Understanding Persistant Pain and How to Get Rid of It

Understanding Persistant Pain and How to Get Rid of It

Many of my clients come in seeking to address pain, but few really have much of an understanding of how pain works. With chronic pain, it is really important to work with a health practitioner who understands how pain works so that treatment is tailored to your  personal experience.  Bodywork, Movement and Coaching and lifestyle changes can all be helpful as a part of the healing process for chronic pain. My goal in writing this is to provide some insight into how pain works, because when you understand more about pain, it can have a huge impact on recovery.  Here are some of the things we know about pain that you might find surprising: 

Some Simple Exercises and Tips for Bunions

Some Simple Exercises and Tips for Bunions

Bunions can be a real mystery but I’m hoping that this mini guide will help shed some light on the issue. In my 20s, after repeated foot injuries from skateboarding I began to develop a bunion on my left foot and it wasn’t until I began practicing Hellerwork Structural Integration that I developed some insight into this common misalignment and began correcting the imbalance in my own feet. I am 46 now and haven’t had any issue with pain in my big toe for some time. I won’t lie, it requires a major shift in awareness of the feet to create a long term shift. At first this can seem onerous, maybe even impossible. How can I constantly be thinking about my feet? Well you don’t have to, you only have to be committed to shifting your awareness little by little for patterns to change. Old dogs can learn new tricks and like any new pattern, it can eventually become second nature.. If you have bunions I hope this helps you to manage or even correct your foot misalignments so they don’t stop you from doing what you love.

A Little Background
With bunions, often the stability in the foot is coming from the heel/arch area (supination), while the forefoot is pronating, or the whole foot is pronating. Either way, because of tension in the calves and lack of contact with the ground in the pinky toe ball and big toe ball, the forefoot will tend to wander side to side right before you push off the balls of the foot.  What this looks like is a heel strike that either gets unstable transitioning to the forefoot, or collapses in towards the ball of the foot as the arch collapses. The majority of the contact in the front of the foot will be in the middle three toes with the pinky toe and big toe more lifted, so the front of the foot rocks side to side like a boat, or just collapses in towards the ball of the foot.  When you look down at your feet, this might not makes sense if you see that your weight is over the outside of your foot, but this collapse inward becomes more pronounced in the terminal stance of the gait cycle, or when your leg is lengthening behind you and you are starting to push off. Long story short, the key to correcting bunions without surgery is to create stability in the front of the foot and to develop a strong arch while stretching the calves (among other things), especially in the terminal stance.

So how do we create more stability in the front of the foot? We can move in the right direction by changing the alignment when doing any exercises involving the legs, stretch the restricted musculature and build awareness of how we are walking.  In a nutshell, this means shifting the groins and waistline back when you are walking or standing, stretching the calves, and doing heel lifts and knee bends with the forefoot with good alignment to build awareness of how your foot is tracking as you move.   In this article we are going to mostly focus on the feet, but don’t fool yourself into thinking that this issue is just in your feet! Addressing misalignments in the hips and even the ribcage, and developing core support are also extremely helpful for improving or even correcting bunions. 

Here is a simplified brake down of how to improve the alignment in your foot if you have bunions.

Exercises 
Bunions are also a reflection of a pattern happening in the legs and pelvis as a whole. If we just focus on hip openers and calf stretches with the knee and ankle tracking straint, we can make a lot of progress towards correcting the imbalance. If you are doing standing stretches for your hips and calves make sure to follow the instruction in the alignment video for your feet at the same time. Balanced alignment in the feet is key.

Check out this video for some exercises to create stability in the forefoot. 

Massaging Your Feet
Any massage for your feet is probably going to be helpful, but there are some specific areas that are especially helpful with a bunion issue. There are some other one’s we won’t discuss here that can be helpful for different feet but these are universally helpful.

Check out this video for some myofascial release tips to help stretch some of the musculature and fascia that create a bunion. This is some of the work I do in my practice and it can be extremely helpful. Keep in mind that the goal is to build awareness so that you can release these tissues without having to work on them all the time. As you are digging into your foot try to bring your awareness to that part of your foot and focus on visualizing the tissue releasing. This will build the connection from your nervous system to parts of your foot that may be gripping without your awareness.

Shoes
For many people footwear plays a major factor in bunion formation by pinching in the toes and forefoot in. It probably goes without saying that it is extremely difficult to correct bunions if you are squeezing your toes into tight shoes.  Any footwear with a wide toe box would help, but some shoes I recommend are:

Lems

Vivo Barefoot

Vibram Five Fingers

Xero

Altra

Some of these brands have models with a slight heel lift. While this is not ideal long term, if your calves are especially tight, you may find that it’s easier to keep your pinky toe ball and big toe ball in contact with the ground through the terminal stance if your calves are not overstretched.  A little bit of heel lift can help with that, but it is not a long term solution. Stretch your calves!  

Again, the most important thing is a wide toe box and a lower heel. Beyond that, comfort should be your guide and there are lots of other options for shoes with space for your toes if you don’t like the ones I’ve listed here.


Toe Spreaders
Some of my clients have found relief with various silicone toe spreaders.  Toe spreaders can be extremely helpful both as a gentle way to stretch the foot and also while doing foot exercises or yoga because they hold the toes in alignment with the metatarsals (next bone up from the toes). Wearing them in shoes is possible for some, but you will need to find shoes with a wide toe box to accommodate the spreader and your widened toes. Wear them for a short period of time around the house at first to avoid straining your feet. I personally find them difficult to wear in shoes or for long periods of time because they cut off the circulation to my feet. Be mindful of this if you are wearing them in shoes. If your toes start to go numb, take them off.  If they don’t fit in shoes, you might also try a single toe spacer for the big toe. These are often available at pharmacies, but again it is still important to have a wider toe box in your shoes. 

Sugar Toes/Diet: 
This is really just food for thought, but you might find it helpful.. I am not an acupuncturist but having collaborated with several acupuncturists in my practice, sharing clients over the years, I am constantly fascinated by how the organs effect structure. I’ve noticed in my own practice that when I do visceral manipulation with a client the musculature around the organ’s meridian often shifts in some positive way. Back to bunions… in Japanese acupuncture bunions are described as "sugar toes". This would make more sense if you know that in acupuncture the spleen and pancreas are related. The spleen meridian runs along the inside of the foot out to the big toe and is generally the part of the foot that is over stretched and weak with bunions. Some things that may help to tonify the spleen meridian, and indirectly support the abductor hallucis muscle that straiten the big toe are:

-Eliminate or lessen sugar, alcohol, smoking, and excessive caffeine. 

-Take natural anti inflamatories. Spleen "Dampness" in Chinese medicine can be thought of as a phlegm reaction to inflammation, so a diet that lowers your inflammation can be helpful. If you are having problems with mucus in your throat or sinuses, you might try taking black pepper and turmeric to help with gut inflammation that may be causing the mucus. 

-Exercise or anything that makes you build a light sweat like running or jumping on a trampoline, or jumping rope are supportive for the lymph. The  muscle that straitens the big toe runs along your midline, so exercises like pilates that promote length while engaging your midline can be helpful as well. 

Finding your center. The spleen meridian is all about the pregnant pause of Indian Summer. In each moment that can be likened to being present in transition. Anything that allows you to get present and grounded may be helpful. 

Surgery
Obviously there are more than one cause for bunions, and I have only described what I see in my practice. These suggestions may not work for you but they have been incredibly helpful for many of my clients.  If your condition progresses to the point of pain that is not relieved by any of the these suggestions, surgery may be an option.  In my practice I mostly see the negative results of bunion surgery so I generally don’t recommend it as a first course of action. Surgery is never a quick fix. As with most surgeries you can expect a minimum of 6 months for recovery and you may not get the outcome you were hoping for.  If you don’t have any luck with these exercises you might want to speak to an orthopedic surgeon who specializes in working with feet. This is the what the American Academy of Orthopedic Surgeons has to say about bunions:  https://orthoinfo.aaos.org/en/treatment/bunion-surgery/


Summary
For many who suffer from bunions it can be corrected without surgery, so don’t give up hope if you are struggling with this. Feel free to contact me if you think I might be able to help you with your own foot dilemmas. I hope this helps! 

In Health, 
David

Structural Integration Mentioned in the Washington Post

There is a raging debate going on in the Structural Integration community about whether the facial model is still scientifically valid or whether we should be focusing more on the nervous system. I personally believe our understanding will eventually integrate connections between the nervous system and fascia, and while current pain science has cast doubt on our previous understanding of how Structural Integration works, that doesn’t change the effectiveness of the work. The interesting journey will be in the evolution of our understanding around why it works. With greater understanding of the mechanism of change, we may develop more effective tools. I’m not passing judgement just yet. Whether or not fascia will still be center stage has yet to be seen. Meanwhile, there is a lot of interesting new research being done with fascia.

Here is the Washington Post article.

Finding Ease

Happy New Year! It is worthwhile to start the New Year and any new intentions with a clean slate. In the body that means starting from a place of ease. When you start by releasing tension rather than putting yourself in an idealized posture, it is far easier to recognize your inherent support. Your body was designed to support you and the way to feel that balance over your bones is to release the tension holding you in any patterns. The internal sense of rightness that comes from letting go and feeling this support can be profound.

When doing anything physical, It is helpful to stay away from the notion that you are trying to achieve some perfect posture and instead focus on creating more balance. You can change your alignment by pulling yourself into some idealize position, but how do you know your alignment is any better? How do you know that you are over your spine or aligned with your joints? You won’t!  Generally letting go of bracing is an easier place to start.  Most people struggle with sitting or standing upright because they feel like they have to do more work to get there. Usually this is based on some idea of what good posture or proper alignment is, rather than what their body is telling them. In other words, they layer a pattern of alignment (tension) on top of patterns of tension they already have (more tension). You can imagine how this might be counterproductive.  Good alignment happens when we let go of holding and feel the support of our skeleton. It is not something that can be layered on top of existing patterns with good results. Your bones were designed to support you and there is no need to add anything extra. 

The following audio exercise is intended to help you connect to your body's intrinsic sense of support and let go of some of the bracing that may be preventing you from moving freely.  Make sure you are in a quiet place where there aren’t any distractions or where you can close your eyes and put headphones on.  This is kind of like a meditation, so make sure you are somewhere you feel comfortable moving around and where you can focus inward. 

Power Posing 101

Power Posing 101

Amy Cuddy's inspiring talk on how posture changes your chemistry. If you don't just want to fake it 'till you make it, if you want it to become a natural part of who you are, nothing is faster than Structural Integration.

 

Ready for change? Take the next step.

Ready for change? Take the next step.

There is nothing I enjoy more than witnessing and supporting my clients through their personal transformation. In addition to my Structural Integration practice, I am training to be a certified life coach with CTI, one of the most well regarded coaching institutions and I am excited to begin offering sessions.  If you are resisting a change, and are having trouble taking the steps to achieve your goals, this practice can be an efficient way to help you move forward.

For the first 5 clients, I am offering a discounted rate of $75 per session with a 3 month commitment.  If you aren't sure what coaching is or what it can do for you, I can offer you a complimentary 1/2 hour session to get a feel for the work. Sessions can be in person or via Skype.  

Lets get started.

Feel free to contact me by phone or by email. 
917.755.1833
transformativesi@gmail.com

How your organs affect your posture

I often integrate visceral work in most sessions and have developed a set of patterns relating restrictions in the musculoskeletal system to visceral restrictions.  What this means is that by balancing the alignment of the body the organs are positively affected, and by working with the organs the person’s alignment and movement can be improved.  I frequently work from both ends of the spectrum in my sessions.

I wrote this article in 2013 on the subject for the International Association of Structural Integration Yearbook on integrating aspects of Chinese Medicine to structure a Visceral Manipulation session.  It gives some insight into where my work is going these days.

IASI Visceral Article

 

Great Posture in Four Easy Steps

A friend of mine who is a writer asked for advice to prevent the aches and pains of sitting at a desk for long hours. Often times those knots we get in our backs are related to posture. Here’s a little experiment you can try while sitting at a desk, without the stress of trying to sit up straight. Most people think of posture as something you have to strain to do, but if you have to work to sit up, as soon as you think about something else, you’re likely to start slouching again. For this reason, good posture has to be relaxed for it to last.

1. Sit forward on your chair with the weight on the flesh in front of your sit bones with your feet on the ground. Leave your arms by your sides for the rest of this exercise. Your legs are about 1/3 of your body weight, so don’t let all that weight go into your seat, let it rest on your feet. See if you can get your knees lower than your hips with your feet still on the floor. You may need to raise your chair or use a cushion.

If you can’t do that and still sit at your desk comfortably, try bringing one leg back, so that one foot is in front of the other. You’ll notice that it’s immediately easier to sit more forward over your sit bones.

2. Now see if you can let your lower back and belly relax. Try rocking forward and back with one hand on your back and the other on your belly to find the most relaxed position. If this is difficult, most likely your knees aren’t low enough. This is especially true if you have tight hamstrings.

3. Let your head fall back so that you’re looking up and breath into the top of your ribs and throat. You should start to feel your upper ribs lift and open a little. Keep the back bend happening in your upper chest and not your lower back. Notice your breath expanding upwards.

4. Finally, leaving your jaw and neck relaxed, let your head float back up on top of your spine. Take a deep breath in your new posture and try looking around the room.

Notice how this new way of sitting feels. It’s okay to feel vulnerable or uncomfortable, but you shouldn’t feel muscle tension. If your back or hips feel tight, again try raising your seat, or try the back bend again and be sure not to use your muscles to pull yourself into balance. Good posture should be relaxed. If you feel vulnerable, try practicing somewhere you feel safe. If you feel upright and balanced, congratulations, you’re doing something right. Also don’t expect to be able to maintain this balance for long periods at first. Think of it as akin to restarting your computer. Things just work better if you do it now and again.

Balancing the Bandhas Through the Breath

In my last article about the breath, I wrote about the importance of contacting our inherent impulse to breath, and allowing ourselves to be breathed, rather than following an external or mental cue.  This exercise is no different, but it takes a little bit more refined focus and it builds off of the last exercise.

The Bandhas in Yoga, or “locks” (as in locks in a river) refer to the horizontal membranes of the body that provide containment and regulate the pressure of the different cavities of our bodies (our guts, lungs, heart and brains).

Where are they? 
The major diaphragms of the body are the respiratory diaphragm, the pelvic floor (muscles between your tailbone and pubic bone), the base of the throat, the base of the skull -at the level of the ear lobes (including the roof of the mouth and base of the eyes), the top of the head, and also the palms of the hands and the soles of the feet.  The joints of the body are also diaphragms.

Why the Bandhas are important… 
When we are having trouble breathing, or our limbs are stiff or weak, it is often reflected by in how our breath moves through our bodies.  For example, if you puff up your chest you will notice that the base of your throat and your respiratory diaphragm have to tighten to retain the pressure in your ribs that allows you to puff up. These pressure regulators also have a dramatic effect on blood pressure, oxygen delivery to the cells, stress on the heart and overall health.  If they are too tight oxygenated blood isn’t able to reach the tissue and if they aren’t toned at all, there isn’t enough pressure to squeeze the blood back to the heart and we tend to feel sluggish. Balanced tone in the diaphragms leads to longer more balanced breathing and a lot less stress on the heart. When we are feeling our best, our diaphragms are gently pulsating between contraction and release to allow a smooth flow of energy through our bodies.

Ready to feel amazing? 
Lie on your back and notice your breath.  Allow your breath to come and go, without changing anything about it.  As you tune in, you may start to notice that when you inhale, all of the diaphragms naturally contract, and on the exhale, they all tend to release. Without changing anything about your breath, see if you can tune into the softening quality of the exhale.  As you begin to inhale see if you can continue to soften your diaphragms.  Since they all move together, you won’t actually have to focus on all of them to receive the benefits of this exercise.

At first see if you can bring your attention to just one or two at a time or try checking in with different diaphragms as you breath.  With practice, you will be able to open your attention to all of the diaphragms at once.  Just be sure you aren’t forcing your breath, either breathing harder or speeding your breath up or slowing it down.  Just let it flow naturally in response to the effects of your attention on the bandhas.

The overall effect of this exercise is that it will begin to feel as if your whole body is breathing, as if your lungs extend all the way from your fingers, to your toes and out to the top of your head, every cell expanding and contracting.  If this is easy, try the exercise sitting or standing. I hope you enjoy the experience.

A word of caution.
Big emotions can often come up when working with the breath.  If you begin to feel overwhelmed or even just light headed, take a break, this exercise should ideally make you feel more connected to yourself and more at ease.

Tips for Meditation

Many of my clients have asked what they can do to support the changes they gain from their Hellerwork series. I usually give an answer something like, “Yoga, meditation, chi gong, pilates, or anything that brings you towards a deeper connection with yourself.”

Meditation is one of the most direct ways to do that and it can be as simple as observing the inhale and exhale of your breath. Of course it’s often not as easy as that sounds. I came across the following advice on meditation and thought I would share it. It’s sound advice for beginners or experienced meditators alike.

I’ll add that if you don’t already have a meditition practice with a group that sits together regularly, I highly recommend it for avoiding many of the pitfalls that beginner meditators fall into. It can help to have some support from other folks going through a similar process.

WHAT IS THE RIGHT ATTITUDE FOR MEDITATION?
By U Tejaniya
Shwe Oo Min Meditation Center
Yangon, Myanmar

1. Meditating is watching and acknowledging in a relaxed way whatever happens whether pleasant or unpleasant.

2. Meditating is waiting and watching with awareness and understanding: not thinking, not reflecting, not judging.

3. Just pay attention to what is exactly in the present moment.
Don’t go back to the past!
Don’t plan for the future!

4. When meditating, both the mind and the body shold be comfortable.

5. The meditating mind should be relaxed and at peace.
You cannot practice when the mind is tense.

6. Don’t focus too hard, don’t control and don’t force or restrict yourself.

7. Don’t try to create anything, and don’t reject what is happening. However, as things happen or stop happening, be aware of them.

8. Trying to create something is greed.
Rejecting what is happening is aversion.
Not knowing if something is happening or has stopped happening is delusion.

9. Only when the observing mind has no greed, aversion or worry/ anxiety will the meditating mind arise.

10. Don’t have any expectations.
Don’t want anything.
Don’t be anxious, because if these attitudes are in your mind, it becomes difficult to meditate.

11. You are not trying to make things turn out the way you want them to happen. You are trying to know what is happening as it is.

12. You have to accept and watch both good and bad experiences.

13. You have to double check to see what attitude you are meditating with. A light and free mind enables you to meditate well.

Good luck and let me know how it goes.

David.

Stop breathing and let yourself be breathed

I’ve been working in a more extensive way with the breath with some of my clients lately. How you breath, and where in your body you breath really sets the foundation for finding more balanced alignment and more ease. A lot of yoga, meditation and holistic health teachers give instruction on the breath, but why we do these exercises is often misunderstood. I’m a big fan of a lot of these exercises, but sometimes they take us away from our bodies own natural breathing patterns, especially if we aren’t conscious of why we’re doing them. Believe it or not your brainstem, which regulates the breath when you aren’t paying attention, has a better idea of your needs for breath than you or I can consciously figure out. It’s important to to develop a deep sense of what it feels like to be moved by your own breath and allow it to flow on it’s own before doing yogic breath work. This will help you stay in relationship with the needs of your own nervous system as you begin to do more consciously regulated exercises. The more connected to the natural rhythms of your breath you become, the more you’ll realize that most of breath instruction came from some yogi who sat still and listened to their own body long enough to get a sense of what made them feel more whole, and more connected to their source.

So try this…
Lie on your back and notice your breath. Allow your breath to come and go, without changing anything about it. As you tune in, you may start to notice that each inhale and exhale is different. When you relax, or get excited, shift your thoughts, or become more present, the inhale and exhale will become longer or shorter and the rhythm will change. The natural pattern of the breath is to speed up and slow down, become deeper and shallower, moving in waves. If you’ve ever watched the ocean, you’ve noticed that the waves come in groups of waves called sets. Your breath will do the same thing as your nervous system adjusts to the ever-changing needs of your body. As you watch this ebb and flow, it will bring you to deeper states of calm.

Stop breathing
Now, if this is not happening naturally, it may be that something is blocking your natural breath from surfacing. This may help…

Let your mind off the hook, stop breathing, and wait. I promise, if you stop yourself from breathing, you will be forced to take another breath. When you can’t hold it anymore, let the air fill your lungs and rest. Watch what happens next with the question, “what does my body want to do next?” You will probably start to notice a new rhythmic quality to your breath as it moves on it’s own. Try this several times and see if you can tune into the impulse deep inside that is begging you to be breathed and allow this impulse to drive your breath. If you need to reconnect to it again, you guessed it, just stop breathing. The more you relax, the easier it is to feel this impulse, but don’t worry, it will eventually take over, no matter how hard you try to hold your breath.

A word of caution: Big emotions can often come up when working with the breath. If you begin to feel overwhelmed take a break, this exercise should make you feel more connected to yourself.

Staying connected to this impulse is at the foundation of any healthy breathwork or meditation practice.

Footwear Alters Normal Foot Function

According to this study conducted by researchers from Belgium and the UK, your shoes have probably shaped your feet to work differently than their original design.  They found that people who go through life unshod tend to have a wider forefoot, better weight distribution through the foot and they speculate, produce less impact as a result.

For a hit of how this might happen, try walking around on a hard floor without your shoes on and listen for the sound. More than likely, your heels are making a lot of noise when they hit the ground. This is often the result of wearing shoes with heel support. We tend to put our weight where we get the softest impact. But when we take our shoes off the padding is gone. When we’re barefoot, the impact of our bodies on our feet becomes our teacher. If you pick up your heel and poke it with your finger, you’ll notice that most of the padding is on the middle of the heel, not the back where you’re probably used to landing if you wear shoes (and who doesn’t!). Try walking letting the soft pad on the bottom of your heel land first. This isn’t easy if you’re used to it and the first thing you’ll probably notice is that you’re walking slower. Don’t worry though this is just the beginning of learning a gentler way to walk. The speed comes from the pushing off, but more about that later. For now, listen and feel if your walk is a little quieter or a little less hard on the rest of your body.