Mind Over Muscle

Pre-stroke I worked out listening to my iPod, thoughts meandering over yesterday, today and tomorrow.  Post-stroke my mind needs to engage as much as my muscles.  First, I relax the spastic muscles in the area I want to exercise; second, I link my brain to the muscles I want to work (harder with some than others); third, I put my core muscles in proper position. Now I exercise, holding all of the above in mind as I repeat the motions.

I liken it to golf and all I had to keep in mind simultaneously to hit the ball on the sweet spot: Keep that elbow straight, rotate those hips, keep that head down – oh yeah, and try to relax! I sucked at golf.

I’m working harder at rehabilitation than I ever did at golf.  The most mentally challenging aspect for me is correcting bad habits – not just those acquired through adaptive functioning – but those that pre-exist the stroke.

Instead of keeping my feet parallel and engaging my core muscles, I turn out one foot for stability. Eric calls it my kickstand and says a lot of people do this, which contributes to the prevalence of lower back pain. I do it when I’m standing at the kitchen counter, in line at the post office, lifting weights. 

The other bad habit many of us have is to use our joints for stability instead of our muscles. It’s easier to lock our knees than to use our leg and core muscles. I use my hip like a linchpin, taking all the weight on it and cocking it as needed to move me. No wonder it hurts. 

For healthy recovery, I need to stop relying on my joints and make better use of my muscles.

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.

In 'N' Out

Sometimes I notice that I hold my breath when I'm doing something challenging. Pre-stroke I caught myself holding my breath whenever I changed lanes on the freeway. Post-stroke I notice it most often while doing hand exercises.

My occupational therapist used to command me to "BREATHE!"

My retort: "I can pick up this ball or I can breathe, but you can't have both!"

I wasn't the only rehab patient with this problem. I heard other therapists bark the same instruction at other straining patients. 

Here's my new tactic: When I become aware that I haven't exhaled, I stop whatever I'm struggling to do and take a few purposeful breaths. Then I make another attempt while focusing on my breathing. Whenever I do this, I notice my coordination and execution improve. I have become convinced that my recovery will coincide with my ability to breathe easily through my motions. Like golf or yoga, the perfect swing or the perfect pose feels effortless.

Jack Kornfield tells a story about a meditation student who complains to his teacher that focusing on his breath during meditation is boring. The teacher grabs the student by the neck and plunges his head under water. When the teacher finally releases the struggling student, he says: "Do you think your breath is boring now?"

Body Awareness

Practicing yoga pre-stroke gave me a familiarity with the mechanics of my body. I learned how to roll and tuck my shoulder blades to open my chest. I learned how to stretch my feet both wider and longer. I learned to balance my weight not only side-to-side but back-to-front. I learned to be aware of the subtleties of my body.

In recovery I am aware of my body changing. Some of the exercises given to me in the weeks immediately following the stroke were premature. I stopped doing them in favor of exercises that seemed more helpful. Now I'm realizing my body is ready to go back to some of those abandoned exercises; I need the skills they were designed to teach. 

As I do each exercise, I try to be aware of the muscles being targeted. I often ask my therapist to touch the muscle I'm working. This helps me focus my mind on it, making my efforts more effective. And by being aware of the sensations and behavior of my body, I can communicate better with my therapists. This helps them help me.

For more than two years now, I have been almost constantly and uncomfortably aware of the pains and deficits of my affected side: It burns, buzzes, tingles, cramps. Sweet sleep or an hour of television provides brief escape. But the long-term escape — recovery — comes from paying close attention. My body wants to heal itself … is trying to heal itself. If I pay attention, I can help it.