Adventures in Back Pain

To my very own domain. Yay! Thanks so much for the love, tumblr. I hope you all continue to follow x

[Who’s having the last laugh?]

A year ago, I was compelled to start this blog after incessant back pain interfered with my favorite weekend of the year: Coachella. Today, I am thrilled to report that I made it through my tenth festival practically pain-free! I was on my feet for 12 hours a day. I danced like a maniac and drank like a fool. And my back rolled with all of it. Ridiculous as it sounds, I feel like this is one of my greatest accomplishments to date. So much of my energy for the past few months has been channeled into ensuring that I was limber and healthy for the weekend and by golly, I WAS! And not just limber and healthy but joyous, elated, tickled silly! In fact, I had such outrageous fun that I think I’ll do it all over again.

Next weekend.

Thank you Alexander and thank you life!

[Back pain-fighting super hero by Jon Perry]

These tips are of a more conceptual nature, all based in Alexander Technique. No single one is going to change your life but together, they have the power to improve the way you move through gravity, thus lessening life’s impact on your back. Behold…

You caused your pain, therefore you have the power to undo it. This applies to roughly 80% of you. If you were in an accident, have fundamental/structural issues or fibromyalgia, please disregard. For the rest of us, our back pain stems largely from years and years of bad habits. If we expect to return to a life of comfort and ease, we must examine the way we use our bodies in all situations and pinpoint where we need to adjust. This is best achieved with the one-on-one help of a Physical Therapist or Alexander Teacher but there’s a lot you can do on your own. Start with one environment, say the car, and deconstruct your behavior therein. Are you holding the wheel firmly or hanging on for dear life? Relaxing your shoulders or wearing them as earrings? Are you an easygoing driver or prone to road rage? If the latter, how does road rage manifest itself physically in your body? Bad habits are stubborn as house cats but awareness is the essential first step in breaking them.

Don’t let gravity get you down. From desk jobs to long drives to sagging sofas, it can seem like the whole world is conspiring to compress us. But guess what, we were designed to be upright and if we want to be pain-free, it’s only logical we honor nature’s intention. How? Don’t sit for longer than forty-five minutes at a time. Think “up.” And pay attention to the next item…

Make like a Da Vinci diagram and extend. As if heeding instructions on a carnival ride, we tend to keep our limbs tucked. Alexander Instructor Leah tells me this habit stems from the cave man days when your limbs were a vital shield against the elements and there was a legitimate chance of losing an arm to a mammoth. Lucky for most of us, life is no longer a constant emergency. The everyday milieus of offices and grocery stores do not double as hunting grounds, leaving us free to fling about our limbs with abandon. Or at least to feel like we can spread out a bit. In just thinking of our arms and legs as separate entities with the ability to float away from us (a fantasy of course: they can’t), we can create space in the joints, helping us to move with greater ease. Try it!

Remember, there’s no such thing as a waistline. At least anatomically speaking. My former teacher Lana liked to point this out and when you think about it, it’s true. Our waist has no function other than an aesthetic one — it helps you fit pants and if you’re a woman, attract mates, but outside of these realms, it’s irrelevant. Waist-centric thinking is especially problematic when it’s time to bend over. Be wary of the direction “bend from the waist,” found in yoga and fitness classes everywhere. If you were to do so, you’d have an extremely limited range of motion. You’d kind of hunch over and sink into yourself. Our bending mechanism is actually the hip joint, much lower down, between the pelvic bone and thigh. It allows you to achieve your full range of motion while maintaining length in your spine vs. crunching your upper body, needlessly engaging your back.

Think of your knees as fists. At least in the following way…Make a fist. Now keep the fist but loosen a little. This is Leah’s clever way of demonstrating the difference between locked knees and a microbend. We want the microbend. Stick-straight legs can put excess weight on your knees, stressing the joint but the barely perceptible softening of the microbend protects the knee from injury. And you can’t have a happy back without happy knees, right?

Thank you to Celio Rodriguez, Lana Spraker and Leah Zhang for their wisdom. I’m continually amazed by the endless applications of one this simple technique.

Valerie is a wise and wonderful teacher. This is valuable information, friends!!!! 

[Valerie looking somehow at peace in her one-legged back bend]

A few months ago, I posted about the damning New York Times article that set the yoga world abuzz. Featuring horror stories about the most freakish of yoga accidents, it warned that the practice is a lot more dangerous than we’ve been led to believe. Well with us today is the lovely Valerie Moselle to shed some light on the issue. A yoga instructor of thirteen years, Valerie is one of my favorite teachers ever. She’s so zen she practically radiates moonbeams. I used to watch her in class and think, wow, the woman is actually glowing. She was the first yoga teacher to really hone in on my back situation and now that I’m thinking about it, the first one who urged me to “undo.” Don’t push into that down dog like it’s your last! Relax, pull back a little. I remember being amazed that I could still maintain good form without tensing every muscle in my body. Which is exactly what I’m learning in Alexander right now. In the west, we’re raised to believe that you have to work for everything when really, it’s sometimes best to just get out of your own way.

Sadly for me, Valerie is in Santa Cruz now so I can no longer enjoy her classes but thanks to modern technology, we can still keep in touch. Below, enjoy her very thoughtful analysis of all things yoga and back pain.

[See? Glowing.]

So that was a pretty damning article from the New York Times last month. What was your gut reaction to it?

As a yoga teacher, I’m well aware of the risks of yoga, and that yoga is towards (in some years ‘at’) the top of the list of ‘sports’ causing, sports-related injuries. I don’t know if this is because of the way injuries are reported, and that there are so many practitioners, or that these injuries are better documented than say a chronic injury that evolves in a runner or another athlete. But I do know from personal experience and from watching the trends grow and change over the last 20 years, that many of the styles of yoga taught in public yoga classes ask extreme things of regular bodies, and that some of those bodies will never mold into the shapes asked of them, simply based on structural limitations. Any practitioner that aggressively asks further and further ‘opening’ of a joint structure that is already at its range of motion (either in muscular or facial resistance, or because of bony barrier), risks injury to that joint, or the joints adjacent. Few yoga teachers in this era of hot yoga, heavy vinyasa, power, and flow yoga truly understand this. Many injuries happen in yoga because less experienced teachers teach crazy, hard, sweaty classes because it makes them popular teachers, rather than because it serves their students. So my first gut reaction was ‘right on,’ it’s about time somebody started talking about this.

On the other hand, our ‘Western’ approach to yoga reflects our own ambitious ‘Western’ natures. The guy who twisted his spine into a broken vertebrae was most certainly not listening to his body, but trying to achieve some end result.

Do you agree that some people or even most should avoid doing yoga?

No. I believe everyone should do yoga. But they should do the yoga that is the right yoga for them. How can they know what is the right yoga practice for them? They should consult a qualified teacher who can explore the right practice for them. This is best done in a private setting. However, I teach plenty of public classes. There is value in that too. Are you more likely to get injured in a public class? Absolutely. And you’re likely to get injured in all sorts of other situations too. In the presence of a good teacher, most of the time, one can develop the sensitivity required to steer away from injuries, and to discover which postures aggravate an existing injury, and which postures help. The practice is a laboratory. It is a place for experimentation, and to develop consciousness. In Hatha yoga, the practice of postures develops sensitivity around the physical (and ultimately energetic) body. Part of this exploration is figuring out what works, and what doesn’t in your body. The cases outlined in the article were extreme examples from practices that take posture practice to extremes, and I would guess the practitioners had an extreme devotion to improving their practice. The article wasn’t a balanced look at all people practicing. In that way, it was fear mongering.

[Bird’s-eye Valerie by Razi Photography]

What kind of experience do you have working with students who suffer from back pain?

In my experience, most students suffer from back pain. Some tell you about it, and some don’t. I’ve heard 80% of people in the West (industrialized nations) suffer from debilitating back pain at least once a year. So I guess that would be 80% of my students! Every student over 30 has some ache or pain, whether it is a back, shoulder, hip, elbow, or knee. And I think you would find that true of almost any human being. Our expectation is that yoga should make us pain free. But that is not the case. Yoga helps us explore, manage, and address the aches and pains that emerge in our bodies from our physical activities, and from the normal course of living in a body. It can also cause aches and pains.

Can you share a few poses/stretches that are particularly healing for the back?

There are many yoga postures I would recommend for back pain. But I find that working with postural alignment and developing core strength are the most helpful for backs. In terms of an acute injury, I design a sequence based on moving the joint(s) at the site of the pain and proximal to the pain through their range of motion. Both in the effort to strengthen surrounding muscles, and to stretch. I also recommend efforts that reduce inflammation. Students want a magical yoga posture to cure their back pain, instead of a magical pill. In my experience, injuries respond to a holistic approach. Stretch, strengthen, reduce inflammation, and nourish the body with nutrition. Next, address pain with practices that reduce stress, and address the emotional component. Seriously, everyone will nod when they read this, but the next time their back is in spasm, they’ll start doing their pigeon pose again, and maybe see a chiropractor. But they’ll stop there, and then complain that yoga is not healing their back. 

Poses that seem to heal backs: reclined twists, pigeon, cobras with little weight in the arms (so multiple lifts into cobra to strengthen the back muscles), forward bends (except in the case of acute disk herniation), lying on the back with the legs up the wall (viparita karani), pyramid pose (parsvotanasana), and best of all, squatting. Get your students squatting. Squat a lot.

[Sun-kissed Valerie by Razi Photography]

Obviously back issues come in many forms. But is there any kind of general advice you can give to the back pain sufferer who wants to start or continue practicing yoga?

Yes. Go slowly, start at the beginning. Pay attention to how your body feels in and after a pose. Pay attention to how your body feels in the two hours after you leave class. If you start taking a class and your back gets worse after a few weeks, then try a different class. There are very talented teachers at almost every studio who teach interesting classes that address backs. You have to find those teachers. They are not going to be the classes with 50 people in them and the heat turned up, where you leave sweaty and spent. They are going to be special classes where you move slower and take time to feel what is happening in the body. They will often be therapeutic or beginning classes. They will often be in the middle of the day, or after the 6PM class. They will be taught by teachers who suffer from back pain and are learning from it in their own lives. They will be taught by teachers that have an interest in yoga for physical healing, rather than yoga for spiritual evolution (these can be great classes too…just a different focus), chanting, or just getting your ‘yoga buzz’ on. (And I am someone who loves the sweaty flow classes, the chanting, and the yoga buzz). Ask around. One of my favorite yoga quotes comes from a dear friend and fellow yoga teacher who said she chose the teacher that she studies with ‘because his class was the only class that didn’t hurt my back.’ For you that may be one teacher. For the person on the mat next to you, it might be another.

Anything else you want to share?

I am deeply appreciative of the work of Paul Grilley in the yoga community. Because of him, I developed my understanding of the concept of analyzing any joint structure to establish whether that joint is in compression (at the edge of its range of motion because of the pressing or squeezing of tissues) or in tension (at its range of motion because the length of the muscles or fascia associated with the joint are stretched). In any posture in my body, I can now analyze whether there is room to ‘stretch, breathe, and lengthen’ or whether I am just jamming tissues together. Jamming tissues together over and over again with the idea that a joint will ‘open’ causes one kind of injury, or injury to other parts of the body that compensate. Over stretching muscles, ligaments, or tendons causes another kind of injury. It is no different with backs. So with regards to the article, if people can begin to decipher whether their neck is in compression in shoulder stand, or whether they are over stretching the neck in shoulder stand, then they can stop trying to pry the body into a deeper and deeper shoulder stand (risking stroke!). They can learn to prop accordingly, to get the benefits out of the pose without strain. Students have to be taught to do this by teachers who have this information and experience. And I have to say, I agree, head stand and shoulder stand are highly overrated. One can also examine compression and tension in a person’s general posture, both sitting and standing.

Wise words from a wise woman! For anyone lucky enough to live in the Santa Cruz area, I encourage you to experience the Valerie glow for yourself. She teaches yoga classes at Nourish Santa Cruz and the Pacific Cultural Center.

[My new teacher. Isn’t she cute?]

Some days I feel like Alexander hasn’t done a thing and then others, like these past few, I can really feel it working. So lest I forget during my next bout of pain, here it is in plain type: there’s something to this strange magic.

I have a new teacher. I would still absolutely recommend the knowledgeable and zen Lana Spraker but she was getting too pricey. So now I’m with Leah Zhang who is seriously great. She’s around my age which is always fun and chock-full of knowledge and visual aids that are rapidly changing my understanding of the body I’ve had for thirty-one years! For example, did you know that your back has six layers of muscle? Here is the outermost:

And here is the innermost:

See those cilia-like things clinging to the spine? They are the muscles activated in postural work. Which explains why our back fatigues when we try to “sit up straight.” We are so overly reliant on exterior muscles like the traps and lats that when we finally do call upon the interiors, they quickly tire out. So quit ignoring them!

Other anatomical factoids:

• The turning mechanism for our skull, known as the atlanto-occipital joint, is a lot higher than one might think. As seen in the diagram below, it’s right around your ear, a bit of a revelation to an ignorante like myself who, when nodding yes or no, tends to think of moving from the neck or chin. Amazingly, just imagining that AO joint in its proper place somehow allows me to move my head and neck more freely. Try it!
• 
• Conversely, our hip joints are a lot lower than we might think. I’ve always associated my hips with the protruding bits of pelvic bone below the waist, a common mistake as evidenced by this google image search for “hands on hips.” In truth, they’re hiding in the crease between the pelvis and top of the thigh. You can’t grab onto them, you just have to trust that they’re there. But guess what? If you can transition from a standing position to a seated one and vice versa, they absolutely are. Hooray! Anyway, the precise location of our hip joints is relevant because in thinking that they’re higher, we tend to unnecessarily engage the back when bending. But if we understand their proper place, we can pretty much leave the back alone as we ease into that chair.

[The hip bone’s connected to the…THIGH bone]

And so my education continues. I admit I’ve been a pretty bad student lately, practicing active rest maybe once last week? Sometimes it’s hard to see the benefit and also, it’s counter-intuitive to interrupt one’s day with a lie down on some old copies of Food & Wine Magazine. But Leah explained it this way: active rest is your five (or ten or fifteen) minute Alexander lesson to yourself. It’s an opportunity to check in with your body and on a busy day, may be the only time that you do. From that perspective, it suddenly seems more important so if you’ll excuse me, I have some reclining to do.

[Venice High. For two bones, its chlorinated pleasures are yours.]

About a month ago, I started swimming at the Venice High Pool (oui film buffs, the iconic facade of Rydell High in Grease). I’ve been wanting to get back to swimming for some years now and with my yoga hiatus burning a hole (with seared edges) in my fitness routine plus all of this great information I’ve been getting on the benefits of swimming for back issues, I decided it was time. And while I’m not sure if my situation is improving because of swimming, my low back is absolutely happier without yoga. In fact (and a million sorries yoga community for continuing to pick on you, I know you help millions find inner peace and yielding groins), it seems that yoga is my biggest pain trigger. And I do some pretty crazy stuff. Like an hour of weights at the crack of dawn. And 16 hours of sitting in one place. Incredibly, yoga aggravates my back more than any of that. But this isn’t about yoga. It’s about swimming. So without further ado, let us explore its many benefits in relation to zee back.

[Striking a pose in the foggy locker room mirror]

BENEFITS OF SWIMMING

1. IT’S A LOW-IMPACT WORKOUT meaning, it doesn’t put any direct stress on the back. In the words of Adam Rostocki from Cure-back-pain.org, “it is much kinder to the joints than jogging, but equally effective.”

2. SWIMMING CAN STRENGTHEN WEAK BACK MUSCLES, reducing chronic pain over time.

3. SWIMMING LENGTHENS THE MUSCLES so they’re less likely to cramp up. It’s in a category known as”long exercise,” along with our friend/foe pilates.

4. WATER IS SOOTHING. Right? I mean considering that hydrotherapy has been used for centuries by everyone from Native Americans to the Ancient Greeks, there’s got to be something to it. I know that after a day of incessant stabbing in my right shoulder aka YESTERDAY, so irksome I debated whether to go swimming at all, it took only a single breast stroke for the pain to evaporate completely.

[Eye of the…shark?]

So viva swimming! I must say, I’ve come to relish my evening routine at the Venice High Pool. The two-dollar entry fee. The chirpy student attendants who unfailingly wish me a pleasant swim. The damp locker-room floors bubbling with bacteria. The burbling “sorry” as I accidentally kick one of my lanemates. These days, they are the markers of my healing.

OUT OF POCKET COST: $2.50 per swim general, $2 with a library card.

Venice High Pool is located at 2490 Walgrove Ave., Los Angeles, CA 90066. For info on hours, their programs and other LA-area pools, head to the City of Los Angeles Department of Recreation and Parks .

“No problem can be solved from the same consciousness that created it.”

                                                                                                  —Albert Einstein

Not gonna lie…Alexander is getting on my nerves. See, you’d think after 31 years of living including 14 years of dance training, 9 years of yoga and pilates plus a healthy interest in fitness and well-being, you’d know your own body but then Alexander comes along and says nuh uuuh, not so faa-aaast, you don’t have a clue. Trying to be patient with my slow progress aka hundredth attempt at transitioning from a seated position to a standing one (this comprises about 1/3 of a lesson) but it ain’t easy. Or cheap.

Still, some days I can feel myself improving. My mom’s in town and she’s noticed a marked improvement in my posture. There’s more time between painkillers. These are very good signs, yes? I’ve just gotta keep on truckin’.

Crankiness aside, I wanted to share a few aspects of Alexander that have stood out for me so far. They are, in alphabetical order:

AWARENESS. Before you can change your bad habits, you must be aware of them. You know, knowing is half the battle and all that jazz.These could be the subtlest of quirks that have imperceptibly burned themselves into your M.O. like crossing your legs (big no-no because it shortens one side), locking your knees when standing (thus putting undue pressure on your joints) or involving your shoulders when brushing your teeth (I tend to invite the shoulders to every party when really, they need their rest like everyone else). So for example, I’ll be happily employing my sonicare travel brush (handy because it doesn’t require a charger) when I notice my right shoulder bobbing up and down. I will then stop my brushing, say oy, YOU, stay put and then newly stabilized, continue my routine. I may repeat this process three thousand times before I can exclude the shoulder for good but without that first step of awareness, change will never be.

INHIBITION. If your mother or school teacher ever told you to “think before you speak,” you’ll be familiar with this one. Except in this case it’s THINK BEFORE YOU SIT DOWN IN THAT CHAIR or THINK BEFORE YOU RISE FROM THAT BED! There’s a good example of this concept in Body Learning. How do you react when you hear the doorbell? Do you jerk yourself into action? If seated, do you jump up and make a desperate lunge for your caller? Whatever our response, chances are we’re not thinking about it. Alexander teaches us to inhibit that initial reaction, take a few moments to plan our approach and then do it in a calm, deliberate manner. In this way, we can avoid potential strain from sudden movements and develop a conscious attitude towards the way we move which ties into the first item, awareness. I also put the phone ringing and someone calling your name in this same category. They’re everyday occurrences that can elicit knee-jerk responses. As a bonus, mastering inhibition will make you appear poised and in control, both of which my spastic self needs a lot more of.

THINKING “UP.” In my first lesson, I asked lovely Brazilian teacher Celio whether I should tuck my chin to facilitate good posture. He replied, “Don’t think of putting this body part here, or that body part there, just think up.” Have wiser words ever been spoken? Too often, we think of posture as a fixed position but really, it should be thought of in terms of direction. And that direction is up. Try it! How much simpler is it to achieve alignment by embracing this two-letter word, than by running through the checklist of shoulders back, chest out, tummy in, blah blah. I’ve personally found this simple direction to be extremely effective. What does everyone else think?

A few weeks ago, we gave yoga a hard time. Now it’s pilates’ turn to feel the heat! Not that I have anything against her. Au contraire, I’ve been enjoying her coretastic ways for nine years. But alas, my Alexander teacher Lana has advised me to lay off for the moment and I have to say this makes sense. Sure, strong tummy muscles play their role in posture and alignment but for people who are used to bringing the low back to the party in everything they do, aka moi, they’re likely to strain their lumbar muscles doing pilates. Indeed, now that I think about it, I do have trouble walking after an hour of roll ups and teasers. Gooo figure! So if you’re a pilates lover with low back issues, you might want to fix your back before swan diving into your next session. Yes indeed.

For some more thoughts on the relationship between pilates and back pain, check out this oldie but goodie from the Mail Online. Again, it warns of the dangers of doing pilates incorrectly but if you have back issues, that’s what you’re going to do! Unless you can afford privates with a specialized instructor. Preferably one certified in rehabilitation pilates. I cannot afford such a thing. At least not on top of my Alexander lessons. Ayayay back pain, you are costing me an arm and a leg.

[Shoulder pain? Meet your match.]

With his Topanga Canyon childhood, effortless style and multi-backslashed job title (Musician/Photographer/Director/Sound Mixer), Dustin Bath is an Angelino to the core. So it’s fitting that his own adventure in back pain (or shoulder pain to be specific) began on his surfboard. Now healthy and happy with a new band that is BLOWING UP, Dustin was kind enough to take ten from his busy schedule to share the details.

Tell us about your injury.

I injured my shoulder about three years ago. What happened was, after a week of surfing and working out at the gym, I decided to play some football at the beach and dove into the sand for the ball. I guess my shoulder didn’t like that and for the next couple of months, it was unusable.

[Keepin’ it real with a nonfat soy latte over ice]  

Did you seek treatment right away or grin and bear it for awhile?

I didn’t seek treatment right away. I thought that if I just rested it for a couple weeks, it would get better and it did get a bit better but would never fully heal. For the last couple of years, I have been constantly re-injuring it working out at the gym and surfing.  I pretty much would keep doing whatever I wanted until it was so painful that I couldn’t move anymore and then rest it for a month and do it all over again.  Finally about six months ago, I decided to try and fix it for good.

I know you tried a few different treatment options before finding what worked for you. Could you walk us through these?

I have tried tons of different things and people. Neuromuscular therapy, deep tissue/sports massage from a few different therapists, acupuncture, a personal trainer, and even went to see my regular doctor.

[Posing with the band — he’s the cool dude on the right.]

Finally, you found rolfing. First of all, can you describe it for us? What’s special about it?

I’m not totally sure on the definition of rolfing but the basic thing they believe is that when one area of your body is messed up, it will cause problems in other areas.  When they treat you, they don’t only concentrate on the area of injury but the whole body.

I discovered rolfing when I was on tour with the band and we stayed with a friend of a friend who turned out to be a rolfer. He took a look at my shoulder/arm and told me my injury had something to do with my bicep tendon pulling my arm forward in the socket and causing the pain. It was the first time someone really described the injury to me like that so I figured I should give rolfing a try.

When I was back LA, I asked my acupuncturist (very LA of me) and she advised me to see Harvey Ruderian in Santa Monica. Harvey actually studied with Ida Rolf, the creator of rolfing and he really combines rolfing with many other body work techniques that he has studied over the last thirty plus years.

[Rock the pain away]

How long before you started to feel the benefits of rolfing? How long did it take for a full recovery?

The benefits were immediate — after walking away from the first session, I felt better. I have been back for a couple more sessions but I was given advice by Harvey to stretch multiple times daily and that has really helped.  I wouldn’t say it’s a full recovery because I still have some tightness in the shoulder/neck but I have no pain and can surf five days a week with no problem,

How did your injury affect your life?

When I was in pain I couldn’t surf, go to the gym, I had a hard time sleeping sometimes and would wake up in the morning in excruciating pain. No fun!

[Loving the pain-free life with girlfriend Hannah]

Any advice for people dealing with chronic pain?

I think the most important thing is the person/therapist you are working with. Get a recommendation from a trusted source and if the first recommendation doesn’t work for you, try someone else and really explore every option before looking towards surgery. I have heard amazing stories of people healing really serious injuries through bodywork.

For more info on super-rolfer Harvey Ruderian, call his office at 310-656-8542.

For more on Dustin, check out his band, Early Morning Rebel or his own site, One Twelve Creative.