physiotherapy


As I wrote recently, part of my posture-reprogramming regime is that I have a watch alarm that goes off every 20 minutes, reminding me to check and, if necessary, fix my posture. (I’ve written about my protocol for fixing it here.) My amazing physical therapist, Shannon, predicts that in the long run, this will be the most helpful part of all the work I’m doing. I’ve been doing it every day for over three months, now, and it does seem to be helping. It is no longer unusual that the alarm goes off and I don’t need to fix my posture, which never happened during the first month.

One entertaining side effect of this practice is that my friends have begun correcting their posture, too, when my alarm goes off. At Not Back to School Camp, this summer, campers and staff figured out pretty quickly what the alarm meant. Here is some footage I took secretly from the back of a camp meeting while my alarm went off:

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I’ve been working seriously on changing my posture for the last six months. I’ve been seeing a chiropractor, a massage therapist, and a physical therapist. On normal days I do about two hours of stretching and strengthening exercises–postural reprogramming stuff that they have assigned. On super busy days I do about an hour’s worth.

I’m strengthening the muscles that hold my shoulders and head back and up. I’m lengthening the muscles that pull them down and forward. I’m decreasing the exaggerated curvature in my thoracic spine (called kyphosis), especially focusing on the top few thoracic vertebrae. I’m increasing the twisting range of motion in my thoracic spine and ribs. I’m learning to relax muscles in my legs and butt, back and shoulder blades. I’m learning how to sit differently, stand differently, sleep differently, and especially walk differently. I have an alarm set to remind me about posture every 20 minutes that I’m awake.

The thing is, I’m almost 40 and I don’t have kids yet. I need my body to stay fit for at least another 20 years, and preferably more like 50 more. But nearly three years ago I started having some serious pain in my body–after 37 years of being as athletic as I pleased, I was suddenly limited in how much I could run, lift, swim, and sometimes even walk. One year I could go to a Lindy Hop event and dance all day and all night, and the next I had maybe two hours, maybe 15 minutes in me. Unacceptable.

And it turns out it’s because of my posture. Joints, muscles, and their connections do not work properly if not in the optimal relative position to each other. The habitual position of my joints had put enough strain on my body that I started having intense pain.

My chiropractor once told me, “You are the most compliant patient I’ve ever had.” My PT and massage therapist have said similar things. That is exactly what I’m aiming at–the most compliant patient. I do not just show up. I do not intend to waste my money or my life getting care and then not following through with the recommendations of my providers. If you tell me not to ride my bike for 3 months, I start walking or taking the bus. If you show me how to walk differently, I will walk differently. If you tell me to do 45 reps of some new, super-awkward exercise every day for the foreseeable future, I will do it. I am your perfect patient. I do it because I’m hoping you know what will help. I want to make you look brilliant. And I do it because if, after a couple of months, what you do and have me do has not helped noticeably, I will find someone else to work with, because I have tried you and your ideas out to the letter.

How should I stand if I want to stand in good posture? The answer I got from many, many sources–books, clips, websites, people–was some version of this: Tuck your tailbone under a little, imagine your head is being lifted, then hike your shoulders up a little, roll them back, then drop them down all the way in that back position. There are some minor variations out there, and some bigger ones–Esther Gokhale, for example, my mom’s favorite posture guru, is against tucking pelvis forward. “Ducky butt, not tucky butt!”

It was a bit of a revelation when my physical therapist, Shannon, gave me my first set of personalized instructions on my posture. I am to roll my shoulders up and back, but not down! I said “You are the only person who has ever given me that instruction. Why shouldn’t I drop my shoulders down as far as they go?” She explained, using a skeleton hanging in her office, how, while that’s true for many people, they way my shoulder blades and spine where out of whack, and because of which muscles are too long and too short from misuse, I need to bring my shoulders up. And I need to bring my ears in line with my shoulder joints. And I can tell the proper tilt of my pelvis based on what gives me the most height. Try it–reach up and move your pelvis and see what position lets you reach the highest. That’s the position for you.

After thinking about it, it seems obvious. Why would anyone think they could give me effective advice about my body without interacting with my body?

I’ve often wished I had a biofeedback device that could tell me whether something I was doing was good, bad, or neutral for my body. I have found pain and other sensations ambiguous directors. What are they asking for? This has been especially important in the last few years, dealing with injuries and slower healing. I recently asked my physiotherapist, Shannon, for her general recommendations for reading pain related to an activity. This is what she said:

1) Joint pain is never okay. If you experience joint pain during or after activity something is wrong; consider getting help to figure out what.

2) You should have no muscle pain during an activity (if you do, it means you are doing way too much).

3) Muscle pain after an activity means you are close to the right intensity – try lowering intensity and/or duration for a while and see how you respond.

4) Mild to moderate muscle pain in the next couple days is fine as long as it doesn’t escalate.

5) Each time you add an activity, do it at a constant level for 1-2 weeks before increasing duration or intensity

I’ve been a commute cyclist since 1992, biking between several hundred and a couple thousand miles a year, mostly in 15-30 minute chunks. I’ve also been a lap swimmer since the mid-80s. In October of 2010 I was diagnosed and treated for a sacroiliac sprain, which basically means that one of my pelvic bones had gotten stuck, rotated backwards compared to the bottom of my spine, called the sacrum. Part of the treatment was refraining from all exercise except walking for several months, while the joint healed. A big change. In January I started adding exercises back in, and last month I started biking and swimming again, slow and careful.

In the meantime, I had been paying close attention to my posture, and doing a lot of physiotherapy for my spine and hips. My experience the effects of biking and swimming is quite different than it used to be. The bikes that I’ve tried now feel badly designed. They make me lean forward too far, hunch my shoulders, round my upper back, and jut my neck forward. And after biking even a few minutes, my low back feels all crunched up, especially in the L5/S1 region, and my psoas muscles feel tight. Swimming feels good while I’m doing it, but afterwards my shoulders are rounded forward and my thoracic curve is exacerbated. Both exercises feel like they are working against the progress I’ve made with my posture.

Can anyone recommend some stretches or exercises to specifically counteract the negative effects of swimming or biking? (I mostly swim freestyle/crawl.) I’d appreciate the help!