Wednesday, March 30, 2011

A different perspective on posture and pain

Posture Perspectives

You don't have to accept things as they are.  When you tune out conventional approaches to problems and see things in a different light, you might be suprised at the results.  I believe some of the greatest discoveries ever made were done so serendipitously.  This is why I think that being in my own version of chronic pain has made me a better massage therapist.

Example 1:
Here are two actual X-rays of a client.  The first X-ray was taken in April of 2004, the second in July 2005, just over a year later, after doing the exercises given to him using the Egoscue Method.

As you can see, he was clearly headed for a knee replacement.  But the second picture shows there are other ways to effect change without the common, conventional, drastic, invasive, expensive, and painful ways we accept as the only solution.  Read more about this fascinating story here.  Time to think outside of the box!

Example 2:
This is an actual client from 2009.  The first picture is from November, 2009.  The second picture was taken in January, 2010.  The biggest difference is seen in his upper back, where, coincidentally, he was complaining of pain.  His complaints began to significantly subside in the few months after being on the program.

Example 3:
Believe it or not, the biggest impetus for learning about the Egoscue Method arose out of my own emerging and seemingly debilitating pain I began experiencing from performing work as a (ironically) massage therapist.  Being a massage therapist puts a lot of wear and tear on the human body, and proper self-care is crucial.  But sometimes more thorough interventions are necessary to really get to the root of the problem, posturally, in order to get better.  Once the etiology of why you are experiencing pain and how to undo these compensating patterns becomes evident, then you can apply the methods that effect the most appropriate change to your body.  So here is a photo of what my ankles and feet look like after a long shift of doing several massages, followed by an "after" photo showing what my ankles/feet look like after only 20 minutes of doing a passive posture exercise with a certain piece of equipment, followed by a picture of said posture equipment known as the "Tower":

Notice the "caving-in" of my ankles.   The ankle bone, referred to as the lateral malleolus in anatomy, is sunken in on both feet, and my arches have fallen flat.  In kinesiology, this is called foot pronation.  Many people see this problem solely (haha, no pun intended!) as a foot problem without looking at the big picture.  Many practitioners, such chiropractors and podiatrists, remedy this situation by applying "crutches" to the otherwise functional design of the human body by giving people foot orthotics or foot levelers.  What this does is realign the foot and ankle position, and possibly relieve some pain in the short term, but it does nothing to address where the problem is REALLY occurring, which is at the pelvis. 

Initially, it took me many frustrating evenings of laying on the couch with heating pads, soaks in the hot tub, chiropractic adjustments, and deep-tissue massages not to mention taking countless ibuprofen tablets in order to deal with the low back pain that I felt after every work shift.  Eventually, with the help of a very intuitive and insightful colleague who works as a personal trainer, I began to look at this whole pain problem more holistically.  She noticed how awkward my gait cycle was becoming, and therefore how the action of my hip flexors were becoming increasingly dysfunctional.  Oh, the irony!  How could the clinical massage therapist have become the pain, tightness, and dysfunction that she tries to get rid of in everyone else? 

This trainer friend passed me a couple of photocopied pages of "Pain Free" by Pete Egoscue, and the rest is history.  It is true that some people are born with fallen arches, and from a very young age it is evident that their faulty posture necessitates the use of custom orthotics.  But human beings walk on their own two feet for a lifetime.  I do not believe our functional design is inherently faulty, that body parts simply cease to function at some point, or that we need to supplant any body parts with fancy ergonomic devices.  A better understanding of the role that biomechanics, physics, and kinesiology play in life, pain, movement and health seems to make more sense.  Frankly, it is pretty frightening to me how many people are not educated in anatomy and physiology or leave the care of their bodies to people who often have no idea that illness can arise from a compound of factors that only you yourself are aware of.

So learning about the Egoscue method and applying these principles to developing a specific program geared to my own muscle compensations and dysfunctions has lead me to discovering a piece of equipment that addresses one of the biggest problems in America today: We're a nation in hip flexion.  Yes, we are spending an abhorrent amount of time sitting down, specifically sitting down at while working at a computer.  Then we sit down some more while commuting home from work.  And then we relax at home, sitting on the couch.  Pretty much in the same position we were in all day at work.  Well, we weren't designed to sit all day at work.  Or maybe we were, but once we get home, we not doing anything to sort of "undo" all this hip flexion or mitigate it.

When I talk about "hip flexion", what I mean is-what is the joint action occurring at the acetabulofemoral joint on a constant basis?  It is flexion; the thigh is brought closer to the torso with the help of the vertebra in the lumbar spine also being in a constant state of flexion.  In other words, the lumbar curves' concave sides face the front of the body in static posture.  Sitting all day places this curve in an unnatural opposite curve, and makes all the involved joints in the lower spine concave.  Just looking at what this looks like makes me cringe and my back hurt:

            So if you think about it, when you are sitting all day in this position without really doing any moving around, you are putting your body through “a bad posture program” all day.  Somehow, there needs to be some sort of balance to this repetitive stress.  And at this point, the myriad of people “developing” “degenerative disc disease” suddenly becomes a lot clearer, doesn’t it?  Do you really believe your spine just wears out, or would it seem more appropriate to propose that bad posture really does in fact accelerate this increasingly common condition, not to mention a host of related others? (Stenosis, arthritis, spurring, facet joint disease, nerve impingement-the list could go on for a while). I’m going for the latter.

So how do we undo this passive “repetitive non-motion injury”?  Balance.  It is really as simple as respecting Newton’s laws of motion.  Every action really does have an equal and opposite reaction.  So if you are going to sit a lot day in and day out, you’re going to have to balance the forces you are putting on your muscles and bones.  Stretching is a good thing, but relieving the awkward forces you have imposed upon your body by essentially passively countering these forces \would seem more effective.  When I am at home relaxing, you’ll almost never find me sitting upright on the couch.  I appreciate what my spine does for me everyday.  It holds me upright even though I put it in many sustained, awkward, and uncomfortable positions on a constant basis.  Allowing yourself only 6 to 8 hours of rest (such as when you are sleeping) per day should not be the only break you give your spine as far as taking gravity out of the picture is concerned.  My living room floor and I have become very good friends, and my spine is taking notice as well.

So when if you are thinking about revving up your workouts or changing your habits or routines around, think also about undoing your daily bad posture program.  If you suspected a loved one was turning to some awful addictions such as drugs or alcohol, you would intervene, right?  You wouldn’t wait until something awful happened.  You would hopefully see the signs of the downward spiral and jump in to get him or her some help.  Well your body parts work the same way.  Many times the body screams at us to let us know something isn’t all that right.  But too often we ignore ourselves and don’t take crucial steps to get better until we’ve been dysfunctional and/or compensating for a while, or a serious injury occurs.  Why wait that long?

We also don’t have the luxury of replacing body parts when they wear out as if we were an old beat up car that needed a new transmission or a new paint job.  In our consumerist society, products are made purposely to last a certain period of time at the end of which we simply replace them with newer and flashier models.  How many cars have you driven in your lifetime?  How many computers have you owned in the last 10 or 15 years?  Could you imagine using the Internet on an Apple II?  Wouldn’t it look silly to try to plug your iPod into a turntable?  It just doesn’t happen.  But we have to enter this mindset when it comes to the human body.  We have to start thinking about ourselves as machinery that needs constant and effective maintenance.  We can’t just buy a new version of ourselves or grow new parts.  We need to be more proactive and sense when things are not feeling quite right.

Driving a car that is out of alignment will cause excessive and premature tire wear.  We know when this happens when it is evident the tread is worn unevenly on one side, when the car seems to drift to one side, and/or your steering wheel vibrates.  So how do we remedy this problem?  Take it to the mechanic, of course, and let the professionals repair it.  But did you ever consider giving your car a painkiller so the tires wouldn’t notice how uncomfortable it is to be worn out unevenly?  Of course not, because that sounds silly.  Well that is what we frequently do in similar situations.  True, your car doesn’t have a nervous system nor can it feel pain.  But it is a complex piece of machinery--just as we are--that can last a very long time given the correct approach to fixing what the problem may be.  I'm certainly not going to wait until I have a blowout before hopefully realizing that I should replace the tires of my car.

Drivers usually approach car repair with how the Egoscue method works, yet the Western world seldom applies the same logic to pain and dysfunction in our bodies.  Our car’s steering wheel vibrates.  But this is not where the true problem is originating.  This is just a symptom of something  somewhere else that needs fixing—as we mentioned before, faulty alignment.  All the reconfiguring and tooling around in the world with the steering wheel isn’t going to do a darn thing for the alignment problem.   We need to get deep into the components of the car’s suspension in order to stop that steering wheel from vibrating.  And maybe there are other areas or parts of the car that are contributing to the problem.  Similarly, we need to get deep into easing the weak and tight hip flexors and their effects on related muscle groups in order to effect real change in the spine.  Just approaching pain and dysfunction from the perspective of the back muscles is not the most ideal way to solve the problem.  And as far as surgery goes, once you take it out, you can't put it back in.

So this is how I approached my back pain.  I am in constant hip flexion all day standing over clients.  It is a different kind of hip flexion, but it is hip flexion nonetheless.  And if you factor into that some rotation, then it is little wonder my back began to really ache if after each workday I did nothing to undo this bad posture.  The pivotal piece of equipment that is the foundation behind what the Egoscue method attempts to achieve looks rather odd and like something my cat would use to sharpen his claws.  It is known as the Egoscue Tower.  And as anyone familiar with the method knows, once you realize its purpose, you will develop a new kinesthetic sense about why you are in pain and what needs to be done to correct it—without covering it up with toxic pharmaceuticals.  In addition, you are able to recognize when you feel out of alignment more easily, and you can read your body's signals with better clarity.

Example 4:
Although I do not personally know this woman, I am showing her here as the undeniable evidence for why, for lack of a better word, “blaming” your front is a better way to look at back pain instead of focusing only on your back.  This actual client who went to an Egoscue clinic used the Egoscue Tower for a total of two hours.  She isn’t posing or purposely standing up straightin the "after" photos.  The bottom pictures are what her static posture looked like after addressing her long-ignored dysfunctional hip flexors.

A wonderful side effect of correcting your posture is being in less pain.  Amazing, isn’t it?  Especially since this article explains that even after back surgeries, many people are still in pain.