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.  

Eric the Closer

Two years ago I started working with a therapist I call Eric the Closer because he fine-tunes me. When I asked him to label his brand of therapy, he paused. How do you encapsulate his techniques?

Not really massage – energy redistribution.

Not really strength-training – recoordination.

Not really reeducation – a new level of consciousness. 

“I guess polarity therapy,” he says.

The dictionary definition sounds airy-fairy – “restoring the flow and balance of energy in the body.” I’d be a skeptic if I hadn’t experienced results: My foot has straightened out, my shoulders and hips sit even, my gait and balance have improved, and my fingers have relaxed.

Example of a typical session: Eric gives me a simple exercise. I do maybe three repetitions and my ankle seizes up and my toes curl. Eric takes hold of my foot and commences battle – untwisting the calf muscles, shifting the ankle, coaxing the toes to elongate.

“Feel that,” he exclaims.  “Feel the cold coming out?!” Now I’m aware of it: my ankle is freezing from the inside. He holds my ankle and stamps his foot, dispelling the trapped energy. A flush of warmth. The skin on my foot and lower leg glows pink as blood pours into the nutrient-starved tissues. We are both sweating.

It’s painful, exhausting, exacting work. As Eric manipulates me into shape, my groans and exclamations sound like childbirth. I keep expecting the gym manager to tell us “Get a room.”

To benefit from the therapy, I’ve had to let go of self-consciousness in a way that harkens back to the rehab hospital – nothing is private or sacred. I cry out, push back, tell Eric where I need his healing hands; in them, I have the strong sense that I will go as far as I can in my rehabilitation. 

Three Steps Back

In my recovery each advance has been hard-fought and has brought new freedoms. Walking without a cane meant being able to carry items from point A to point B. Stronger muscles meant more stamina — to run an errand or do a chore. These abilities gave me a sense of usefulness, which helped my mood.

In the last months of 2012, I surrendered these luxuries by agreeing to an experimental treatment designed to improve my lopsided gait. Arbi had the unusual idea of injecting Botox into my peroneous longus and peroneous brevis muscles, essentially immobilizing them. Without them my foot inverts (rotates inward). To walk I was therefore forced to engage my weak extensor muscles, which assist with foot "eversion." This was the objective: to strengthen the minor muscles around my ankle.

By the end of each day, my ankle was so tired and painful, I couldn't stand up even to microwave dinner. I became more dependent on my husband again. I started using a cane again. Friends who had celebrated my progress watched me regress.
It was really hard.

But three months later my ankle is stronger, my foot straighter and my gait more even. I now sometimes take a half-dozen steps that feel almost normal. I can envision a time when I will walk without a limp and what that might feel like.

But it won't be within the next few months. Arbi just told me that the experiment has been such a success, he wants to repeat it —
to force those tiny ankle muscles to work even harder.
Sigh. Six steps forward, three steps back.

Unbrace Yourself

I left rehab with an Ankle-Foot Orthosis (left) to support my ankle and keep my foot from dragging. I hated it. I hated having to wear long socks in hot weather. I hated having to put on a brace and shoes in the morning just to walk to the kitchen for a cup of coffee. I hated wearing shoes that were two sizes too big so they could fit the brace.

I googled alternatives and found the Freedom Soft Footdrop Brace (center). I discussed it with my since-dismissed physical therapist who said it wouldn’t give me enough support. I ordered it anyway (July 2010, $120). By allowing more ankle flexibility, my muscles strengthened.

When I started with Arbi (Feb. 2011), he said, "Marcelle, why are you wearing shoes that are too big for you? No wonder you walk funny." He directed me to a sports brace (right). It was only $20 and I could wear it with my regular shoe size!

The first few days wearing that brace my foot felt like it was going to roll over and break off at the ankle. I questioned Arbi – but he was firm and so was the brace. Within weeks, my ankle strengthened and, in July 2011, I stopped using a brace. Period.

I read in a fellow survivor’s blog that she had become dependent on her AFO because it had prevented her muscles from developing. I don't know if what I did would work for everybody. But I am glad I ignored the skepticism of my first PT and trusted Arbi enough to follow his advice. Half the battle is knowing who to listen to and when to listen to yourself.