Holistic Body

Reversals: What and Why?

Reversibility is the ability to stop, start, and change the direction of a motion at any point in time.

According to Moshe Feldenkrais, the ability to perform reversals is a key indicator of well-organized, refined movement. When performing a movement, consider your ability to turn around and go the other direction, pause, or do something else. When our reversibility is impaired, it indicates a lack of freedom to change our minds or to respond to changing circumstances. This can be evident in certain functional movements: can we sit down in a chair or get on the floor slow and controlled, or is there a plop? When attempting to change the direction of a movement (e.g. pelvic clock circles), are we able to find a flow or is there jerkiness and incoordination? Can we walk backwards? 

Reversibility is not just a movement, but a state of existence.

Our ability to be spontaneous, go with the flow, adapt, maintain presence and freedom of choice. An ability to perform reversals indicates that we are not moving on autopilot, but have a keen sense of what and how we are doing something in the present moment. When we reverse, we are traveling the same territory but from a flipped perspective. In the muscular system, what primarily for a particular muscle or muscles has been a concentric action (muscle shortening under tension) will become an eccentric action (muscle lengthening under tension). As mentioned above, “sit to stand” is a concentric action, and “standing to sitting” is an eccentric action. When we purposefully choose to reverse, it provokes the cognitive process of attentiveness, comparing and contrasting. This is one of the key requirements for learning.

When we use movement to enhance our learning, the quality of our lives can expand.

As we go through life, there may be a gradual tendency towards settling into our habitual patterns, and an associated loss of spontaneity, functional mobility, and options for how we move and engage with ourselves and the world around us. We may not be able to respond as quickly to the demands of the situation, like needing to step back quickly to avoid an oncoming vehicle while crossing the street. Or we may lose the agility required to turn around when we forgot our keys, and instead of taking one step backwards, we may need to take several small steps to turn ourselves around. The person who has difficulty with these reversals is much more vulnerable to falling when they do have to turn around quickly. Practicing reversals helps us learn more about how we move, and can expand our movement repertoire so we have more options available to us. We certainly do not want our only option to be able to plop down into a chair each time, rather than gracefully descending in any way we choose. Reversals are a key requirement for developing and improving balance, agility, neuromuscular control, and eccentric strength. In fact, dynamic balancing is essentially reversals in action.

Practicing reversals

Walking backwards

Walking backwards is a task that may have originally been easy, but perhaps can become impaired over time. If unsteadiness is present, perform this practice next to the kitchen counter or back of the sofa to have something to hold on to as needed.

Simply start by walking forwards slowly, paying attention to how your body moves, how the feet make contact with the ground, etc. Then, reverse it. Walk backwards, comparing and contrasting this experience to walking forwards. 

Check out this article that dives into the health benefits of walking backwards.

Focus on the eccentric

Bring attention to the lowering component of a movement, whether this is in strength training or daily life.

A simple example is to practice standing up from a chair, paying attention to how you do this. Then, try to sit down the same way in reverse, challenging yourself to lower down slowly. Compare and contrast the process of standing and sitting in terms of the mechanics of the movement as well as the sensory experience.

If strength training is part of your routine, pay attention to the lowering movement such as the descent into a squat, the lower of the weight during a bicep curl, or the lowering of your chest towards the ground during a push up. Try to refine the control of the movement, with the ability to slow it down, pause it at any moment, or reverse the movement at any point in time. Also, in a safe manner, practice some reversals quickly, because sometimes that is what life demands!

Yoga Transitions

If yoga is part of your routine, tune in to the transition between two poses.

A simple example is cat and cow, which involves reversing between spinal flexion and extension. Tune in to the exact moment of transition, and explore reversing the movement at different speeds, and at different phases of the motion (e.g. can you do the cat cow in slow motion, and switch between cat and cow through variety of ranges, rather than going all the way into the full expression of cat pose before transitioning into cow?)

This can be applied to any transition in yoga (or life off the mat). Get creative with it- pick any two yoga poses, and explore a variety of transitions between the two shapes.

Explore Your Own

Enhance your sense of spontaneity and exploration by bringing reversals into your daily life.

Perhaps make up a dance move. Practice the move again and again. Then, try reversing the move, as if someone recorded you and played it in rewind. Or, take an everyday task. Reaching for a glass. Can you pause as you reach, and reverse it? Repeat this, reversing the movement at various stages of the reach.

Notice if this brings any greater sense of awareness of your movement and ability to choose different options for how to reach for something. And notice how much more confident you will be crossing a street when an unexpected vehicle requires you to take a very quick step backwards.

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

Posture Part I: Does It Matter?

Posture is an extremely complex and nuanced subject that often gets oversimplified into “good” and “bad” posture. What is posture, and is there such a thing as good or bad posture? How much does posture matter when it comes to comfort, function, and overall well-being? 

Posture vs Acture

There is no one “correct” posture, as our bodies are dynamic, and it is literally impossible to stay in the exact same position if we are alive and breathing. The position that we are in depends largely on our environment and situation in real time. Moshe Feldenkrais encourages paying attention to dynamic posture rather than static posture. Feldenkrais uses the word “acture” as an alternative to posture, which he defines as the “ability to move equally easily in all directions without additional preparation for action”. This action-oriented word is perhaps a better description of human function compared to considering static posture. Our nervous system should allow us to be adaptable, changing our position quickly and easily depending on the demands of our environment. To achieve this, we need efficiency. It is not efficient for us to hold unnecessary tension in our backs to achieve an arbitrary “correct” posture, as this tension uses energy, is uncomfortable, and does not allow movement in any direction at any time. It places excessive and unnecessary forces across joints causing joint and tissue stress. Living in the other extreme of a slumped, folded-in posture is also inefficient, as this limits our readiness for action and can decrease spinal mobility over time. A sign that the posture (aka acture) that you are in might be inefficient would be the development of discomfort after sitting, standing or moving about for a while, indicative of musculoskeletal strain.

“Good” vs “Bad” Posture

A lot of our ideas about posture come from society, our parents, even teachers at school. “Stand up straight, shoulders back.” “Don’t slouch.” Beliefs like this cause us to work hard to try to keep an artificially straight spine, which we associate with “good” posture, and as soon as we stop paying attention to it we will slip right back to where we were. Our spine is not meant to stay in one effortful position for a long time, as this requires certain muscles to be working hard to maintain the position, thereby limiting our acture. Rather than muscles having to tense to maintain our posture, our spines should be able to “stack”, like a column of blocks with minimal muscular effort. When that is the case, each of our bones can receive support from the bone from below, rather than relying on muscles to maintain posture. (It should be noted that the spine is not exactly like a straight column of blocks, as we have a natural curvature inwards at the low back and neck, and outwards at the mid/upper back). Unfortunately, many people begin to lose this effortless stacking, and more effort becomes required to find an upright carriage. 

As we age, many of us begin to adopt a forward flexed posture known as kyphosis, characterized by an exaggerated rounding particularly of the thoracic spine. This condition and associated loss of spinal and rib cage mobility, contributing to increased strain on the musculoskeletal system and thereby impairing functional mobility (e.g. balance and agility, reaching overhead, turning with ease, lying prone). Kyphotic posture can even compromise our respiration, making it difficult to breathe deeply and effortlessly. This forward flexion is what many people consider to be “bad” posture. These changes happen very slowly over time, and sometimes we don’t realize it until we see a photo of ourselves perhaps at a wedding, or someone we haven’t seen in a while makes a comment about our posture. The posture in the moment is not what is “good” or “bad”, but the issue lies much deeper than surface level in how we developed habitual postures over time, and if we have lost the ability to effortlessly achieve different postural options.

Posture and Pain

Many people associate their pain with their posture, or their posture with their pain. The chicken or the egg relationship may be unclear in many cases- are we adopting a posture because we are in pain, or are we in pain because of our posture? The relationship between posture and pain is extremely nuanced and depends on many individual factors. However, the relation is clearly present and worth investigating for those of us with pain influenced by prolonged sitting and standing. Check out this research study to learn more about how postural awareness and pain are related. The researchers found a clear association between self-reported postural awareness and clinical symptoms in people with chronic spinal and shoulder pain. In conclusion, they found that improvements in postural awareness facilitated by participation in activities including mindfulness training, yoga, and qi-gong were longitudinally associated with reduced pain.

Inefficient Postural Tendencies: How did we get there?

It is not the posture itself that is good or bad, but rather how we got there. A person who spends some time slouching is probably not harming themselves in the moment, unless pain is present. However, is slouching the new normal, with spinal stacking no longer feeling easy and natural? Does slouching become the only option as time goes on and the joints and tissues become habituated to this set point? Is posture a source of frustration and having a negative impact on confidence and self-image? Is the habitual posture associated with pain, discomfort, impaired breathing, and a decline in functional mobility? If so, the posture has become a problem. 

Dysfunctional postural tendencies can happen over time, and can be influenced by many factors. Some people tend to gravitate towards certain postures more on a subconscious level, based on their own personalities, confidence in their bodies, insecurities, histories of trauma, lack of body awareness, and internalized societal norms. Other factors that can contribute are our society’s lack of celebration of embodiment, comfort, and regular mindful movement, and tendency towards encouraging productivity above all, disconnection from our bodies, and sedentary behavior. Additionally, our life is becoming increasingly lived within the context of an extracorporeal two-dimensional world that is situated below and in front of us, thereby facilitating a forward-flexed posture (smart phones and computers). Over time, our physical structures and nervous systems become very much habituated to our go-to postures, creating a negative feedback loop that makes it increasingly more difficult to achieve a variety of efficient postural options.

Where To Go From Here?

To answer the question of Does posture matter?, the answer is certainly yes. However, posture can not be simplified to good vs bad, as such a complex subject requires multifactorial considerations. Becoming more cognizant of your habitual postures and implementing strategies to improve your body awareness, movement hygiene, joint mobility, and sitting strategies can all be very helpful in improving posture or preventing postural decline. Tune in to the next blog to learn some practical strategies to bring into the rhythms of your life.

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

Chaos Vs. Rigidity: Finding Your Balance

All of us live our lives on a spectrum between chaos and rigidity. Some of us tend to live more in a state of chaos and constant change, while others tend to live with more rigidity and stagnation. If our life is overly chaotic, we may live in a constant state of fear, anxiety, hyperactivity, and reactivity. On the other hand, if we are too far on the rigid end of the spectrum, we may become inflexible, resistant to helpful changes, and even close-minded. We might have certain contexts within our lives that are towards one extreme or the other- chaos in our work life, rigidity in our home life, or vice versa. Perhaps we subconsciously bring structure and rigidity into one aspect of our lives, such as our fitness routine, in order to balance the chaos and unpredictability within other aspects of our life. 

Daniel Siegel, M.D., described this spectrum in his book Whole-Brain Child. Because living on either end of the spectrum can be problematic, it is important to find integration, or a harmonious place somewhere in between rigidity and chaos. This finding of balance can be described by considering floating down a river in a canoe. On one side of the river, there is no flow, only still stagnant water. This side represents rigidity- it is safe and predictable, but unfulfilling and devoid of energy. On the other side is white rapids, rocks, and dangerous currents. This side represents chaos, overwhelm, constant change and even danger. In this extreme, we can lose our footing and get lost without any sense of control. A good place to be is the center of the river. This area is a system that has flow and energy, while still allowing us to maintain a sense of control. This allows us to explore, experience new things, learn and grow. How can we find this in our lives?

It is important for anyone to practice self-study, which in yogic philosophy is known as “svadhyaya” (sva meaning “own” or “self”, adhyaya meaning “lesson” or “study”). Can you feel when you are moving more towards a state of chaos, or stagnating into rigidity and mindless repetition? Our emotional state can be an excellent barometer of where we are at. In the middle of the two extremes we find a state of flow, in which we experience the most joy, discovery, and creativity. We should all seek to build a resilient self in which we are strong and stable, but also adaptable, flexible, and open to positive change. 

Our self-care and movement practices are excellent strategies to direct ourselves towards this state of balance. The low hanging fruit is… are we taking care of ourselves? Are we sufficient in sleep, nutrition, hydration, movement, relaxation, and social connection? What are we doing a little too much of, and what are we doing not enough of? Within the context of our movement practice, we can find even greater finesse.

Consider the following: 

During many functional movements, we have to find a balance between mobility and stability, which can be likened to chaos and rigidity, respectively. Our hips are essential for providing mobility (ability to move in all directions) and also stability (ability to maintain or control joint position). If our hip has too much mobility and not enough stability, our movement would be out of control (chaos). If we have too much stability and not enough mobility, our movement would be stiff and inefficient (rigidity). The middle of the river is an excellent place to be, which allows us to move with both fluidity and strength. 

Consider the examples of unilateral movements in our previous blog. The single leg stand to reverse lunge is an example of how the weight-bearing leg must stabilize, but also allow for controlled movement to occur. A similar phenomenon happens every time we walk, go up stairs, and even kick a ball. Our weight-bearing leg must provide stability so we do not fall or strain our tissues, while also allowing our pelvis to move relative to our thigh bone, so we can move and participate in life. Consider this “movement snack”. Can you feel how the weight-bearing leg is controlling the movement with a balance between mobility and stability? When the stabilizing leg is well organized for mobility, that is referred to as skilled movement, and is a necessary component for moving with efficiency and ease. 

At the Wellness Station, we will help you become more in tune with your natural rhythms, and provide opportunities to help you find your balance between chaos and rigidity. 

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

Walking Your Way to Better Health

It’s no secret that walking is good for you.

A natural and low impact activity that helps us connect more deeply to ourselves, others, and the world around us. Walking has been shown time and time again to boast some magnificent health benefits. The benefits tend to rise and peak around 10,000 steps per day, but any amount of walking is infinitely better than none. Research studies have demonstrated that regular walking can reduce the risk of heart disease, cancer, dementia, hypertension, and much more. It can also boost mood and mental health, bone density, balance, and aerobic fitness. Walking is great for your brain! Especially when done in new places, walking can promote neuroplasticity, bringing about remodeling in the white matter of our brain. This remodeling can improve memory, spatial awareness, and other higher level cognitive functions. When you combine a regular walking practice with a healthful diet rich in plants, social engagement, high quality sleep, and living true to your ikigai, you have found the fountain of youth.

If walking is so great for us, why aren’t we doing more of it? Many people may face significant barriers when it comes to walking. Some barriers may be environmental. Perhaps not living close to any safe walking areas, but rather an inner city with spotty side walks and heavy traffic. Or, perhaps it’s the weather. Many of us become Goldilocks when it comes to the temperature. Maybe it’s simply a lack of motivation. “I don’t feel like it.” “I don’t have the time.” Most commonly in physical therapy, the barriers are pain, as well as balance or mobility issues. Regardless of the barriers, it is important to become aware of them and address them accordingly.

For many of the barriers, it can be helpful to shift away from an “all or nothing” mindset. Many people feel like if they are going to walk, it has to be a long walk, and it has to be every day. Otherwise, what’s the point? The barriers become too great and instead, we end up not walking at all. A better strategy would be to find the middle ground between the all or nothing. How can I walk today? Can I sneak in five minutes after eating lunch and before my next meeting? Can I park farther away and take the stairs? Can I walk while I talk on the phone or listen to my audiobook? Perhaps if a long daily walk is daunting, set small realistic goals instead.

No matter how short the walk is, finding consistency in a routine is far more important than the actual distance walked. Perfect is the enemy of good.

Significant barriers to a regular walking practice as mentioned previously are challenges with pain, mobility and balance. At the Wellness Station, we can work together to figure out ways to get you walking without being limited by these challenges. Some factors to consider might be frequency and duration of walks, as well as implementing more rest breaks into walking. Or perhaps a mobility device can help take stress off certain joints or improve the ability to maintain balance while walking. Activity modifications can help decrease the barriers to a regular walking practice to help us get moving more regularly and with greater confidence.

Oftentimes, the movement patterns that we have developed can actually be limiting factors to the quality of our gait, which can contribute to pain and dysfunction. We learned how to walk once- we can learn some new ways! Relearning new motor patterns might start with a simple awareness practice.

Consider the following practice, perhaps walking around inside:

As you walk, pay attention to your footstep. Some things to be aware of are… “How do my feet make contact with the ground?” “What is my foot print like on each foot?” “How heavy or light is my step?” “How long is my step length?” “How wide is my step from right to left?” This awareness can be applied to many other aspects of the gait cycle and body parts which may include attention to the knees, pelvis, hips, spine, rib cage, shoulders, and head.

After becoming aware of the way in which you are walking, it is time to explore some changes. There are infinite ways to bring about changes into the mechanics of gait. Here are some examples:

  • Slow walking. Simply change the speed of your walking to notice what it is like to walk in slow motion

  • Walking in different directions. What is it like to walk backwards, or from side to side?

  • Strut like you mean it. Introduce a fluid glide in your hips as you walk, and allow your arms to swing with your opposite leg. 

As you explore some variations in your walking, it is important to not play “fix it” with your body. There is no “right” or “wrong” way to walk, simply more options. As body detectives, throughout the therapeutic experience it is our job to find options that are more comfortable, thereby allowing us to sustain a healthy and active lifestyle. 

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

References:

  1. https://www.cnn.com/2022/09/12/health/walking-cancer-heart-early-death-wellness/index.html

  2. https://www.nytimes.com/2021/07/14/well/move/exercise-walking-brain-memory.html 

Your Spine is Not “Out of Alignment” - A Holistic Approach to Pain Science

Have you ever been to a practitioner who assured you that the cause of your pain was one of the following, or some combination of these very technical sounding terms? “Your ____ (spine, hips, etc) is out of alignment.” “Your pelvis is twisted.” “Your SI joint is jammed.” “Your pain is because of your leg length discrepancy.” The list goes on and on.

These types of claims are not helpful, and can be downright destructive due to the nocebo effect.

First of all, joints don’t go “out”. If your joint was dislocated, it would be a medical emergency that you would be well aware of, and warrant a trip to the ER. Additionally, structural explanations for pain (aside from acute pain due to tissue injury) are generally unsupported by evidence. These claims (e.g. joints being “out”) have extremely low interrater reliability, meaning two different clinicians would almost never agree on them.(1)

By teaching people that these minor asymmetries are “serious”, clinicians are over-medicalizing normal human conditions. We all have asymmetries, and we do not have good evidence that asymmetries will lead to pain and dysfunction. By believing that your pain is structural, it is taking you out of the healing equation, and will consciously or subconsciously rely on external sources for healing, including surgeries, injections, and frequent chiropractic adjustments. 

Fortunately, the human body is not like a car. Because issues as complex as pain are not due typically due to structure alone, they typically do not require a structural solution. Unlike a car, the human organism has a nervous system, an immune system, and higher consciousness that allows us to think, feel, move, make decisions, and change our beliefs and behaviors. It may be convenient for some clinicians to blame structural issues as a scapegoat, as it can be easier and quicker to explain than the other contributing factors, and can also be an effective business model. Also, many patients may also be looking for some structural issue to blame, as it can be extremely frustrating and distressing to be in pain for a long time and not understand why. However, it is crucial for clinicians to educate patients on the real causes of pain, and move away from teaching people the body is a machine that breaks down, inevitably leading to pain. We need to lean in to educating people on the messier science, including physiology, neuroscience, psychology, as well as social and lifestyle factors. 

The truth is, pain is multifactorial. Sometimes it is very simple, sometimes it is extremely complex. Simple cases tend to be acute- you stub your toe, the nociceptors (pain receptors) fire, your brain registers the sensation as pain, and you say “Ow!”. However, chronic pain is a different beast. After pain persists and the initial injury is gone, brain changes tend to be what keeps the pain cycle alive. Our nervous system can get a bit confused, and the helpful pain perceiving pathways can start to run awry. We begin to get overly sensitive to stimuli that normally wouldn’t cause pain (known as allodynia), and perceive that pain is more intense than we normally would (hyperalgesia). It is very hard to turn that sensitivity back down, and it requires neuroplasticity (brain change). 

So how do we change our brain to affect our pain? We have to address pain biopsychosocially, meaning we address the biology, the psychology, as well as social factors.

Biologically (or physiologically), we rehabilitate the physical body through movement and exercise, improving efficiency of movement, decreasing unnecessary tension, and improving fitness. This might mean gradually desensitizing our body to painful movements or activities. We also want to make sure we are sleeping well, eating healthful foods, staying hydrated, and being very mindful regarding consumption of certain substances.

To address psychology, we must challenge our beliefs, improve our mental health, find appropriate coping mechanisms for stress, and change our relationship to our pain to become less reactive and more responsive.

To address the social factors, we have to make sure we are surrounding ourselves with the right people, participating in activities that bring us joy, and seeking support rather than battling with pain alone. 

Hopefully, this path to healing does not seem overwhelming. By addressing these biopsychosocial factors, we can take control of our lives and make decisions that better ourselves and improve our quality of life. We can take an active role in our own healing, and won’t be as reliant on expensive and harmful procedures. While the healing journey is not linear and will come with challenges, it is the direction to go for all of us, with and without chronic pain. 

It is our job at the Wellness Station to take the role as educator, detective, and coach. We strive to teach you about the science of pain, figure out the greatest contributor factors, and provide guidance, encouragement and support as you begin or continue your healing journey.

References:

  1. https://www.painscience.com/articles/structuralism.php

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