Taking Care With New Routines for 2017

As we close out 2016 and enter a new year, I wanted to share how my movement, yoga, and self care routines have evolved and what is working very well for me at this time. People ask me all the time, how do I exercise with a 13 level spinal fusion? Yoga ? How ???? Well, it's not easy and can require a high level of mindfulness and self care ... 

30 years later, I am still trying to take care of this and forever will be! 

30 years later, I am still trying to take care of this and forever will be! 

At 41, my body requires a new level of movement and mindfulness. After about a year of experimentation, I have developed a routine that works well for me now. This will probably evolve again in another year or more, but this program is therapeutic, efficient, and is multi-modality. I don't feel bored with it and it moves quickly!

First, I do not attend any public group classes (yoga, barre, etc etc) anymore. I've just found that my body has become too particular and sensitive, and requires too many modifications for group classes. So I'm saving my money, and doing everything in my home. I spend about 30 minutes to an hour with this in the morning, and I like to get up about an hour before the family so it works for my schedule.

1. I begin on my yoga mat centering, breathing, and welcoming myself into the day. It is usually still dark so I might light a candle or two and sprinkle some essential oils around. I'm not much for listening to music anymore, so many times I will play a podcast of something inspiring or of interest as I begin to move. I am into The Liturgists, On Being, Bliss and Grit, and The Deconstructionist Podcast right now. 

2. I move organically for about 15-20 minutes. These days this looks like my variation on the Bowspring Method. I like using the Bowspring because it really fires up my lower body,  glutes, and hip stabilizers which are key to low back health. My heart rate is usually up and my legs and glutes are working hard, yet it is still a mindfulness practice. I have to really be in my body to do this right! Don't let the curves of the bowspring throw you, it's a directionality more than an appearance. Bowspring takes some work! Here is an example of my work with the Bowspring and how I'm adapting it to fit my fusion ( I am fused T3-L3 ). 

3. I then pick up my 3 lb weights and move through a series of upper body resistance training. Triceps, biceps, and shoulders. I have to be careful not to overdue this as my upper back and neck flare up VERY easily. No overhead lifting. 3 -4 sets of 10 with little breaks, and good form is the key. This maybe takes another 10 -15 minutes. I'll throw in a minute - 2 minute plank and side plank (left side only for my scoliosis) for good measure!

4. Fasciablasting! I'm back on the blaster, AND I've figured out that fasiablasting is a lot of work - my heart rate stays up so I consider it part of my morning movement program. I use Brahmi oil on the skin and blast away (arms and legs primarily). Don't be surprised if you bruise a bit. More on fascia blasting HERE. After the blasting I am really feeling "well circulated"!

5. I use one of my Yoga Tune Up balls to the face and neck. This is great if you wake up with sinus pressure or headache, and plumps the skin nicely. Below is a little video of how I use the balls (note I am not using my YTU ball here). I recorded this a few years ago for a workshop "Melting Into Peace." 

6. If I still have time, or if my body feels like it, I will do some resistance flexibility exercises. 

7. Finally, a brief rest using the posture pump for my cervical spine. I LOVE this thing! Don't pump past 2 pumps when you first use it and I would not recommend this with a cervical fusion. Make sure you are physician clear for cervical traction. I've made the mistake of pumping too much and it leaves me a bit sore. Moderation these days is the key. 

Give it a try ! Let me know how you are doing and what you are doing these days to take care of your body, mind, and spirit. 

Back Care Tool Kit

I chuckled to myself yesterday as I looked around my home and realized I could run a therapy clinic out of this place. Heating pads, cold pads, kinesiotape, massage mats, therapy balls .. the list goes on. I’m in the middle of a neck flare so all my rehab equipment is out, about, and in use as I attempt to tell these overused neck and upper traps to calm the f$c% down.  As a former occupational therapist I’m no stranger to modalities. Now as a yoga teacher, who hopes to one day call herself an official yoga therapist, the combination of the two has been invaluable to me in my own personal self care and spine management.

As of late, I am active in a new Facebook group, Forever Fused, that I started for people, like myself, who have had spine fusions for scoliosis surgery. We get together in a virtual hub and chat about all things rods, hardware, stiff spines, and the like.  It is amazing to have a resource like this!  Unfortunately the common bond that most share (many of us 20 plus years post fusions) is that we are managing pain on some level or another. Back pain is all too common, and all too stubborn. I proudly boasted that I never had back pain except for an occasional flare up here and there through the years UNTIL I turned 35 and then, like others in the group, I started to become aware that the body couldn’t just be thrown around like back in the old days. Think jumping out of airplanes (yes I did ).

So let me start by sharing my mantra –

THIS IS A FLARE. IF IT FLARES UP, IT WILL CALM DOWN. AND SO IT IS.

The body-mind connection is powerful and strong. I’m really careful with using the word “pain.” I hold on to the belief that the body is always searching for its best health, or homeostasis, we just have to listen and support the process. The body is not designed to hold on to pain in a chronic state. If it flares up, it will calm down.  So when “things” get exacerbated in my body, I drag myself to my meditation mat and LISTEN. I usually learn that my Type A, overachieving nature is getting the best of me again. I find I’m overworking, overexercising, or just trying to DO more than I need to.  I’ve learned this almost 40 year old body requires a high level of self care to run at its best.  I got away with a lot in my 20s and early 30s but at some point things change. For everyone. Usually the message comes loud and clear. We just have to LISTEN.

SLOW DOWN AND REST. YOU DON’T HAVE TO DO THIS ON YOUR OWN. YOU DON’T HAVE TO DO THIS JUST PERFECTLY. PACE YOURSELF.

A flare up forces me to rest more and quiet my body. I used to get very frustrated as I like to use and move my body every day, but now I welcome these times as a respite. A time to heal and be more gentle with my activities. I welcome Restorative yoga, meditation, and pranayama (breathing) practices. I walk. I alternate activity and rest, activity and rest. AND I pull out my back care toolkit. My tools in my toolbox are a necessity!  Sometimes I don’t need any of them for months as my body stays flare free. But when the back or neck gets angry I’ve got my resources.

AND here they are (drumroll ) ….

* DISCLAIMER* – This is not medical advice! Always consult your doctor to design your own unique individual plan of care. This is MY plan based on years of education and working with my own body almost 30 years post extensive spine fusion for scoliosis. 

1. All activities of daily living are modified and superb body mechanics are in place. Lighten the loads, pace yourself, think energy conservation and work simplification. No lifting (spine fusion patients should not lift over 15 lbs ever), no bending forward. If you don’t know basic back care body mechanics visit youtube.com and you will find great tutorials there. “Body mechanics for back care” should be the search you use. Also, little spurts of activities at a time. For example … cleaning the house. Take it in small little segments. Www.flylady.com helped me with this tremendously. A little something everyday so the work doesn’t pile up and stays manageable. Small daily loads of laundry instead of huge piles. Daily routines is the key.

LISTEN at the FIRST SIGN that something in your body needs RICE.  Rest, ice, compression, elevation.

I can’t say this enough. The body will usually give you a “twinge” before a full blown flare. Treat aggressively and on first sign, don’t wait or blow off that little twinge or twitch. Don’t push through it. This is very important ! ALSO, when it calms down you must go another week with your rest plan. We always think OK “it” has calmed down, so tomorrow I will go full speed back at the gym. Nope. Doesn’t work that way. Once pain free, go another week pain free. Then ease back in slowly, very slowly. Trust me on this one.

2. I pull out my go-to resources a Physical Therapist once gave me. These are two books I hold tightly; Treat Your Own Back and Treat Your Own Neck by Robin McKenzie. I work the protocols.  (*note if you have a low lumbar fusion (fused to the sacrum) or a total cervical fusion these programs will not apply).*

3.  For a low back flare I have a few things I do including the Treat Your Own Back protocol.

A.  Brace it ! Compression helps A LOT. I have a few lumbar braces (drug store variations) but I really like my old fashioned Miraclesuit girdle. It is tight and has eye hooks up the front, but fits well under clothing. The compression dulls other sensations, stabilizes my lumbar spine area just enough, and reminds me not to move too much in order to let any inflammation cool off.  If I need more compression I will wrap an ACE wrap around my lumbar spine and cover it with a compression girdle.

B.  Thermacare – these things stay warm all day. Don’t buy the generic it has to be the brand name. Wear one under your compression garment. There is also a patch called Icy Hot. Ice or heat ? It’s a little confusing which to use but THIS should help you sort that out a bit.

C.  Supported bridge pose. This is my go-to when my low back gets cranky. I put a yoga block at the level of the sacrolumbar junction and rest here for 5-7 minutes throughout the day whenever I can. It provides a tiny light traction and a gentle massage if you GENTLY rock your knees side to side.

With Spinal Fusion bring the block down to the lowest level and release the strap  

With Spinal Fusion bring the block down to the lowest level and release the strap

 

My opinion is low back pain should clear in a few days although I’ve had a few more major episodes that lasted 6 weeks. It DID go away. The major episodes occurred after lifting something (or some little person) I shouldn’t have. I don’t practice vigorous vinyasa yoga with lots of up and down, side to side movements of the spine anymore. I don’t do boot camp style exercises.  My exercise choices have to be designed with little excessive spine movements and low impact/compression. The more neutral I can keep my spine while exercising or in classes the better. Classes need to move slow enough so I can use stellar body mechanics. I don’t run or bounce. Keep the spine neutral ( a few forward and back movements are fine and healthy but too much is too wearing) and keep the core engaged.  NEUTRAL SPINE! Not sure about neutral spine postures ? Check this out.

Some of the barre methods are great for us, but you may need to modify the abdominal section.

Also if you must sit for long periods of time, use a lumbar roll behind the low back (The Treat Your Own Back book has resources for those) and stand up once every 30 minutes to lengthen and neutralize the spine. Or sit on a wedge where your hips are higher than your knees. Better yet adapt your workspace to stand while at the computer at least some of the time if possible.  I hate to break this to you – but SITTING IS THE ENEMY.  

4. For a neck/upper back flare this is what I do: * some of these can also be applied to other areas of the back *

First off I have to figure out what flares my neck and upper back and I’ve discovered it is this:

1) long periods of working at a computer at a table (or doing anything leaning over a table). I do all my extended computer work (example composing this blog) from a recliner or the bed completely propped on pillows. I don’t hold my neck up at all, I’m resting back. I realize this is hard to do in an office situation but when modifications have to be made, they have to be made.  You will need to figure out some accommodations.

2) repetitive upper body exercises such as repeatedly lifting the arms overhead over and over again, or with weights in hand. No, No, No. Just refuse. There are plenty of other ways to develop arm strength than repetitive overhead lifting. Not to mention eventually this will shred everyone’s shoulder to pieces.  So keep the arms down unless you are stretching them overhead a few times (which we need to do).

A. I use Biofreeze or its drug store variations. Biofreeze is a cooling gel that seems particularly good for neck pain. Keep applying that stuff throughout the day! It calms things down and gives you a different sensation to attend to.

B. Compression ! I love compression. Just give me a little light pressure down on those upper traps and voila. So I have this, the Shoulders Back Posture Support that I will wear when needed.

C. Therapy balls. Thank you, thank you, thank you Jill Miller for introducing me to Yoga Tune Ups.  I will do the tune up rolls to the upper back, neck, and shoulders throughout the day when I need to calm tight overused muscles. It’s like having a deep massage.  Which speaking of massage, get thee to a massage therapist on a regular basis!

D. I had great success after a really long muscular tension type flare up getting trigger point injections. I saw a local Physical Medicine and Rehabilitation doctor (Physiatrist) and he injected my traps and rhomboids with a lidocaine substance plus added "needling." Some physical therapists are doing needling and it is very effective.

D.  Kinesiotape !  OMG I LOVE this stuff. I was introduced to Kinesiotape in my Occupational Therapy days when we used to tape certain muscle groups as a soft splint, or to decrease muscle tone,  provide support and enhance circulation. Some chiropractors and Physical Therapists will do this but I ordered my own Kinesiotape, watched a few YouTube instructionals, and trained my husband to tape me (yep). This stuff stays on from 5-7 days and is like magic for my neck (have used on lower back as well).  Sometimes I have to continuously tape for a few weeks but it works for me.  Combine the tape and the upper back brace for long periods of sitting or computer work.

E.  Topical pain prescriptions. Must be prescribed by an MD. For me the verdict is still out on the efficacy of these but some people have great results. It’s a compounded cream of a few different ingredients including a muscle relaxer, anti-inflammatory, and a few other ingredients. Much better than anything you might take by mouth. You rub it on the affected area four times a day. Worth a try!

F. You can’t go wrong in getting a physician assessment if you are dealing with a pain flare that is not settling down in a week to 10 days. It can be helpful to have the area x-rayed or even for more depth of information MRI.  * YOU CAN HAVE AN MRI WITH SPINAL HARDWARE * An MRI will show what is going on in the disc space. It can be helpful to know if you are dealing with a herniated spinal disc, degeneration, stenosis etc.  X-Rays give you limited info. Push for the MRI. Many times the MD will refer you to Physical Therapy for a 6-8 week course of treatment. Ask to see a PT who is a spine specialist and give it a good try.

G. The fascia blaster.  Enough said. 

I hope this helps you to create your own back care toolkit. It takes a lot of work and an investment as well, but it is definitely worth it to have a plan of action when things go awry. Keep moving, keep breathing, and practice superb self care.  Your back will thank you !

Peace,

Julie Wilkins

www.foreverfused.com

Building The Team

Building the Team

Whenever I work with people in pain, managing chronic issues, or just in a health crisis I always advise " build your support system with really good healers, bodyworkers, and doctors." Support is the key to healing, but the quality and care of the team is super important.

I've spent years exploring my local network of health care providers to build my own "team" as well as to have referrals for people I work with.  Here is what I've discovered along the way :

1. Start with a really good primary care physician. I love mine. She listens, she takes time, and most importantly she views me as a partner in my health care decisions. It may take a while to find the right person, but you want a doctor you can truly connect to. Sometimes I need her frequently, and sometimes I won't see her for a year, but I've stuck with her and she knows me. She remembers my history when she walks in the room, and she has seen me through my post partum bleak days through now as I enter my 40s.  

2. Find a good bodyworker. Someone suggested to me once "have a skilled bodyworker put their hands on your regularly ." If anything the positive energy exchange is good for the body and soul. The key here again is connection.  This could be a massage therapist, reiki worker, rolfer, or other body work professional.

3. Chiropractic - OK so I've had really bad chiro experiences and now seem to have found a really good one I can work with. Chiropractors definitely run the spectrum in terms of focus and skill set. In my opinion, the more tools they are using outside of just the "crack and adjust" , the better. Find one that offers soft tissue therapy such as ART, Graston Technique, Kinesiotaping, needling,  and so on. 

4. Physical Therapy - I have to admit after years of working with PTs some are really, really good and some ... well, not so much. You have to watch the PT clinics nowadays as they can become a little like a machine; moving you through the stations and having many different therapists, assistants, and techs working on you.  Do your research, call the office, and ask to speak to the lead PT/manager. Ask the questions ! I have a really great PT locally I can recommend if you live on the Eastern Shore, AL email me.

5. Acupuncture - I had a fabulous acupuncturist who retired and moved, but I believe acupuncture has a great place when combined with western medicine.  Some cities will have more resources in this department, while we here in the south are still lagging a bit. 

6.  Physiatrist - I have recently been working with a Physiatrist, or Physical Medicine and Rehab MD due to some chronic neck issues and a nagging hip/groin injury. *sigh* .  I have not had much experience with physiatrists but see now how they approach the body from a different viewpoint.

 "Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move."  For those with spine fusions from scoliosis, these doctors may be better at longer term management of nagging issues than your orthopedist might be.  I also noticed they tend to lean on the side of injections and procedures,  while going "straight to the injury" rather than using system drugs. It's worth checking into ! 

Now for the cost $$$$$.  Chiropractic care, PT, and of course your MD visits are covered under *most* health insurance policies. The other services are out of pocket. 

Now that I have my team in place, I kind of rotate around depending on what is going on to keep the wheels on :) . I go through phases where the services are not needed, and phases where I need more care, BUT the biggest thing is knowing I have a team in place. 

Cheers to the TEAM.  Now go build one. 

Peace,

Julie 

Radiant Heart

Work Wise with Bowspring

I'm home and processing a wonderful weekend of participation in the Bowspring Method workshop hosted by Springs Yoga in Atlanta, GA.  

Coming from a rehabilitation background as an Occupational Therapist, I saw some very valuable alignment principles in the method. Think smart functional training patterns, wise attendance to back body strength and power, and a lightness and lift in the body structure. The physical postures are unique, demanding, and in the beginning intense, but the mind/body message is clear and strong.

This is movement medicine.  

The Bowspring practice informs our daily living skills.  You retrain the postural template to "work wise."  Our teacher Desi Springer, talked about the difference in work hard vs work wise.  Work hard has a posture. Think about it, when we are over-efforting the jaw clenches, the shoulders tighten back, the sympathetic nervous system revs up. We want to learn to work wise and develop "sensitivity before strength." Which is why in this method, the teaching is to put our hands down fingernails first then flat hands.  Sensitivity then strength. Weight bear on paws of the feet (toe pads and mounds) and keep the foot soft on top, expand the ribcage circumferentially.  The practice forces us to slow down and feel first.

Other postural principles we learned throughout the weekend was to let the shoulders float on the ribcage. Easier said than done for someone whose upper traps are so tight her ears rest on her shoulders !  As we worked through this it got easier, you just have to get lighter and fuller from the inside out. The posture is empowering. No more closing, rounding, flexing, and folding. Think up, broad, and bright, "a posture of worthiness."  The way we hold ourselves becomes a message, a message to ourselves and a message to the world. 

“This is where the inner body meets the outer body"

— Desi Springer

On day two, Desi described the three parts of the postures which are HEART, HIPS, and HEAD. We start with the heart which represents accountability.  Be full, broad, and light. Float more. Expand more up and out. Be accountable. The hips broaden back and wide (sit bones apart, hips back from rib cage) so the belly can be long and strong. The belly is shaped like a bow. This is compassion. We see our human-ness without shame. Then the HEAD becomes broad, the throat is open and the gaze is on the horizon. Don't tighten the mind ! 

“The inner shape stays the same regardless of the external shape"

— Desi Springer

The Bowspring practice is "power posturing." Trust me, by the end of a full weekend training you will feel EMPOWERED. 

We talked about some of the more therapeutic aspects of the method including working with knee pain and low back pain. The Level 1 syllabus is mostly if not all composed of bent knee postures. With the knees bent, the postures can dynamically pulse so the knees are pumping quite a bit.  If there is any knee stress, the instruction was to open the pelvic floor more ( butt back and wide) and work the feet with higher integrity. I might also add that possibly engaging the back body more especially hamstrings and glutes might lighten the load a bit on the knee joint.  Same goes for low back. If there is any low back pain in the postures, the instruction was more leg action more gluteal action!  When the muscles are asleep the sensation will dump in the low back.  I am prone to low back pain below my fusion level and I will testify that if I kept my legs and glutes firing I felt no discomfort.

“The back body muscles are the muscles of choice and power"

— Desi Springer

Bowspring engagement is exactly that ... ENGAGED.  If you want to come hang out, stack your bones, and dump yourself in a pose than this is not for you.  It is mindful and it is work. It is also incredibly soothing for the nervous system which is counterintuitive when you look at the Bowspring system from the outside.  But Desi compared it to a how you calm a baby .. you swaddle and bounce.  We swaddled ourselves in our own muscular strength and intentional energy, and then we bounced with the pulse of the dynamic postures.  Nervous energy be gone! 

Being that we ended our training on Mother's Day, the practice can be compared to the "tough love mother."  Like the mother, the Bowspring Method pushes its students up and out in the world with compassion, courage, and a graceful power that comes from the heart. 

I am looking forward to continuing my studies in this system and am incredibly grateful to meet and study under these wise teachers. Let the journey continue ! 

Sacred Space Embodied

Sacred Space Embodied

It has been a long and incredible journey of healing to find comfort, space, and easeful movement in a body that has had 13 spinal vertebrae fused for correction of severe scoliosis. For years following my spine surgery, I definitely did not feel spacious. My body felt far from sacred. In many ways I felt invaded, ripped apart, rewired, and tightened back into place from an extensive spine surgery.

I discovered yoga 15 years after my spinal surgery for scoliosis. In those initial few years of exploring my practice, my body did not feel sacred OR spacious. I felt tight, fearful, angry, restricted, and doubtful. I sought out teachers, workshops, books, and anything else I could get my hands on to learn HOW to move with a spine that was 90% fused and immobilized in order to prevent further aggressive curvatures.

Over time the fear dissipated. Slowly. I began to trust myself, my surgeon, my body, and the choices that were made to manage this condition. Through diligent yoga practice and intentional healing, Sacred Space now resides in MY body.

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