Self-management – Rheumatoid Arthritis

Self-management – Rheumatoid Arthritis

Jackie M, a 47 year-old pharmacist, started Alexander Technique lessons hoping to reduce pain levels, especially in her neck. She had suffered from rheumatoid arthritis for 10 years. She found that she was indeed able to influence her pain levels and to be more comfortable in everyday life, as well as learning a procedure to help her when things were particularly bad. Of course, the Alexander Technique did not address the rheumatoid arthritis, but it helped Jackie to cope better. It helped Jackie to recognize where she had more power and control over her situation than she had thought. Jackie found there was scope for applying her lessons in all the activities of everyday life, with valuable pain-reducing results. Her back improved generally, particularly her neck and lower back.

An intelligent woman, Jackie had been doing her best to manage her condition, including paying attention to her posture. Like John and also Debra, her understanding of what good posture consisted of, how to achieve it and how to maintain it, were all based on a series of common but potentially dangerous misconceptions. Their Alexander Technique teachers were able to gradually correct these.

Neck and Shoulders

Neck and Shoulders

Recent research bears out our observations. When we did a survey a few years ago about what our pupils valued the most about their Alexander lessons, the top answer was “getting out of pain” and the second answer was “knowing how to stay out of pain or get pain-free again”.

Rachel, a 38 yo mother and public servant wanted help with pain around her neck and shoulders. At her first visit, it was apparent that the level of tension in these areas in particular was very high. Rachel had limited range of movement in her head and neck, eg looking right or left. Interestingly, Rachel’s perception of the tension was very low. She just recognized the discomfort and the restricted movement. This experience has a basis in physiology; muscle receptors tend not to fire when a muscle is constantly held short.

Correcting misperceptions about key anatomical junctions (eg head/neck joint, hip joints) meant that Rachel was starting to send anatomically consistent messages to herself. With repeated and progressively more delicate hands-on guided experiences of releasing tight muscles in a coordinated way, along with sending the right messages, Rachel steadily eased and dismantled her pattern of tensing, shortening and narrowing in response to life’s daily stimuli. Underneath the old tense pattern was something closer to the ease and grace which we all tend to enjoy as children. Within about 12 lessons, Rachel had put a significant dent in her old habitual ways of moving and postural support, and was much more comfortable.

Postural Pain – Trying Too Hard

Postural Pain – Trying Too Hard

Bob is an IT expert, 36 years old, educated and well-travelled. He has suffered from chronic pain-inducing muscular tension for about 15 years. He has tried various approaches… all to little avail.

I wondered whether he was approaching his situation from the wrong place.  His approach was about what to “do” (Pilates, remedial exercises, fix his posture) or else passive (acupuncture or massage).  I suggested to him that errant “doing” was actually part of the problem and that maybe there was some information that he was missing.  To start with, he was unaware of his habit of tensing his neck every time he moved, something that was happening hundreds of times a day. Once it was pointed out, he was able to start to control this. (Being unaware of this particular habit can become a long-term problem resulting in having a very tense neck, and also inducing compressive tension throughout the back). Bob’s neck-tensing was part of an underlying habit of “trying”, which even extended to the way he looked at his computer screen.  Bob backed off trying (to be right, to fix, to make things happen, to do, etc) and started to adopt more of the stance of an “interested observer”.  Over a few short weeks, he was able to allow his neck to become freer and also to find a more economical balance for his body, relying less on muscular force (not so much holding himself up) and more on letting his bones carry his weight. Everything started to “relax”; not tense, not floppy, but still toned and ready for action.  Bob was in much less pain, and also understood how  he had unconsciously contributed to the pattern of pain through his habit of “trying too hard”.

Breathing

Breathing

Alice is 35, has experienced chronic illness and felt that she did not breathe well. Many years ago F.M. Alexander, known as “The Breathing Man”, made the intriguing comment that, “there is no such thing as breathing as such”. Alice had been maintaining her posture with a great deal of misplaced tension. This tension certainly “held her up” but at the cost of restriction to ease of movement and to freedom in the breathing. It was as if she was wearing a suit of muscular armour which kept her stiff and her breathing unresponsive and limited.

“If the framework is right and you don’t interfere, your breathing will always adapt itself to the needs of the activity you are performing” (Langford). Unfortunately, the “IF” is a major stumbling block, because of the vagaries and standard of one’s personal habits of use (misuse). To what extent do we habitually use ourselves poorly, without ever realizing it?

Alice has been having regular lessons, frequently at first, recently less so, now that she has learnt how to work on herself.

Gradually, paying attention to the Alexander triple bottom line of posture/breathing /movement, Alice has been able to recognize when she can reduce tension in her neck, shoulders and back. A state of less general tension has gradually supplanted her old habits and with it she has progressively made more elasticity available for her whole breathing function to work more freely and with more responsiveness. She also moves more freely and has more energy, since she is squandering less on continuous, unnecessary tension. As the “framework” has improved, so too has Alice’s breathing and issues to do with breathing have steadily receded.

The Art of Skiing

The Art of Skiing

The Art of Skiing

As one beginner skier complained, “My brain understands the instructor’s directions, but my body won’t carry them out!”. Recognizing that the way we approach anything is going to affect the outcome, the Alexander Technique pays great attention to how we’re doing what we’re doing. Discovering that not “trying so hard” can mean not only learning more easily, but also actually skiing better and with less effort, often comes as a pleasant surprise to many people.

The Alexander Technique is about improving self-awareness. We can learn self-mastery through gaining conscious access to the very delicate and precise mechanisms that control our balance, posture and coordination in everyday activities as well as, for example, in skiing. It is an approach which can be applied to learning or improving any skill, from playing a sport, or playing a musical instrument to dancing, just sitting in a chair, or meeting a complex emotional situation.

Recognizing that the way we approach anything is going to affect the outcome, the Alexander Technique pays great attention to how we’re doing what we’re doing. We quickly discover that we often have very little idea of our underlying mental or physical attitudes to activity or to learning new activities or to the way we express ourselves.

So not only do we need new knowledge, but we also need a means of putting that knowledge into practice. As one beginner skier complained, “My brain understands the instructor’s directions, but my body won’t carry them out!”.

The Technique is a way of becoming more aware of balance, posture and movement in everyday activities as well as, for example, in skiing. This can bring into consciousness tensions previously unnoticed, and helps us differentiate between necessary and unnecessary (appropriate and inappropriate) tensions and efforts. Put in other words, the Alexander Technique is a way of developing the skill of looking inside, checking our inner environment, so that we take care of the instrument through which we are achieving whatever we do in the outer environment.

The Alexander Technique is popularly supposed to be concerned with posture and relaxation but, of course, posture is far more complex than just standing or sitting up straight. It could be described as how we support and balance our bodies against the ever-present pull of gravity while we go about all our daily activities.

From Alexander’s own observations, since confirmed by scientific research, it has become apparent that there are natural postural reflexes to organise this support and balance for us without any great effort, provided we have the necessary degree of relaxation in activity to allow these reflexes to work freely. This has obvious practical application for skiers.

Most of us learn to ski on a more or less trial and error basis. Even when we have lessons it is clear that some people are simply more apt than others. These are the people in whom, unconsciously, those “postural reflexes” or “mechanisms of support and balance” are working relatively well (typically in younger people).

The mechanisms of support and balance (for which poise is a useful term) can be seen working beautifully in most small children, but they are very delicate mechanisms and are easily interfered with. The emotional and physical stress accumulated through life can soon become fixed into the body in the form of chronic muscle tensions and patterns of distortion throughout the physical structure. These patterns in turn restrict the workings of the natural postural mechanisms. Common language expressions such as “things are getting me down ” or “I’m feeling uptight” suggest a feeling for how our relationship with gravity is disturbed.

On the snow we are not only coping with these ongoing interferences to our postural mechanisms, which give us our “base line” of tension, but also with further interferences engendered by the unfamiliarity of the situation e.g. the fear involved in learning to ski.

In watching beginner skiers one is sometimes struck by their stiffness which, of course, severely impairs their ability to balance, and they fall over very easily.

Ease and poise on skis, as anywhere else, is characterised by an easy, upright carriage of the head which facilitates engaging the postural reflexes as a whole. Integral to this process is the quality of contact of the feet on the floor (skis, ground). If the feet or legs are tense, it will be much more difficult to have a real ease in activity.

Learning is often associated with anxiety and tension (this need not be the case, but that’s another story). In learning a balancing skill this is often more so, at exactly the time when ease of balance and an absence of tension would be most desirable. For anxiety-tension interferes not only with our balance and coordination, but also with our perception both of our inward environment e.g. failing to notice that we are tightening our legs or holding our breath, and our outer circumstances, so that hills appear steeper, or speeds higher.

Enhancing kinaesthetic awareness (awareness of one’s inner environment), and learning greater control of one’s mechanisms of balance and coordination is thus an enormous help to beginners.

More advanced skiers can also gain from this approach. Experienced skiers often have trouble improving past a certain point. Their initial learning may have taken place in a tense manner and this tension has become a fixed part of their skiing technique, limiting further improvement.

Discovering that not trying so hard can mean not only learning more easily, but also actually skiing better and with less effort, often comes as a pleasant surprise to many people.

The Alexander Technique gives us some simple ground rules through which we can observe ourselves, in order to achieve a gradual general improvement in balance and coordination, as well as simultaneously supplying ourselves with conditions most conducive to the acquisition of a new skill.

© M Stenning Canberra 1997

Exercising but getting injured?

Exercising but getting injured?

Would you like to be able to perform your choice of exercise with efficiency and grace?

Would you like to ensure good “form” whether in the gym, jogging, swimming, stretching, walking or even in martial art forms?

Would you like to avoid strain on joints or other tissue when you exercise?

What have summer and winter Olympic athletes, marathon runners, hammer throwers, elite equestrians including Australian Olympian Mary Hannah and the entire British team, multi-disciplinarian Daley Thomson and many others in common?

They have all used the Alexander Technique to improve some aspect of the way that they function – breathing, freedom or efficiency of movement, balance, dealing with stress, aches and pains or injuries.

In the early l950s, Percy Cerutty, the celebrated and sometimes controversial athletics coach, wrote in a letter to his Alexander teacher, “Alexander is a “must” for all competing athletes. You have taught me a lot of interesting material about the correct use of the body which I have passed on in my training with marked results eliminating bad use.”

The Alexander Technique is being increasingly adopted by recreational and competitive Sports people. Athletes involved in sports as diverse as long-distance running, dressage, swimming, X-C skiing and hammer-throwing recognise the benefits that come with a training in the Alexander Technique. For Sports people these can be divided in to three categories:

  1. General fitness (how to avoid wasting energy);
  2. Technique (ensuring that you’re actually doing what you think you’re doing); and
  3. Avoidance of or recovery from injury (not using yourself in a way which imposes unnecessary stresses on joints or other tissue).

Economy of effort

The Technique is particularly relevant because it is directly concerned with the working of the “postural reflexes”, i.e. the mechanisms that enable us to support and balance our bodies against the ever present pull of gravity while we go about our daily activities. It addresses how to move with an economy of effort and maximise poise and balance.

How hard are you making it?

The tensions and distortions that most of us, over the years, build into our habitual way of being and which have thus slipped below the level of our conscious awareness, provide an on-going restriction to the working of these natural postural mechanisms. This restriction renders movement more effortful and less efficient than necessary and can predispose us to injury. In our sporting activities, we are coping not only with these on-going interferences, which give us our “base line” of tension, but also often with further interferences engendered by the situation, e.g. the challenges involved in learning a new skill or the pressure of competition.

In other words, we’re making hard work out of simply standing upright, before complicating things with moving.

“My brain knows what to do but my body won’t do it”

In training or competition this is often more so, at exactly the time when economy of action and an absence of tension would be most desirable. This interferes not only with our poise and coordination, but also with our perception both of our inner environment, for example failing to notice that we are tensing our shoulders or holding our breath, and of our outer circumstances, so that for example, distances seem greater, or it feels as if we have insufficient time.

Enhancing kinaesthetic awareness (awareness of one’s inner environment), and learning greater control of one’s mechanisms of balance and coordination are an enormous help in any activity.

It is not just the elite who can learn to optimise their way of working with themselves to gain that competitive edge. Sports people who have trouble improving beyond a certain level can also gain. Technical imperfections can easily be unwittingly established as part of one’s basic modus operandi, limiting further improvement. Who at some time has not said to themselves, “My brain knows what to do but my body won’t do it”?

Discovering that not trying so hard can mean moving further, faster and with less effort, often comes as a pleasant surprise to many people.

The Alexander Technique gives us some simple ground rules through which we can observe ourselves, in order to achieve a gradual general improvement in poise and coordination, as well as simultaneously supplying ourselves with conditions most conducive to the development of a skill and reducing the risk of injury.

Understand How The Alexander Technique Can Help You

Understand How The Alexander Technique Can Help You

We often get asked questions about how the Alexander Technique (AT) can  help and how it relates both to effective pain management and to performing any skill better.  Below are some answers to give you more insight into the AT.

1. Why is it so hard to maintain good posture?

Have you ever stopped to wonder what “good” posture means? It can’t be what we were taught in Kindergarten, because that version of “good posture” is stiff, uncomfortable and unsustainable.  The AT can help you achieve light, easy posture and movement, regaining some of the grace and poise of young childhood.

2. Do you suffer from any of the following, either intermittently or continuously?

  • Neck pain
  • Back Pain
  • Shoulder pain/stiffness
  • Headaches
  • Muscular Tension

When we use ourselves well, it feels good and there is no pain. Chronic aches and pains are signals. They may be your body’s way of alerting you that your way of (mis)using yourself, ie your “personal norm” of posture and movement, involves unnecessary strain. Your way of using yourself is unconscious and habitual. It feels “normal” even if it is uncomfortable!

The AT helps you to reduce strain in the ordinary, everyday activities of life; discover how you can ease that aching lower back, relax those stiff shoulders, avoid tension headaches, control sciatica…

3. Do you suffer from any of the following?

  •  Fibromyalgia
  •  Tenosynovitis
  •  Overuse-type arm or hand pain

Multi-factorial conditions invariably include poor Use, which keeps the sufferer stuck in a vicious circle of pain. Then the pain itself leads to potentially harmful adaptation.

The Alexander Technique can help you break the vicious circle of pain.

4. Have symptoms intensified or increased in frequency?

Our habits of movement, and posture tend to intensify with time. Whatever mildly bad habits you had at age 25 will be deepened considerably by age 50 or 60. Similarly the accompanying symptoms of misuse will tend to intensify, increase in frequency, or become chronic.

The Alexander Technique can help you to wind back the clock, easing poor postural and movement patterns, and any associated symptoms. Not only does it feel good, it also looks better!

5. Have you been involved in any car accidents or suffered major falls, eg from a horse?

Following an injury, we adapt and compensate for the injured part. It is difficult to avoid these compensations becoming part of our on-going base-line of co-ordination. Symptoms arising out of injury-induced adaptations may develop months later, and therefore be difficult to relate to the original injury. Whiplash is one of many examples.

The AT can help you to back-track and eradicate symptom-producing patterns of posture and movement which have arisen out of compensation or adaptation following trauma or injury.

6. Have benefits from manipulative therapy or drug treatments “levelled off”?

Once manipulated, you may get up feeling better, but your underlying, symptom-producing habits of (mis)Use remain. It may just be a matter of time before your habits of (mis)Use reassert themselves and start to hurt again.

The AT addresses your Use – how you use yourself affects the way that you function: with ease and grace, or strain and pain. Yoga, “remedial” exercise eg Pilates, gym routines etc. all are performed out of your habitual pattern of use. If your habitual use is implicated in the problems you have, then exercising in this manner may further entrench or exaggerate the problems. As the nursery rhyme puts it, “A crooked man walks a crooked mile”. The AT addresses your Use, coming in as a means of enhancing your Yoga or T’ai Chi practice, or other discipline.

7. Have you had to give up or reduce any exercise?

Any activity performed with poor form is likely to lead to strain and injury, as well as reinforcing the poor form.

The AT emphasises good use (ie good form). Exercise with good form – you perform better, last longer, tend to suffer fewer injuries, and deepen your good form into everyday life.

8. Do you suffer any type of breathing-related issues?

The AT is well known among actors and singers as being a great underpinning to their art: Voice projection, hoarseness, vocal depth and beauty, breathing related to sporting activity, playing music and singing, even asthma.

Early in his career, Alexander was known as “the Breathing man”. Optimising your use of your self generally is inseparable from optimising efficiency in the way you breathe: Deeper, slower and above all freer.

9. Are you able to avoid the build-up of tension or unnecessary internal strain?

Does pain make you suddenly realise that you have been sitting too long, or that you overdid it in sport or other leisure activity? Wouldn’t it be useful to notice before you hurt?

The AT gives you the basics which are relevant to staying comfortable whatever you are doing.

10. How effectively do you minimise musculo-skeletal wear and tear, particularly in relation to neck, back, shoulder and arm issues?

Wear and tear is a fact of life for most of us. But have you ever considered those who seem to function well, with no injuries or strains, well past the age that many start to suffer?

What are they doing that the rest of us aren’t? Perhaps they have learnt to use themselves without strain, the secret of the AT.

11. Are you able to maintain good “form” across the range of your activities?

The Grace and ease of childhood can be re-acquired! It feels and looks good!

12. How much would you value having greater control over your physical well-being?

A survey of our pupils (not “patients”) showed that what they valued most from the AT lessons was simply getting out of pain. What they valued next was knowing how to regain their pain-free state when they lost it. We all “lose it’ from time to time! Knowing exactly how to get yourself back onto a centred, even keel is invaluable.

The AT shows you how to avoid strain and pain.

Pain relief for life

Pain relief for life

Does your back or neck hurt?

What information are we missing? It should not have to be this way! If it’s aging, the passage of time, why doesn’t everyone over a certain age have these problems? And why do some very young people, in their 20’s and teens even, have these problems? Why do some of us recover more fully from accidents than others? Why do some of us remain fit and active far longer than others? What makes the difference between those who breeze comfortably through life, and those who seem to suffer successive aches, pains and injuries?

“Everyone wants to be right, but no one stops to consider if their idea of right is right” – FM Alexander

There is no shortage of advice and injunctions. We all know about the desirability of relaxation, flexibility, good posture and the absence of tension.

Yet by the end of the day your shoulders ache, or perhaps it’s your neck or your lower back. You’ve tried to improve your posture. You’ve done various exercises, stretches, treatments. They work, up to a point. Your approach is palliative, a management strategy. Things are OK most of the time, but occasional periods of more pain, or a real “back attack” get you. You see your therapist of choice, the pain mostly goes away, until next time. Perhaps you feel you are “just getting older”; some activities are a little circumscribed, perhaps knees are giving a bit of trouble, or your flexibility is decreasing.

Or else you’ve had a diagnosis of something actually “wrong” – scoliosis perhaps, or part of your spine is “too straight”, or else you have osteophytes, or disc degeneration. You have been told that “nothing can be done, you’ll just have to live with it”. Maybe you have a special exercise or stretching routine that keeps the symptoms under control, but you know you might be in trouble if you miss a day or two.

Despite our best intentions, despite relaxation classes, fitness classes and Eastern disciplines, despite stretching exercises, posture exercises, taping and Californian know-how, we’re still tense and uncomfortable in our bodies, with aching backs, sore necks, stiff shoulders, injuries and named conditions. Diagnosis of a named condition can also give the impression of permanence, so that one does not look further for a solution, and not learn to exercise the choices that can make a big difference.

We don’t even know it is there. The hidden part, the unseen portion of the problem, is that many of us get stuck in a certain level of tension, or fixity, or distortion, or holding, which becomes built in to our habitual way of being. We become accustomed to “typist’s hunch”, “jogger’s slump”, “mother’s hip”, “driver’s neck”, “student’s shoulder” and the like. Because it is there all the time, our own individual holding pattern simply slips below the level of our conscious awareness.

Our own personal pattern of “use” can levy a hidden strain, lowering performance and predisposing us to injury and back pain. Yet we remain unconscious of the fact that the pain we are in may be a cumulative result of strains we are inadvertently imposing on ourselves, day in, day out. In other words, it’s the things that we don’t know that we are doing, that may be at the root of back or neck pain.

Our individual movement and postural patterns, comprising our way of applying ourselves across all our activities, may encompass compensatory mal-adaptations to earlier injuries or on-going adjustments that generate further strain and injury.

This personal pattern, for better or worse, comprises the matrix out of which all our actions are performed; exercise, relaxation, work, leisure. It is precisely in unravelling these patterns that the Alexander Technique of neuromuscular re-education sheds light and may be invaluable.

No other body of knowledge encompasses this depth of understanding of (body)-use, which can simplify and cut through problems which have defied specialists of all persuasions.

How are you “wearing” yourself? Aches, pains and even degeneration may be symptoms of a hidden problem. Until the “conditions of use”, ie the individual’s habitual holding pattern or way of “wearing” themselves, has been adequately assessed, the diagnosis has only been partial. If there is an undiagnosed pattern of movement which involves, for example, unremitting pressure through the lower back, then until that pressure-producing habit is changed, the results of the pressure (ie pain) will continue.

An Alexander Technique teacher is highly trained to recognise poor habits of “use”, assessing where and how a person is introducing unnecessary strain into their posture and way of being. The Alexander Technique teacher brings to your attention things you are doing that you are unaware of. That is, (s)he helps you to extend your choice in the way that you move, act and react. ….You learn a new way of moving; sitting, standing, applying yourself across the range of your activities with less strain, less effort and less energy. You begin to feel lighter and freer as old habits are unlearned. Pain, even of many years’ standing, may start to dissipate.

Whatever our situation, we can learn to minimise strain, and work with ourselves, rather than mechanically performing mindless exercises, stretches or forcing “right” positions, and ultimately fighting what could be perfectly natural, comfortable, strain-free and sustainable.

Retained Primitive Reflexes and the Alexander Technique

Retained Primitive Reflexes and the Alexander Technique

Why do some people find it hard to apply the Alexander Technique? With some pupils, it’s really as if the spirit were willing but the flesh is weak.

They might be able to use themselves very well as long as they give their use 100% attention, but as soon as the demand goes up a little, eg talking, interacting, walking, doing anything at all, it’s straight back to the old patterns. It’s as if those patterns reside at a level in the nervous system that are not completely open to cortical control, or something else is also plugging in and steering the person’s responses.

I have seen this among pupils, trainees, and even among experienced and effective Alexander Technique teachers.

A primitive reflex is an unconscious stereotypical movement which has a role in developing an individual’s musculature and neurology. The sequence of primitive reflexes prepares and develops the foetus’ and neonate’s neuromusculature, leading towards integration and the capacity for free ego expression. The postural reflexes provide mature balancing, movement and behavioral responses. Their working rests upon the inhibition of the primitive reflexes. Free and responsive cortical control is not fully available when the effects of retained early reflexes echo through the neuromusculature.

This early developmental process often is not complete; it may be disrupted for a variety of reasons and in different amounts. Also, even if complete, trauma, eg a whiplash injury, may cause the re-emergence of a primitive movement pattern. (This can, by the way, explain the nature of on-going problems following a whiplash injury). This means that in order to function we may be obliged to enter into some sort of compensatory pattern. I believe that in some of our adult pupils, what we may often be working with are the adaptations that the individual has unconsciously been obliged to enter into, in order to function in a body which is being at least partially steered from this neurologically deeper level. Depending on the strength of any such influence, it may be difficult for the pupil to apply the basic principles of the AT.

Common retained reflexes, which are fairly easy to spot, include the Moro, TLR, STNR and ATNR. An individual with such retained reflexes will still learn to get up and walk and function within the normal range as adults, although they may indeed find some aspects of learning difficult.

But there is always a cost associated with a neural pathway which is not the simple pathway. The cost is greater effort physically and mentally – fatigue, stress, and tension aches and pains.

Some authors give the impression that reflex inhibition is the whole solution. However, both from an Alexander Technique point of view, and also from the the point of view of the Extra Lesson, I think it’s probably only part of the picture. Beware of anyone peddling simple solutions to what is probably a complex problem. It usually takes time!

And depending on the depth of the retained reflex(es), steady Alexander Technique work may make a huge difference.