to follow along.

 

Back Pain – There is Good News

relieve-back-pain

The bad news is you may have or know someone that is experiencing chronic or persistent back pain. The good news is, there is a way forward.

Yesterday, three important papers about back pain published in the Lancet (one of the world’s oldest and best known general medical journals) were referenced in the The Guardian, The Telegraph, the BBC News and the Daily Mail . So current evidence-based information, at last, making its way to the public domain.

In briefly reviewing the papers (published March 21, 2018), the key points for me are these:

Low back pain is now the leading cause of disability worldwide.

“Prevention of the onset and persistence of disability associated with low back pain requires recognition that the disability is inseparable from the social and economic context of people’s lives and is entwined with personal and cultural beliefs about back pain.”

“Most low back pain is unrelated to specific identifiable spinal abnormalities,”

Globally, gaps between evidence and practice exist, with limited use of recommended first-line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences.”

“Recommendations include use of a biopsychosocial framework to guide management with initial nonpharmacological treatment, including education that supports self-management and resumption of normal activities and exercise,…”

Thank goodness this is getting the attention it deserves so it can help people who need it most. And that’s a LOT OF PEOPLE.

Why now, finally? I think it’s gaining traction due to spiraling health care costs along with the opioid crisis that is so prevalent.

Over the next while I’m going to break down and comment upon some of the points and principles presented in the papers, as many form the basis of my work.  In the meantime, if you care to read the papers yourself they can be found here.

Lorimer Moseley, one of the world’s top researchers on pain continues to make the related point that people need an understanding of what pain is and what it isn’t, as he does with a touch of humor in his TEDx Talk in 2011.  Professor Moseley is most known, however, for publishing 260+ papers on pain science and his continued work as Professor of Clinical Neurosciences and Chair of Physiotherapy at the University of South Australia. And one of many leading the charge globally in what he calls a Pain Revolution.

A huge paradigm shift is required as understandably, information about what works to treat back pain and what doesn’t is confusing.  It seems counter-intuitive to ask people who are in pain to ‘just move more”. As the latest interviews I’ve listened in to with Lorimer, he states that with what we’ve learned ‘recovery is, back on the table’.  There is hope. As I mentioned earlier, there is a way forward.

I talk about this all the time with family and friends … who often have a hard time believing what I describe as it is a change from what we have believed for most of our lifetime. 

But, if we really truly want to get people out of this pain cycle (and I will say most any pain cycle) we need to help with the understanding of what the evidence shows and how to best work with it. This will also require huge shifts in our public policy, etc. as stated in the Lancet papers.

“These potential solutions include focused strategies to implement best practice, the redesign of clinical pathways, integrated health and occupational interventions to reduce work disability, changes in compensation and disability claims policies, and public health and prevention strategies.”

So come along for the ride if you or anyone you know is experiencing chronic or persistent low back pain (or any pain, really).  With 1 in 5 experiencing chronic pain of some kind, unfortunately, you won’t have to look too far.

 

 

Do you feel stuck?

babies
It used to be so easy

Look at a baby or a young child for a few moments and you’ll notice they make all kinds of movements, in all kinds of ways.  I watched a video yesterday and thought back to the crazy, wild, wonderful things we did as kids with no thought or consideration about how to move our bodies.

Look at old or aging people and what do you notice? I suspect it would be unsteadiness, stiffness, feet shuffling, bending or moving with great care.  For me, the word rigidity comes to mind.

Rigidity – Not able to be bent easily, not easily changed, not willing to change opinions or behavior.

What happened between then and now, new and old?  What does the future look like in terms of your body’s ability to get around in the world?

Today I noticed a question on a Facebook site, “If there was one thing you could change about yoga what would it be?”  

One of the responses was “Having people talk about flexibility the moment I mention I teach yoga.”

Flexible – able to change or be changed easily according to the situation; able to bend or be bent easily without breaking.

You could also add – the ability to be easily modified, willingness to change or compromise.

People always link yoga with flexibility which can be true. I want you to think of flexibility, however, in a slightly different context than the ‘bendy’ flexible yogi.

You don’t need to have a ‘bendy’ body to do yoga or live your life. However, you DO want to be able to manage the task at hand, whatever that might be for you personally.

You want to have options, multiple ways of navigating rather than narrow lines, restrictions, or rigidity.

How can you do this?  How do you go from feeling stuck and/or experiencing chronic pain to feeling flexible in this context?

That you have options in your body, in your life?

Follow along… and we’ll find a way to bridge the gap.

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