Friday, November 27, 2015

Coming From the Core

One of the first observations Eric made when analyzing my walk was that my stomach muscles were not engaging. I've heard  "Let your fingers do the walking," but "Let your belly do the walking?"

Many muscles, not just leg muscles, play a role in walking. I was engaging only the powerful quadriceps on top of my thigh to swing my leg forward from the hip. Eric wanted me instead to tighten my abdominal muscles and use them to help lift my leg forward.

At first the abdominals on my affected side would not engage. To "turn them on," Eric sat me in a chair and told me to exhale as if I were blowing up a balloon. Once I could force no more air out, I froze my belly muscles in that tight position and held it as long as I could. No sit-ups, no crunches, but I broke a sweat.

My abdominals now remembered what it felt like to work and had been given permission to do so. I practiced walking, using my abs to help lift my leg, which no longer felt as heavy as when I had been swinging it. Over time, my abdominal muscles began to flatten instead of bulging uselessly on the affected side.

Now we're working on my back muscles, which need to help stabilize me when walking.  This has proven especially challenging because of a lower back problem that preexists my stroke. Apparently, I have been misusing my abs and back muscles for years.  Now that I'm addressing the core issues, my back pain has changed; it's no longer a spike in the hip joint, but a soreness in the hip muscle – like after a good work-out.

I think I'm learning to walk properly for the first time in my life.

Friday, November 20, 2015

Incremental Improvement

I don’t want my recent posts to give the impression that once Eric releases the trapped energy in a particular area of my body that it’s cured. It isn’t. The tension can build again and the adaptive habits of the past five years can reassert themselves. 

When Eric works on me, I’m able to move correctly for a limited number of repetitions, but my muscles fatigue quickly because they are unaccustomed to exercise and don’t store much energy yet.  Consistent with everything else you’ve read on neuroplasticity, I have to use the muscles repeatedly in the correct way for my body to reestablish healthy muscle memory.

The benefit of my sessions with Eric is that he gives my muscles space to move. An ankle locked like a block of cement must be swung and plunked on the ground. An ankle that flexes, however, lands heel-to-toe and ready to push off for the next step, which encourages the calf muscles to work. 

When my tension rebuilds, Eric releases it again and, over time, there has been sustained improvement. It’s a slow process that requires my constant mindfulness. Sometimes I think about babies learning to walk and marvel at how relatively unconscious they are. I am conscious of every step and must focus my attention on so many muscles. No wonder I fatigue so easily!

To maximize neuroplasticity, I’ve added another therapy day to my schedule so that I see Eric three times per week. We are greatly supported in our efforts by his boss, Dr. Arbi Derian, who still weight-trains me once per week and treats me three times per week with electrical stimulation, adjustments and passive stretching.

I always feel better after my treatments and believe they will help me continue to improve incrementally.

Friday, November 13, 2015

As Above, So Below

I marvel at the connectedness of my arm and leg – how working on my arm causes a reaction in my leg and vice versa. I’m told the body is wired for efficiency – that the nervous system’s control mechanism for the arm and leg, which perform essentially similar motions, is the same. Brain damage makes you wish nature had built in system redundancy, but alas.

What this means is that I can’t work on one area in isolation. More than any other function, I would like to recover my leg – so I can walk quickly and distances, ride a bicycle, kick in the water. But sometimes my foot hits a wall in its progress and the solution has been to work on my arm.  When the tension in my wrist releases, my ankle relaxes and the foot straightens out.

Eric tells me “as above, so below,” meaning that you can roughly approximate the shoulder to the hip, the elbow to the knee, the wrist to the ankle and the fingers to the toes. It’s no coincidence that the finger and toe I have trouble extending are the same – the second. 

Recently, as Eric and I practiced walking, I was having trouble straightening my foot and my ankle threatened to roll outward.  I pointed to tightness under my upper arm. As he worked through it, the triceps engaged to roll my arm and shoulder back. Simultaneously and without thought, the peroneus muscle on my outer calf adjusted to pull my heel straight beneath my leg.  Eric worked the kink through my hand and there was a snap as the tendon in my second finger released.

I set off across the gym floor on a straight ankle and a flat foot with a gloriously elongated second toe.  

Friday, November 6, 2015

On the Table: Re-coordination

Sometimes Eric and I spend our sessions in the massage room. I lie on my back and he circles the table, moving each of my body parts into its correct position.  He does this over and over again – jostling, rotating and pressing me into proper alignment.

The sessions are relaxing, but I don’t just lie there: I’m an active participant, paying close attention to where he shifts my body. He’s constantly correcting the rise of my shoulder, the tuck of my chin, the tilt of my hips. My job is to learn to assume these positions myself.

I focus on the position he leaves me in as he moves onto another part of my body. When he reaches my spastic arm or leg, my torso often contorts: on the healthy side, my ribs bulge, my back arches. This compensation for my affected limbs is particularly noticeable on the table where I feel the absence of the supportive pressure beneath my back.

These same types of contortions occur when I’m upright and trying to use my affected leg. But they are more controllable on the table where maintaining balance is not a factor. If I can gently reassert the proper spine position while Eric works, my spastic muscles respond favorably, elongating as he pulls and shifts them to release the trapped energy that makes them stiff.

This illuminates two of the important principles that Eric has taught me:

1) The connectedness of the body – how the parts affect each other.

2) The necessity of re-coordination in stroke survivors to remind all of the muscles how they are supposed to work together.

More on these as we continue to examine Eric’s techniques.