It has been a while since I’ve written anything here. I have to say, I’ve really enjoyed not sitting in front of my computer, and I think this is something I’m going to be doing more often. Maybe you’d like to try it, too?
In fact I’ve been up to some fun things in the real world, like trying out circusy stuff at the Collingwood Circus Club and sharing some movement/strength goodies with them, and learning how to sing.
In this pic I am doing what is supposed to be “swan”. My left splits leave much to be desired…
Much as I like the “real world”, I don’t want to let my unwritten words fester in my brain where they might start to rot and stink (Yes, I used deodorant today. Yes, I’ve showered…. I just haven written for a few weeks).
Let’s get down to it. (Fair warning, this post is long)
SEVERAL CONSTRUCTIVE USES FOR PAIN
They say “no pain no gain”, and “rest is for the weak”. However, this can potentially lead one to Broscience based evidence.
I prefer, “exploit pain for personal gain”. As is the topic of today: Living completely free from pain may be unrealistic, but we can meet it with our understanding and find that it can enrich our lives in many ways.
Writing this blog post brings me back to first year university anatomy class with one of my favourite professors of all time, Sam Booker.
It was in this class that the idea “pain is information” was first introduced to me. To paraphrase Sam’s words, “Pain is a sign from your body that you need to listen up and stop doing something because it feels bad”. Or something along those lines.
At the time, this blew my head off. You mean, pain isn’t just the annoying feeling of something hurting? Pain is trying to tell me something useful?? NO WAY!
And then, as per 19-year-old-Monika’s style, I memorized this fact for a test (aced it), neglected to further consider its practical application, and, for the next 4 years of my dance degree, I endured, ignored, and disregarded that my near-daily pain could be information worth tuning in to.
A few years ago I came across the work of Lorimer Moseley, the pain research guy from Australia, and read his and David Butler’s book Explain Pain. Explain Pain, again, describes pain as information about something our system is experiencing that could be potentially dangerous. Not that it is absolutely dangerous, but that we perceive it could be.
Our body uses pain to try to keep us from getting into too much trouble. Like the smoke detector that goes off just in case that smoke from the bacon you accidentally overcooked is actually a life-threatening fire (the actual story of my morning). Thank goodness the smoke detector is that sensitive, just in case.
Pain is a construct of our brains. Not to say that it isn’t real, or that it is imaginary. Our experience of pain is very real! But it’s not our finger that feels pain when we slice it open chopping onions- it is our brain that interprets the information from receptors in our finger as “danger” and produces a sensation that we call “pain” to let us know that “that was dumb, don’t do that if you want to keep living with all your blood”.
That’s great, Monika… But pain hurts
It’s all great to say: “Pain is just information. It’s in your head”. Ok… So how does that actually help us? How do we decode this information and use it to our advantage when we are injured, hurting, or sore?
(As you read on, keep in mind that if you are currently in a state of pain severe enough as to affect the quality of your life, get some help from someone you trust. I’m not a medical professional and I can’t help you through the magic of the internet.)
As my friend Rob Sawyer from aussie-land, recently wrote, living with the expectation of being completely pain free may not even be realistic.
Being pain free is a preference you and I are likely to both have, but it is just that: A preference. And pain, as I have learned, can be an enriching experience that helps us to learn more about ourselves. I used to think I could not be happy until I was completely out of pain. Why wait to be happy until that hypothetical, unrealistic date?
Rob wrote a lovely little piece comparing “pain-free living” with “balanced living”, which I will copy below:
I am surprised at how often the term “Pain Free Life/Lifestyle/Living” is used to lure in people who are experiencing pain in their lives… This terminology sounds extremely attractive… A life free from the experience of pain… But is that realistic?? Can we delete it from our existence? Mmm I think not.. So why is this continuously advertised? To prey on those that are hurting?
Is pain something we should be free of in this lifetime? Or might pain be a valuable experience that can help guide us?
I have met many inspiring people along this journey who have experienced great transformation in there body and lives, and they often had one thing in common… They gave in fighting and trying to be free from their pain, and began to honour it, explore it, listen to it, let it be a guide.
Can we life a Pain free life? A life free of pain?
Or a balanced life? A life enriched with the experience of both pain and pleasure?
Pain, in fact, is quite useful, and over the years and injuries, I have found quite a few uses for pain.
The following are some #protips for exploring pain as information, which may be useful if you wish to diminish its threat-status, live in harmony with your body, and even exploit pain to enhance your quality of life.
Avoid self-pity and subjectivity
A requisite for balanced living with pain is to be able to stay objective and avoid self-pity. These two bits are crucial going forward with any kind of treatment or therapy. Feeling sorry for yourself doesn’t make using pain as information possible- It makes you resent the pain and wish it was gone.
Of course, I don’t wish pain upon anyone, it’s not that you should ever wish you were in pain, but making up stories about your pain and wishing it wasn’t there isn’t going to help get to the truth either.
Stories I’ve heard:
“I’m broken, and I no one has been able to help me”. Can you absolutely know that this is true? Have you worked with everyone? Or have you tried three therapists and given up hope already? Or, have you tried actually doing the work they asked of you?
“I’m just getting old.” Well, what about all those young people in chronic pain? What about all the 90-year-olds that live healthy, happy, active lives able to manage pain effectively and live with minor discomfort? Pain doesn’t discriminate by age.
“It’s because of my posture that I inherited from my Dad, he had the same issues as I’m having now”. Pain is not a genetic inheritance, and posture doesn’t necessarily correlate to pain.
Drop the stories and drop the self-pity.
Be open to feeling your pain
It might seem redundant to say, but, for us to exploit pain as useful information we must be open to actually feeling it in order to explore what it means, not wish it was gone or try to dissociate from it, or numb it with painkillers.
“But I shouldn’t be in pain!” (there’s that self pity I warned you about). Well you are. That’s the reality of it. Love that it is there, because it is, and you’re about to learn some useful things from it.
This sounds a bit cruel, but you can only hide from your own body for so long. I remember needing to take pain killers to get on stage and perform, and I remember getting prescription pain meds instead of getting help from a therapist. Pills are just easier, and ignoring pain is much easier than facing it. For a while…
Dig deep for more descriptive words
It is useful to make pain less “painy” by describing it in as many neutral terms as possible, which I encourage you to try right now if you have something going on in your body.
I have one client in particular who, despite her impressive vocabulary (seriously, she knows ALL the words and corrects me frequently), and my insistence to find different words for her experience, consistently comes back to, “It sucks”, “It hurts”, “It feels shitty”.
Sucks how? What kind of hurt? What’s shitty about it? We need more information if we’re going to do anything with what you’re experiencing. In fact, she uses “it sucks” to describe a lot of exercises that don’t hurt in the “pain” way, but that are just hard to do.
If you currently have something that hurts, what three words would you use to describe the pain sensations? Burny? Grabby? Pointy? Weak? Grindy? Stuck? Dull? Sharp? See what happens as you get clarity on this. Just try not to use the words “tight” or “painful”.
Click here to use a thesaurus, if you’re struggling.
Remember, exploiting pain doesn’t necessarily mean “making it go away”, it means meeting it with your understanding, lessening the threat, and reducing the negative sentiments attached to it so that it can be used as a learning experience.
Pain as an object of meditation
You don’t need a meditation app if you have pain to work with!
The challenge with pain is that we are generally biased to judge it as a negative experience (there are however some individuals who genuinely enjoy pain. I’m not talking about those people). Then again, maybe that’s just my naivete speaking, having never broken a bone, never been stabbed, never fallen from a 10 story building, and never woken up mid-surgery to find the anesthetic had worn off prematurely.
I’ve never felt I was in life-threatening pain, so, easy for me to talk.
Regardless, we can use “pain as neutral information” for a fascinating meditation.
Similar to noticing a tree over to the left, or a pile of dog poop on the sidewalk, we can notice pain. We can tell a story about the tree or the dog crap, or we can just notice they are there.
We might see a tree and think, “Oh look, my favourite tree! This tree is beautiful. This is the same tree I had a wonderful picnic with my grandmother under just before she passed away. I love this tree and I will take my children here one day, too”. The tree brings back happy memories and so we become happily attached to it. No harm done here. But we can also look at it and see it for just what it is: A tree. No stories or sentiments attached.
As I mentioned earlier, we will also often tell stories about our pain, and sometimes these stories keep us stuck. The key difference: It is not so pleasant to become attached to pain as it is to a tree.
Using pain as an object of meditation is to observe it without the story, without the judgement of “bad”, and feel it for what it is.
I would argue that it is an equally valuable experience to be able to look at a tree and see it for what it is, not for the story of the picnic with a cherished relative and the fond memories it brings, but for just being a tree. Since the tree is not a bodily experience, this might be an easier place to start than the pain meditation.
For example, in my meditation practice, currently, I am working on observing myself observing: Noticing the thoughts (words and images) that come in, saying goodbye to them without letting my mind get too carried by with them, and noticing the space between the thoughts. My awareness becomes the object of my observation. There are many ways to meditate, but this is what I am working on now.
If I reach the 15 minute mark, I often start to notice some discomfort in my upper back and knees, and my foot falling asleep. At this point, it is easy to become frustrated with these sensations and wish they were gone because they are distracting me and I find it difficult to ignore them and I just want to get back to meditating! But then I realize that what is distracting me is not the pain itself, the pain is just there, like the tree, but it is my story and thoughts about the pain that are distracting me.
So I bring my awareness to the area of discomfort as I would to the tree. And I just try to “see” it as part of the landscape, along with all the other things in my awareness.
In “mindfulness” meditation, this is essentially what we are doing: Taking in everything with all our senses, and just observing it as it is. The pain is there, no doubt. But if I didn’t attach the “this is annoying, I wish this was gone” story, what would it feel like?
Interestingly, as soon as I shift my focus as such, the pain and discomfort start to drop off, becoming a dull hum, not so sharp and omnipresent. The painy feelings cease to be as bad and distracting, and I can simply notice that they are there. And then, the pain may even disappear, which blows my mind.
Sometimes the act of observing changes the observed without us having to try to change anything.
Using pain in this way has made for very, very interesting sessions, and makes pain an excellent teacher for being in the moment, focusing on what is real, and practicing non-judgement.
INJURY AS INSPIRATION
I will finish this long post up with the quick story of how I used some recent wrist pain to enhance my pistol squats.
Last summer I started rock climbing (bouldering) and it was going pretty well (If you define embarrassing myself a bunch while trying to overcome my fear of heights as “great”…) but recently my wrist has been bugging me, and I’ve had to take a little break from it.
Years ago, I would have ignored an injury and kept performing through it. Monika 2.0 doesn’t do that shit anymore.
In fact, with my extra available time not spent climbing I wondered, “What if I used the passion and time I dedicated to climbing and redistributed it into the recovery process?”.
So that’s what I decided to do, and some pretty interesting stuff has come out of it, and, through the process of body-detectivery, this minor setback has been teaching me a lot about my body, stuff I may not of otherwise discovered.
To borrow the words of Gary Ward, I “interviewed my body”. Even if I do rest from climbing until my wrist feels better, I would also be best served to learn where this issue was coming from. Bodies don’t just start hurting randomly, for no reason. There is probably some good information to dig into here.
I will now skip all the dry technical stuff (but I wrote a few more pages on it, if you’re interested…). To sum it up, the interview process went as such:
- How does my body hold itself statically?
- Where is the perceived “center” around which my body is currently organizing itself?
- What movements am I not accessing?
What I discovered in the process was a lack of ribcage/pelvis opposition in rotation, so I followed that trail. This incongruence in rotation turned out to be a missing piece of my left leg pistol squat puzzle.
My left side pistol squat used to be extremely wobbly, and even kind of painful (I mean tight, I MEAN…) for my hamstring (old injury). As it happens, on my left leg, my pelvis and ribcage were rotating the same direction (both to the left, instead of pelvis left, ribs right). In gait, and in most exercises, the pelvis and ribcage should rotate in opposite directions, not the same. I just hadn’t noticed this until I took the time to interview my body.
View from the top down: Skull and pelvis both rotating to the left (L), while ribcage opposes and rotates to the right (R)
Now, with the awareness of my lacking oppositional rotation, I can go just as low into the pistol squat as on my right side (which is still pretty pitiful) with no discomfort, and all I have to do is reach forwards a bit further with my left hand.
And I’ve been blaming my “short achilles tendons” all these years… It was just a rotational pattern I didn’t know I wasn’t doing.
Pretty cool to be able to trace some wrist discomfort to an old hamstring injury, and use the info to revamp my pistol squats.
What’s really interesting to me is that paying all this extra attention to my body over the past week, it feels amazing, in fact, never so good. However, my wrist still feels the same. Not worse, the same. Pain is still there, but I feel enriched by the experience of exploring it.
Patience is truly a most important virtue, as this process has been teaching me.
Nope. I’m all worded out. Gather your own conclusions. You can do it! I believe in you!
And seeing as we’re getting towards the 3000 word mark, I think this is a nice place to wrap up.
What do you think? What’s your experience? Hate or love what I have to say? Leave your kind words and/or abuse in the comments section below.
Read THIS BLOG POST if you want a bit more background on what Anatomy in Motion is, and my experience with the course the first time around.
Yep, I did it again.
I got #shiftphased for a second time. In other words, I spent last week studying the human body in motion with Gary Ward and Chris Sritharan of Anatomy in Motion at the beautiful Integrated Exercise Therapy facility in Bridgehampton New York.
Although this is actually suspension phase…
Why did I do it again?
Some things in life are so good you have to repeat them. In fact, I plan on taking it again.
AiM is not a model for fixing people’s pain or movement. Through the Flow Motion Model we are not learning how to heal people, but how to help facilitate their own process of “letting go”; providing the body experiences to reclaim what it is currently missing- What it can’t do or won’t do, and trusting that it will be able to heal itself if given the option.
Inevitably, by immersing ourselves in a process of exploring new ways to interact with ourselves and others, our class let go of a lot of shit in New York last week.
People’s bodies changed as they experienced movements their systems were being denied. Other’s made decisions to completely change the way they practice with clients. It was an honour to witness these transformations.
I observed as one class-mate experienced his frontal plane for the first time in who knows how long.
I saw my friend fully extend her knees post double ACL surgeries for the first time in 15 years, and effortlessly bend down to touch her toes, something she hadn’t been able to do since before her injuries.
And I saw another class-mate left speechless, with a huge grin on his face, as he reclaimed sagittal plane spinal motion.
In six days, bodies changed, paradigms shifted, life paths altered. These are things I can’t describe with words. But I’ll try.
What is Anatomy in Motion?
To get a full appreciation of the philosophy AiM is built upon, I’d recommend reading Gary’s book, What the Foot.
Here’s my “Spark Notes” version, for what it’s worth:
AiM is a model for looking at human motion as it occurs in the gait cycle (the Flow Motion Model).
Gait is walking, and walking is hopefully what you spend most of your time as a human being doing. Or not doing…
Which each full cycle through your right and left side in gait, each joint in your body has the opportunity to perform all of it’s potential movement in three dimensions, which takes between just 0.6 to 0.8 seconds. Doesn’t that blow your mind a little? That you can take two steps and every one of your joints will have moved in all planes of motion that it possess.
What does this mean for you? That one second is a precious bit of time. Just one rep can be an opportunity to heal, or not.
Less than a second can be used to experience optimal movement variance- Tappable potential. With each step you can heal, or you can feed a repetitive pattern that could lead to sub-optimal system adaptability and a skewed ratio of the two “p” words we love: Pain and performance.
Optimal joint motion through the human gait cycle lets you “walk it off”, and walk things in.
Sub-optimal movement, missing movement, and even missing entire planes of movement, makes performing well challenging, and pain common.
This is the beauty of AiM: It teaches us how to heal through the simplicity of the most fundamental thing we do as humans beings. Walking!
I’d like to use today’s blog post to share some takeaways from my second time through AiM’s six day “finding center” immersion course- The course that makes me feel OK about not having a formal education in biomechanics stuff, because it only means is I have less noise to unlearn (a serious challenge for many clinicians learning this material).
No headaches this time!
I don’t generally get headaches, but when I do it’s because I’ve been thinking too much. The night I launched Dance Stronger in September 2015, for example, I had a massive headache.
Last November when i took the course in Toronto for the first time I developed a headache by the end of day 2 which persisted throughout the 4 subsequent days.
A note to future attendees: It helps very much to start the course being able to name the bones of the foot. Other bones in the body, too, but the foot in particular was my sticking point, a body part we don’t spend enough time learning about in school.
As a fine-arts major with minimal formal education in anatomy, bio-mechanics, or anything “sciency”, anything related to fitness, training, (read anything I’m currently doing with my life), I am not ashamed to say that I have major gaps in my knowledge base. I often find myself in situations where I am the underdog, the least intelligent person in the room, and with no choice but to rise to the challenge (hopefully…).
A note for the dancers: For dancers transitioning into new careers, your lack of formal education need not stop you from diving into something new. Skills and character traits you acquire as a dancer are absolutely transferable to any career path in huge ways.
My first time through AiM I didn’t know what the talus bone was. To be honest, I didn’t know what any of the foot bones were.
This meant I was simultaneously learning the 26 moving bones, 2 non-moving bones, and 33 joints interactions of the foot, while being asked to appreciate the 3 dimensional movement potential of the rear foot, forefoot, and toes through each phase of the gait cycle as it relates to the rest of the body.
“What does the rear foot do in relation to the pelvis in the frontal plane during the shock absorption phase of gait?” Wait… What’s the rear-foot? What’s the frontal plane??
Enter headache city. Somehow I made it out alive, and even wanting more.
But enough about my educational short-comings.
While the AiM course material is badass and can help people change the way they move and feel in insanely short periods of time, the number one reason to take this course is simply to learn from Gary and Chris in person- Two of the most patient, generous, intelligent, and honest individuals I’ve met. Being in the same room as them guarantees you level up in one way or another through osmosis (unless you’re a podiatrist… Just kidding. Mostly).
I want to share some of the most beautiful, wise, and hilarious things that Gary and Chris conveyed, and while these were communicated in the context of teaching a room of clinicians, trainers, and bodyworkers, they apply to anyone who takes a vested interest in how to optimize the way their bodies (and lives) perform.
ON MOVEMENT AND BEHAVIOUR
AiM doesn’t just teach anatomy, it teaches a metaphor applicable on every level of our lives. We can’t look at how someone moves or holds themselves without wondering what behaviours brought them into being. Any trouble that appears in our body will also show itself at some other level in our lives. The same laws of motion we apply to anatomy and biomechanics also can apply to our relationships, experiences, and interactions in nearly every domain.
The big (complicated) questions: Why do things hurt? Why do we adapt a particular posture or way of moving, even if it is less desirous long term? Why do we adopt “dysfunctional” patterns?
The big (simple) answer: Because they are serving us.
Pain serves simply as information we can use to help us change and create new opportunities. Inefficient movement presents in our bodies as a result of us bravely coping with an internal or external stressor, sometimes expressed as pain. This is a beautiful way of thinking!
May we be grateful for the signals and strategies our bodies lend us that allow us to cope and keep on keeping-on despite our duress. But may we also be wise enough to notice them and adjust accordingly.
To paraphrase and blend the verbiage of Gary and Chris:
Why do people move or hold themselves the way they do? Because it serves them! It’s not something to get down about. They are using their most “balanced”, available point.
Other good stuff they said:
“We can’t change the way you move until we can change the value you get from it” ~GW (as mentioned above, we do things with our bodies because they serve us, but that doesn’t mean this is the most efficient way of doing things in the long term. We need a “pattern interrupt” and a superior reward from a new, more sustainable habit)
“You ground your own bones, you striated your own muscles” ~CS (on taking self-ownership and acknowledging our formative behaviours)
“Are you working with it or working on it? If you’re working on it, the CNS will whoop your ass every time”. ~CS (on meeting your body where it’s at, choosing new words for your experience, and practicing non-attachment)
“We can move anything without moving IT, by moving everything else” ~GW (on the illusory strategies we use to keep us in motion. For example, to keep my head level on the horizon, I don’t need to move it, but everything else in my body can move around it to create the illusion of neck movement)
ON THE SUBJECTIVE SIDE OF THINGS…
A huge part of the course is appreciating the art of the self-check-in, which we did everyday as a class.
Subjective, yes, but often all that really matters to the people we are trying to help is their subjective experience.
Objective measures can and should change if they are causing trouble, but if our clients and patients don’t feel different in their own bodies, objective results aren’t meaningful enough. In AiM we are taught to appreciate both: The subjective check-in, and the observation and re-testing of “objective” movement (if assessing movement quality can even be objective… I don’t think it can be, not 100%, given the body’s ability to disguise movement and non-movement as each-other).
In checking in, we were encouraged to change the words we used to describe our experiences. “It hurts” and “it feels tight” were not good enough. Why? They don’t tell us anything useful to work with!
Gary gave me further context later:
The word “pain” gives us nothing. No info. No size of area. Duration of time. Good pain. Bad pain. A stretch pain. A compressive pain. The term is insufficient for understanding what’s going on.
From this we can see the importance of digging a bit deeper into our clients’ experience of their own movement quality. Subjective, but hugely important, for them to learn about themselves and also for us to guide them through their process.
Some more good stuff on the insufficiencies of “pain” and “tightness”:
“Pain is an external description of ‘how I am’” ~GW (’nuff said)
“Pain is (a) bullshit (word)” ~GW (on empowering people to find better ways to describe how movements feel. This is not to invalidate someone’s experience of pain, but to understand that pain can be present for many reasons. There are many more useful words that we could use and encourage our clients to use to describe the experience of movement. “it hurts” on it’s own does not give us enough information. Don’t kill me for this, Gary…)
“Tight is bullshit” ~CS (in response to students who only could find the word “tight” to describe movement. It is an insufficient term, like “it hurts”, because “tight” is an ambiguous feeling, not a quality of movement. It’s an easy answer. Find another word, another quality, and you’ll open up new ways of experiencing your body’s truth in a non-limiting way).
Still going strong on my #Simpsonschallenge. I hope at least 3 of you appreciate this…
Gary and Chris are incredible teachers who inspire me to become better at communicating with my own clients.
They are impeccable with their choice of words. They make sure no one is left behind. They meet each group of students where they’re currently at, and so each course is slightly different in delivery. They don’t try to “blow minds” (although it happens anyway) but wish for us to simply understand.
Their teaching style is to create an experience for the class to discover the material in themselves, knowing that you can’t teach people things, they have to learn it for themselves, when they’re ready. This is rare and refreshing.
Here’s what I mean:
“We don’t want to feed you information you haven’t experienced” ~CS (on why it’s important for us to feel the model in our own bodies as part of the learning process. Or, to quote Gary from the September 2015 course in Toronto “Let’s not just BELIEVE shit, that’s why the world’s a f&@!cking mess.”)
“Movement is in spheres. No axis of rotation. But we have to break it down in three planes to teach it”. ~CS (on discussing the limitations of talking about triplanar movement- It’s something to be felt, witnessed, and understood, not just talked about)
“The noise is in the words, not the action” ~GW (following from above, words make things complicated. Wars are waged over choice of words)
For an anatomy course,very little time was dedicated to actually talking about muscle function. In gait, muscles react to joint action (one of Gary’s rules of movement: Joints act, muscles react). Rather than look at muscles and what they “do” concentrically to move our bodies, we looked first at joint actions to appreciate which muscles must decelerate them to allow them to safely occur, and most importantly, we felt it in our own bodies.
For example, if you put your arms overhead and bend backwards, the abdominal muscles should load up eccentrically (lengthen) to slow the movement into spinal extension before your spine bumps into itself, and you should experience stretch across your abs. Compressive pain with backbending can be related to abs not being able to lengthen under load to safely allow this joint action. Flips the core training paradigm upside down to think this way (and I encourage you to do so!).
To paraphrase Gary:
It’s important to know muscles really, really well so that you can stop thinking in terms of what they do, and start looking at how the body moves.
A few other things that was said about muscles:
“Muscles aren’t designed to pronate the foot” ~GW (They are designed to decelerate pronation. Due to the shape of the calcaneous, gravity pronates our feet for us and getting out from pronation becomes the common challenge).
“Muscles are managers” ~GW (on the role muscles play in the moving body as managers of our center of mass. Muscles essentially manage freedom of movement in the joints, allowing joints to approach their end range before safely returning back to a restful center. Restricted or hypermobile joints will influence how it will be managed by the muscles.)
Gary knows his feet. Just don’t call him the “foot guy” or he’ll flip his shit.
“Fashion will always fuck us up” ~GW (on the foot’s function as a mobile adapter in flip flops, high-heels, and even pointe shoes. He is suggesting fashion will always limit us unless we learn to override and counter the imbalance it inflicts upon us. We can, however, organize ourselves better to enjoy fashion, because life is too short not to!)
“Supporting forefoot varus versus encouraging ‘neutral” ~GW (on what orthotics generally are built to do, versus what movement and wedging can do).
“Create an experience inside the foot.” ~GW (on the purpose of foot mobilizations)
Orthorics vs. “floorthotics”: Creative AiM foot wedging strategies with one of my clients
AiM is a course centered around the motion of every joint in the body in every plane of movement as it should ideally happen at each moment in the gait cycle. So yeah, we talked a bit about gait.
Here are the most memorable gait-related quotes:
“Every condition presents in the gait cycle because they are either stuck in it or can’t get into it” ~GW (on “diagnosis” of forefoot varus, scoliosis, and other “syndromes”. Yes, there is a scoliotic moment in gait, and it’s normal!).
“Everyone is stuck in a moment in time” ~GW (same idea as above, you can get stuck in a particular moment of the gait cycle and it can become problematic. I just like how romantic this sounds)
“Assessing gait will not show you what’s wrong, it will show you what’s missing” ~CS (“what’s missing”… Rather than looking for what IS happening- dysfunction, pain, sloppy movement- we need to be seeing what’s not there so we can give them back that experience)
“In gait, muscles never shorten first” ~GW (as per his second big rule of movement: Muscles must lengthen before they contract)
“If you can’t straighten and internally rotate your knee, you’ll have no ability to supinate.” GW (on the knee’s role in creating a rigid lever in the supinating phases of gait, which sadly, many of us never experience. If you can’t internally rotate the knee, you can’t extend it. Full knee internal rotattion, which looks like a femur rotating externally beyond the external rotation of the tibia. If you can’t IR and extend the knee, you can’t create a rigid lever through toe off, extend the hip, load the hip flexors, and go about running and jumping effortlessly, pain and strain-free. Bridgehampton 2016 was deemed the “knee course” because it seemed like everyone in the room had a knee extension/rotation issue).
ON ASSESSING PEOPLE IN MOVEMENT
AiM provides some useful ideas for assessing our clients and patients, but something I respect about their approach is that they don’t tell us exactly how we should do it (which would infuriate other folks who need to be told what to do, rely on protocol, algorithms, and evidence to take action). The most important part of assessing is to be able to see what’s missing from their bodies and extrapolate how providing a safe experience to give it back could create a desirous change in their system.
What is beautiful is that the tools we already have to assess fit nicely with AiM philosophy if we can see what’s missing from a person’s system. AiM shows us a simple and useful movement exploration to take our people through, but I’ve also used NKT and PRI testing to guide and integrate AiM movements (and improve re-test outcome). Every movement is an assessment. You can use a simple half-kneeling drill, look for “what’s missing”, and re-integrated it with an AiM movement.
Unfortunately, if you’re looking to be told exactly how to do something step by step, and become paralyzed without a strict formula, this might not be the course for you. But if you’re creative and like tinkering with options, I think you’ll appreciate the freedom AiM brings you.
Some ideas to ponder:
“It’s not ‘what’s wrong with them?’, it’s ‘how are they managing their mass?’” ~CS (as per Gary’s rule of movement: Everything revolves around center, and their function will be dictated by how they manage their center of mass around their perceived center).
“It’s important to be able to assess things in isolation, but contextualizing it is what we need to do better” ~CS (on looking at structures of the body in relationship with the rest of it. Sure, we need to know what the hips are doing, but to get the complete picture, it needs to be put into context of what the hips are doing relative to the ribcage, skull, scaps, and the rest of it. If someone comes to see you for help with their hips, for example, the hip assessment can’t be focused only on the hips, but the relationship their hips have with the rest of their bodies. This resonated with me in a huge way, as it is something I am currently struggling with).
“If something appears neutral, but nothing else is, the neutral thing could be the problem!” ~GW (all or nothing: Either everything is neutral, or nothing is)
“You can’t be hypermobile everywhere” ~GW (same thought as above: Everything has to balance out. Even congenitally hypermobile folks have non-moving bits that are the glue holding them together despite the illusion of them being bendy everywhere)
“A fused joint is a new ‘optimal center'” ~GW (as an answer to a question about how joint fusions affect the gait cycle and their implication for training and rehab. A fused joint isn’t “bad”, it just creates a new perceived center for them to work with. Unfortunately, we label fusions and other limiting conditions as just that: Limitations! A simple change in language- “limiting” to “optimal”, can change the relationship people have with fusions, and both patient and practitioner see how to work with their new center, not on it, fight it, or resent it. Getting comfortable with the ‘new normal’ and managing the inevitable compensations).
“If things don’t go right, go left” ~CS (on what to do if your strategy isn’t working. It always comes down to one of two choices. Sounds easy, doesn’t it?)
The actual view from the coffee shop I’m writing this blog post in 🙂
If asked for one single take-away, I don’t think I could find the words (that’s why this blog post is over 3000 words long).
I feel fortunate to have this blog as a medium to share the AiM philosophy, and am looking forward to seeing what come out as I work to revise and create new chapters for Dance Stronger. AiM was hugely influential in the creation of this resource the first time through, and it will certainly become a larger part of it moving forwards.
(PS Dance Stronger is 100% available by donation, so no excuses not to check it out and see what I’m talking about).
My friend gave me a flower one morning. I kept it on my bicycle, and by the time I’d arrived at my destination, through 20 minutes of heavy Chiang Mai traffic, it was, as expected, more withered, but still beautiful. In Buddhism, flowers are placed on the alter to remind us that all things are impermanent. The freshness, fragrance, and beauty of flowers do not last. They will become withered, scentless and discolored. But this is how nature is. It is a reminder that we should value what we have now and live in the present.The withered flower is beautiful in it’s honesty, its representation of the world we live in.
Pain is like the flower…
This one is personal.
This is for those of you who are nurturing injuries or in a healing process.
For months I had this pain in my left posterior mediastinum. When I took a deep inhalation, expanding the area, I experienced a sharp, tight sensation that would radiate around my scapula.
It was oddly comforting. It reminded me that I had something to work for- To become pain free.
It was guidance. Information. It was pain but I didn’t think of it as “bad”, and I respected it by not pushing its boundaries. Instead I explored its limits and played within them.
Then one day it was gone. And I missed this pain!
It was a point of reference for so long. When I breathed into the area, I FELT something, and I missed that with each inhalation I could feel myself and knew that I was alive.
The pain reassured me that I was expanding posteriorally with my breath, something that I had been working so hard to achieve. And now my reference of it was gone. Was all my hard work gone, too?
Shouldn’t I have been happy? Wasn’t to eliminate pain what I wanted?
But instead, I missed it. I wanted my reference back. I wanted the daily reminder that there was a goal I was working towards: Becoming pain free, which, ironically, felt empty. But now there was no reminder. I got what I wanted… But was it really what I wanted?
Did I want to be pain-free, or did I want to feel that I was alive? Did I want to get rid of something, or did I want reassurance that something important was present in me?
And then, months later, the pain came back! Was I happy to be reunited with the “friend” I had missed? No. I was annoyed. I thought I had dealt with this! I thought I had learned this lesson. I had finally let go and found new points of reference unrelated to pain.
I had to question: So now am I moving backwards and not forwards?
But time only moves forwards.
To experience something similar to what has been in the past is not to regress, but just to feel something different. This was not the same friend as before. I felt less attached. Less reassured by its presence, and more assured that I could, at last, let it go.
And a few days later, the pain was gone, again. Just like that.
A funny relationship to have with pain. To become so attached to it while simultaneously wanting to let go of it. And then when let go, unsure what to do without it. Upon its return, to have a completely different relationship. That is the transient nature of pain- We can never fix it (also a pleasant reminder that we are never broken).
This reminds me of the times rehearsing heavily when it felt foreign not to be sore. How being sore reassured me I was still a dancer because we are told that to be a dancer is to be in pain.
Here’s the fallacy: All those who are dancers may experience pain and soreness, but not all those who are sore and in pain are dancers.
A suggestion: Let us not judge pain, for it can be a great reference and guide. We can explore pain, for it is an incredible source of information. Let us not get too attached to it or make it an integral part of our identity. Remember that we can decide to let go of pain when it is no longer necessary as a reference or a guide. And when it is gone, we do not need to keep looking for it.
Let it go, and carry on living.
Understand that all life is volatile like this. Pain comes and goes. You can gain or lose from volatility. You can gain or lose from pain.
Pain is volatile. There one day, gone the next. What can you gain from volatility? What can you gain from pain?
I’ll start by stating the obvious: Dancers get injured. A lot.
Studies show us that the injury rate in dance is similar to that of collision sports and, while each study presents a different statistic, the injury rate is often somewhere between 60-100%.
Not to mention that you can’t completely rely on studies that include self-reported data, because many dancers don’t report getting injured.
THIS study, outlined in Science Daily says:
injury rate for ballet dancers over an eight-month period was 61 percent. This is comparable to rates found in other studies for athletes in collision sports such as football and wrestling. The average time lost because of a ballet injury was 10.5 days, with the actual time loss ranging from one to 87 days.
In THIS study, the injury incidence in professional Irish dancers was shown to be 76%.
And in THIS study of young ballet dance students, of the 476 students in being observed, 438 injuries were recorded. The injury incidence rate was 0.8 per 1,000 dance hours.
If you dance, you will get hurt.
Am I scaring you? I’m only doing it to make a point. How does hearing these statistics make you feel? Are you inspired now to go out and take care of your joints? Or are you paralyzed, discouraged, and unsure what to do about it?
That’s my point. Scary stats aren’t enough to inspire action. Telling dancers they need strategies to prevent injuries doesn’t count as guidance. One-off injury prevention workshops don’t give long-term support that dancers need.
THIS study done in the UK looked at dancers’ perspectives towards injuries and pain, and one conclusion was:
Dance injury rates do not appear to be decreasing significantly, despite greater awareness and the promotion of the “healthier dancer” in dance training schools, universities and among professionals in the UK.
The way we’re presenting injury prevention to dancers is not effective enough.
There’s enough research supporting cross-training to make it mainstream, yet even the dancers who cross-train get injured.
And fear mongering, kind of like I’m doing now (it’s only to make a point!), isn’t an effective means of getting dancers interested in preventing injuries, it only makes them focus on their fears.
Is it really helpful to focus on pain? To be told that you will get hurt if you don’t do x-y-z? Has being scared into trying to prevent injuries ever really inspired you?
Michael Mullin’s Facebook page is always full of gems like this one below, which I’ve been making a conscious effort more recently to be aware of in my own practice:
Pain science shows us that focusing on pain only draws our attention to it more, making it more pronounced and threatening in our minds. The more we fear pain, the more we try to stiffen ourselves to prevent feeling it, and the more we alter our movement patterns in compensatory ways that can cause even higher risk of injury.
Please watch this TED talk by Lorimer Mosely, author of Explain Pain, which summarizes nicely why things hurt (and read his book, too):
What if we stopped focusing on pain and injuries?
And what if we stopped putting the onus on the dancer to change they way they do things, and instead, change how WE work with dancers.
It’s a mistake to keep telling our students the same things over and over expecting them to change, while we ourselves refuse to adapt to their situation. We don’t study dance science for our own personal gain after-all, it’s to help the dancers. Isn’t it?
Our language needs to change.
What if, instead of naming programs as “injury prevention screens” we called them “performance optimization screens?” They are the exact same program only with a different name.
What if instead of saying “don’t do this or you will become injured!”, we said, “If you try to do things this way instead, you will be creating better patterns of moving that will help you perform better and stronger”.
Subconsciously we react differently to hearing words like pain, injuries, don’t, not, and bad. Over time, constantly hearing these words can start to change the way we feel about ourselves, and limits our potential.
Take the emphasis off the threat. Let dancers focus on their love of dance.
Does inducing fear help reduce pain in the same way that encouraging dancers to experience gratitude does?
Consider that you’re trying to motivate a dance student, or yourself for that matter, to start a cross-training or therapeutic exercise program. How would you word it to them?
Would you a) Attempt to instill a fear of spraining an ankle if you don’t do it, or b) Express how the exercises will make you stronger and better at dancing.
I think it’s obvious.
Changing your language, both to yourself and to others, is a challenge. It requires that you are completely aware of every word coming out of your mouth. This seems unrealistic but it is possible, and this subtle switch can make a massive difference, and is 100% worth the effort, with zero cost.
I have made this switch myself, and it drove me crazy when I realized how my words could be sending the wrong subconscious message to my clients, and to myself, despite my best intentions.
They say you become what you focus on. I know this to be true.
When I was recovering from an eating disorder, the hardest part was trying to teach myself how to eat again in “normal” portion sizes, without becoming completely obsessive about it. I’m sure if you’ve been through one yourself you can relate to the challenges of acclimating back to being a regular person who eats regularly.
Food was on my mind constantly. When would I eat next? How much would I eat? What would I eat? How many calories? How many carbs? How much protein? Did I deserve to eat that many carbs? Should I go exercise before or after eating? Is that too many calories or not enough? And then how many hours should I wait until I eat my next meal? What should I have for my next meal? Should I just skip eating today altogether??
When I reflect back on the hours wasted and the mental energy spent every day just thinking about food, it’s no wonder I was always exhausted and injured.
It wasn’t until I finally decided to stop thinking about food that I was able to eat like a “regular” person again. Canada is not a third world country. There is ample food here. I had no need to worry for hours each day about where my next meal would come from.
When it comes to injuries, constantly obsessing about them and their prevention is counterproductive in a similar way that my food planning obsession was. It’s a waste of mental energy that can be used more productively.
Don’t get me wrong, we need people to think about injury prevention, but it’s not the dancers who should be worried. It’s us- The scientists, the physiotherapists, the trainers, teachers, parents, and doctors to think about these things, maybe even worry about them a little, but only so that the dancers don’t have to.
Let the dancers worry about dancing, and we, the dance educators can carry the burden of their injuries. Because we’re geeks and we’re into it, and our bodies aren’t the ones on the line.
We, the educators, trainers, and therapists, need to learn all we can about prevention, but not only prevention- We also need to learn how to communicate this information to dancers in a way that doesn’t make them afraid, but empowers them to become stronger. Because the fear and obsession tactics don’t work.
In my first year at Ryerson University I remember that we were asked what our biggest fears were, as dancers. Our response? A unanimous fear of becoming hurt and no longer being able to dance.
What causes this fear of injuries?
You’re afraid of injuries because you don’t know enough about how your body works to be able to heal yourself without an entire team of specialists (which you can’t afford).
Injuries are scary because of the time off you don’t want to take, for which you will have nothing else to fill it with, because dance is all you know.
You’re afraid to become hurt less because of physical pain, and more because you tempt losing a piece of your identity.
You don’t want to think about the fact that you can’t afford rehabilitation fees.
And you’re afraid of injuries because you perceive that teachers will judge you as inferior for becoming hurt (“if your technique was better this wouldn’t have happened to you!”).
So you push these fears to a dark corner in your mind so that you can dance without limits. When you’re not injured you feel invincible, and it feels good to dance like you’re invincible. The best dancers to watch must be the ones who feel invincible because they don’t hold anything back.
You don’t need the constant reminders that you will get hurt, you need goals for performance, a well designed strength training program that is actually fun to do and that helps you feel immediate reward so that you’ll want to keep doing it. You need to be educated on how your body works so you can enjoy using it and, by understanding your limits, you can respect them.
What I feel is lacking for most dancers, unless part of a professional ballet company, is a safety net that has your back when you do get injured. Because injuries will happen. We as educators know that we can help dancers to get injured less often, but it still happens.
By safety net I mean a system that ensures that a dancer doesn’t need to be afraid of becoming injured, because they will have access to the support they need financially, emotionally, physically, and mentally in that situation.
It’s not the dancer that needs to change, it’s you and I. How we educate, train, and make ourselves a part of a dancers’ rehab process. We need to change the system rather than expect the dancers to fit into the one that currently exists, and often fails them.
Anyone who has become injured knows that it doesn’t just hurt the physical body, but it can trigger deep depression and cataclysmic feelings of low self-worth. You feel like you’re losing your identity when you lose your ability, if not only temporarily, to dance.
I am fortunate to live in Canada and that my father works for the government.
Had to insert a Justin Trudeau pic in here somewhere
While I was in school, I was covered under his benefits and could get my physio fees reimbursed through his insurance policy. Physio which, by the way, was not effective because I had no idea how to choose a therapist that would fit my needs.
Despite this accessibility, my rehabilitation experience was not good and, eventually I maxed out my parents’ coverage to the point that I stopped going because I could not afford it anymore. I even paid for treatments out of my own pocket that were ineffective.
I felt bad about myself for not getting better. I felt judged by my teachers and felt the pity of my peers. I felt guilty that I had used all of my parents’ insurance coverage and still could not dance.
It could have been much different if a system was in place to help. If I didn’t have to make decisions alone that I knew nothing about. I was alone and ignorant. Alone, even though I’m sure every dancer in my class had gone through a similar struggle.
At the IADMS conference this past October, I distinctly remember one presentation showing us evidence that insufficient coping skills was one of the top reasons dancers get injured. I can relate.
Most of us don’t have a support system unless we go out and create one for ourselves. We all have the right to a safety net. An incredibly supportive, effective, affordable network.
What if each dance program/school had a network that consisted of a rehabilitation team, a strength and conditioning team, and a therapist.
Welcome to my perfect world where:
1. Each dance school/program has a built in a budget for student rehabilitation. This budgeted amount is established knowing that dancers will get hurt- Not if, but when. This allows dancers to receive a certain minimum amount of treatment for their injuries, and a subsidized rate beyond that amount, so that they can focus on their dancing without fear.
2. Strength and conditioning is a mandatory part of the curriculum. Not a bootcamp, Barre fitness style class, but a sensible, periodized, dance-specific program taught by a competent coach who would have as much a role in education as supervising exercise, empowering dancers to become their best while feeling good about themselves and their abilities.
3. The dance program has it’s own team of rehabilitation specialists. They observe dance classes, communicate with the other teachers and faculty, and, most importantly, aren’t only into making money with fancy treatments and passive therapies. Did you know that some physios can make hundreds of dollars by prescribing an injection that takes them 5 minutes to administer? Makes it pretty tempting to do this than work long-term with a patient to teach them how they came to be injured.
4. Dance teachers are educated on how to speak and interact with their students. They are taught to avoid negative language and help them adopt a growth mindset, set goals, and raise their self-worth rather than make them feel bad about their abilities.
Imagine how reassuring it would be to dance at a school that had this kind of support system. The dancers in this program would thrive knowing that if their worst fears came true, they wouldn’t have to deal with it alone. It would allow them to dance with more confidence, not subjected to inappropriate language and fear mongering with no talk of solutions.
I write this because a dancer I know has been going through some hard times in his last year university and a system like this could have prevented his current situation, as well as that of many dancers.
I “met” Michael via email (probably chatting initially about deadlifts and hamstring injuries, two things we have in common).
Despite his best intentions, desire to learn how to take care of his body, and love of strength training, he became badly injured and has now accumulated thousands of dollars in medical bills he can’t afford to pay, and is still trying to get back on his feet.
Michael’s not an idiot. He’s way smarter than I was at his age.
Michael didn’t do anything wrong. He only wanted to work hard and succeed at something he loves, but he didn’t have the support and education he needed to overcome his injuries.
When his physiotherapy program was not helping him improve adequately, he didn’t know whether he should call it quits and find someone new, because that isn’t taught in school.
When he was cleared to go back to dance, still in pain, he was not educated on how to know when to rest, something we all need an education in.
He loves strength training and knows it’s good for him to do, but like most students, he wan not able to afford supervision and a customized program that would have ensured his cross-training was helping him, not just grinding him into the dirt (unlike other collegiate athletics programs which almost always include strength and conditioning training).
Michael didn’t get adequate recovery because he felt guilty about resting, and felt judged for sitting out. He didn’t have a better plan so he pushed through his injuries to perform in a show which, by the end, found him unable to walk without pain.
While he will probably look back a few years from now and see his situation so clearly, it’s not so easy to make the right choices when your life is ruled by judgement, competition, and pressure to succeed, with little support.
Michael needed a system.
He needed better quality physio that insisted upon adequate recovery, guidance for his cross-training, financial aid, compassion from his teachers, and to be re-assured that he would have a smooth transition back into dance if he followed their advice.
He needed a trustworthy system with this kind of incredible communication between rehab, cross-training, and teaching, with the budget to support him so he didn’t have the financial burden at the forefront of his mind.
Of course there are some challenges this model poses.
The big one: Money. Where does this budget to subsidize rehab, training, and education come from?
Another biggie: Time. Convincing the head of a dance program that it is necessary to make time for screening and strength and conditioning in the already packed curriculum isn’t an easy sell.
This system is my dream. Just give me 10 years and I’ll make it happen ;).
How is Michael now coping with his situation? He’s started a Go Fund Me campaign to help pay for his medical expenses and get back to dancing. It takes courage to put oneself out there and ask for money. I certainly would rather have given up completely than ask for help.
But Michael shouldn’t have to be asking for money. Dance students should not have to reach out to their friends and strangers on the internet because they can’t afford physical therapy. That said, this is Michael’s reality, and if you’d like to help him out, please contribute to his campaign. Better yet, reach out to UC Irvine where he studies and ask them to consider creating a better support system for their dance students.
Michael has been inspired by his situation to start a charity that would support dancers through times of need like his. For now, his Go Fund Me campaign is his charity, and if he meets his fundraising goal, he also hopes to donate to a charity that does something similar to support dancers. Please help him out, and share this post.
And if you are aware or organizations that support dancers, please let me (and Michael) know about them. Many of us are not aware what resources are available to us, so post them in the comments below.
What do you think? Am I too idealistic? (I for sure am, but I’m not changing). Can you relate to Michael’s experience? I’d love to hear your thoughts.
And yes, realize that I used a lot of negative verbiage in this post, but it was mostly to make a point!
I’m working with a dancer this summer who reminds me a lot of me. When we first started to work together she didn’t know what pain was. Silly, right?
This lovely young lady is dealing with some pretty chronic hip, knee, shoulder and neck pain upon many passive and active movements. How has she been dancing? How does one successfully perform the infinite ranges of motion and challenges of stability that dancing requires when it hurts to do a basic, passive movement?
A lot of things are possible when you ignore pain. But for how long can you maintain that?
A huge part of what I do with some clients is pain education, something many dancers won’t ever get.
No dance teacher ever taught me how to listen to my pain, but told me to push through it. We’re told that pain is an inherent part of our existence. But I’m telling you it doesn’t have to be.
I don’t care how annoying it gets, I will ask you how you feel after every exercise.
If I know you have knee pain, I will always ask you how your knees feel, because as lovely and sweet and awesome as my aforementioned client is, she never mentions pain until I ask her. And then it finally comes out after some probing. “That hurt my knee”. WHY DIDN’T YOU TELL ME DURING THE EXERCISE WHEN YOU FIRST NOTICED IT???
The presence of pain changes motor control and facilitates the development of compensation. That’s why you don’t ever want to repeatedly perform movements that hurt.
Yes, to dance you will have to do some things with your body that feel uncomfortable, but that isn’t the same as pain. Do you know the difference between pain and discomfort?
I have never had a formal education in the science of pain, just like I never received a formal education in anatomy, biomechanics, neurophysiology, or many other things that I would have liked that relate to my interests in the field of training and rehabilitation. Fortunately (or unfortunately), I learned straight from the source.
While my dance teachers may never have warned me that “if X joint starts to hurt upon Y movement, go seek help because that’s bad”, I learned eventually, anyway. Was it worth it? I often wonder…
So in case a dance teacher fails to deliver this important message (that might save your dance career, by the way):
If your arm goes numb when you put it over your head, go see someone about it.
If it hurts your neck when you turn your head to one side, go see someone about it.
If your knee sometimes gives out painfully while you’re walking down the street, go see someone about it.
If any part of your body is experiencing pain at any time while you dance or otherwise, take a freaking break and go see someone about it!
It doesn’t make you weak to acknowledge pain, and taking time off from dancing when movement is painful won’t cause irreparable regression. You often need to regress to progress. That’s what pain is telling you. That’s your education from pain. Let it teach you it’s lesson, and move on to better things.
Pain is your body’s way of telling you something isn’t right. Will you listen? It’s an opportunity to make huge improvements. Will you take it?