address change!

If you’re a learner like me, you like to understand the end before you can fully grock the whole process. In other words, the question “where is all this going? what’s next?” is just as important at the beginning as at the end.

As its worst, I think, this kind of questioning is a way of avoiding, of mentally needing every duck in a row before committing to something (and there are always ducks not in their rows, yeah?). As its best, though, it’s an appreciation of the whole, of beginnings and endings mirroring each other, and existing co-dependently.

That’s my long introduction for what’s below: a one-page letter I just wrote to give to my first, and subsequent, graduates of a KMI Structural Integration series. So even though it’s not a letter to you per se, if you haven’t gone through a full SI series, it’s for you if…

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The Anatomy of Self-Healing (pt i : the knee)

I’d like to share a wondrous, and quite beautiful I think, example of our bodies’ abilities to self-heal.* Maybe this’ll provide a little inspiration for a post-dinner walk, too (I know it did for me).

Let’s start with a little anatomy review. (If you’re all savvy on this, see you at the next paragraph that starts with a few stars *****): our physiology demands of our knees both stability and mobility. The knee, the tibio-femoral joint (the meeting of the femur of the thigh and the tibia which, along with fibula, are the bones of the lower leg), is known as a modified hinge. This means that it’s primarily a back and forth hinge (standing and sitting, jumping, anything linear), but also must have a little rotational ability (think the ability to turn your body while your foot is planted, like a quick turnaround while playing soccer; this rotation isn’t completely carried out through the knee, but certainly enough where it’s got to be able to turn a bit).

To accomplish this, we see a really stunning arrangement, both in its thoroughness of territory covered and in its elegant relative simplicity. On the outside “shell” of the joint we have the dense ligaments LCL and MCL (you may’ve heard of the MCL before, usually relating to some accident). This shell keeps the knee not only from dislocating if someone tugs on your leg, but also from approximating (read: grinding) the femur and tibia.

Inside this shell live the cartilaginous discs, the menisci, that further aid in this easeful glide of movement of the knee. Also, an “X” inside the joint capsule is comprised of two more ligaments, the PCL and ACL (the latter of which most people have heard, usually in a story that makes wince anyone who’s even mildly tweaked a knee).

Also, bathing all of this connective tissue is the synovial fluid, which serves to lubricate and nourish the poorly-vascularized articular surfaces and connective tissue. The kicker is: if there was fluid everywhere, ballooning against every surface inside the knee, we’d have no mobility. Thus, there’s less fluid than space available. This is a key we’ll be back to shortly.

For now, we’re going to stay zoomed inside the joint capsule, where things are going to get even more interesting as we introduce motion …

*****Okay, we’re back! All this connective tissue needs to be very dense by design and thus lacks much notable blood supply. We don’t really think about this with an un-injured knee. We’ll probably think about it a lot if we wind up with a torn meniscus, as it’s blood supply that’s going to be your primary healing agent (side note: this is part of the philosophy behind an anti-inflammatory like ibuprofen: less inflammation = more blood flow possible).

So we have this very dense, and in many ways quite vulnerable tissue, essentially buried inside a joint capsule with little or no blood supply to heal it.

So, what’s a knee to do? Or, thinking evolutionarily, how can our form and function work most harmoniously?

Dig this: the synovial capsule extends under the patella (the kneecap) and travels back between the little nobs on the ends of the femur to the back of the knee. And so … when you take a step, the knee straightens as the quadriceps tighten, which pushes the patella against the fluid underneath, which squeeeeeezes all the fluid toward the back of the knee, and past and into all the connective tissue;.

In the next phase of your step, the push off, the musculature in your calf contracts, which squeezes the fluid back, again past all of these otherwise-never-touched cartilages. This continues all the way through the joint capsule until, again, the fluid rests behind your patella, awaiting your next step and flush of restorative fluids through the knee.

What’s cool to note, too, is that this most efficiently happens while walking, more so than running or biking or rollerblading or whatever …  We’ve had a long, long time to make this most basic of exercises work for us, and us for it.

Walking! Awesome. I’d say your knees with thank you if they weren’t a part of you :)

*This article largely informed by Tom Myers’ article “Body^3: the knee and thigh” in Massage Magazine, Nov/Dec 1997. Also available as part of the textbook Body^3: A Therapist’s Anatomy Reader

Seeing Before Naming

Last week I was in Germany visiting a dear friend. On one of my days exploring Hamburg, I happened upon (and I love happening upon) a greenhouse.

Sprechen Sie Deutsch?

It wasn’t until I started walking through that I caught a glimpse of my near-OCD impulse to always read every sign about every plant and ecosystem, to get all the facts I can about them, to know. I caught this glimpse, I’m pretty sure, because I couldn’t read the signs; I don’t speak German.

So there I was, still in this wondrous greenhouse, words all around but gibberish to me, and the plants …  I felt my guard go down, so to speak, from my brain to the soft-tissue matrices of my myofascia and guts. (a great line to impress at a party!). All that was left for me was to smell, to touch, to sense in my gut what this plant, this community, was all about.

Reminded me of how we tend to relate to the body, too … [did you know I was going there? :) ].

We have a stupefying amount of information available to us about our various systems and organs and WBC counts and vitamin D levels.

And still, it seems, we often have a significant lack of a felt sense, of feeling before we give something a name.

I’m certainly not making a case that textbook knowledge about the body isn’t useful: if I break my leg, I want to the doctor who has a solid intellectual understanding of the arteries, veins, nerves, bones and muscles. (And in the case of plants, I’d sure want to know textbook stuff about the plant community if I were, say, in the wild and needing to eat some [though I’d venture to guess that kind of information is also available on more intuitive, non-intellectual levels, too]).

But on a day to day existence level … it seems pop-literature for both traditional and alternative medicines are full of: read this, understand this, and ultimately, buy this (either my idea or, most often, a product). Much less out there saying: well, this is pretty much all in German anyway, so why don’t you start by taking a deep look inside with all of your senses, see where that takes you …

Types of Pain

“Is this supposed to hurt?”

It’s a question I’m sometimes asked in my bodywork practice (like this one), and find myself asking too in some scenarios. It’s such a huge part of human existence, and yet it seems to me that our education as a society in the realm of pain is pretty lacking. It’s an area that in my experience we could use a little more breadth, and a lot more depth, in our understanding.

Just turn on the TV, right? The quest to rid ourselves of pain is an enormous, multi-gagillion dollar industry. The message is fairly basic and clear: “You’re in pain. Pain sucks. Take this and you won’t be. That’s way better.”

And, of course, yeah it’s better! Anyone among us save the masochists don’t want to endure suffering for its own sake (and even them, I’d venture; truly for its own sake? I doubt it). So it’s certainly not my intent to say we should be taking some sort of high road with this, or like seeking to end our pain doesn’t make sense; it makes about as much basic sense as basic sense gets.

That said, the idea that our pain may be telling us something vital is not a new one. So … what’s it saying?

I think some more words for pain and its many forms would be useful. This expansion of breadth of ground covered, similar to the notion that the native Eskimo have so many more words for what we usually just call “snow.”

I’d like to propose a partial list here. If you have anything to add, please add to the comment section below. Thanks to Tom Myers for his interview with Massage and Bodywork for the inspiration for this inquiry.

– the dull pain of lack of sensation (i.e. numbness)

– the quick pain of a new injury being prodded, like trying to walk on a sprained ankle

– the burning pain of an old injury being uncovered (in the physical body, this might be having deep work done on old scar tissue; in the emotional body, this might be seeing a lover from years past with someone else for the first time)

(quick note: I think it’s the difference between those last two that is one of the most important distinctions we can make as therapists working with clients, equally in our understanding and that our clients get the feeling of ‘oh wow, that pain isn’t coming from this work, but this work is uncovering the pain that was already there, stuck’)

– the pain imposed from the outside, that wasn’t there before (garden variety trauma, like you threw a rock and it hit my leg)

– the scouring pain of loss, of something that was psychologically “mine”

– the kind of sweet pain of coming clean, the fire when we tell the truth after lying to ourselves or others for any period of time

– the immediate and searing pain of torn myofascial tissue, or a broken bone, similar to that imposed from outside only its clearly and entirely contained within your skin

– chronic, lingering, in-the-background pain, like with autoimmune diseases or cancer (this is the only one on this list I haven’t experienced first-hand, so if you can educate me more about this, please do)

That’s it for now. Not quite like the 40 words I’ve heard the Eskimo have, but … it’s a start. I’d love to hear your thoughts!

The Right Question

“My back hurts … what do I do?” Fair question. More on this in a moment. But first …

I’ve been reading a fair amount lately about the topic of asking the right question in a business setting. To illustrate: your company is asking for feedback about the structure of staff meetings. Most of your fellow employees are likely going to give feedback quite pertinent to the structure that’s set up, like “I don’t think Robbin is the best facilitator to lead the marketing review; Larry should do that” or “Five minutes isn’t enough time for a realistic bathroom break for 70 people” or even “I want blueberry muffins.”

Right? Two things.

1) This feedback will likely all be addressed in a satisfactory way. For every question (which is what the feedback is, essentially asking “can we do it this way instead?”), there’s a very legit, real, true response

2) All of those questions, and therefore all of their answers, are completely moot if someone asks another question—”Is having a meeting really the best vehicle for doing what we as a company want to do in this case?”—and the answer is no.

The rug is simply pulled out. I love this! And while it seems pretty clear and Four Hour Work Week-ish in the office—spend your time on business, not just busy-ness—it may be less so when it comes to leveraging our own strengths in our health.

I’m certainly finding this our for myself. How many times did I as a college athlete count how many grams  of protein I’d need for each twenty minutes of plyometric training? How many mg of ibuprofen to combat the inflammation in my knees without giving me an ulcer? How do I release my left hip that’s been seizing up when I’m two hours into a grueling workout?

While all of these questions received legit answers (eight, 600 and a heel lift for my right foot), there were more fundamental things that needed addressing that probably would’ve made these questions moot. In short in this case, I was overtraining, and my form would get so poor at the end of long workouts I was wrenching my knees in my best attempt to just get through. I was also really favoring my right leg.

My questions in some ways were quite obvious to the situation. But there were much more fundamental questions I could’ve been asking, which would’ve pulled the rug out on the other ones.

And so … “My back hurts. What do I do?” If you ask a room full of experts in their given fields, you’re likely to get just as many answers, and all of those answers totally legit, actual, and empirically true. Yes, there’s a molecular thing happening with the actin and myosin; yes, T4 is locked in rotation; yes, your fascia is bound is a particular way; yes, your posture may well reflect your deepest emotions and beliefs about the way the world works …

See how fundamental and out-of-the-box you can get with your question first. It’s the most empowering and true thing for all of us.

Orthotics: Help or Harm?

Interesting article in the NY Times at http://www.nytimes.com/2011/01/18/health/nutrition/18best.html

Orthotics changed my life when I was 14, from a daily routine of pain whenever I stood to no pain whatsoever in my feet. One day, out of high school, I quietly set them in my closet and never looked back …

Mind Asleep, Body Awake

I had an interesting session today in which my client wasn’t actually there. I mean, he was there in that his body was there, but my client as I knew him was checked out, in dream-land. And I was left to have a conversation with his myofascial system.

I’ve never had anyone fall asleep on the table. Either the sensations of the work are so intense, or I’m asking them to engage specific muscle groups, or something … no one’s fallen asleep until today. Today I was left to work entirely with the body—Karl’s body, in this case (not his real name)—devoid of any consciousness of what I usually think of as this entity called “Karl.”

The interesting part, for me, was what a conversation I had with Karl’s tissues, the systems underneath my fingertips, my forearms. In particular, while working his right hip abductors, I found his musculature doing things that I had always been certain were informed by the conscious mind: actions like prolonged guarding and pulling back.

As I sank slowly into a trigger point in Karl’s gluteus medius, I felt a familiar slight recoil of the tissue (meaning “too much!”). I backed off completely for a moment, then began slowly to put slight pressure on the same trigger point, only to have the whole structure pull back and guard again, like you might envision a jellyfish pulsing in the ocean under a false attack.

I had always been sure that this stuff was conscious mind stuff, like “okay, it’s too much because he’s anticipating my next move, thinking about how he’d better guard that area” … but Karl, indeed, was snoring away quite loudly throughout this whole “conversation” I was having with his hip. He was gone.

The body seems to have a personality of its own, wisdom aside.

Anyone else who’s had this experience, please comment or shoot me an email. I’d love to hear it, as this is all new stuff for me.

Anatomy Pop Quiz!

Get out a pen to jot down your answer. Got one? Great. Now please, stand up, arms relaxed at your sides. From here, lift your arm straight out to the front, palm down, up 90 degrees (that’s straight out from your shoulder).

The pop quiz question: what was the first muscle to engage in that movement? (You don’t need to know technical anatomical language for your answer to count, as in, you could say “the front of the neck.”)

Probably some muscle in the shoulder, right? Like the anterior deltoid. (That was my guess when I took this quiz.) Or, if you were being super savvy and had a sense of where this was headed, maybe you answered some part of your core, like the deep transversus abdominis.

The answer: the soleus, one of the deep muscles in your calf that connects to your Achilles tendon.

The reason: to begin the process of lifting your arm out front, and thus moving your center of weight more forward, your unimaginably intelligent body begins with an ever-so-slight movement of plantar flexion, or the ball of your foot pressing into the earth (or, if you’re driving a car, on the gas pedal).

(Another visual that might help if you’re still feeling confused: recognize that the plantar flexion, if left unchecked, would push everything above your feet backwards. And that’s where your arm moving forward comes in as a sort of balance, so only your arm actually moves.)

Can you feel it happening? (I can’t, but kudos if you can!)

Amazing, no? Now, pass your papers to the front of the class …

Is Ida Rolf’s 10-series too formulaic?

A great question that I’ve wondered many times, answered is his latest blog post by Tom Myers here : http://www.anatomytrains.com/blogs/tom-myers

(As a quick refresher: Ida Rolf’s 10-series is the foundation, if not the protocol, of the school of bodywork called structural integration. SI works with the body’s 3D shape through the fascial network—the all-pervasive connective tissue covering literally everything in the body.)

Google’s “Body Browser”

Oh, man … this is pretty cool. http://googlesystem.blogspot.com/2010/12/google-body-browser.html

The link brings you to an explanation of how to get Google’s pre-beta (read: pre even the official mass-testing) version of an interactive map of the human body.

I’ve just started to tool around, and really dig it. You can search—i.e. “femur” or “medial collateral ligament” or “small intestine”—and view what you find in relation to other layers of the body. In 3D to boot!

For all of us bodyworkers out there, I bet this’ll be an awesome tool for client education.

Enjoy!