Feldenkrais, Health and Wellness
Lorraine Davis
Mindful Movement at The Wellness Station

Find out more about how you can participate in the mindful movement classes offered at The Wellness Station, including Breakout Yoga and Awareness Through Movement.

Mindful Movement at The Wellness Station
Feldenkrais, Balance
Lorraine Davis
Balance For Life

Balance tends to decline with age and inactivity. Do not let these difficult circumstances affect your balance and increase your risk of falling. Follow this blog to gather insight in the mysterious systems that allow us to maintain our balance, and learn more about the services The Wellness Station offers that can help enhance these systems.

Balance For Life
Lorraine Davis
My Journey to Embodiment With Feldenkrais 
My Journey to Embodiment With Feldenkrais 

Healing Pain

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Jill’s Journey Through Back Pain: A Case Study Part II

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In the previous blog post, we introduced Jill and described her journey with back pain. Now we will discuss more specifically the approach we used to help her navigate this complex situation. 

As the Wellness Station is a holistic practice, Jill’s plan of care was based on the biopsychosocial approach. This means that our care integrates factors related to biological/tissue structure and function, as well as psychological and social factors. Our approach is inspired by the Feldenkrais Method of somatic education, as well as therapeutic yoga, mindfulness, and traditional physical therapy.

(For further understanding of the biopsychosocial approach to pain, check out the following two previous blog posts: Does How You Think About Your Pain Affect Your Pain? & A Holistic Approach to Pain Science)

Bio

In collaboration with Jill’s referring provider, we made sure that Jill was managing pain most effectively with the lowest possible therapeutic doses of medications with the least potential for adverse effects. Jill’s goal was to get off medications for good, as she did not want to rely on them over the long term for pain management. 

We also ensured that Jill was consuming a nutritious, whole-food diet to support an internal environment conducive to healing (she adopted an anti-inflammatory diet similar to the Mediterranean diet). 

The bulk of our treatment approach focused on movement patterns that were likely putting additional strain on the injured tissues. Jill was extremely sensitive to bending movements, as well as prolonged sitting. Using biomechanical principles, we broke down patterns of spinal flexion and extension necessary to bending and lifting, and provided opportunities for neuromuscular learning- new strategies of bending that felt more comfortable, efficient, and less stressful on Jill’s back. This generally involved keeping Jill’s center of gravity over her base of support, sending her hips back to counterbalance her reach, and lifting objects with the strongest muscles of her core and legs.

Jill began to practice picking objects up in her daily life using new techniques, and eventually picked up her two year-old granddaughter in her new and improved way! 

We also provided education about posture and the importance of changing position throughout the day, especially during prolonged sitting. Jill found that a children’s ball placed behind her back in her chair was incredibly helpful for back support, as well as performing small, regular movements of her pelvis, hips, and spine known as the pelvic clock. 

See How Your Spine Moves Part I and How Your Spine Moves Part II for some ideas on what Jill learned here.

Psycho

Psychologically-informed care was necessary for Jill’s treatment approach. The grief from the loss of her husband was affecting her more than she cared to admit. She also recognized that a fear of aging and loss of confidence in her own body’s resilience contributed to a sense of hopelessness. Addressing these factors allowed Jill to further align with her goals, and she was able to instill a sense of self-compassion into the rhythms of her day. Combined with education on the psychology and neuroscience of chronic pain, as well as a daily practice of mindfulness meditation, Jill was able to insert a mindful influence on her pain. She recognized that by shifting the way she thought about her pain, her back, and the active role she could have in her own healing, she was able to take control of the situation more effectively. This helped her body and mind to begin to function more as one.

See Mindfulness and Movement for more of an idea on how we integrated mindfulness and self-compassion into Jill’s therapeutic care.

Social

Without others, we are lost. By creating a strong therapeutic alliance, Jill and I were able to work together on an even playing field. Unlike previous therapies she had been to in which an authoritarian figure prescribed what she should do for her back, Jill and I collaborated as a team, along with her physician. This feeling of support improved Jill’s confidence in her providers, as well as in herself as a necessary member of the team.

See Enhancing the Therapeutic Alliance for more information on the importance of the relationship between the patient and the provider.

We also addressed Jill’s social life and relationships with others. We encouraged her to seek support from her daughters and her friends. Jill began to feel more comfortable asking for help. She also began to go on regular walks with her friends, which she realized was very helpful for her back and much more enjoyable than walking alone. 

A Whole New Jill

Clearly, Jill’s issues were not just in the tissues. The tissues in the back are part of a living, breathing, thinking, feeling, moving organism. Any persistent pain or mobility challenge is multifactorial. Throughout the healing process, the biopsychosocial approach was taken in order to holistically Jill’s issues.

As mentioned previously, Jill is now back to rowing, walking with her friends, strength training with weights, and playing on the floor with her grandchildren!  This has further motivated her to continue to stay active and improve her life and her movement capabilities. She feels that she has gotten her life back!

“In the last eight months, I have shared my experiences with friends and shown them some of the simple movements. I have traveled, concerned I would re-herniate a disc. Not. That truly felt like success. I now know that this process takes time and patience but it is well worth the investment.”

Jill will occasionally experience instances of increased pain. However, these instances are drastically different from the flare ups of the past. They are far less frequent and less severe, and do not bother Jill as much emotionally. She also has much more clarity as to why the flare ups are happening, based on what she has or has not been doing.

Jill no longer sees pain as the enemy, but rather as an informant that helps to guide her actions. She recognizes that pain is inevitable for us all, but how we believe and behave relative to our pain can make all the difference.

Jill has the tools to manage and diagnose how to treat her pain, and she still does a monthly check in at The Wellness Station for support and for a review of movements and techniques.

Jill had an extremely active role in her healing journey, which will be a gift that keeps on giving for the rest of her life.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

Images: 

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Jill’s Journey Through Back Pain: A Case Study Part I

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Who Is Jill?

When Jill first presented to the Wellness Station, she described her life as “a mess” and felt skeptical that another attempt at physical therapy would make any kind of difference. Jill is 75 years old and had stayed generally active with outdoor rowing and exercising with weights. However, Jill has experienced recurrent bouts of debilitating back pain over the last 15 years, which tended to set her back for quite some time. She had been to physical therapy several times, which never made any long-lasting difference for her.

Jill was having an extremely challenging year. She had become more sedentary during the pandemic, as she did not feel as comfortable working out with her personal trainer. She lost her husband, her lifelong best friend. On top of this, her sister also lost her husband around the same time.

While at her sister’s house to support her both emotionally and physically and to re-organize their house, Jill suffered a severe back injury. A herniated disc in her lumbar spine became sequestered, and the sequestered disc fragment led to nerve compression. Jill began to experience severe back and leg pain, which was constant and severe. She had herniated several discs in the past, and she described this pain as far worse.

Jill went through a course of traditional physical therapy and described it as follows:

““It was very modest stuff. I felt like there wasn’t much of a progression, and it wasn’t as individualized as I would have hoped. They might have used the same printable exercises as any other old lady with back pain!” ”

Jill Finds The Wellness Station

Jill was referred to the Wellness Station four months after her sequestration injury, and was still experiencing constant, debilitating pain. In coming to the Wellness Station, Jill hoped for improvement but wasn’t sure what to expect. Her goals were to improve her fitness and build her core strength in order to be active, independent, and play with her grandchildren- however, she was beginning to lose hope that any of this would be possible.

““In the first session, I found Jacob Tyson to be an exceptional listener as I outlined my back pain history, the recent event and goals. The room was calm as was his demeanor that set a relaxed tone.””
““I still was puzzled in the first few sessions that focused on just a few movements or exercises to establish what is called the pelvic clock. But at each weekly session, the new movements built on the previous week, a method I could appreciate as a former newswriting instructor, teaching the basic journalism language and incorporating more concepts and practices as students learned newswriting style.” ”

Jill Turns the Corner, & Beyond! 

As we worked together over the course of weeks to months to a year, we gradually progressed Jill’s home exercise program by introducing new movements, slightly more challenging than the week before. We continued to layer on educational and lifestyle components that were related to Jill’s life, including concepts of biomechanics, anatomy, exercise physiology, psychology, mindfulness, pain neuroscience, and more.  As Jill continued to learn and build her strength and confidence, she has been able to do more demanding physical tasks without any increase of pain.

“ “Through the sessions, I learned how to stand up and walk in new ways, to use my legs and tailbone to shift weight, to improve the flexibility of my entire spine—all aimed at relieving the pressure and weight on the lumbar part of my spine. We also did relaxation and simple meditation to promote mind-body connection. After each session, I received an email, summarizing our activity. I have compiled all those exercises and support into a file that I can use to refresh my memory of exercises—and to see my progress.” ”
““The knowledge and movements I learned gave me a feeling of accomplishment and control over the mechanics of my body. Usually an exercise or stretch would relieve the pain, and I did not take any medication. A triumph!” ”

Jill is doing much better today, and feels that she has gotten her life back. She no longer feels limited by her pain, and feels empowered to stay active and engaged in life. She is now back to rowing (weather-permitting!), going to the gym twice per week, and having no trouble lifting her quickly growing grandchildren!

Jill also improved on the Modified Oswestry Disability Index (a survey used to measure the impact that back pain has on quality of life) from a 58% to a 12% over a period of six months, which is over four times the threshold of clinically significant improvement. 

Stay tuned in to see our next blog post, which will break down more specifically what we addressed with Jill biologically, psychologically, and socially.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

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You Can Break the Cycle of Chronic Pain!

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It’s All In Your Head: Your Brain & Pain

Many of us who experience pain might feel very offended if we were told that this pain was all in our head. However, all pain, as well as any other sensation, is created by the brain. This is because pain is a perceptual process- the experience of the pain is not actually happening in the part of your body that hurts, but rather it is happening in your brain. Sometimes this perception of pain can be a very useful process (Ouch, I just touched a hot stove, let me move my hand away as quick as possible!), but when it comes to chronic pain, this process can severely impact our quality of life.

In cases of chronic pain, the brain tends to get hypersensitized to the pain until we are in a constant state of high alert. A learning process occurs in which neural pathways involved in pain perception of a certain area (the low back, for example) become strengthened. The neural pathways responsible for chronic pain experience go far deeper than our acute pain pathways, such as in the stove top example. This is because over time, the neural pathways related to the chronic pain will be embedded into the memory and emotional centers of our brain, making chronic pain far more complex than pain from acute injuries.

As with any learning process, we form associations, such as... sitting = pain, long car rides = pain, exercise = pain. These associations can contribute to a self-perpetuating cycle in which we avoid certain activities because of the fear of pain, which decreases our quality of life, thereby contributing to depression, inactivity, limited social participation, and other factors that will actually make our pain worse over time.

How do we break this vicious cycle?!?

Pain is our brain's opinion of how much danger we are in, and we have to change that opinion. Our brain was capable of establishing these detrimental neural pathways that contributed to the chronic pain, and it is just as capable of creating new pathways that will help us get out of this situation. This is because our brain remains plastic for our entire lives, meaning we are always capable of learning. We must learn that we are safe, and that movement of the affected body part is safe and beneficial.

At The Wellness Station, we help those in chronic pain learn that they are safe.

By creating individualized movement programs, we help our clients learn ways of moving and relating to the body in a manner that will drive neuroplasticity. We will help to teach the little person in the control room (aka your brain) that movement can be associated with calm, pleasure, and ease, rather than movement = pain. The movements lessons are designed to help our clients move with greater efficiency to make movement easier and to decrease tension and tissue strain. We will also help with self-care tools necessary to calm down the nervous system to decrease pain sensitivity, and provide guidance regarding management of the psychosocial aspects of living chronic pain.

Do not let pain stop you from living life to the fullest. It is never too late to learn!

Written by Jacob Tyson, DPT - Physical Therapist,Yoga Instructor and The Wellness Station Team

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Exercise and Chronic Pain: A Guide

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It is well known that exercise is an extremely beneficial activity that can elicit substantial improvements in many different measures of health, well-being and fitness.

Exercise is a broad category, as there are many different types and manners in which exercise can be carried out. (See Movement, Physical Activity, & Exercise blog for more information.)

There are many factors to consider when determining what kind of exercise might be best for an individual. These individual considerations might include health conditions, fitness level and experience with exercise, injuries, goals, cultural factors, socioeconomic status, access to safe spaces to exercise, personality, and the existence of chronic pain. One size does not fit all when it comes to exercise.

At the Wellness Station, we provide holistic care based on the biopsychosocial model, which takes these differences into account to create individualized movement programs.

 Can Exercise Help with Pain?

Pain is an extremely complex, subjective experience, it is difficult to apply generalizations to this topic. That being said, exercise can be extremely helpful for individuals with chronic pain for several reasons.

  • However, individuals with chronic pain may become more physically inactive which may be due to fear-avoidant behavior (they may avoid movement for fear of triggering their pain), depression, or many other reasons.

  • Inactivity can make chronic pain worse, as the tissues of the body will become deconditioned, inflammatory processes may increase, and weakened tissues may become more likely to be irritated and strained from acute stressors.

  • Exercise, when performed appropriately, can have tremendous health benefits for all individuals, those with chronic pain included. Engaging in intentional exercise can help improve metabolic, cardiorespiratory, and musculoskeletal functioning, and also triggers the release of endogenous hormones (endorphins) that help us to feel good and decrease our sensitivity to pain.

  • Exercise can improve the confidence we have in ourselves and in our painful body parts, which can also help with our experience of pain. This confidence helps us feel empowered to make positive changes, and less limited by fear of movement.

  • Targeted exercise can help to nourish tissues with fresh blood and nutrients and  improve tissue strength and resilience.

It is clear that exercise is helpful for pain both directly and indirectly, but one must consider how exercise might be applied differently for someone experiencing chronic pain compared to an individual using exercise solely for fitness gains.

An Exercise Program with Chronic Pain: Factors to Consider

 The interventions chosen at the Wellness Station are highly individualized, as the intervention will depend on the unique characteristics of the individual.

  • The individual will be encouraged to be generally more active in physical activities that are enjoyable and do not trigger pain.

  • If the activities (such as walking) do trigger pain, it is a matter of changing the movement patterns involved in the activity. Often, people with chronic pain experience a pain pattern during specific activities because they have adopted compensatory, stressful and inefficient movement patterns. Unless these patterns of movement change, the pain cycle may continue. It is our job at the Wellness Station to identify these movement patterns and help you to change them.

  • In addition to changing movement patterns, we can also make changes in the parameters of the activity (including the frequency, intensity, or duration of the activity). For example, engaging in several shorter walks throughout the day rather than a longer walk, if long walks trigger pain.

  • The individual will learn not to push into pain, as this oftentimes will reinforce the pain pattern, contributing to flare ups. Rather than pushing into pain, the individual should learn how to listen and respond to the pain, as pain is your body’s way of communicating information to you. Contrary to the popular mentality of “no pain no gain”, “it’s got to hurt to be effective” when it comes to exercise, if you want exercise to be helpful for your pain you must take a different path.

  • The movement program should also include specific, intentional practices that directly and/or indirectly involve the affected body area. If low back pain is the problem, the movement program will most likely involve the low back, whether that is performing movements that improve mobility, strength and control of the low back, or perhaps improving the movement capacity of a related body area (e.g. mid back or hips) to help spread out the forces of movement over more of the body. Engaging with the involved body part in this way is helpful not just biomechanically, but also psychologically, as it will improve the confidence you have in this area.

  • The movement program for an individual with chronic pain will likely be progressive, meaning it will increase in complexity over time, but the progressions will often be much more gradual than a program that is more oriented towards fitness gains. The parameters of the program and the decision to progress will be based on evidence of neuromuscular learning, comfort, and effect on the pain pattern. By contrast, progressions for a program solely for fitness would likely be based more on the subjective challenge of the activity (e.g. it begins to feel too easy).

Enhance your Fitness for a Better Life

Physical fitness can be described as the ability for all body systems to work together in order for us to maintain health, and perform daily tasks with ease. Strength, balance, agility, cardiorespiratory endurance, and body composition are all components of fitness. It is extremely important for all of us, including those of us with chronic pain, to maintain our fitness through exercise. As we age, it becomes harder to maintain our fitness, as our muscle mass and bone density begin to fade unless we regularly strengthen ourselves. Maintaining and enhancing our fitness will help us stay independent, active and involved in the activities we love, while helping us avoid falls, fractures, metabolic diseases, and more. Pain is often a huge barrier that discourages people from exercising, so addressing the pain as described above can contribute to improvements in fitness overtime.

At the Wellness Station, we use movement to empower people with and without chronic pain to take control in order to live happier, healthier lives.

Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5461882/ 

  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491894/ 

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Top-Down vs Bottom-Up Processing: Applications to Movement and Pain Science

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Top-down and bottom-up processing are ways of interpreting stimuli

Top-down processing refers to the utilization of previous knowledge, beliefs and expectations (existing schemas) in the perception of incoming stimuli. The higher levels of our brain make judgments about what we are experiencing based on past experiences.

Bottom-up processing focuses on the incoming sensory informationin real time, and does not require prior experiences. It relies on raw data from our sensory organs, which then transmits information to our brain which perceives the information. 

In other words, in top-down processing our higher brain directs our body. Your higher brain creates a story, and can tell your body what to do. In bottom-up processing, the body is informing the higher brain, which has no reliance on our preconceived ideas.

How might these types of processing relate to the development of pain behaviors?

**We have written several articles related to the neuroscience and psychology of chronic pain. Please browse our previous blog posts for a deeper dive on this topic.** 

Consider an injury in which someone bends over, picks up a box, and injures their back.

  • During the injury and for a short time afterwards, bottom-up processing would contribute to the pain experience.

  • Nociceptors in the injured tissues would send signals to the brain, which we would experience as pain. From the bottom (body) up to the top (higher brain), we are receiving sensory information that we perceive as pain.

Now consider the top-down processing that might occur for hours, days, weeks and months following this injury.

  • The higher brain might begin to tell stories and our behavior might change accordingly. “Bending over is dangerous”. Based on the past experience of pain with bending over, this activity is now associated with pain and fear- therefore, we avoid it.

  •  “I am weak, and cannot pick up anything heavy”. The emotional circuits of the brain are engaged, and a story is created about core weakness, and further avoidance of activities that involve picking up objects is perpetuated.

  • “I should be lifting like this, not like that”. A superimposed idea of keeping the back straight and bending only from the legs leads to a change in movement patterns, which may or may not be beneficial for that individual.

  • Now, whenever the back is bent in the future, the movement is deeply associated with pain and fear. The tissues that were originally injured might be healed, but weakened. The top-down processing that occurred after the injury may contribute to the development of chronic pain and disability.

Our work at the Wellness Station involves recognizing these movement patterns and behaviors that are habitual, and may be dysfunctional, stressful, or inefficient. We help you relearn how to move safely, comfortably, without limitations from fear or less than optimal movement patterns.

How does this relate to movement and exercise?

Many clientele will ask questions or otherwise indicate that they are functioning primarily in a top-down state. This presents as trying to do the exercise “correctly”, focusing more on what someone might observe from the outside-in rather than from the inside-out.

In order to optimize biomechanically-efficient movement patterns, there must be an interplay between top-down and bottom-up processing.

During a movement, the person might explore based on instructions from the therapist, previous experiences, or trying out various options. The higher brain might be saying “now listen to what your glutes are telling you when your feet are placed that way, and then compare that with the sensations, from the bottom-up, when you place your feet in a different way.” 

Consider the pelvic clock: Lying on back with knees bent, roll your pelvis towards 12 o clock (towards your head). Do this several times. Notice if you are pushing down through your feet as you go to 12. If not, try pushing down through your feet. Now bring your hands to your glutes (buttock muscles). When pushing down through your feet, observe that your glutes will contract. When not pushing down through your feet, observe that your glutes will not contract as much. The instructions “engage your glutes” would be top-down, and the instructions “observe what you feel in your glutes when you press through your feet” would be bottom-up. You could also observe differences in how your glutes are engaging when you place your feet closer or further from your bottom, or closer or further from each other.