Heal Thyself: Part Three

In Part One I touched briefly upon disorders, treatments and an admonition to find another way to heal oneself other than traditional treatment.  In part two I talked a bit about movement of the wrists (dorsiflexion, ulnar deviation, radial deviation, etcetera) and the body in whole.  Here I'd like to talk briefly about why some people will never heal.

If an injury is the result of improper movement or from extensive stretching of the tendons, to the point that they have micro tears and consequent layers of scar tissue, the only way to heal is to cease creating micro tears and break up the existing scar tissue.  Imagine if you cut a three inch circular hole in your favorite sweater then without replacing the missing swatch, simply sew up the hole.  The knot that ensues and the stretching and pulling of the fabric is sort of what happens to your muscles when they are hog-tied by scar tissue.

In order to cease creating micro tears one needs to stop moving and bending incorrectly and stop stretching the tendons to the point where the body needs to create scar tissue.  Coaches and physical therapists prescribe stretching to warm up muscles when really, all they are doing is creating micro tears in the muscles and tendons.  The body's response to this minor damage is to rush blood to the damaged site which makes the body feel warm.  The  body is not technically warming up, it is rushing blood to the site to immobilize the tissue:  Nature's cast.  If coaches really want to warm up the body of their athletes they would make them sit in a sauna and give them a massage.  Just ask Olympic trainers.

In order to break up the scar tissue created by over stretching, you need to, well, stretch.  The solution to this conundrum is actually very easy; allow the body to move naturally in its mid-range of motion.  That is why I am a strong opponent to the use of braces because they inhibit the body from moving in its mid range of motion and also forces the wearer to overcompensate by using other unnatural movements on areas of the body which will only strain new joints and new tissue.  This new misuse and overuse will facilitate a downward spiral of repetitive motion disorders.  I have heard many stories where the inital pain started as a twang in the forearm, then a sharp pain, then numbness of the hand, followed by constant pain in the wrist, then elbow and shoulder pain, back pain follows then it become bilateral. Revisit that old song, "The hip bone's connected to the knee bone."

Most injuries occur because the athlete (or musician) had something not in proper alignment in the first place and over or under compensated with another part of the body which wasn't intended to move that way.  Proper movement promotes healing, plain and simple.  Once the body is trained to move properly, scar tissue will begin to break up, inflammation will go down and symptoms will disappear.  The body will begin to work as efficiently as it was designed while it is slowly freed from the tether of scar and pain.

Have you ever been buried in snow or sand to the point where you couldn't move?  Brute force will not free you from the  mass piled upon you.  However, if you gently move up and down, left and right, forward and backward, you will create little air pockets.  As the pockets increase in all directions, not just one, you will eventually obtain enough space where you can use more and employ larger muscles to displace greater mass and eventually break free (unless you are in a ten foot deep avalanche).  The person with over and misused tendons must start out the same way; free to move effortlessly in every direction and expand from there.   After meeting with my practitioner for the first time, during the following week I experienced painless snapping sensations in my forearms.  That was the scar tissue breaking and releasing my tendons as they began to move as nature intended.  I was no longer overstretching but moving just enough to entice the scar to release its hold on my muscles.  Much like the Chinese finger torture we all experimented with as kids.  The harder you try, the harder it is to get free.

Unfortunately, when there is a glimmer of hope, that is where many people give up on their training and begin moving "normally" again.  At that point, the ailment comes back with a vengeance because they are no longer creating micro tears but tearing the whole mass of scar tissue.  Those are the type of people who never heal, much like a yo-yo dieter.  Many people won't even get that far.  Musicians are the worse.  I had one student who dutifully practiced the exercises that I prescribed to him then he practiced other music he was interested in but, without employing the new movements I was unconditionally demanding of him.  He was using his motor memory which was flawed and ingrained in his muscles and brain from the first day he touched a piano, causing his problems of today.  He was in a downward going from one step forward to two steps back.  There was no hope for him to heal and I dropped him as a student after three lessons.  Another woman wanted to heal NOW!  I told her it would be six months of moving ONLY as I instructed her but that prospect was too difficult.  She opted for the quick fix of surgery.  Two years later, her carpal tunnel syndrome reasserted itself and she had a second surgical procedure.  This time following her surgery her fingers no longer responded the same and she no longer plays the organ in church and still has pain.  A third student with the discipline much like I had did nothing but the exercises I prescribed to him and after a few weeks he was pain free.  He continued working with me and very soon he was playing much better than he did before his injury.  His symptoms were gone and he was able to transpose his new found discipline to other parts of his body where he told me his walking, driving, hiking and skiing drastically improved. 

A friend of mine complained most of his life of knee pain.  His physical therapists dutifully treated his knee pain symptoms.  After over twenty years of icing, exercising and resting his knees he saw a new doctor who told him that his knee problems was in his hips.  Because he had a hip problem he unnaturally over compensated each step which put unnatural and misaligned strain on his knees. With very simple sleuthing, the doctor discovered that his hip problem was caused by an old shoulder injury.  The shoulders and hips work together when we walk.  His right shoulder was frozen in tandem with his right hip which caused stress problems in both knees.  The bulk of the damage was in the hip so he had a hip replacement and the knee pain practically disappeared.

The difficulty in trying to help someone to help themselves is that they need to give 100% of their effort and dedication toward the healing process.  Anything less is unacceptable and doomed for failure.  There can be no deviation from the course.   With the insidious disorder of tendonitis, in the words of Yoda, "There is no try, only do."  There is no option for cheating, no break from dedicated effort, no shortcuts and no going back.  The only way to heal is the hard way - by making movement easy and effortless as the body was designed.  It is really simple.  But, we flawed humans want it now.

Buddha said "Before enlightenment there is chopping wood and carrying water.  After enlightenment, there is chopping wood and carrying water.  The differences are tremendous but not visible."

-Malcolm Kogut.

Heal Thyself

I once presented a series of workshops around the northeast called "Playing with Fire."  It was designed with musicians in mind but I have healed many people from various professions.  Not everyone has the capacity to heal themselves and much like Ellen Burstyn's "Edna" character in "Resurrection," I don't offer the workshop anymore.

Tendinitis is a particularly nasty injury because it's mostly caused by inflammation due to improper usage or prolonged use of certain parts of the body. If you ignore it, most likely it will get worse. Left untreated, you will get scar tissue which will cause more pain and discomfort. Tendinitis takes a long time to heal. As the tendons become inflamed, they can press on nerves.  One particular nerve which is susceptible to tendon inflammation is the median nerve in the wrist.  The pain and numbness resulting from that is often called carpal tunnel syndrome.  That problem has been around for centuries and has been called many different things, usually associated with occupations which are repetitive. Pain is the body's way letting you know it needs something or that something worse is about to happen. Never ignore pain.  Continuing to stress it will only cause more damage and more pain. When the pain becomes excruciating and you finally seek medical help there may be more damage than can be corrected.

It is actually quite easy to heal through movement modification because proper movement promotes healing. I had tendonitis and I was in so much pain for a six month period that I couldn't sleep.  I couldn't even pick up a piece of paper.  I drove with my knees.  Monday through Friday I did absolutely nothing (well, I got a great tan) and saved myself up for playing the organ for six Masses on the weekend only to find myself doing hours of contrast baths every Sunday evening to ameliorate the agony from the weekend abuse.  It wasn't until I sought the help of a woman who "healed" me in minutes. At the very least, she had me playing the piano pain-free. After an hour of special exercises, she asked me how my hands felt and for the first time in six months, they felt normal. Of course, it took six months of intensive re-training to actually heal but, I healed.  The really cool effect was that I began experiencing snapping sensations in my forearms as scar tissue was releasing and healing.

Healing does not have to be some elusive elemental thing. Many people think that surgery is a quick and easy solution for median nerve entrapment - provided you don't continue doing the movements which caused the problem in the first place.  Surgery solves the symptom but the underlying problem still exists and the problem is that we are simply moving incorrectly.  Current medical treatment consists of rest, medication, shots, physical therapy or surgery.  The best analogy I can come up with is if you have a nail in your shoe which is causing you pain and bleeding in your foot, you can rest until you heal. But the moment you begin walking again, the nail is still there and the symptoms of pain and bleeding come back.  You can "walk it off," work through it or try to build up muscle but that won't work.  You can take off the shoe and put on a band-aid but, the moment you put the shoe back on the problem will still be there.  You can take medication so that you don't feel the nail and its attendant pain but, the nail is still there.  The only solution is to remove the nail and the foot will heal.

If your car is out of alignment you will eat through your tires.  The worn tires are the symptom of the poor alignment.  You can always put on new tires but those will wear, too.  The solution is to fix the alignment.  Our bodies are fulcrums, levers, pulleys and rubber bands.  They are designed to work at prodigious efficiency.  Can they work inefficiently?  Absolutely.  Poor posture and misalignment has a respectable place in our repertoire of movement.  Misuse isn't the problem, overuse isn't the problem; it is when we combine both misuse with overuse that we cause problems. 

Surgery will open up the carpal tunnel so that our inflamed tendons are no longer be pressing on the median nerve.  The pain and numbness will go away but you still have inflamed tendons.  What happens when they become even more inflamed?  How many surgeries can we have to open up the tunnel more and more?  For someone who depends on fine and efficient movements such as a musician, at what technical cost is there in changing the landscape of this efficient and tightly compact design?  Think of removing the miles of intestine within our gut, then packing it all back in.  Sure, it can be done. Will it be the same?

Anyone who fishes knows that you can't cast a broken fishing pole.  Sure you can tape it together but it won't work as efficiently as an unbroken one.  Musicians all have the capacity to enjoy pain free virtuoso techniques but first we need to undo the motor memory of the very first flawed times we touched our instruments.  Not many of us had the right teacher at our first lesson. Pianistically, this teacher would have been someone who only let us play one key, with  one finger, for several weeks before we were allowed to employ a second finger.

As I said, I was suffering from a bout of long flexor tendinitis as result of overuse and misuse.  It was actually while building a deck in my back yard when I first noticed a twinge of pain.  Eventually, as I played the piano I was occasionally charged with a stabbing pain in my forearm.  It started off intermittently but then became constant with every use of my fingers or hands.  I went to see the doctor and he started me on a course of anti-inflammatory drugs.  They actually helped for a brief period.  The problem with these drugs was that they were taking away the pain or, masking the symptoms but not solving the problem.  The problem was that I was misusing my hands.  Since the drugs relieved the inflammation which was causing the pain, feeling better, I continued to misuse my hands.  This made my tendonitis worse.  Eventually the pain became bilateral and my arms were in pain 24 hours a day.  My doctor sent me to see the physical therapist who prescribed more movement which only made my symptoms worse.  In addition to the constant aching, I was unable to perform the simplest tasks.  I couldn’t pick up a pencil, I couldn’t brush my teeth, I couldn’t comb my hair, holding a fork was painful, flushing the toilet, zipping a zipper, driving, tying my shoes.  Everything caused pain and exasperated my symptoms.

After about a year of therapy, drugs, and rest, I thought my career as a piano player was over.  Movement re-education gave me my life back.  Mind you, I was not cured, rather, I just discontinued misusing my hands, proper movement put everything in natural alighnment and my body healed itself.  Every once in a great, great while I get a twinge of pain when I thoughtlessly revert back to my old way of moving but a quick readjustment of my alignment fixes everything.  I actually found that moving properly not only permitted me to move again, but it made me feel better in everything I did.  It took over a year when I realized that I forgot that I ever had the pain.  Those lessons have since been transposed into every aspect of my moving life.  Everything about me improved.  My music, skiing, hiking, even driving my car.

As I asserted earlier, I do  not heal people anymore but, know that there are alternative and amelioratative ways to mitigate this apparent failure of medical enterprise. Having been there, I am very disappointed that the medical community has not embraced the over 300 year old solution but continues to perpetuate false dogma.  Although, I suspect the blame lies with those of us who want a solution now, at whatever cost - along the path of least resistance.