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When is Less More

Just for today can you tune into what brings you pleasure? No, what really brings you pleasure?

Do you need to rest? Do you need to exercise? If you didn’t sleep well last night, what might you do to help you get a good night’s sleep tonight? Do you feel lonely? Or do you need more alone time?

Do you need to push yourself or lie back a little today? How about food? Take a minute. Check in to see what your body really needs in terms of nourishment. Or relaxation. Or stimulation.

Is it time to take a day off? Or would you feel better abandoning the comfort of procrastination and getting to work on that project you are excited (and maybe fearful) about.

Can you pause right now to tune into what you’re really feeling and thinking. Then, can you do just one thing that will make you happy. Just one little thing — whether it’s indulging in a 10-minute nap in the afternoon or putting 15 minutes into the project you keep pushing to the side.

Just for today, maybe less is more.

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The Role of Posture in Back Pain

Part I – Coming to the Floor

Image from Gray’s Anatomy 1932

Yoga can be an excellent modality for managing and healing low back pain. Just as many poses in Yoga are ideal for healing certain kinds of back pain, other poses may make back pain worse. It depends on the nature and cause of your back pain.

I agree with Robin McKenzie, a New Zealand Physiotherapist, that poor postural habits play a big role in most back pain. McKenzie has developed a body of work that successfully treats back pain. Many of the exercises that are prescribed by the McKenzie are the same postures that can be found in many gentle or beginning Yoga classes. (Unfortunately, many of these same postures have been dropped from more advanced Yoga classes today.)

We live in a world in which we are sitting — at our desks, in front of the television, at our computers — for many hours of the day and night. We sit in slouched postures, with our spines rounded forward, our heads jutting forward (check out your posture right now). The position of the spine in this curved forward “C” position is called flexion. We have four natural spinal curves, at the neck, the thorax, the lumbar and the sacral spines which form a gentle S from the top down. However, with the demands placed on us from early childhood, when we begin to sit at uncomfortable desks, we begin to alter our natural spinal curves. We begin to lose our ability to find a neutral, or comfortable, position. We begin to slouch. We slouch when we’re sitting. We slouch when we’re standing up.

We slouch because we can’t find a comfortable position in which to counter gravity, a constant force pulling on our bodies. When we give into dysfunctional postural habits, then we end up fighting gravity, one of the strongest forces in the Newtonian universe. What happens next is that the anti-gravity/postural muscles in our necks, extending to the entire length of our spines begin to overwork. As they overwork, they fatigue. As they fatigue, they begin to hurt. It’s not that we don’t try to sit up straight, but we end up slouching because we don’t have the strength to maintain an upright position anymore. It becomes a vicious cycle.

These long muscles, the erector-spinae muscles, extend in series from the base of the skull to the sacrum. In a slouched posture, not only do they overwork and become tense, but at the same time they become over-lengthened, weak and painful. They are not able to do their jobs in holding the trunk upright against gravity. Once these muscles become weak and over-lengthened, other muscles in the hips try to compensate. The hip muscles, working to keep the body upright against gravity, depending on their placement and your anatomy, become short, tight, weak and painful.

At the same time, the Core muscles, the deep abdominal and pelvic stabilizing muscles surrounding the hips, become weak and flabby. Breathing is often shallow. With a slouched posture, the ribs are compressed in the anterior body and the diaphragm, the primary muscle in breathing, is placed in a disadvantageous position.

The body may feel tense and tired. Trying to sit or stand erectly becomes more and more difficult. Our bodies are out of balance and out of sync with gravitational pulls. The body ends up fighting gravity rather than working efficiently within the gravitational field.

How do we restore balance to our bodies?

The best way is to go to the mat, to the floor, where the body can rest into gravity, without having to fight it. The flat surface of the floor provides maximum support and feedback to a body out of sync. Once lying on the floor, you can begin to realign yourself, front-to-back, right-to-left, head-to-toe. The four spinal curves are supported. Where the spine is rotated, a common occurrence in people who suffer from back pain, it can begin to unwind.

The body craves balance. Coming into the floor, embracing gravity and relaxing into it, combined with breathing mindfully, is the beginning of healing your back pain.

 

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Mindful Advice for a Painful Shoulder

This was written to a patient after I had seen her for an initial treatment. She had developed a painful shoulder from shoveling snow earlier in the Winter.

You may want to notice your shoulder at different points during the day, or at night, or in the morning when you’re still in bed. Just quietly become aware of extra tension or holding in that shoulder. Then, breathe into it gently a couple of times.

It may relax, or it might not. What’s important is to gently become aware of what’s going on with an accepting mind and then to breathe WITH the tension, discomfort or pain. It isn’t necessary to have a goal to change the feeling, but simply to notice it and to breathe into and with it.

I’m passing this along because when I woke up this morning, I became aware that I was holding my left shoulder, one with a chronic & old injury, in a tense and elevated position. Then, I took a quiet, mindful breath into my shoulder and watched it unwind from the tense holding pattern that had crept into it. Amazingly, it felt much better once I noticed the feeling of tension and holding in the shoulder.

Sometimes we hold our hurt wings with tension, in anticipation of pain. This can set up a pain, holding/spasm, pain cycle just like an injury can. But the tools of awareness and breathing mindfully can help relieve the fear of anticipation to derail the tension/holding/spasm before it gets going.

Try this the next time you wake up with pain: Notice it. Accept it. Breathe with it. Then see what happens and get on with the day.

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Your Lymphatic System

Did you know that your breathing habits may positively affect your lymphatic system?

Let’s begin with a review of the anatomy and functioning of the lymphatic system. Closely related to the cardiovascular system both anatomically and functionally, the lymphatic system is composed of capillaries; larger lymphatic vessels, called collecting vessels; the lymph fluid itself; lymph nodes; and numerous lymphatic ducts.

The journey of the lymphatic fluid looks like this: lymph fluid is picked up from the cells, where it travels via the lymphatic capillaries to the collecting vessels, then up to the lymphatic ducts, where it is filtered and  returned to the bloodstream.

What is this lymph fluid? It is a fluid that is the byproduct of cellular function and respiration. It is extra, or interstitial, fluid containing bacteria, fat and proteins, fluid that remains between the cells which was not picked up by the bloodstream. It is a waste by-product discharged from the cells. This clear and colorless fluid is then transported to the lymph nodes, where it is filtered and cleaned of foreign substances, bacteria, proteins and other large particles. From the nodes, the lymph travels to the ducts, formed by the convergence of lymph vessels. They include the lumbar duct, the common duct that empties into the cisterna chyli, the cisterna chyli, the thoracic duct, the left jugular and subclavian ducts and the right lymphatic duct.*

Lymph, then, travels from the cells to the capillaries, to the nodes, through the ducts, to empty in the large blood vessels located at the base of the neck, where it is emptied back into the bloodstream. However, unlike blood, lymph moves in only one direction through a variety of parallel mechanisms:

  1. hydrostatic pressure;
  2. valves to prevent back flow;
  3. voluntary muscle contractions throughout the body;
  4. respiratory movements that create alternating pressures within the chest cavity (pressures created by the contraction and relaxation of the diaphragm and respiratory muscles);
  5. contractions of the abdominal wall upon forceful exhalation — vigorous exercise, coughing, sneezing — creating a positive pressure in the cisterna chyli that pushes the lymph up towards the large veins in the neck;
  6. pulsations of adjacent blood vessels throughout the circulatory system.*

Three liters of lymph enter the bloodstream every 24 hours. Since muscle contractions aid lymph flow, you can see how important general exercise is to aid turnover in your lymphatic system. Furthermore, the thoracic duct, cysterna chili, the lumbar duct and the common duct are all very near the diaphragm, our primary breathing muscle. The thoracic duct passes through an opening in the diaphragm.

On an anatomical level at the very least, you can see how deep breathing exercises may have a direct and positive impact on lymphatic flow. Deep breathing exercises create greater pressures within the chest and abdominal cavities. Additionally, through the contractions of the diaphragm and abdominal muscles, a positive pressure is created in the trunk to further push the lymph upwards towards their emptying ports in the neck.

Another reason to get moving and to do pranayama — powerful breathing exercises!

 

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*Information taken from Anatomy by Ernerst W. April and Grant’s Atlas of Anatomy. Please note also that the above information is not comprehensive of the entire lymphatic system, which also includes the spleen and lymphocytes.

 

Read more about Sharon Gary, Yoga Physical Therapy and what a typical treatment with Sharon Gary looks like.

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The Body Electric

Dancing is more like high-interface action verbs than nouns and subjects. I’m very interested in the electric threshold; dance can be like live voltage, or crossing realms. Sometimes the body is flooded and energized by an excess of impulses, spasms, jerks, shakes, tremors, and responds with quirks and undulations. -Kenneth King

If a dancing body is capable of these responses, these expressions — spasms, jerks, shakes, tremors — then where do these responses go in everyday life? Where do we put that kinetic energy while we sit quietly in front of the computer or clutching our cell phones, thumbing our blackberries and iphones? Do we even breathe when engaged in these activities, never mind allow our body its natural expression?

Part of our successful socialization, or the price of success if you will, is based on the ability to suppress physical, visible, reactions. We freeze our faces (Botox anyone?). We freeze the muscles in our bodies. We do this whether we are excited, disappointed, angry or overwhelmed. But remember, the brain and its extension, the body, are coded for action/re-action. If we can’t flinch, quiver, cry or grimace, what happens to those impulses? Do we take these neural stimuli into hiding? Might it be these inhibited impulses that unexpressed hide out in the neck (spasm), eye (twitch), head (pound), back (grab), stomach (gurgle), intestines (run)?

Instead of releasing, do we repress? Maybe it’s the crazy person, the schizophrenic off his meds on the subway platform who might still embody his own natural reactions, reactions that haven’t been re-pressed. Scary, isn’t it? Or think of the disorder of Tourette’s syndrome, where the nervous system is operating without the appropriate neural brakes or neural inhibitions. (For it is the inhibitory part of the nervous system that allows it to operate smoothly by applying braking mechanisms that allow for smooth, controlled movements.)

Paradoxically, one of the beauties of meditation is that it allows us to sit quietly and to be with our own mental and emotional processes. It is why it can be so uncomfortable to meditate. All of the sudden, we give permission, time and space to those thoughts and feelings, the same ones that we try, with decreasing effectiveness, to control, to keep down, to run away from. We give these very thoughts and feeling permission to bubble up, as if from the primordial soup, and they want to be heard. In meditation, we can study this live voltage, this energy that gets trapped in our bodies. We do this by sitting quietly, tuning into the repetitive cycles of the breath.

One appeal of yoga is that we invite ourselves to slow down and to feel the body. We are invited to extend the head on the neck, the neck on the spine, the fingers, hands and wrists, torso, toes and limbs out of habitually tight ranges. By doing this, we give ample time and space for the muscles, thoughts and emotions to unwind. Is it any wonder that we feel calmer, with fewer aches and pains after giving the bodymind its say?

Think. What posture is most typical of Western life? Sitting. We sit in front of the computer, the TV, at our desks, in our cars, on the airplane. We are a nation of sitters!

Many, if not most, of our aches and pains, our illnesses (including diabetes and heart disease) are caused not by overuse of ourselves, our bodies, but by under use. We move too little in quantity and variety. So, let’s get up and move, dance to get the electric body moving, and we will all feel better and be healthier for it.

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Get Up and Move

Your Brain and Well-Being May Depend on It

The brain is the CEO of the body, the chief organ, the director. It initiates and sends the signals that allow us to accomplish tasks. Making and drinking that cup of espresso. Reaching out to reassure a loved one through a gentle touch. The brain also governs organ function. It monitors and creates neurotransmitters and hormones, complex and dynamic interactions in the body we still know very little about.

Besides sending signals for movement, action, reaction and creating homeostasis within your body, your brain receives and interprets information coming to you from the environment outside you, as well as the environment inside — your body, mind and emotions. Are you hot/cold? Is it light/dark? Are you afraid or calm? Are you sleepy or rested? Happy or sad? Is it safe out there? What does it feel like in here?

We tend to think of the emotions as originating in the brain, in our minds. Buddhists and many psychologists believe that emotions are caused by our thoughts. Become aware of the faulty thought, identify it as such, and the painful emotion will change, switch or even disappear. Becoming aware of the emotion may mean learning to feel where the tension of that emotion is felt in your body. Continue reading “Get Up and Move”

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How Yoga Physical Therapy Works With Pain

Day 2. I started this blog because I want to get the word out about NY Yoga Physical Therapy. Sometimes I come home after working with a patient who has chronic pain with a great idea that we discovered during our session, and I want to share it. So this is a way to get me started writing about the work, to explain what it is that we do in Yoga Physical Therapy.

First and foremost, I look at the body with the eyes of a Physical Therapist. The training was the best I could find for understanding the components of the human body and how it moves in space. From my background in dance and yoga, I became a Physical Therapist because I was hungry to know about muscles, joints, the nervous system, and how it all fits together. Then, by studying the pathology of injury and disease, I learned what happens when something goes wrong. My job as a Physical Therapist is to find a way to help the injured body in pain recover. These 20 plus years of working with injuries and disease have only increased my understanding and intuitive approach.

Yet as great as the Physical Therapy training was, it didn’t give me a way to deal with the whole person. Often I would find people were tense, upset and holding tension in their bodies, especially those with low back pain, upper back pain, neck pain and those with frozen and painful shoulders. (I also see people holding tension in their feet, knees and hips.) At first, I didn’t know what to do with this growing observation. I wasn’t trained in how to deal with stress and the psychological components of pain, disease and injury.

Once I consciously started practicing holistically, incorporating Yoga, mindful breath work and other holistic practices into the sessions, I began to be able to help people help themselves with the effects of stress held in their bodies – physically, emotionally and psychologically. The introduction of the breath, not only into the exercises, but as a separate activity in itself, began to transform the effectiveness of the therapy sessions, especially in those with chronic neck pain, upper back pain, middle back pain and low back pain.

By helping you learn how to breathe into area injury and pain, you become aware of your own experience of feelings, holding, tension and tightness in that area of the body. On a physical level, getting breath into a tight or tense area literally begins to open up the area. As the muscles relax, they loosen their hold on the bones. The affected bone(s), pulled out of line by an overactive muscle, can begin to relax back into place. When the muscle, then the bone(s), release back into a relaxed state, then the affected joint can begin to realign itself. Yes, you can learn to breathe into targeted areas of the body. As the body relaxes, or disinhibits from tension and pain, then the breath can freely move the trunk.

Secondly, blood does not flow freely through tense muscles. So another result of using a mindful breath is that it helps muscles to relax. Relaxed muscles allow blood to freely circulate through these affected muscles. With more blood flow, more oxygen gets into the area. More oxygen equals more healing. The molecules and chemicals for healing can now get to get to the injured, painful area. Not only that, but the byproducts and waste molecules from cellular respiration – or cleaning up the debris from the injury –  is now able to move out of the area more quickly. This aids in decreased swelling, inflammation and therefore improved healing.

On the psychological level, mindful, meditative breathing is documented to lessen the effects of stress, including lowering blood pressure and decreasing heart rate. It lessens the effects of cortisol, the stress hormone of the fight-or-flight reaction. As a person becomes more aware of  bodily tension and learns to breathe into it, often the emotions or thinking that contributes to that tension begin to loosen their hold as well. As the mind begins to relax, so too does the body. Once the body begins to relax, so do the mind and emotions. It’s a dynamic, interactive process.

I’ve had patients thank me for helping them to identify and learn to work with the stress that is contributing to their pain and injury. Once they developed an awareness that they were holding tension in their backs, necks, feet or hips, they were able to begin working with, and begin lessening, that tension. Their pain started to go down, too.

For one patient with chronic back pain and neck pain, a sudden awareness and acceptance of how he held tension in these areas was the turning point in his treatment. He said, “I thought about what you said last week about accepting the discomfort. And over the weekend, I got it. It was weird, but my experience of the pain changed.” He stopped therapy shortly after.

Awareness is key. So is acceptance. With aware breathing into an injury, combined with specifically targeted positioning or stretching of the body, the healing process is powerfully supported. Using a gentle and mindful breath also gives us an effective tool to support the entire healing process, body and mind. Paradoxically, acceptance of pain can reduce the anxiety and fear surrounding it, which then contributes to the relaxation of the tension that we hold because these feelings.

Sharon Gary of Yoga Physical Therapy in mid-town Manhattan can help you with this holistic, integrative approach to healing.