From Injury Prevention to High-Level Performance

Most people believe that the road to athletic success comes from working harder. Although there are benefits that come with keeping a disciplined regimen, the toll of stress injuries that accumulates throughout an athlete's life can be nearly incapacitating.   A common routine of athletes is to work hard to get in shape, get an injury, then work in pain or not at all, recover and repeat.

I would like to suggest a different model.  I think it is critically important to work smarter rather than harder.   The best way to improve performance is by moving in ways that prevent injury and the best way to prevent injury is to perform with greater agility.

How can we do that? By learning to move like a child again with non-linear movement.

Traditionally, athletes and active individuals have performed warm-up and flexibility exercises in a rather boring, mechanically linear manner. We have treated our bodies as if we were stick figures drawn on a chart, stretching first our hip flexors, then our hamstrings, moving one side of the joint in one isolated part of the body and then the antagonists muscle group on the other side of the joint.  Most recommended flexibility routines involve a significant number of linear stretches, which are eventually supposed to affect all of the joints and muscle groups in the body.

But how many of us, against our better judgment, have rushed through such routines simply because they are boring? The very attitude of treating ourselves like trivial machines contributes to a body image that perpetuates diminished flexibility and consequently, a dangerous propensity towards injury.

A better approach involves learning to move like a child again. Moving like a child means a complete break with linear exercise.  This means using all of your joints at once in every flexibility and warm-up routine. As children, we learned to develop bodily movements more rapidly than at any other point in our lives. 

© Anton Novozhilov - Dreamstime.com

© Anton Novozhilov - Dreamstime.com

We would never think of stretching our babies to increase flexibility, nor would we think of tying weights on their limbs to improve strength.  Instead, the way a baby moves on its own is sufficient to develop very complex movements like tumbling, rolling, falling and recovering, etc.  Imagine performing movements similar to the way a child moves as it develops control and coordination of its body.  Now imagine performing those movements with the understanding of an adult.

Photo by RJ Muna

Photo by RJ Muna

To replace typical stretching, warm-up, and rehabilitation exercises, I encourage "neuro-muscular tune-ups," movement lessons that are intriguing and stimulating, require very little effort and most importantly, teach athletes how to pay attention to themselves with the same high level of awareness required while engaging in a sport or activity.

The awareness that a baby develops simultaneously with its movements is part of what makes us unique in the animal kingdom.  While other animals know instinctively how to walk and run, humans must learn.  Yet amazingly, this attribute of bodily awareness is rarely used, except at a very crude level of operation when we are told to twist a little more to the left or right.  Ironically, athletes and dancers are most aware of their bodies through feelings of resistance, effort and finally, injury.  If most of us as babies underwent this experience while developing motor control- resistance, effort, injury, it is doubtful we would ever want to learn to walk!

The key to injury prevention and improved performance is to learn how to move without resistance, how to become more nimble, agile and deft, and just as importantly, how to develop awareness. Awareness of how we move should be the goal of physical education. 

-Frank Wildman, PhD

Freeing Your Middle Back, sample lesson

This “Freeing Your Middle Back” exercise is excerpted from the book, The Busy Person’s Guide to Easier Movement, by Frank Wildman, PhD, which has common-sense lessons connecting the mind and body through movement to help people move with more ease, comfort and efficiency.

This lesson will help you to integrate your upper and lower back, as well as your shoulders and neck, into a fuller, more efficient posture. This lesson could also be of benefit to people who experience stiffness or pain in their lower back.

1.     Sit comfortably tall in your chair with your feet flat on the floor. Place your right hand on your left shoulder and allow your elbow to hang against your chest. Take your left arm across your chest underneath your right arm, and with your left hand, hold on to your right shoulder. Your right elbow should be resting on top of your left arm. You are now giving yourself a big hug.

Freeing_your_back1a.jpg

2.     Keeping your hands on your shoulders, lift your elbows straight up and point them forward, then bring them back down to rest against your chest. Repeat this movement several times, each time allowing your elbows to go higher until you can point at the ceiling, then down to the floor. Look up and down as your elbows are pointing and feel the movement in your upper and middle back, as well as your lower back. Rest in the middle of your chair with your arms in your lap.

3.     Repeat steps 1 and 2 with your arms crossed the opposite way. Place your left hand on your right shoulder. Reach with your right hand underneath your left arm and hold on to your left shoulder. Allow your elbows to rest against your chest. As you point your elbows up and down, from ceiling to floor, be sure to let your head follow. Feel how your pelvis can assist you. Rest your hands on your lap or desk and observe any changes in your posture.

Freeing_your_back1b.jpg

4.     Cross your arms again as you did in step 1. Raise your elbows to point directly in front of you. Now turn your elbows to your left as if pointing at something on your left side. Look where you are pointing and move your elbows from the center to the left several times. What does your pelvis want to do? Let the right side of your pelvis slide forward and backward in your chair to assist you as you go back and forth. Rest in the middle and re-establish your hands resting on your shoulders.

5.     Again, lift your elbows to point in front of you and point them to the right and back again several times. Be sure and allow your head to turn with your arms and let the left side of your pelvis slide on the chair. Rest completely, leaning back in your chair.

Freeing_your_back2.jpg

6.     Once again, sit in the middle of your chair and cross your arms as in step 3, with the left hand going to the right shoulder first and the right arm underneath the left shoulder. Point your arms forward and begin to turn them right and left several times, while feeling your pelvis pivoting in your chair. Rest your elbows against your chest and re-establish your hands on your shoulders.

7.     Lift your elbows again. Keep your nose pointing straight forward and turn your elbows left and right several times without moving your head. Pause. Point your crossed elbows from side to side again and let your head follow. Do you find yourself able to point farther than earlier? Rest completely.

Freeing_your_back3.jpg

Awareness Advice:
Be sure you are relaxing your jaw and face. Some people have been caught smiling while doing these movements. It’s possible. Observe where you prefer to inhale and exhale.

8.     Cross your arms again as in step 1. Let your elbows hang down and slowly raise them as you turn to the left so that you find yourself pointing up to your left side. Then bring your elbows down to your chest as you return to the center. Raise them up to the right as you turn to the right. Your elbows will be making a large arc reaching up at the sides and down at the middle. Rest in the middle with your hands on your lap or desk.

-Frank Wildman, PhD

 

Anti-Exercise for the Older and Wiser

The older we get, the more clever we must become.

Old age, for most people, is a time of increasing physical discomfort, stiffness, and fatigue. Everyday activities like walking up a flight of stairs or carrying groceries becomes more and more difficult. To counteract the process of apparent bodily decline, older people are told to perform traditional forms of exercise designed to strengthen muscles or increase endurance. This seems sensible and obvious, and indeed contemporary research points to the benefits of strengthening, flexibility, and endurance exercises for the elderly patient. But traditional exercise programs often involve a degree of strain, fatigue and regimen that many older people are unwilling to partake in. A seventy-year-old woman who has difficulty with degenerative joint disease is neither ready for, nor enthusiastic about jogging or weightlifting.

After a certain age, our bodily wisdom tells us it’s too difficult to slam our bones, strain our muscles, and do the things we used to do with will power and brute strength. But as we age, it is more important to use our bodies more efficiently. We must improve our quality and ease of motion, our coordination, our sense of balance, control and comfort. Unfortunately, little in our fitness culture encourages us to learn how to reduce stress while increasing muscular efficiency in a pleasurable and comfortable manner. Because of this, it is not common for people in their 50’s, 60’s, 70’s and older to explore new ways of moving as we did when we were infants, which is really the key for continued coordination.

An infant’s body and its capabilities are quite different from those of a five-year old, a teenager, or a 40-year old. However, most people continue through life with the same movement patterns that we taught ourselves in the years between birth and when we considered our mobility good enough to do whatever we wanted to get around in the world (i.e., walk, run). If an individual was interested in athletics, there would be further training, but often with little regard for how the body actually works, such that success at sports was usually understood to be the result of talent and hard work, rather than wisdom about how to use the body efficiently.

Proceeding through life with the same set of movement habits developed and codified at age three, it's not surprising that eventually those neurological habits will no longer be applicable to a changed body. As these ingrained habits become less efficient with an aging body, a natural reaction is to try harder to ingrain and repeat these patterns.

The work of Dr. Moshe Feldenkrais offers a thorough application of current models and approaches to motor learning and motor control in order to change our ingrained movement habits. Movement lessons invite a student or patient to recreate the childhood experience of learning to organize and control all the body’s movements, including all aspects of interacting with the environment and what one has to do to move through that environment. The lessons provide an innovative and exciting movement program that can enhance your ease of movement, flexibility, relaxation, and posture faster and further than any form of conventional exercise.

Focusing our awareness on how we move

Dr. Moshe Feldenkrais systematized the process of paying attention, a rare and necessary element in the process of growth and change. The lessons begin with the proposition that correct movement is movement with minimal effort, and that most people have learned to move incorrectly by straining with more than the needed effort to do what is required. The goal of the lessons is to call into awareness the basic movement habits that cause stress, and then to systematically release the body into more effortless motion.

For example, when most people, especially the elderly, move from a lying to a sitting position, whether in bed or on the floor, they strain their abdominal and neck muscles. I would work with this person to retrain them to sit up by first becoming aware of exactly how they strain and where the focus of tension is, and then by altering the dynamic pattern of the movement, so as to reduce fatigue. Rather than repeatedly doing sit-ups, a person learns how they sit up and how many different ways they can sit up, while learning how to sit with less effort.

At a movement program for older adults presented through the University of California, I introduced students to gentle and intriguing movement lessons developed by Dr. Moshe Feldenkrais. The results were astonishing.

The majority of the people in the class believed their physical limitations and difficulties were the inevitable result of aging. They had a self-image of pains that don’t improve, rigidities, and movement limitations. They had come to the class with the idea of exercising their limited bodies to develop enough strength and flexibility to continue on, but only within the same essential body image. But instead of straining, groaning, and stretching, they learned stress-free interesting movements that were easy to do and, most importantly, changed the way they understood and used their bodies.

There were striking changes during the course of the program. In the first class, many participants needed help getting to the floor and even more needed help in standing. Lying flat on the firm floor was a painful experience for many. By the tenth class, people simply got down to the floor and up by themselves. During class, they lay flat on their backs without pain, some for the first time in decades.

The results of this class reached beyond improved posture and muscular efficiency, as the students gained an awareness of how to use their bodies better. They were able to perform tasks previously accomplished with much force but little skill, for example, standing up from a chair. It doesn’t take much leg strength if done properly, if there is an understanding of the relationship of legs to back to pelvis to shoulders to head. However, if someone does not have a clearly felt image of the relationship between body parts, it can be an extraordinarily difficult task. The less information we have about how to coordinate a simple action, like standing from a chair, the more effort it takes.

The renewed awareness was often life changing. Some people had stopped going out alone because they feared they would tire or lose their balance or not be able to get up from sitting without asking for help from a stranger. When they learned how to get out of a chair in a balanced, smooth fashion, they were amazed. Some cried. The world had opened up to them again.

While anyone would benefit from learning how to sit up more efficiently, it is older people who need such training the most. As strength and stamina decline, it is necessary to learn how to make the best use of available energy. To address the needs of the older population, I recommend gentle and innovative movement lessons to introduce new ways of moving, and thinking about moving- anti-exercise for the older and wiser.

If you are interested in working privately, please email me at frank@frankwildmanmovement.com or call 510-283-5494.

Click here for one of my sample movement lessons, Freeing Your Middle Back.

-Frank Wildman, PhD

More Sensory-Motor Concepts: Rolling

In the first Sensory-Motor Concepts article, we discussed basic gross motor skills organized around anterior/posterior motions of the body, vertical movements, and lateral and rotational movements. In this second article, we'll explore a narrower but still quite prevalent category of motor concepts.

This exploration of motor concepts is based on observations from my years of teaching and working hands-on with clients.  Like a natural historian, I use my observational skills to try to categorize the things I see. However, since there’s not much hard research on these concepts and connections, I will add to the discussion of these motor concept categories some questions for further research, along with possibilities for intervention to improve movement. I look forward to hearing your experiences and observations.

ROLLING vs. SLIDING

This is an example of rolling the arm up and down.

There’s a movement lesson I’ve taught to thousands of people in many different countries, which involves lying on your back with your arms straight out to the sides, about shoulder height. I would then ask the student to make a soft fist and roll their arm and fist down toward the feet and up toward the head. In other words, the amplitude of the movement of the arms would be determined by how far you could roll your fist.

This is an example of sliding the arm up and down.

Some people do not roll the fist or arm at all; they only slide the arm up and down on the floor. More people roll a small amount and then slide. About 1 out of 3 people might partially roll then slide their arm down and up.

Now one could say, “So what?”

What I’ve observed countless times is that people who roll clearly and fully in both directions will also walk in a softer manner, as if rolling the bottom of the foot on the floor, moving softly from heel, across the foot and off the toes, thus making knee and hip actions easier.

People who tend to slide the arms do not readily show this kind of walk and foot action on the ground. Instead, particularly in older adults, the tendency with arm sliders is to shuffle with the feet, almost as though they were trying to slide their feet like they slid their arms in the lesson.

A dramatic example that has appeared several times in my courses: I’ve also asked people lying on their backs to roll their legs, in and out, internally and externally. Most people understand those words and how to translate them into their bodily actions, but some arm sliders can only think of sliding their legs together and sliding them out. These people have very pronounced shuffles in their walks.

To understand how pervasive these issues are, often a student might need to be handled so they could feel what it’s like to roll an arm compared to sliding it. If students watch other students rolling their arms on the floor, they can at least approximate the idea better but sometimes the translation from seeing to sensing is also not available.

Another interesting issue/observation- people who roll their arms while lying on their back generally look more graceful and coordinated if asked to simply roll onto their stomach and return to their back. In some people, this whole body rolling motion is done easily and quickly as one simple whole body movement. In other people, it takes multiple movements and adjustments to move from their back to their stomach and even more movements to roll from stomach to back.

And again, people who physically understand the motor concept of rolling seem to maintain the concept in a large number of actions. But then, people who slide their arms in the lesson I described show that sliding and shuffling belong to a large number of actions, as though that too was a motor concept.

Further movement puzzles: if someone who can’t understand the feeling of rolling the arm compared to sliding it is handled so they can sense what the word ‘roll’ means and that sense is accepted and internalized, it still takes some teaching to develop the same sensation in the legs while still lying on the back or rolling over. Only then does it seem to affect how they experience the ground that they walk on. In which case, a shuffler can learn to organize rolling across the foot much more easily.

Clearly more research needs to be done on how our brain organizes the control of movement. So far no theories of motor control address some of these important issues and observations.

Questions for further research

  • Is the motor concept for rolling so pervasive that if it doesn’t show in the arms, it might not show elsewhere in the body, like in walking and the feet?

  • Why and how does a simple movement of the arms reflect itself in similar qualities of motion in the legs and feet?

For the next article in this Sensory Motor Concepts series, I’ll discuss motor concepts related to balance.

-Frank Wildman, PhD

What is a Sensory-Motor Concept and Why is it Important to Know?

Understanding sensory-motor concepts is the crucial element to moving well as we age or regain lost skills after an injury, trauma, or cerebral accident.  This understanding is not cognitive in the ordinary sense.  It requires sensing how we perform an action so that we can improve our motor skills with a deeper felt sense.  It’s called a sensory-motor concept because if we have not developed a sufficient felt sense of our own movements, we will have a much more difficult time coordinating any and all of our movements.  For example, if you don’t feel the difference between left and right, no amount of strengthening or stretching will help you.

Our fitness-crazed culture might suggest exercise—weight lifting or endurance exercises to strengthen muscles or stretching for our muscles and tendons—as the solution to our movement problems however they came to be, but without involving our brain in the way we organize our movements, all of the exercise in the world won’t restore our movement abilities in a lasting way.

The good news is that there are three primary sensory-motor concepts that we all mastered as babies.  These sensory-motor concepts determine how we organize all of our actions as well as how we orient ourselves in the environment.  The coordination that results from highly developed sensory-motor concepts is a matter of what occurs in your brain when you explore movement. 

The first and most critical sensory-motor concept is to fully feel and move in what’s called anterior-posterior directions, i.e. front and back.  Without this concept, reaching for something in front of you and bringing it back, to let’s say your mouth, could not occur.  Babies first learn the movement of front to back as they start to understand and connect with their environment.  For example, they see some food or a toy in front of them and bring it back to their mouth.  Discovering how to put things in the mouth is critical for survival, but also, for a baby, it means to understand something through the senses and to develop the movement skills involved to bring the world to the mouth so it could be understood.  Eventually as movements become more expansive, the baby brings the mouth to the world.

The second great sensory-motor concept is called vertically, i.e. moving up and down.  To move all your weight away from the ground to standing up is a complex activity.  It’s not only difficult, but also impossible to do without a developed sensory-motor concept of orienting ourselves vertically.  We can see babies learning this concept as they explore many different ways to bring themselves to standing or sitting.

The last of the three major sensory-motor concepts is laterality.  Laterality includes knowing left from right and being able to turn easily or rotate one’s body.  Infants learn this concept of laterality as they master how to turn, sidestep, or reach left or right.

Understanding these sensory-motor concepts is essential for survival.  With out the concept of front and back, we couldn’t feed ourselves.  Mastering the concepts of verticality and laterality is crucial in being able to flee danger or to seek pleasure or satisfaction.

Beyond survival, feeling and understanding these sensory-motor concepts can result in tremendously complex movements.  Imagine a high diver: You can’t jump off a high board or platform, do a triple somersault, half turn and hit the water perfectly without a felt understanding of your sensory-motor concepts.  If you make a mistake and hit the water at speed, you could break your neck.  You have to know when you jump off a board or platform where left and right is, where up and down is, and where front and back is.

Another example illustrating how this felt understanding of sensory-motor concepts works is getting up from a chair.  A person without a developed felt sense of verticality may awkwardly try to bring their head and body higher by pushing down on the armrests with their arms.  If you have a better feel for the concept of verticality, you may organize yourself to lean your torso forward to shift your weight over your legs and then push through your legs to raise your body up.  This would indicate a better understanding of how your body relates to gravity and how you might need to reorganize to move with less effort and greater clarity.

As we age or after an injury or trauma, we lose these sensory-motor concepts in the reverse order that we learned them as babies: First our lateral movement becomes more difficult or limited, then our ability to get up and down becomes compromised, and finally our movement options shrink to just dealing with what is in front of us.

With loss of laterality, you may experience an uneven gait, balance disorders, and the inability to play sports you once enjoyed like tennis.  You can live a good life but you might feel stiff, which no amount of stretching will improve.  Relearning the motor concept of laterality can melt this stiffness. 

If damage is so severe that the second sensory-motor concept of verticality is compromised, then the person would have to be in a care situation because getting up and down and walking towards objects would be difficult. 

If the damage were even worse so that the first sensory-motor concept of anterior-posterior disappeared, then the person would need to be in a total care situation, since without this sensory-motor concept, they would be unable to even feed themselves.

Happily we can reverse the loss of these sensory-motor concepts by relearning how to feel them.  Physical education, various forms of physical therapies, training, coaching, practicing (be it dance or sport of any kind) should be approached from a point of view that strongly involves sensory-motor skill development.  This is so completely different from our current fitness craze as to make the concept of conditioning, sculpting six-pack abs, and working out to your max actually artificial and unnatural.

Teenagers and adults need to re-learn sensory-motor concepts in the same style that we all originally learned as children.

My work with people of all ages and abilities focuses on developing coordination, offering the possibility of regaining forgotten movement skills and expanding our movement repertoires and improving our skills.  Both students in my programs as well as in my private practice have found themselves able to perform activities they gave up because they didn’t feel successful or found the activity hurt too much.  Many of them not only enjoy dancing again, playing tennis or golf again, but they also find themselves able to perform new skills that emerge out of a superior sensory-motor understanding.

This is the first part of series of articles on sensory-motor concepts.  More to follow.

-Frank Wildman, PhD

Transforming Pain into Pleasure

The following is a case study of a women I worked with as patient demonstration at one of my hospital-based courses for physical therapists. While I see my private clients in a studio rather than hospital setting, I address many of the same movement issues and challenges as I discuss here.

Following an accident, the patient, let’s call her Ann, had a difficult knee injury that was now infected.  She was in a lot of pain and tactilely defensive-- fearful of being touched or even approached.

Ann, who was around 25 years old, was wheeled in to me at a hospital.  She had an I.V. in her arm and a drainage tube in her right knee.  The infection was spreading to other parts of her body and she could no longer step on her right foot.

Ann had experienced so much pain in the hospital that she was in a state of alarm as to what I might do to her, especially in front of so many of the staff.  As I approached her from across the room, she winced with pain. What could I do?

We started by my asking Ann to tell me how close I could come to her and still have it be comfortable, and by my promising that I would do nothing to hurt her.  I said that under no circumstances would I touch her right knee of leg unless she begged me to.  This reassured her enough to allow me to get closer.  I maneuvered slowly around her body, looking for the areas where there were "windows of opportunity" to bring us closer.  I then got close enough to ask her if we could shake hands.  I asked her if that hurt.  She said "No," and I asked if we could shake hands for a longer time. 

And so, I began working with her through her right hand, then, up the right arm to the right shoulder.  I then asked for the other hand.  As she began to relax, I asked her if she wouldn't be more comfortable lying down.  This involved carefully transferring her to the table to avoid any pressure under her right foot.  She said she woke up in the morning on her back, so that's where we started.

I then began to play a game with Ann that she found intriguing.  I asked her if I could touch her head.  My question to her was, "On a scale on one to ten, ten being the most painful, how much does it hurt?"  She said that she liked it.  In fact, she was amazed that she liked it.  So I asked her to develop another scale--a pleasure scale.  Ten would be the most ecstatic pleasure she could imagine.  I began to explore her shoulders and ribs and I worked deep in her belly and diaphragm.  She began to appear larger.  Color came to her skin and I said to her, "Now could you smile please?" which made her laugh.  Her laugh immediately turned into crying because she hadn't laughed for so long.  I then asked her if I could touch her left (non-painful) leg.  She became nervous and said, "If you touch the bottom of my right foot, I couldn't bear the pain.  Please don't touch it."  So, I did lots of things with her left leg, her head and her pelvis, always asking her, "On a scale of one to ten, how much did it hurt or how much pleasure is there?"

I then asked Ann to help me make her feel good.  She learned how to breathe and to reorganize her tensions in very subtle but precise ways so that she didn't trigger or overreact to pain.  She then said, "I wish my right leg could feel like the rest of me."  I replied, "Doesn't it feel better?"  She confessed that it did, but attributed this to the fact that I had not been touching it.  I said that maybe if I touched it, it would feel better and she agreed to let me touch it.  I would not touch the foot until she asked me to, as we had agreed.  She laughed, now without tears.

Eventually, I touched the right foot and was able to push on it.  I touched the knee and taught her what to do with the rest of herself to make the knee feel better while I was touching it. For example, Ann learned how to lower her high-set startle tone throughout her body so she could lower her muscular stresses and not react so strongly to the fear of pain and the pain itself.  She was very impressed that she had control over the pain in her knee by using the rest of her body in particular ways.  In fact, she was delighted.  Ann first described the knee pain as a ten, and we were able to get down to two.

Basically, we re-created a map of her body so that rather than having all of herself feel stress and pain, especially her knee, she now had a body that felt good almost everywhere.  She had also differentiated the pain in her knee into several controllable stages that stayed compartmentalized at the area of the knee itself.  Ann no longer hurt -- she simply had a sore knee.

I then ended the session by moving her body through functional patterns that would be useful for walking such as relearning how to flex her hips and move her pelvis.  As I worked, I always made sure that whatever I did would reflect itself in movements of her right knee and feel very good.  She began to build a pleasure scale for her body, rather than an absence of pain scale.  Next, I had her contract the muscles of the right leg and learn what to do with her breathing so that she could actually have voluntary control of her extraordinarily thin muscles.

At the end, Ann was able to stand up and step in her right foot for the first time in many weeks.  With amazement, she walked several feet to her wheelchair.  But that was not the end.

Several days later, after returning home, I received a call from one of her attending physicians who told me that her knee had been undergoing an impressive healing.  They had been considering the possibility of amputating her leg but now decided that they certainly would not have to remove her leg and were already able to remove the drainage tube from her knee.  He also reported that she was starting to eat again and was beginning to go for short walks.  He thanked me and at the end of our conversation said, "How do you pronounce the name of this stuff, again?"

This lesson re-inspired an idea I have had for something I am calling a Pleasure/Pain Chart.  In pain clinics everywhere, there is often a stiff-looking body on paper, with painful words on the same page.  The clinic asks the patient to circle the painful words and draw an arrow to where he feels that pain.  (For example, if a client has a stabbing pain in a specific area of his back, he circles the word "stabbing" and draws a line to that part of the figure's back.)

In my Pleasure/Pain Chart, we had an artist draw a relaxed-looking person, standing in a natural pose.  To the left of the person are thirty words for pleasure, many of which we use during body scans in movement lessons.  To the right of the person are only eighteen words for pain.  The instructions are that for every painful word, the patient circles and relates to some part of his body, he must also circle two words from the pleasure scale and relate them to parts of his body.

What this does for the pain patient is remarkable.  Most people in extreme or long-standing pain feel their body as an undifferentiated mass of pain.  As in the lesson with Ann, people filling out the Pleasure/Pain Chart form a differentiated image of their body which both reduces the area of pain for them, and the intensity, by shifting their attention away from "things only hurt more or less," to very specific descriptions that they are forced to come up with in relation to pleasure.  I have seen people filling out this chart visibly alter their posture, muscle tone, respiration, and entire demeanor by the time they were finished, with an often desperate attempt to locate pleasure in their body.  For some people, especially pain patients, it may by the first time they have ever had the experience of their pain reframed.  For most people, it is a radical and startling experience to bring into language, and therefore into their field of attention, very specific pleasurable qualities throughout their body.

-Frank Wildman, PhD

Learning How to Fall. It Begins in Your Head.

The fear of falling is one of the most basic anxieties anyone can experience.  

For some people, if they walk on a trail by the edge of a cliff, they cannot look down from a height without feeling a little dizzy.  Sometimes people even freeze in their movement because the fear of another step near the edge will lead to a fall. This fear can even follow us while we sleep, as you know if you’ve ever dreamt of flying and woken up with a start at the moment of sudden descent or landing.

This fear of falling can carry over into our day-to-day lives, when we walk on uneven pavement, or even think about having to walk in the dark.  

Most people try to prevent themselves from falling by stiffening their hips and the muscles of their back in such a way as to pull themselves away from the ground.  But let me suggest another way to approach the movement.

Instead of crashing to the ground, imagine that in the moment of descent, you knew that you could trust your body to land safely and softly—without bruises or broken bones.

If you feel like you are going to fall, the safest thing is to learn how to do so.  If you stiffen the muscles of your back and hips, you are more likely to hit the ground harder.  

It would be helpful to anyone who feels afraid of falling to practice getting down to the floor and up again as a mind-body exercise. One of the best strategies would be to learn over time to move to the ground as quickly as possible so you have control of your landing.

By practicing going down to the ground, you will eventually be able to move faster.

In learning how to fall, you’ll learn to move as fast as gravity.

The first step to master these physical concepts is a simple thought experiment that asks you to imagine (rather than perform) movement.

Without actually moving, imagine going down and up from the floor. The next time you imagine going down, go all the way down to lying on your back. Not only will this imagined movement melt your old habits, but it will also enable you to create new movements by expanding your embodied imagination and adding new neurons to your brain.

Next bring your imagination to the physical movement: move from standing to the floor and back to standing as you saw yourself doing it in your mind. You might even find that it’s good exercise to go down to the floor and onto your back, then return to standing—something you could practice every day. Feel free to invent your own variations, as long as how you do them is clear to you.

Try going at various speeds so that you can go up and down from the floor without bumping. Feel how smooth the movement can be and how light you can make your return to standing.

Imagine if photographs were taken of you getting down to the floor and returning or coming up from the floor to standing and then returning to the floor.  If your movement was controlled, a viewer would not be able to distinguish from any given direction you are going because your movement, if controlled, would be completely reversible.

Once you’ve mastered each step, you can then speed it up as quickly as you want.  Then, starting on the floor and getting up, you’ll learn to reverse the trajectory perfectly when going back down to the floor.  This principle of reversibility in movement will help you control your body if you go at high speed.

This up and down movement is very stimulating to the inner ear, and sometimes we need to take time to adjust to that. When you increase your speed, you might find yourself getting dizzy. If so, simply rest sitting in the chair for a while. Eventually the exercise will strengthen your vestibular system and improve your balance. You’ll find yourself becoming less concerned about approaching and leaving the floor.

And your future, falling self, with thank you. If you find yourself in sudden descent (tripping over a tree root, or a uneven sidewalk), you’ll have the body/muscle memory that will help you avoid panic and move through your fall.

By learning how to fall in this way, you can overcome basic anxieties and lessen the chance of  injury with your new smooth landing.

-Frank Wildman, PhD

Upper and lower back pain: What you don’t know will hurt you

Difficulties with our backs can lead to a variety of problems—including pain in the upper and lower back, the sacro-iliac joint, and even the neck, as well as loss of work, large medical bills, and distress at not being able to live life in a comfortable way.  

The major contributors to back pain? Stress, poor posture, and a lack of body awareness.

Many years ago, I developed and conducted a back pain program for the University of California.  What I learned was that very few people sensed their back, how it moved, and how they used their back to do almost any activity.  In other words, there was a low level or even a completely absent sense of their back.  It’s as if pain was the only signal that provided the information that they even had a back.  

This lack of back awareness is understandable.  Most of us can easily see the front of ourselves and we might find it quite easy to touch the front or even the sides of our body with our hands.  We are naturally more aware of the front of our bodies.  But it’s difficult to see our back (barring eyes in the back of our heads) and for most people, not so easy to touch our back.  

What this means is that it’s difficult to notice when our muscles are overworking to simply sit or stand—or for many people, even to lie down.  I’ve seen this firsthand as a large number of people that I work with report waking up with back pain in the morning after a night that should have been rejuvenating their muscles.  

Over the decades, many exercises for the treatment of back pain have gone in and out of style.  Some decades ago, it was very fashionable in the world of medicine and physical therapy to promote the use of something called Williams’ Flexion Exercises (this involved folding the front of your body).  That worked for a small number of people, but for most people, it didn’t, and for some people, it worsened their condition.  Later the opposite idea took hold with McKenzie Extension Exercises (these involved bending backwards to wake up the back muscles and activate them more).  These exercises met with similar results: they worked for some people and they made some people worse.

The key insight: How we perform exercises is more critical than which ones we do.

No exercise, trendy or not, will be useful if you can’t feel what you are doing. Imagine you were told to walk in order to strengthen your back. You can walk around like you do everyday, but that won't improve the condition of your back; it will just strengthen your old habits of arranging your body in painful ways.  But if you sense what your back or body might be communicating-- "I'm holding my breath anticipating pain with each step" or "I'm not swinging my arms"-- you can begin to adjust the way you organize your body to move. You need to be attuned to the sensory information from your muscles and your joints, in exercise and in daily life.

A person who uses a lot of their back muscles while sitting and even more when moving may first receive signals from the back to the brain saying, “I feel tight, but I don’t hurt yet” and then “Now I hurt, but only a little ache.”  If those the messages from your back are ignored, if you don’t sense the amount of effort in your muscular use of yourself, your back will eventually signal, “Now I really hurt so badly that I am not going to let you move without pain.”

The best approach to back care is to provide as much sensory information as possible so the person can detect and change, for themselves, how much effort are they putting into their muscles when they move or rest.

Take, for example, sitting.

Electromyography (a measure of how much you are activating your muscles) has shown that some people at rest in a sitting position use only 2% of the muscle fibers in their back while others use up to 15%.  These people can go to workshops or meditation retreats for days—sometimes sitting in difficult positions, but experience no pain after a week of meditating.  Other folks drop out of these programs after the first day because of the pain in their back brought on by sitting.  

Once you start to move, there is no option but to use more of your muscles.  But how much more? or how little more do you need to accomplish your desired activity with ease?

My goal in working with people to deal with their back pain is to educate them to better sense their backs.

I’ve worked with many clients suffering from serious back problems.  I try to help clients sense whole new ways of moving while learning how to decrease effort with every movement. Rather than trying to relieve the pain, my approach has been to give them a heightened sense of the shape of their spine, the textures of their muscles, a clear feeling for how the spine is involved in movements of their body.  This may require first touching and moving the client in such a way that the person can feel the details of the shape of their back and the amount of effort their muscles habitually use.  

Very often, their back pain would disappear.  They would react with surprise at the results:  “But you didn’t do anything,” “I felt my bones and muscles so clearly,” or “I can’t figure out how the exercises you gave me would help, because they were so simple.  No hard stretching, no repetitive movements to strengthen muscles…but I feel so much better.”

I try to give another voice for the back to signal the brain with non-pain related messages like, “I feel myself more. I even feel good. I thought I needed to stretch and pull my muscles but now I know how to release excess tension because now I recognize it.”

The secret ingredient to dealing with back pain is to learn how to recognize and sense your back more thoroughly.  Without that, there’s not much you or any therapy can do on a lasting basis.

-Frank Wildman, PhD

How the age of specialization may be holding you back from healing your arm, shoulder, hand, or neck

In this age of specialization, there are many hand therapists and hand therapies, many therapists who specialize with what is called the upper extremity. There are special therapies for rotator cuff injuries of the shoulder, for elbow injuries, for muscle tears, as well as therapies for the general upper extremity of your arms.

With all this specialization and detailed knowledge of how these body parts work, why is it that more people are suffering from injuries and are taking overly large doses of opiates to deal with their pains? Well, there’s a good reason. Perhaps it is the overspecialization itself, which makes it more difficult to address how the whole body operates in an action. Perhaps it is time for a more generalized approach.

You may be suffering from some of these injuries and challenges and meeting with limited relief from all the specialized therapies. My approach is to work with the body and mind as a whole, not discrete body parts with specialized but limited solutions.

I want to help you improve the functionality of your hands, arms, shoulder and neck by involving your whole body in the process and, most importantly, your brain.

Do you think it is possible to hold something in your hand and pick it up just with your upper extremities? To lift something up, the weight has to go down through not only our backs, but also our pelvis and legs. In other words, to use our arms in the real world requires the use of our whole body. If that weren’t the case, every time you picked up a frying pan, you’d simply tip forwards. For every pound you carry in front of yourself, your back and your legs have to work to stop you from falling forwards.

But the issue of having functionality from our upper extremities is bigger than simple dynamics. To fully integrate all these different areas of your body and coordinate our body to perform actions in the world, we need a brain and in fact, the complete integration of the neuro-orthopedic body.  And even more, numerous studies on grip strength show that one of the key factors that will improve or fatigue grip strength is the condition of one’s heart and blood pressure.  We can have no strength in our upper extremities without that.  

Key factors for our muscles to be able to move us and for our organs to support those movements are our brain and our skeleton.  Nothing can move without a brain and a skeleton.

Since any issues you are facing with your hands, arms, shoulders and neck involve more than just those discrete body parts, perhaps it’s time to develop a more generalized field of inquiry and how to improve the full use of all of ourselves.

A baseball pitcher with a shoulder injury will of course have limitations.  If these limitations can be addressed therapeutically, great. But what if the pitcher could learn variations in throwing the ball that would not further damage the shoulder but could actually help heal the shoulder?  For example, learning to move from the back leg to the front leg and accelerate the trunk over the standing leg reduces the need to develop so much acceleration largely in the shoulder. In which case, learning to throw a ball with a better understanding of whole body use requires a different kind of analysis of motion and a deeper understanding of what a pitcher needs to learn to use their throws to help the tissue heal.

This approach is not a new notion. There are attempts to do this by sports coaches involved in different sports from all over the world, but it does require the skill to perceive what’s needed for each individual to learn to improve.

This is the kind of evaluation, strategic approach to healing, and improved coordination that most of my clients need regardless of how local their injury feels or how locally they’ve been conditioned to compartmentalize their bodies.

-Frank Wildman, PhD