Driving:

Unless you happen to have an automatic car, driving is going to be difficult for a few days/weeks immediately post injury. (This is also true should you decide to get an ACL reconstruction at a later date. The process of rehabbing from a torn ACL and from ACL surgery is virtually identical).

This may seem odd. After all, you’re sitting down, so what’s the big deal?

The issue is two fold: changing gears, working the gas and other maneuvers that use your injured leg…hurt. What’s more, sitting down for prolonged periods of time may cause localize swelling (called oedema) in the injured leg, further decreasing mobility.  You may find this also happens if you sit a desk for too long.

Secondly, getting into and out of the car is problematic. At this stage, given the limited range of motion in the injured limb (along with the likely compensations your brain has enacted to ‘splint’ the part), fitting into a car can be challenging. You may also have crutches or a cane to contend with.

Solution:

Rent or borrow an automatic car, or if appropriate, use public transport. Figure on adding an extra 5-15 minutes for getting to your destination. Get a pimp cane ASAP and wave it irately at ‘those damn kids and their damned ways’.

Those danged kids and their...ways

Walking, sitting, standing:

If driving is a difficult, walking is what Mark Twain would call “tragedy plus time”

While this varies from person to person, you can always factor in some level of difficulty. Remember, the purpose of the ACL is two fold: firstly, it keeps the lower leg from extending past the upper leg, thus acting like a support strut. The second function is something like a GPS. The ACL contains multiple sensors (proprioceptors) that help your brain ‘find’ your leg while you’re doing things (like walking).

Dude...where's my leg?

One of the first things that happens post injury is a kind of a system wide amnesia. Remember, the area is being ‘splinted’ or immobilized to prevent further damage. If you actually take the time to run your finger nail down the lower part of the injured limb, you may notice a marked decrease in sensation from side to side. This is a part of the same phenomena. Furthermore, there can sometimes also be (temporary!) nerve damage to the lower limb due to the nature of the trauma. These factors combined make walking, standing and sitting down an interesting challenge.

Solution:

The big thing to remember is that a torn ACL doesn’t mean that your leg is just barely dangling on by a few pieces of flesh. Despite what your brain will try to convince you, the other structures surrounding the knee can and do provide support. Sure, you’re not going to be able to dance Swan Lake anytime soon, but you should be able to walk and get up off the toilet ASAP.

There are three things that can help you regain control.

(1) Squatting:

Grab a hold of a ledge, a draw or a sink and slowly lower yourself up and down 10-15 times, a couple of times throughout the day. The act of squatting serves to remind your brain that you have a leg to stand on. It also acts to ‘pump’ the lymphatic fluid around and decrease the swelling. While you’re there, add in some toe-raises (the lymph fluid circulates up the leg, so it may even be better to start with toe raises first, then squats. This is akin to some of the ideas behind Peripheral Heart Action circuit training)

It should go without saying that (a) only work within your comfortable limits and (b) don’t use added resistance / weights.

But I’ll say it anyway.

Only work within comfortable limits. Do not add resistance / weight.

At this stage of your recovery, the goal is to regain the ability to walk. You’re not trying to do 100 repetitions in 30 seconds. You’re trying to – literally have a leg to stand on. So, approach this exercise as an experiment.  How far can you comfortably squat down? What speed do you need to go at (slower is better)? Can you distribute your weight equally between both feet? Can you keep the weight on the same parts of your foot on both feet, or are you favoring towards the ball of the foot on the injured side? In short – what is the most comfortable, most controlled way to do a supported squat – and how might you improve that?

(2) And more squatting:

There is some good research (click) out now showing the benefits of training the opposite limb to strengthen the other. If you consider the body as a whole (again, your brain is trying to trick you right now into thinking you have a ‘leg problem, on the _____ side’), then this makes a good deal of sense.

So, seeing we’re wired this way, we may as well make use of it.

With one leg temporarily unreliable, you’re probably favoring your other leg every time you sit down, stand up or walk (crutches or not). Make good use of that by performing what’s called a ‘negative only, one legged squat’ every time you do so.

How? Pretty simple – you’re probably already almost doing it.

Place your weight onto the unaffected limb and lower yourself down. sticking your butt back first. I recommend hold onto something- it helps create the right trajectory and unload the knee, which traditionally are the two big problems with learning pistol squats.

Not as hard as it looks when you know how

You also need to figure out how to fold at the hip first. (The action of the knee is a little like  the fore-end of the shotgun sliding over the barrel: meaning, smooth and free. In other words, your knee isn’t what’s controlling the descent, so much as the muscles of the leg and butt. I’ll speak to this more in a moment).

The knee slides fluidly

The best way to begin experimenting with the right groove is to hold onto a door frame and then sit down and back, until you’re butt is touching the floor (or a chair behind you).

Pistol Squats from Beastskills

I was fortunate a few months ago to change my home office into a floor office (click). This means I get a lot of practice getting up and down off the floor. (My partner calls this ‘that crazy breakdancing thing you do’).

(PS: There are numerous benefits to being able to shift from a sitting, to a lying or to a standing position whilst working at the PC, so I recommend reading the above article and ’The Chair’ by Dr Kranz as well).

(3) Brain retraining – aka, your leg is still a part of you

As I mentioned above, your leg probably doesn’t feel very reliable at the moment. It may hurt. It may be swollen. Or, it may just be unstable. Consequently, despite your best intentions, walking et al is difficult.

In the next installments of this series, I’d like to give you some simple tools / experiments to start addressing that (it deserves a post of its own, rather then getting shoe-horned here).

So – make sure you join me next time. We’ll talk about the impact of injury upon the sense of self and what you can do to get back in charge, in a non woo woo way. I’ll also discuss the nuts and bolts of leg rehab.

Roughly two weeks ago, on an otherwise unassuming night, I tore my left anterior cruciate ligament (ACL) asunder. I’d like to take a few minutes to reflect and share my (likely unusual) perspective. Maybe someone else going through this will find it and gain a sliver of hope. This is the first part in a series.

Be nice to your knees

Firstly, I have to admit that ‘ACL rupture’ has always been the boogey man for me.  It is for alot of athletes, recreational or otherwise. We know the downtime involved with ACL tears can be upto 12 months. We know it hurts. We know it’s expensive. We know the rehab is meant to suck. We know (or think we do) – so we develop a phobia after the first near miss.

Ever since I started judo (circa 1998) I’ve always been extremely leery of my knees. I’ve seen people blow their knees out and it looked horrifying. Every judoka hears the horror stories – ‘Young judoka are good at throwing…old judoka are good at watching from the sidelines’.  Other sports have similar anecdotes.

My first near miss was in 2001, when I twisted my right ankle and felt a pop in my knee. Fortunately, that proved to be just a scare. It worked. I was scared.

You’d be too. Consider – the idea of a penniless, 22 year old student (without health insurance, naturally. We all think we’re bullet proof at that age) waiting  upto 24 months on the public hospital waiting list to get a $5000-$10,000 (out of pocket) knee operation.

If you haven’t broken out into a sweat yet, add doing all that whilst trying to make a living, going to school and looking after other concerns. To really turn up the heat, imagine adding a mortgage, job and kids. (I didn’t have those at the time).

Think about being that snowed under – and not being able to walk. Or get up and down off the toilet. Or drive a manual car.

Are you scared yet? I was. Fortunately, there’s some good news.

Snap, Crackle, Pop

Yes, ACL tears suck.  But they are not the end of times. Let’s start at the start.

"We have the technology, We can rebuild him"

Wikipedia can give you all the dry details of what’s inside your knee and how it looks. Let me give you some info that Wikipedia doesn’t have.

What does it feel like?

Different folks will experience different sensations. For some, the tear is agony. Conversely, others will get up and wonder if they’ve maybe just strained a muscle. Mine was somewhere in the middle. My knee pealed out a loud gunshot. Then, my leg simply disappeared off the radar. The feeling is a little like going to the beach, scooping up a handful of sand and letting it slip out of your fingers. Literally, my leg melted out from under me.

I recall crying out, more in shock then in pain. I was carried off the floor (I’m pretty heavy, so it took a team of sherpas working double time). There was concern all around (and after a while, some ribbing to and fro. Psychologically, gentle ribbing is important at times like this. Much like a baby duckling imprinting on its mother, the moments directly after an injury are a critical period for determining future outlook).

A moment later I felt my leg seize up (known as ’splinting’ or ‘guarding’, this is the brain’s attempt to prevent further injury at the site by preventing movement). After about 10 minutes of applying ice, I hobbled to the change room, got changed and watched the rest of the session. Then I went home thinking ‘gosh, that was close. Maybe I ought to get it checked out’.

The Day after

Adrenaline gone and with my knee slightly swollen, I decided to get serious. Seeing that it’s remarkably difficult to perform your own knee orthopedic assessment (I tried. My arms just aren’t long enough to peform my own Lachman’s or Draw tests), I bought a pair of crutches and hobbled off to the local sports physical therapy clinic. They were kind enough to confirm my suspicions – something’s not right here, and it’s likely the ACL.

The Day after the day after

After consulting with my GP, I asked to be reffered for scans. I begged and pleaded to avoid CT Arthrogram (a procedure wherein an contrast dye is injected into the knee, which is then scanned using a CT machine) on the basis that the physio told me it hurt and took a long time. Of course, the attending physician at the radiology department was having none of that. Here’s how the conversation went -

“Your refferal slip says CT plain”

“That’s right”

“That’s a waste of time. All that I will be able to say in my report is that I can’t rule out ACL or meniscus tears. Then you’ll have to get a referal to a specialist who can order a MRI”

“Fine, use ultrasound then”

“Ultrasound is no better then Xray, really.” (this is debatable, but I wasn’t in the mood)

“-SIGH- You know, my knee really hurts. I don’t want you jabbing needles into there”

“I’ll give you a local”

“How long is this gonna take? And how much extra?”

“Same cost and time as normal CT ”

Pondering my options “…Awesome”. (I think my sarcasm was lost on the recipient).

I’ll spare you the details of the CT arthrogram. Suffice it to say – it (a) doesn’t hurt so much (though it feels like your knee swells up to the size of a watermellon) (b) only takes about 20 minutes. (c) A tiny blotch of the dye leaked out of the injection site and has given me a nifty new birthmark.  (Maybe try to avoid that last one).

If you do suspect any kind of knee damage, you may want to consider requesting it. The scans it produces are pretty conclusive

The long story short

This is what a knee without an ACL looks like

Something's...missing

(by the way, if you want to read up on how to interpret these results, check out http://www.ceessentials.net/article27.html)

Or, in layman’s terms -

Twang!

What’s next?

In part two of this series, I’ll discuss some of the challanges I’m currently undergoing (ever tried to walk without a knee? Or get up off the toilet? Or use crutches to walk prolonged distances? I’m topping out at 1km at the moment and it’s exhuasting) and share with you the silver lining in all this. Because believe it or not, the world shouldn’t end just because of a torn ACL.

More soon! Feel free to ask questions or make coments

]]> http://thinkfeldie.com/blog/how-to-survive-knee-injury-using-feldenkrais-pt1/feed/ 2 http://thinkfeldie.com/blog/how-feldenkrais-can-enhance-your-pilates/ http://thinkfeldie.com/blog/how-feldenkrais-can-enhance-your-pilates/#comments Sun, 06 Jun 2010 04:07:56 +0000 bob_stra http://thinkfeldie.com/?p=1069 Here’s a great article I stumbled across the other day. It really meshes well with what I had to say a few days ago on the topic of Feldenkrais and exercise.

Here’s Peggy Z. Protz, Feldenkrais teacher and Pilates instructor, talking about how Feldenkrais improved her pilates practice. What do you think – let me know in the comments section!

Throughout my whole life, it seems as if I have been on a mission to improve myself. I started dancing when I was five years old and continued professional training throughout high school and college. I worked hard at it–always in the studio–stretching, bending, and practicing. I was stumped, however, at how technique came so easily to those who seemed to never work hard.

In college, I discovered Pilates. It was 1989 in New York and my college had one of only a few Pilates studios in the New York City area at the time. Now, I’m sure, there are hundreds. I was attracted to the innovative machines and whole body philosophy. I thought this could be the answer to my quest for physical perfection. I was around the studio so much that I soon became an instructor and found myself teaching professional Broadway dancers, who were sometimes twice my age.

I was still far from satisfied with my own abilities, however. Various aches, pains, and stiffness led me to try any other technique or modality that promised relief. By this time I was in Seattle and was attending an Awareness Through Movement class. I was intrigued by how these often slow, small, and subtle movements not only offered relief from chronic tensions, but also gave me a feeling of integration and wholeness, that perhaps was what I was looking for.

I joined a four-year Feldenkrais® training in 1998. We met three times per year for 2- to 3-week intensive segments. After one particular segment, I was trying out some familiar Pilates moves on the “High Barrel.” I was performing a “swan dive,” a significant back bending movement where the goal is to touch and possibly walk down the wall behind you with your fingers. Back bending had never been easy for me and usually I would experience a level of resistance that I would have to push past before touching the wall. This time I practically bruised my fingers slamming swiftly and effortlessly into the wall!

What had happened? I hadn’t practiced this move in months. Did I suddenly become Superwoman? Something was different. I felt more alive and integrated, yes, but after further reflection I realized that I could explain it another way. I was no longer working against myself. My intention to bend backwards did not have to fight against parts of me that had previously refused to bend. Other Pilates moves also felt more graceful and effortless—all without excessive work or practice!

My mission continues, but my experience with theFeldenkrais Method has changed my perspective. I have learned that more practice and hard work does not guarantee improvement. The Feldenkrais lessons offer me increased awareness and the opportunity to perceive myself moving with greater ease and elegance. This is something repetitive practice cannot provide. It may, in fact, be the essence of the perfection I seek.

Source: North American Feldenkrais Guild

• Australian Health Managment
• Australian Country Health
• BetterHealth Cover
• Illawara Health Fund
• Senior Advantage
• Australian Unity Health Ltd
• CBHS Friendly Society Limited
• Credicare
• Grand United Corporate Health
• HBA
• HBF (physios only)
• Health Care Insurance Ltd
• Health Partners Inc
• MBF (BUPA)
• Medibank Private (to be confirmed)
• Mutual Community
• NRMA Health Pty Ltd
• Peoplecare Health Insurance
• Reserve Bank Health Society Ltd
• SGIC Health
• SGIO Health
• Teachers Federation

It should also be pointed out that other funds may be eligible. Please contact me for more details

Whilst the previous location was wonderful, the new location is even more central.  Not only does it have copious access to parking and public transport,  it’s also wheelchair friendly and on the ground floor. All in all, more access and more options. Awesome sauce

Come and see the new digs

True or False

Feldenkrais is exercise?

Yes and no.

Depending on your perspective, the answer for this one can be true OR false. Let me explain. It’s ‘false’, in so much that the intention of Feldenkrais isn’t to give you a killer workout – at least not in the way we commonly think about such things. On the other hand, it’s ‘true’ in that Feldenkrais ‘Exercises’ (actually called Awareness Through Movement Lessons) do provided a graded, progressive experience in which the person is challenged to adapt to circumstances. The outcome is often more power, grace and fluidity.

So, how is this paradox explained?

At it’s simplest, Feldenkrais is about adapting to the environment in such a way as to increase your ability to ‘hang out’ in challenging circumstances.

For a person who has poor balance, this can mean finding a way to progress from a rigid, protective stability (usually, that includes bracing, limping, guarding or pain) to graceful and dynamic motion.

On the other hand, for someone with body image issues, this could mean getting to progressively know and like yourself while developing trust in your own abilities.

And for an athlete, this could mean “how can I perform better without wrecking myself? How can I get the edge on the competition?”.

In each of these three examples, the individual develops more ability (the kind of results we associate with exercise) but by engaging with and exploring novel movement experiments (unlike set exercise routines).

Feldenkrais is gentle, easy and….boring?

That one is false all around.

While Feldenkrais has a reputation for being gentle, it’s in no way unlively. Bear in mind that Moshe Feldenkrais (the originator of the method) was a judoka, engineer, soccer enthusiast and soldier. This was not a man who could be considered a ‘hothouse flower’, in fear of breaking a sweat.  Nor was he someone to sit around and sing Kumbaya whilst navel gazing!

Feldenkrais was a do-er, and his method reflects that.

So why the disconnect?

The lessons are done gently for two reasons. The first reason is familar to anyone who has used a cheap mobile phone. Excess, incorrect effort causes ‘noise’. Noise scrambles the message. The end result is frustration instead of clarity.

The second reason is – if you always do what you’ve always done, you’ll always get what you’ve always got. Simple, right? Yet we all sometimes insist on banging our heads against a brick wall (click)

In other words, the slow, gentle pace gives folks a chance to explore and become aware of alternatives that would not have otherwise occurred to them. After all, if you want different results, you have to act differently.

Does this mean that Feldenkrais teaches folks to be limp noodles? Hardly. Recall that Feldenkrais himself came from a tradition of action and intellect. There are many lessons that are powerful, potent and acrobatic. They require just as much concentration (and movement) as sport – but they are done in such a way as to promote ability and self development, not just sweat or competition.

Is it boring? That depends. Do you find yourself, how you interact with the world and your life boring? I sure hope not!

One final point here: many years ago, I recall a discussion with Dr Mel Siff (who sadly died some time ago). Dr Siff was (and is) a recognized authority on exercise, rehabilitation and sport training. If you search the Supertraining yahoo group, you’ll see that Mel Siff gave Feldenkrais two thumbs up. This from a man who wasn’t affraid to call a spade a spade (while you’re there, check out what he had to say about the ‘core’ craze and some of the more interesting exercise trends. His book – Facts and Fallacies of Fitness is also worth a look).

So, do I exercise or do Feldenkrais?

Both! Doing Feldenkrais lessons / exercises will enrich you experience, ability and give you new insight into whatever you love to do. Want to run faster? Lift more? Improve you golf, tennis or swimming? The answer may very well be Feldenkrais.

Brad Spence from Irene Gutteridge on Vimeo.

Dorko’s Desk

Musings on the human-ess of therapy and how science and art interact in healing. Some great stuff on neuroscience, pain, learning and deep models of understanding, from a guy who abhors woo-woo.

Everyday Systems

It took a librarian – of all people – to come up with one of the cleverest diet and exercise ideas that I’ve seen in a while. The reason I like Reinhard’s stuff is that by focusing on psychology and habit, he nicely simplifies what can otherwise be overwhelming. His entire exercise and diet manifesto can be summarized in 14 words!

Feldenkrais Research Archive

As I mention in my very first post, Feldenkrais not only has a sound theoretical basis but also a growing body of scientific literature to support it. I hope to one day add my own (for the curious, my interest are:  movement sonification – that is, the use of sound as a channel for feedback / feedforward – and EMG (electromyogram) profiles of skilled vs novice performers. Basically, think of when Neo ‘learns kung fu’, but without needing to install a socket into your skull)

Full Recall Software

Flash card software that uses a clever and easily visualized AI algorithm to help you learn stuff. If you ever wanted to install Google Analytics into your brain, then this is it. Easy to use, intuitive interface and scientifically sound approach (google spaced repetition) to remembering things indefinitely. This little doo-dad was pretty much *the* reason I passed first year biomechanics and anatomy (*shudder*)

The Art of Non-Conformity

One man’s approach to living a meaningful life. Lots of great ideas on work, personal freedom, travel and finding meaning. All without being sappy or glib. Win!

TED talks

TED’s mission statement? ‘Ideas worth spreading’. It’s impact? Profound and bountiful brain food. Visit this site and watch even 10 mins on any topic. Your brain will thank you. Whether your into high tech or high thought, TED is the place to hear and see experts in the field discussing it. Some of my favourites include Brain Magic (on how perception can be fooled with) and 6 ways mushrooms can save the world.

One of my favourite Feldenkrais aphorisms is “The only thing permanent about our behavior is the belief that it is so”. It’s interesting to think about this process and how the Feldenkrais Method goes about addressing it.

Change is a process of discovery and adaptation. The actual change – from A to B, from this to that, is very rapid. Actually, it happens the instant a threshold is reached. Why? Because people inherently seek a state of ability and empowerment. And as soon as you know how – and give yourself *permission to* – change occurs.

But the build up to that threshold – the ‘leg work’ – takes time.

Let’s take a look at an example. Here’s Perth’s Shuan Hern Lee, a recent contestant on “Australia’s Got Talent”

Shuan – who by any measure is an *outstanding* pianist, is 7 years old. Seven. Putting aside precociousness and ‘he was just born that way’, what do you suppose Shuan’s secret is?

It’s actually very simple. The secret is…. multiple, playful iterations of an experience, each slightly different, until a whole pattern emerges. Again and again and again. Until, one day, you’re on Australia’s Got Talent leaving audiences gawking with wonder.

This is exactly the process of learning you encounter within the Feldenkrais method. Multiple, novel iteration of an idea that sneak up on you, until – seemingly by magic – you can do something that previously seemed impossible. It surprises you and others, just like a 7 year old blasting out a perfect Rachmaninov.

Notice the words ‘multiple, novel iterations’ though. Trying to brute force a solution, by doing the same thing over and over and over will not help you reach ‘change threshold’. There’s just not enough ‘juice’ for the brain in the same piece of worn out chewing gum. An neither will following some rote metric: “Today I will practice the piano for 45 minutes. Tomorrow, 65. The next day, 90″. Change isn’t just about ‘time in service’ – that’s mediocrity. Growth is about attention, variation and play.

In our world, it’s very easy to look at the end product and with wistful sigh mutter ‘gee, I wish I could do that’. Gee, I wish my back didn’t hurt. Gee I wish I could dance, throw a ball, solve an equation, walk up a flight of stairs, make a soufflé, get rid of my neck pain, relearn to walk.

But instead of starting with ‘Gee, I wish I could…’, what if you approached it as an engineer, like Feldenkrais, might?

“Hmm…how could I…”

It’s this ‘how could I?” that’s at the heart of the Feldenkrais Method. “How could I” allows for making mistakes, exploring and making your own way. It allows for ownership.

Want things to be different? Figure out a way to act differently. Not on the basis of wishful thinking or rah rah optimism. Nor by doing the same thing over and over and expecting a miracle. Instead, change happens when we play with the environment and the way we are in it. Then you too can ‘make the impossible possible’.

Want to know more? Feel free to contact me directly

And – like raising a baby – everyone but the parents can be blinded by the fact that…dang it…the kid is ugly.

So, in an effort to avoid raising a little monster I adore but others want to kick, I’m going to make a special offer.

Starting from today (May 7th, 2010) and running for one month (June 7th, 2010), I’m inviting honest feedback on site layout, looks, readability. What do you like? What do you hate? What could be better? All you have to do is either email me or post something substantial and specific (at least a paragraph or two) to enter.

In return, I’m offering one free Functional Integration session (for those local to Perth) or one free, specifically tailored Awareness Through Movement Mp3 (world wide) to the winners. Your choice.  This offer is open to the first five (5) winning entrants, to be announced on the 7th of June.  I will notify winning entries and update this post as and when it occurs.

So if I give you this bunny, you'll give me all those plants? Sweet deal

Wanna improve your golf swing? Run better? Get rid of aches and pains that are bothering you every time you get up? Sing with more clarity? Or just wish you could sit more comfortably at your PC? Then drop me a line.

That right. 1 free hour – specifically tailored to you and your needs – for quality and intelligent feedback on this site. Fair trade? Then get reviewing!

What if someone could offer you a way to take control of your life? An intelligent, YOU-centered solution that honours and involves you as an equal partner, instead of a broken machine? Something that isn’t just about ’stretching’ or ‘toning’ but about finding more physically intelligent ways to do things?

A method that’s guaranteed to improve your performance, ease your aches and pains and let you live with less stress.

Want to find ways to live, work and play better? Then contact me and let’s talk about how we can achieve that for you. No risk, no obligation and no hard sell.

I’m here to help.

Think differently. ThinkFeldie.