Effort vs Discipline: Creating a Sustainable Home Exercise Program

A sustainable movement practice is not about doing easy things- it’s about making difficult things easy, and even elegant.

Think back to a time where you may have had difficulty with the sustainability of your home exercise program. Perhaps you attended physical therapy for a while, but would not find time to practice your exercises at home. Or you did for a while, but after stopping therapy, the exercise routine started to fade away. Maybe you found you lacked the discipline or the motivation to perform the exercises regularly.

On the other hand, perhaps you had an exercise routine that was simply too much. You put in excessive effort into it, and you found that it was energy-draining, and perhaps actually felt worse after doing the exercise rather than better, and eventually you began to avoid it. These kinds of routines are not sustainable- they do not last over time. 

What are some keys to creating a sustainable routine to maximize the therapeutic effects? Finding the balance between effort and discipline is very important. We want to have discipline- the ability to train ourselves in a consistent, habitual way. However, we don’t want our movement routine to be overly effortful. If we put in too much effort into the movements, we won’t look forward to doing our routine, because it will drain our energy and not be very enjoyable.

You may recall that Feldenkrais-inspired movement lessons emphasize whole body coordination and thus the same action is now accomplished with LESS EFFORT -that is why, especially to children, highly skilled athletes make very difficult activities look easy!

Rather than striving for a strict discipline in which we force ourselves to go through effortful motions, how can we develop a sense of playful discipline, in which we regularly engage in enjoyable movements?

One mantra to consider is a little bit, very often, with ease. It can be difficult to develop a consistent routine in which we are engaging in movement very often. Some helpful strategies could be creating a safe space to dedicate to movement at the same time every day, perhaps first thing in the morning. This may start out as a very short time, five or 10 minutes, and may gradually expand as it becomes more habitual. Gentle movements should also be sprinkled throughout the day, especially during prolonged sitting. One might consider a reminder system such as a phone timer for a brief movement break each hour, or putting up sticky notes near the computer screen. After the initial growing pains of establishing these lifestyle habits of moving very often with ease, positive habits will be formed that will make it much easier to sustain these changes over time. 

An excellent way to build discipline and improve motivation is to focus less on the outcome, and more on the experience. For example, consider healthy eating habits. One strategy is to educate people on how terrible sugar is for you, and all the health benefits of green vegetables. This strategy actually might not be that helpful because it focuses too much on what we should and should not do. However, most of us have a tendency to crave things that perhaps we would be better off without. Only engaging in things we “should” be doing can be draining on our will power. A better strategy would be to fully engage in the experience of a positive health behavior. Take time to slow down and enjoy that delicious veggie bowl. Consider all the nutrients that soaked in from the soil and sunlight, the stunning visual of all the colors, the smooth or crunchy textures, the explosion of tastes in your mouth, and the embodied sense of nourishment after giving your body the building blocks it needs.

Now, apply this to movement! Try not to force yourself to do something just because you think you should be doing it. How can you fully experience the movement? What sensations can you feel? How might it be nourishing your tissues? What can you learn about your body and your tendencies while engaging in movement? What can you have gratitude for in regards to how your body functions? How might this impact the quality of your experience and your relationship with healthy movement practices- and your whole self?

Rather than striving for a strict discipline in which we force ourselves to go through effortful motions, how can we develop a sense of playful discipline, in which we regularly engage in enjoyable movements?

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

All About Awareness

What is awareness, and why is it important?

Awareness can be loosely defined as perception of a situation. If we are in a state of awareness, we are perceiving what is happening in the present moment with clarity. Focusing our attention into the present moment, also known as mindfulness, has been shown to improve our health and well-being in many ways. Randomized controlled trials have demonstrated that mindfulness interventions can improve pain for those of us suffering from chronic pain, and also may be helpful in the outcomes of stress-related illnesses such as PTSD, Irritable Bowel Syndrome and more.1

The state of our mind greatly impacts the state of our bodies. If our mind is frequently jumping around to anxieties rooted in the future or regrets from the past, it is likely that we are operating in a sympathetic nervous system state, which comes with the release of cortisol and adrenaline, contributing to tense muscles, rapid breathing, raised blood pressure, and impaired well-being. What we do with our attention has been shown to impact many physiological functions in our body- by training the mind to focus in the present moment, we can boost the vitality of our immune system, improve our cardiovascular health, support healthy sleep, deepen our relationships with others, and even increase longevity.2

How does awareness apply to movement?

By paying attention to movement in the present moment without being shackled by self-criticism and judgment, we can find joy and relaxation during our movement practice. By making movement a meditation, we can shift into a parasympathetic state of the nervous system, which is consistent with our relaxation response (decreased stress hormones, blood pressure, etc.) This is contrary to distracted movement in which we may be rushing, thinking about other things, and neglecting to respond to sensations in our bodies. Awareness during movement also facilitates learning: where attention goes, neural activity flows. By paying attention to how certain body parts are moving, we increase connections in our brain that help us to feel and move these areas, as well as integrate these body parts with our whole being. Attention combined with consistent practice over time can actually change our brain structures, facilitating healthy adaptations in our physiology and the ability to move with greater ease and efficiency.

Over time, awareness practices help to change the relationship we have with our body. Judgment, criticism, and fear begin to melt away, and are replaced with self-compassion, body wisdom, and enjoyment of moving for the sake of moving. By paying attention to our movement in this way, we can calm our nervous system, decrease pain, improve our movement, and turn a seemingly simple motion into a profound learning experience.

Well, what about when I’m doing other things? Do I always have to pay such careful attention?

An excellent question that many clients will ask. For most people, it isn’t realistic to be 100% attentive during every waking moment! With a Feldenkrais-inspired movement program you are improving old or learning new action patterns. By the very nature of engaging in challenging but not overwhelming movement patterns, you are stimulating the neuromuscular system in such a way that inherently brings us to an attentive state. And once that pattern has been established and repeated, myelin thickening around the nerves improves the responsiveness of our intent and subsequent actions, we no longer have to think about it so much, it becomes automatic.

A Mindful Movement Practice

Take a couple minutes to practice this gentle lesson:

Begin by lying comfortably on the floor with bent knees (or a bed if the floor is not accessible). Imagine there is a little clock underneath the back of your pelvis, with 12 o’clock pointing towards your head, and 6 o’clock towards your feet. Begin to tip your pelvis between 12 and 6. This pelvis tilt goes along with an arch of the low back towards 6, and rounding of the low back towards 12.

Rather than just going through the motion and assigning any judgment to how far you’re able to go in each direction, if you are doing it “right” or “wrong”, or what “benefit” this exercise might have, try to tap into your embodied senses. Notice any sensations you feel. Pressure? Tightness? Where exactly do you feel the sensations? Can you feel certain muscles engaging or releasing?

Is there a way to carry on the same movement but in a way that feels more comfortable or easy? What micro changes can you make to improve the experience for you?

Then begin to notice what is moving. We know the pelvis is moving, and the low back is as well. As you continue to move, what other parts of you seem to be moving or engaging? What do you notice in your hips? Rib cage? Head? What seems to be pressing down, and what is lifting up? Perhaps you notice that as you pay close attention to your movement, the more you become aware of.

References: 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613793/#:~:text=The%20effects%20of%20mindfulness%20on,and%20ultimately%20improves%20health%20outcomes).

2. https://health.usnews.com/wellness/for-parents/articles/2018-05-30/enhance-your-awareness-to-improve-the-well-being-of-your-family

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

Creating a Safe Space for Healing

Take a moment to reflect on a visit you have had with a provider (doctor, dentist, physical therapist, etc.) for an issue you have had. Consider if there has been a time where something did not feel quite right- perhaps you did not feel listened to or you were interrupted. Or maybe the plan of action that was suggested (medication, procedure, or exercise) did not feel aligned with your values, beliefs, or otherwise consistent with what you felt like the best treatment would be for your unique situation. What about the language, verbal and non-verbal, that the provider used? Did you ever feel talked down to, disregarded, or rushed? Were you treated as an equal player in your healing journey, or was your condition described as something that was out of your control, requiring care that only the practitioner could provide? 

The manner in which care is provided is extremely important, and is a significant determinant of the outcome that is achieved.

Unfortunately in our current healthcare system, there are several factors that can hinder the healing process. Aside from the Western mentality of treating symptoms rather than the root causes, the environment in which care is provided also plays a significant role in outcome. Many clinics are extremely busy, with therapists and doctors pressured to achieve unrealistic productivity standards. A shortage of practitioners as well as systemic issues related to the pandemic play into this situation as well. These factors will certainly impact a practitioner’s ability to provide their undivided attention and to engage in deep listening. In fact, the average amount of time before a doctor interrupts a patient is 11 seconds! For physical therapists, it is not much better at around 15 seconds. This leads to a sense of rush, and greatly impacts the communication and therapeutic relationship between patient and practitioner. In addition to time pressure, many clinics are set up to trigger our sympathetic nervous system (fight or flight) with bright lights, loud noises, and lack of privacy. Interacting with a rushed provider in this kind of environment instills a sense of unease within us as well, and can limit our ability to feel safe and comfortable.

At the Wellness Station, we take these factors into account. We recognize the importance of creating a strong therapeutic alliance, as the patient-provider relationship is an extremely significant element of the healing process. We strive to keep our environment conducive to healing by providing our care in a relaxing environment with appropriate aesthetics, adjustable lighting, and gentle background music upon request. We are able to provide individualized care for our patients for close to an hour every session without a sense of rush.

The environmental factors that we implement allow us (patient and provider) to operate in a parasympathetic state, the rest and digest division of our nervous system. This safe time and space allows our patients to feel comfortable letting their walls down and developing a trusting relationship with the practitioner. By creating this safe environment for healing, the patient and practitioner can dive deeper into the care that will be the most suitable, sustainable, and effective.

Consider these factors when you are engaging in your movement program at home or at a studio or gym. How is the environment affecting your ability to pay attention to your body and develop a positive relationship with yourself? What are some changes you might make to your environment to create a safe space and time for healing?

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

The Importance of Moving Slowly

When it comes to movement, and the way we live our lives in general, we all have room to slow down and exhale.

You may recall a learning experience in which your Wellness Station practitioner offered you the option of repeating a portion of a movement lesson considering various speeds, such as moving more slowly. Very often we will encourage our clientele to move more slowly than what is typical, which can be challenging and elucidating for many.

Why is it important to slow down?

When we are rushing, it is much more difficult to be embodied in our experience. We are less likely to notice signs of strain on our body tissues, and far more likely to revert back to habitual and stressful movement patterns without even being aware of what we are doing. By moving too quickly, we may miss the opportunity to improve the quality of those moves.

Think about a time you were at a grocery store and you may have been rushing around, trying to get in and out as quickly as possible. Did you forget something? Many of us have been in this situation, and may have even forgotten the very item that caused us to go to the store in the first place! Rather than saving time by rushing, we may have had to make a second trip back to the store to make up for the mistake. The irony of rushing is that it will ultimately slow you down. 

When it comes to engaging in movement, slowing down is extremely important. As part of your therapy at the Wellness Station, we begin to learn new movement patterns. Our job is to help you and your brain identify movement patterns that are less efficient, and develop new ones that are less stressful and more nourishing for your tissues. The purpose is not to practice what you already know, but to build more options in the way you move your body and engage with the outside world.

---

Mindfulness Movement Exercise

Take a moment to stand and walk around a little bit. As you do, choose one hand to make a light fist and continue to walk with that hand held in that fashion for 30 seconds to 1 minute, and then release that hand as much as possible. Which hand now feels more relaxed and free and easy? Is it possible that habitually you hold some extra tension in your hands and the contrast between purposeful tension and releasing informs your brain to release more fully? Many of us hold excessive tension in our bodies as we go about our days without being aware. By slowing down and paying attention during our daily movements, we can begin to let go of some unnecessary tension and begin to move with greater ease.

---

How can you learn something new unless you truly slow down? Consider learning a new language. If your French teacher spoke a mile a minute, would you have any clue what they were saying? It takes time and attention in order for our neurons to make new connections. Ever heard the phrase “Neurons that fire together wire together”? When we are engaging in new movement patterns, this is exactly what is happening. Neurons in your brain are beginning to “speak” to each other in order to create connections that can be utilized in the future. If the “speaking” is done too quickly, meaningful connections cannot be created or sustained, and learning does not occur. 

Slowing down also will affect our tendency to be kind and gentle to our bodies. If we are rushing, we will be more likely to force our body into a new movement pattern, rather than allowing our brain to lay down and incorporate new connections. Are you willing to be gentle and easy, or is your predisposition to develop frustration or put in excessive effort when your body doesn’t immediately respond? These factors affect the relationship we have with the tissues of our body, and can either perpetuate our patterns of stress and strain, or begin to foster a positive and deeply communicative and compassionate relationship between mind and body.

---

Mindfulness Movement Exercise

Take a few minutes to practice doing something much more slowly than you are used to. Consider engaging in mindful walking, perhaps just around the house or on a quiet trail. Walk very slowly, paying deep attention to the way your feet make contact with the ground, your sense of balance, the changing sensations in your body, and anything else that your mind is drawn to. How does this impact your experience of walking? what kind of connections might your brain be making?

---

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

Osteoporosis and Osteopenia: A Healthy Movement Practice

Are there any special considerations for a movement practice for someone who may be at risk of osteopenia or osteoporosis, or perhaps is already diagnosed with a condition of impaired bone density? 

Absolutely! One size does not fit all when it comes to movement, especially when it comes to protecting the integrity of our bones. At the Wellness Station with our Feldenkrais-inspired approach, it is our job to address osteoporosis and osteopenia with individually-crafted lessons that are unique for every individual. Factors that are important to consider throughout therapy are how to maintain and increase bone density, improve muscular strength and responsiveness, body awareness, and help prevent the risk of a fall or compression fracture.

Here are some key considerations when engaging in yoga or any movement if you are aware that you have decreased bone mineral density:

1. Communicate effectively with your body: 

When we move, we are engaging in a dialogue with our body. We initiate the movement, and it is our job to listen to how our body responds, and modulate our movement based on that response! In other words, what are the subtle signs that we can pick up when we are putting our body through strain? Do we notice when we are doing a forward fold that we feel uncomfortable pressure in our abdomen? Do we notice that the way we pick up a heavy object from the floor causes us to hold our breath and feel a sense of distress? If so, we have to change the way we are moving.

2. Modify movements that put excessive load on the front of the spine or neck of femur: 

The most common osteoporotic fractures are of the front vertebral bones in the low or mid back. Notice in this image the location of the compression fracture is in the front of the spinal bone towards the middle of the back. There are many types of movements that increase load on these bones, such as bending forward at the waist, as well as twisting and turning the body when bent at the waist. When engaging in movement that involves compression of the front spine, consider the load that is going through these bones, and be careful not to push or strain if any discomfort is felt.

Consider a forward fold. Especially if the hamstrings are tight, the spine may become very rounded in this pose, which can put extra load through the front vertebral bodies, especially if we are straining to try to get the hands to the ground.

When modifying your movement practice, consider the intention of the movement, and modify to match the intention but in a safer and more effective way.

The intention of a forward fold is to experience lengthening and relaxation throughout the back of the body, including the hamstrings, gluteals, and muscles of the low back, and the fascia (connective tissue) that runs down the back of our body.

Notice that in this movement sequence, these same intentions are met, but the spine is fully supported by the ground and we are able to move dynamically without increasing the load on the vertebral bodies.

The neck of the femur just below the hip joint is also a common fracture area. Be cautious about poses such as pigeon, as this position subjects that bone to a high amount of load. Many people practice pigeon in a very passive way, which is not helpful for strengthening the bones and the surrounding hip musculature.

Consider these hands and knees variations of pigeon pose. Notice that by performing this “wagging the tail” movement, we are bringing suppleness into the whole spine, and also challenging the weight-bearing leg (the leg that is down on the ground). Notice that “sitting back” into the weight-bearing leg is very similar to the “pigeon” position, but it is a dynamic rather than a passive movement. This challenge can stimulate bone density as well as improve strength and responsiveness of the supportive hip muscles including the gluteals and piriformis.

After you get the hang of wagging your tail, try to make circles! Notice the engagement of the entire body with this dynamic movement pattern.

3. Prioritize extension postures rather than flexion postures

Flexion-based movements such as forward folds are when the spine is bending forward, which puts more compression on the front of the vertebrae. Extension-based movements do the opposite. Also known as backbends in yoga, extension-based postures are very safe for those with bone density loss. Spinal extension helps to reverse the compression on the front of the body, and helps to strengthen the muscles that promote healthy posturing. 

Notice these extension-based movements performed while lying on the belly. This is an excellent way to build strength and awareness of the back side of the body. Notice the balance and stability that is created by performing these diagonal movement patterns  in which the right upper body moves with the left lower body, and vice versa.

4. Challenge your balance with ease and support 

Yoga can be an excellent tool for improving balance, but it is important to be able to maintain stability and ease throughout your standing practice. There is no point in practicing feeling unbalanced, so modify your practice to meet yourself where you are. If you are feeling too challenged and at risk of falling, then this is not doing you any favors. Maintain stability and ease by modifying and using props. My favorite props for balancing poses are the wall, chairs, and even the kitchen counter. By gently contacting one of these props with a hand, we can maintain groundedness, and correct ourselves more easily if we begin to lose our balance.

Notice the use of the wall as a prop to perform this standing side bending and circular movements. This sequence is the same as what we did on hands and knees, but now in a standing position. As balance is a dynamic process, adding movement is more helpful for improving balance compared to holding a static position such as tree pose. Additionally, the weight-bearing leg is being stimulated in a way that will help improve bone density and strength. This is also a great way to warm up the body before further activity such as going on a jog.  

At The Wellness Station, we will help you become aware of habitual movement patterns, yoga poses, and lifestyle factors that may be affecting your bone density and risk of fractures. We will help you develop or modify your movement practice with considerations of your individual needs, medical history, and goals. Every day is an opportunity to get to know your body on a deeper level in order to stay active, healthy, and strong, even with osteoporosis.