Wednesday, March 16, 2011

Diagnosed with Degenerative Disk Disease and Depressed about it?

At the age of 42, after an MRI, I too was diagnosed with Degenerative Disk Disease. I also had two bulging and one herniated disk in my low back. I went home, crawled into bed and cried, convinced that my body was aging beyond repair, and it would be all downhill from there.

The Bad News
Yes, with a diagnosis of Degenerative Disc Disease maybe your neck or back hurts. Worse, you have a condition with the word “degenerative” in it and you despair of ever feeling better. You can’t even bend down to feed the cat without pain and stiffness. Maybe you don’t have any neck or back pain, rather your fingers or foot is numb. Or you have pain, numbness or tingling in your arms, or your buttocks, knee or calf. It’s been going on longer than you care to admit and nothing seems to make it better. 

The Good News
Yes, believe it or not, there is good news. You can get better. More likely than not, you can return to a completely pain-free life. With the right treatment and a few targeted exercises, you can restore flexibility to your neck and spine. You can become stronger than you’ve ever been. You will probably need to learn a few postural adaptations along the way, too.

The other good news is that this is a wake-up call while you are still fairly young. Once you learn new postural patterns, you can sit, stand and walk more effortlessly. With the appropriate Core strengthening exercises, you might find that not only do they make you feel better, you look better, too. Another plus is that with a stronger Core, you might discover that you have more energy.

Who Can Help?
A Physical Therapist with skills in McKenzie’s Techniques, Manual Mobilizations, Neural Glides, Yoga, Feldenkrais, Alexander or Pilates can help you. A Physical Therapist who has healed from her own neck or back pain -- and there are many of us out there -- has a unique perspective.

Don’t try to go it alone. Certain things that well-meaning friends or teachers think might help — like forward bends and intensive hamstring stretching — may make the situation worse. I would avoid twisting exercises until you know more about what’s going on in there. Backward bends, like sphinx and cobra poses help many people but make others worse. It might be best to avoid abdominal crunches or other heavy-duty abdominal exercises at first. There are many wonderful and effective Core strengtheners that involve little to no neck or spinal flexion.

Seek out a knowledgeable Physical Therapist who has experience in successfully treating chronic neck and back pain. Today might be the day you begin to heal and feel better.

Friday, January 7, 2011

What are your Intentions?

                                                                                                                           I did it my way.
                                                                                                                                Frank Sinatra

Why I prefer Intentions over New Year's Resolutions

Creating an intention is about finding out what I’d like to do or have happen in the New Year. It is a gentle process, one of tuning in and listening to the still small voice within. It’s a taking stock of where I am with my life today, and where I’d like to steer towards tomorrow. Am I heading in the desired direction? Do I want to tweak it here and there, or are we talking major changes here?

Resolutions connote differently. I RESOLVE TO sounds, well, like a legal document. Or the beginning of my Last Will and Testament. It’s a do or die proposition. It sounds authoritarian. Parental. Since I have issues with authority -- who doesn’t -- when faced with a directive like this, I tend not to listen. Or, if I’m in a particularly self-defeating mood, do the exact opposite. Besides, I don’t think that I ever kept even one New Year’s resolution. Have you?

Last year, my intention was to write morning pages* every day. It took me 4 or 5 months to get there. First I only wrote them at night once or twice a week. Then I started writing them more frequently, but still only at night. Maybe the late afternoon. For seven months now, because I want to, I write them just about every morning.

It took time to get here. I didn’t do it because I thought I should or because I obeyed an inner dictate. It came from a deeper, lighter place within. This process of daily writing grew into an activity I look forward to every morning. It grounds me deeply. It helps me to find the cheer and energy to face the day.

Check that one off the list.

This year my intentions are to meditate 10 minutes a day, and to write for this blog 10 minutes a day. Not publish, just write. Only 10 minutes. I’ve only been successful two days so far. It’s just something I want to do. I don’t have to.

Won't you join me?

*The concept of morning pages was developed by Julia Cameron in the Artists' Way.  Click on to learn more.

Saturday, October 23, 2010 | Dance NYC

Click on above to see video footage from the Bessies.
Issac Mizrahi MC'd. It was a night of fun, shouts and tears devoted to choreographers, dancers and the usual suspects in New York's vibrant dance scene.

Thursday, October 21, 2010

Sleep Apnea: An Alternative Approach

Obstructive sleep apnea syndrome (OSAS) is caused by a disruption to the breathing cycle, often for 10 seconds or more at a time, when you are sleeping. Contributing factors vary -- from narrow or clogged airways to the tongue falling back in the throat cutting off the air supply. If you snore, keep your partner awake at night and wake up tired every morning, you might have sleep apnea.*

Since sleep apnea is a common breathing disorder, and since your breathing is controlled by your brain and breathing muscles, wouldn't it make sense to use breathing exercises as a front-line treatment? After all, Physical Therapists and Yoga Therapists use exercises all the time to restore balance to the body's neuromuscular systems. And, Yoga provides the best system I know of, hands down, for exercising the breathing apparatus -- muscles, lungs and brain. 

Can we then apply this same treatment logic -- of restoring balance to the body with exercise -- with years of documented success, to sleep apnea? It seems we can. Two randomized studies have recently been published in support of using different forms of breathing exercises to successfully treat obstructive sleep apnea.

The first, published in the British Medical Journal February 4, 2006, showed that didgeridoo playing is an effective treatment alternative for moderate sleep apnea. Here 25 patients were randomized between a control group of 11 people and a treatment group consisting of 14 participants. The treatment group practiced didgeridoo playing for 25.3 minutes for 5.9 days per week for four months.

The didgeridoo players showed significant improvements in terms of daytime sleepiness and snoring. The sleep apnoea-hypopnoea index (a measure indicating the severity of the disease in terms of sleep disruption and decreased oxygen saturation in the blood) significantly decreased. Happily, their partners also reported less sleep disturbances.

The second study was published February 20, 2009 in the American Journal of Respiratory and Critical Care Medicine. It was a randomized trial of 31 patients with moderate OSAS. For a period of three months, 15 patients received sham therapy and 16 patients received a set of exercises for the mouth, soft palate, face, tongue and throat.

Not surprisingly, the exercise group showed significant decreases in snoring frequency and intensity, a decrease in daytime sleepiness, improvements in sleep quality and a significant decrease in the severity of the measure of OSAS.

Doesn’t it make sense that yogic breathing exercises might have the same desired effects?


     * To get a good diagnosis, please consult with your primary care doctor, who can refer you to a sleep clinic for evaluation.

References and Resources
GuimarĂ£es K, et al, 2009. Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome. American Journal of Respiratory and Critical Care Medicine Vol. 179: 962-966.

Puhan M, et a,l 2005. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. British Medical Journal, 332(7536): 266–270.

Thursday, September 30, 2010

Friday, September 17, 2010

Recommended Reading

The Best Buddhist Writing 2008
  edited by Melvin McLeod
  2008 Shambhala Publications, Inc.

This is a great book of essays by some of my favorite Buddhist writers: Norman Fischer, Joseph Goldstein, Natalie Goldberg, Thich Nhat Hanh, Sylvia Boorstein, His Holiness the Dalai Lama, Pema Chodron.

I especially liked Noah Levine's Learning Forgiveness, Joanna Macy's Gratitude, and Traleg Kyabgon Rinpoche's The Practice of Lojong: Cultivating Compassion Through Training the Mind.


Monday, September 13, 2010

One Thing You Can Do Today to Prevent Pain

 Look down at your feet. Seriously, take a look at your shoes.
  • Are you wearing supportive shoes? Our mothers were right on this one. Good shoes are supportive. After all, your feet support all 100 plus pounds of your body weight. Yes, they are an investment; good shoes don’t come cheap.
  • Repair worn down heels. Try having your shoemaker place soft rubber taps on the part of the heel that wears down, most often the outside border of the shoe. It’s an inexpensive way to significantly extend the life of your shoes.
  • Throw out shoes where the inner soles are flattened and worn out. Similarly, throw out shoes where the outer soles are worn beyond repair. 

If you walk a lot, keep your shoes in good repair. Your feet, and thus your shoes, provide a hopefully stable base of support to your ankles, knees, hips and all of the other joints in your body. It can be only a millimeter or two of an uneven shoe sole that aggravates your foot or knee pain, or causes you to trip and fall. 

Most people haven’t a clue that their shoes are worn out. “But I just got these shoes last year.” For people who walk a lot, and that is most New Yorkers, you need to make friends with your local cobbler. They will save you money on new shoes and doctor’s bills.

Loafers do not provide good support. They’re okay to wear around the office if you are sitting most of the day or if you are blessed with strong feet and arches. (Most people aren’t.)

High heels are great to look at but hell on your feet, knees, ankles, hips and back. The higher the heel, the more the distortion to the entire skeleton. Enough said.

When someone comes to me with foot, ankle or knee pain, I include an evaluation of their shoes. It is surprising how adopting this one simple recommendation can suddenly clear up what seems to be a perplexing problem.

So, if you suddenly -- for no discernible reason -- develop pain in your feet or legs, take a good look at your shoes. 

Thursday, September 9, 2010

Tips to Prevent Back Injury

Tips to Prevent Back Injury - The Iliopsoas Muscle

You may wonder why it might be a good idea to avoid double leg lifts, whether your knees are bent or extended, if you have a history of back pain. In yogic terms, this would include boat (navasana) and its variations.

Q: Why would double leg lifts re-injure the back?

A: Because of an unequal and excessive pull on the spine and hips by the iliopsoas muscles, considered to be the primary hip flexors.

The psoas major has its origins on the spine at vertebrae T12 and throughout the lumbar spine on L1 through L5. The iliacus arises on the inside of the hip bone, the ilium. They both attach on the femur on the lesser trochanter. They also serve as important postural muscles.

Let’s look at this more closely. In almost every patient that I have treated for low back pain or injury, including sacro-iliac problems and sciatica, she also shows a curvature, or rotation, of her spine. This curvature may be an acquired scoliosis, from injury or unequal use of the body over time. Overuse of the right side of the body is common -- we live in a right handed world. (Quickly, what hand are you holding your mouse with?) Or, she might have classic scoliosis, called idiopathic scoliosis, which develops in children, usually around adolesence and seems to run in families. This means that the psoas muscles, arising from your low back, are pulling unequally on either side of the curve or rotation in your spine.

Further, the legs have weight. Together, they are approximately 40% of your entire body weight. In a 150 lb. person, if one leg weighs 150 x .20 = 30 lbs., then both legs together weigh 60 lbs. 

In a double leg lift, whether you are lying on your back or in the boat pose, whether your legs are bent or straight, the psoas have to move and hold 60 lbs. This is exerting a pull of at least 60 lbs. directly on your back. 

Think about it. If you lift, or worse, hold in an isometric contraction as we do in navasana, that much weight on an unstable back -- a back which is rotated and uneven on top of an unstable and rotated pelvis -- then does it make sense that you might feel or develop pain in your back? 

Remember, an unequal pull of the iliopsoas muscles will only exacerbate an already unstable situation, leading to back strain, reinjury and pain. And, we haven't begun to mention that the different fibers of the psoas, at its multiple insertions on 5 vertebrae in the low back, pull unequally and different points in the movement cycle.

Tuesday, June 22, 2010

Free Your Body - Part I

 Free your mind and the rest will follow. 
                                        En Vogue

Free Your Body - Part I

These days I am thinking about freeing the pelvis. I keep coming at the topic from different perspectives. While swimming laps today, I was stimulated to think about it in yet another way.

To have an efficient swim stroke, it needs to be relaxed. In the crawl or free style, you let the body roll when you turn the neck and face to get air. You let the spine move side to side, like a fish, when you are stroking and kicking. For a swimming novice, this may seem counterintuitive. You might think that if you hold the body in a straight line, and just turn the head and neck, it would be a more efficient way to swim. If you say "rigid" to your body, you will tend to move that way. And, if you swim that way, what you really might get is a stiff and sore neck.

When I let the body roll from the pelvis, I decrease the cranking on my neck. Today I discovered that if I pushed my face down -- again very counterintuitive -- in the roll, it further integrated my ability to roll in a unit. First, I initiated the roll from my pelvis, which I cued silently to myself as “move the pubic bone.” Then, as I began the turn of my head, I pushed my head into the water. The buoyancy of the water itself facilitated the head turn rather than using my neck muscle to lift and turn the head. It felt great.

I was able to relax into the water, to let my weight drop further into it to allow the water's buoyancy to, well, buoy me.

We can do the same thing in gravity. By pushing down into gravity through our feet, we can engage more directly with the ground reaction force, which travels in an equal and opposite direction from gravity. By pushing down through the feet and releasing the weight into gravity, we can more effortlessly stand taller. We discover buoyancy and ease in our everyday movements, like walking, standing and sitting. I will elaborate more on this topic in days to come.

Holding On vs. Letting Go

Now think about the concept of “holding the body.” When you arae learning a new movement activity, whether it be dance or tennis, there is a tendency to hold tension all over the body, using extra effort to learn the new skill. Movement cuts paths through space. Our bodies move in space. Until the motor pathways are well established in the brain, the movements tend to be inefficient and to take a lot of extra effort. With practice, practice being key here, there are well-established neuronal pathways laid down. Over time, and with lots and lots of practice, the movements become easier. You use less tension to accomplish them. You are able to do more. You have more fun.

We often think of it as kinetic or muscle memory. Really, it is that new motor pathways have been laid down in the brain. Further, if you have aptitude and a good teacher, these movements over time will be increasingly efficient and effortless. Think of the best dancers. They seem to throw away all technique and to move effortlessly.

Practice Practice Practice

After a cerebral vascular accident, also known as a stroke, we can see varying degrees of recovery. Sure the first factor is the severity of the stroke and the extent to which different areas of the brain are damaged. Another significant factor, in my experience, is that those people who had a good fitness level before the stroke did better. It is probable that because they had developed more in terms of quantity and diversity of motor pathways in the brain, that when the brain was damaged in the stroke, they had a head start on recovery. Maybe the motor pathways are deeper, cut in deeper grooves. Certainly, they are more plentiful.

Is it similar in psychological terms? The more one practices anger, say, the angrier one gets. Is this because we have deeply embedded the neuronal processes and pathways that spark anger? Is this why cognitive-behavioral therapies have such a good track record with depression, because they teach the patient how not to just keep repeating the same old patterns -- cognitively, emotionally or behaviorally -- but to establish new ways of thinking and behaving. In essence, beyond the mystical and mysterious results of seeing the changes in one’s thoughts, emotions and behaviors, are we simply establishing new neuronal pathways?

We let go of the tension to have greater freedom of thought and movement. To have greater possibility.

More to follow in days to  come.