Graston

Today I was thoroughly bruised by a doctor with a butter knife. I have never been happier.

It’s called the Graston Technique, and it might be the most efficient massage I’ve ever had. Six stainless steel tools, just begging for Sweeney Todd marketing partnerships, are rubbed and dragged across your oiled skin in order to break up myofascial restrictions. Aka knots, tightness, and scar tissue. If you bruise easily, you will be left with an enormous hickey across your offended part. My shoulder has never been sexier.

The treatment is good for tendonitis, plantar fascitis, carpal tunnel, etc. Supposedly it’s now used by all the major sports teams. Watch this video to get the gist.

The beauty of the technique is the leverage that the tool provides — you’re not limited by the strength of the therapist’s thumbs. The end is used to dig a ditch under your shoulder blade; the long edge rakes out your neck. It was actually less painful than I anticipated. One by one, he called out the muscles and neighbors of my rotator cuff, and attacked them. In twenty minutes, he found and dug into every little knot my last four massages had touched on.

Dr. Minardo at Infinity Sports Medicine did the job; their whole office was strongly recommended by a marathoning friend. Dr. Babiy checked out a little knee puffiness (no drama, just imbalance!), and Stephen Kim taught me some physical therapy. They had a range of suggestions for my chronic shoulder tendonitis, including trigger point INJECTIONS (of saline)… but who could turn down “a massage with a special metal device?” (One covered by my insurance, too?)

I felt almost guilty going to a Western office, like there was some Eastern technique I just hadn’t found… but you gotta love German engineering, too. And, I’m telling myself the 8am appointments count as a morning practice. I go back twice next week, but the real test will be for me to keep up w/the homework (ice and stuff for the knee). If I can clear up this shoulder I will be SO happy, cause there’s a time limit on your body’s ability to regain full elasticity; you can’t leave it knotted for too long. It’s time to say goodbye…

I’ve run all over New York City. I’ve raced in and out of subways, ran to meetings, stayed out too late, drank too much, danced all night, but I could always catch up on my sleep and I was never as tired as I am now, as a mother.  When you become a mother, 8 o’clock rolls around and you’re ready to get in bed.  It sounds crazy, even to me. I look at my past life in Manhattan and I can barely remember who I was.

Presently, if I go to bed at midnight, I think to myself, “Oh no!  My baby has 5 hours on me already and I have to wake up at 7!  He is going to run me over tomorrow!” When I lose sleep or don’t get enough of it — which is often — I make excuses to skip yoga class.

On top of this, my baby is a big boy and I started getting terrible shoulder pain from holding him all day — up and down the stairs, in and out of the car, dancing (we dance everyday). It was so uncomfortable that for a while, I was sleeping with a heating pad on it — my husband would roll over in the middle of the night and I’d be on fire! I thought yoga would put too much pressure on my shoulder and make the injury worse.

This yogi knew she had missed too many classes, and so I went to yoga class yesterday.  I always feel worse when I don’t practice regularly. So I said to myself, “You see more clearly after yoga. You feel better. You are stronger and leaner. This is the one place where all you have to do is be on your mat and breathe.”

I told my yoga teacher that I’d been having terrible shoulder pain. She told me to monitor my responses to the poses. If my shoulder pain seemed worse after class, I’d need to make the appropriate modifications. But after class, as always, I felt like a new woman and my shoulder was not hurting.  I told my teacher and she said, “If you only have a little shoulder pain, yoga can help the healing process and keep the shoulder joint stable.”

It is possible — I just found more reasons to practice and love yoga.

Namaste,
YogaMamma

Beth Hinnen

So. My shoulder thing is still going. Lots of crunchy noises (which the sports medicine guy said are no big deal, unless there’s also pain) and the occasional sharp pain (which is moving from the top of the arm to the inside of the shoulder blade). It’s lessening and lessening, but still not gone. I know this stuff takes forever to heal, so I’m trying to be patient. But I’m also trying to keep my practice habit intact. I was already struggling with slacking, and then the injury confused me almost to the point of inaction (much like a muscle in spasm). I’ve been wondering how much rest my shoulder needs, how much work and what kind, how much stretching / massage / release, and, most of all, what is up with my Down Dog? (My left shoulder doesn’t feel anything like the right one now.) I’ve been unable to distinguish pain that is strengthening my shoulder from pain that is further aggravating it. So, I’ve been looking for some specific guidance on what poses to practice, and what poses to avoid.

A friend who also has a left shoulder injury (from a skiing accident, much more glamorous than my sleeping accident) recommended Beth Hinnen at Integral Yoga. She studied Structural Yoga Therapy, an Iyengar-based system of individualized therapeutic yoga, and wrote her final paper on rotator cuff injuries. (Note: I don’t know any other teacher training that makes you write a thesis.) The class is general Hatha II, with a mix of men and women, young and old. We did some gentle warmups, three rounds of Sun Salutes with variations, some standing poses and inversions, and closed with pranayama and meditation. (Warning: there is chanting, for those of you who can’t take it.)

I’ve been three times now, and been helped greatly by each class. In the first class, after I introduced my injury (not that it’s a separate being…), she gave me some great adjustments in Down Dog. She really emphasized the external rotation of the upper arm bones, while keeping the inner rotation of the forearms, until my shoulder blades simply couldn’t wrap around the side of my ribs any more. She eliminated my overarched back by waking up my abdominal lift and containing my flared lower ribs. I felt strong in the pose again, and not scared to practice it any more!

The second class started with the Joint-Freeing Series, a sequence of wrist, elbow, and shoulder movements that’s also great for arthritis. She also gave us shoulder tips in each and every pose. But I had a flashbulb moment at the very first instruction. From sitting, she had us bring our arms straight out in front of us, and stretch them forward. “Now pull the shoulders back, into their sockets, and feel them relax downward.” Well, mine were the opposite: relaxed when stretched forward (out of the socket), tense and awkward when drawn back home. So I’ve been working on that adjustment for three weeks now, and noticing crazy subconscious postural habits. (I really think injury is 90% posture, and 10% irritant.)

In the third class, the Cobra instructions were really helpful. Lying on the belly, palms under the shoulders, relaxing the lower back and butt. Keep them relaxed as you raise the forehead an inch off the floor. Try again. Try again. It’s amazing how much we overuse our lower back. This method helps release the lower back, and strengthen the upper. We also did Locust with arms by the side, out perpendicular, and in front, for three more levels of strengthening.

Beth was also kind enough to bring me the handouts from the shoulder workshop she teaches: anatomy articles from Yoga Journal, diagrams of the rotator cuff bones and muscles, and instructions for the Joint-Freeing and Shoulder Strengthening Series. She taught me Cat Bow, a short pushup from Table Top (with the shoulders in front of the wrists) that helps strengthen the serratus etc. These two series take about 15 minutes total, so I’m trying to practice them every day.

It feels really good to have a strategy now. I really appreciate all the tips Beth gave me; I have a path back into my poses. If you have a rotator cuff injury, a slipped disc, a bad knee, or really any kind of confusing pain, I urge you to check out the research papers on the Structural Yoga Therapy site. It will give you an amazing introduction to the field of individualized yoga therapy, if you haven’t encountered it already.

This morning I went to a free class at Om Factory, schlepping over to the Garment District at 10am. (Still better than the 7am call time when I used to teach there.) I was puffy-eyed and groggy from some gluttony the day before, but knew that three hours before breakfast wouldn’t work for me, so I had a quarter-cup of coffee with cream en route. (I had to save the rest of my daily coffee allotment for a meeting at everyone’s favorite coffee place, Grumpy’s.)

The class was slow vinyasa, a perfect pace to guard my shoulder from any aggravation. (I saw a sports medicine MD on Tuesday, who assured me my shoulder was no big deal and would heal without problem. Tendonitis is a really common yoga injury. But weight-bearing will stress it, I have to be careful to strengthen and not stretch too much. I have ligaments “like rubber bands.”)

I felt so alive and awake afterward, I wondered why I don’t practice in the mornings any more?? Then I remembered: the hump. I don’t make it past the first 15 minutes. If I plow through it I have an amazing, creative, fulfilling solo practice, but I have issues with plowing through yoga. Aren’t we supposed to listen to our intuition? What if that body awareness is saying “I don’t want to move! I want to lay back down!” How do we know if it’s actually tamasic (heavy) energy that needs to be burned up?

This is the weird dialectic that is my practice: I have to force myself through the beginnings, but once I’m going it’s an easy flow.

Leslie and not-me

On Friday I went to see my anatomy teacher Leslie Kaminoff, who noticed my blog posts bemoaning my injury and kindly invited me to come in to his clinic. Yay for blogs! I sit in class every week and watch him fix people, but I kept thinking my shoulder would be better tomorrow, or tomorrow, or maybe tomorrow…

I did my little demo of snap-crackle-pops around the left shoulder blade, which he said was probably tendonitis (inflammation of the tendons). I told him about the pinch in the upper arm, and how I’d tried to treat it according to my trigger point book, which pointed me to a big painful knot on the back of my shoulder blade. He said that the spasming muscle was probably the teres minor, more than the infraspinatus, since I felt the knot better with the arm over my head. He asked about my job and computer use, so I described my work station… turns out that elbows on the desk is “really, really bad. There’s your problem.” Villain!

Then came the treatment. It’s like a bit of chiropractics, a dash of Thai yoga massage, and a pinch of Shiatsu all mixed up as a breathing lesson. He found a rotated vertebrae in my neck and fixed that. He found all the “stuck” vertebrae in my back, and popped them. He stabilized the center of my diaphragm (aka “pushed on my tummy”) to force my ribs to expand upwards as I breathed. And he cranked me into this one twist that I swear popped the fused vertebrae in my tail. Then he stretched out my hip flexors, my hip extensors, and my neck. We hadn’t even gotten to my shoulder yet.

All these adjustments were like adding an extension onto my house. When I sat up, it was like I had a third lung; I just kept inhaling. He said that when we have an injury, we have to look at what’s supporting it. So, a neck or shoulder condition can result from tightness (or collapse) in the ribcage. When we have good support below, we can have full mobility above.

Then we adjusted the shoulder a bit. He pressed his thumbs into my back as I moved my arms from side to side, up and down. I felt the knots underneath squirming and trying to escape. He popped the humerus back into its socket a bit, I don’t know how. And then we were done!

I can’t get over the fact that the solution to this is breathing better. It makes sense; if I loosen up my ribcage, I can stretch my shoulders from the inside, too, 24 hours a day! But it seems so easy. As with my meditation, and asana practice, I’m going to have to beat myself over the head with the “secret”: it’s all about your breath! Maybe I’ll take it literally, Monty-Python-style. That’ll convince the masochist in me. I will still be squelching the knots under my neck with my tennis ball; it’s a new favorite sport, and I have to undo all my computer poses. But it’s amazing how posture — the way we align ourselves in the 22+ hours OUTSIDE of yoga practice — will make or break our health.

So. Next step is to rearrange my whole computer setup, ugh. (And up my olive oil intake, it’s the best anti-inflammatory and that should help my tendonitis… along w/the icy New York weather.) I guess I need a higher chair, or a lower desk. But I already went today and bought one of those ugly laptop stands, so my computer is floating six inches above my desk (like a good yogi) with a new keyboard underneath. My big head is no longer looking down at my screen, pulling on the back of my neck. My elbows are opening downward, and my wrists are flat. And my shoulders are relaxed.

POSTSCRIPT — I forgot an interesting part. Leslie said that the infraspinatus (or was it subscapularis?) and rhomboid muscles work in opposition, and while we do a lot of rotator cuff strengthening in yoga (chaturangas and other “pushing” movements), we don’t have a lot of poses or movements where we “pull” our arms back or shoulder blades together and strengthen the rhomboids. So he said I could loop a strap around a door handle, hold it with straight arms, lean back, and pull from the shoulder blades in little pulses to strengthen the rhomboids. Without overdoing it, of course. I think I might try to get myself back onto an erg…

There's a muscle underneath the shoulder blade!

I’m trying to watch the inauguration replay, but CNN.com Live is not loading… the Facebook sidebar is giving me more info than CNN.

I haven’t posted since last week… it’s been same old same old with my shoulder. It feels better for a day, then worse in another way. I should probably see a doctor, but I’m worried that my superbasic freelancers’ insurance won’t cover much. I don’t know a sports medicine specialist, and my GP is a kind old grandpa who tells me incorrect information about my prescriptions. The knot on the back of the shoulder blade is much better, and the pinching feeling around the top of my arm is reduced — but still there. I’ve been going to my regular vinyasa and hatha classes, but taking it easy and just holding basic versions of the poses. My guess was that I should keep warming up and gently strengthening / stretching the infraspinatous and teres minor… but is a week too short a time to expect it to be better? Patience is not my virtue. I kind of forgot to keep massaging the knots, though.

The cool part about an injury is that you get to study one part of the body in detail, and understand what that part is doing in each pose. It actually inspired me to practice at home more, since I wanted to explore poses for the shoulder. It put me back into beginners’ mind for my studio practices, since I had to reconfirm how I wanted to approach, hold, and exit each pose. And it gave me an excuse to do more gentle stretching and breathing practices. It might also give me an excuse to get a massage with this woman who works on the New York Ballet dancers… I’ve heard her sessions are INTENSE.

One other lesson: be kind. I think I instigated the problem (tension and knots) when I realized that my left side is weaker than my right, and promptly tried to fix the problem by putting more weight and flexion into my left side during Down Dog, Mountain, whatever. I still think strengthening is probably needed on that side, but maybe I went at it more aggressively than I realized? Can’t think what else would have caused a non-dominant side injury. Unless it’s my computer pose: elbows on the desk, leaning slightly into my left arm…

I’ll keep you posted on this issue that is transfixing the nation. Back to the webcasts now.

Possible pain (in red) and its trigger points (marked with an X)

A few nights ago, I slept funny and woke up with a tweaky shoulder. Shooting pain when I moved my left arm in certain ways, and a few new snap crackle pops when I rotated my shoulder. This is my second sleep-related injury; I need to do a public-service announcement.

Finally, I remembered julstro.com. The website of Julie Donnelly, it saved me the last time I was hurt. Julie is a massage therapist who works mostly with triathletes. She’s identified all sorts of conditions that are actually caused by muscle tension, and teaches a system of trigger point massage to release the knots and thus the pain. The crazy part is that these knots are not always located at the source of pain — my knife-in-the-back shoulder pain was caused by a spasm under my collarbone! The spasming muscle can impinge nerves or other muscles, and cause pain at the other end of the system, similar to pulling someone’s hair. So Julie has mapped out where to look for knots when you have pain in various areas.

The website has a great forum (be sure to search the archives) where you can find dozens of people asking your same question. Julie is amazingly generous with her time on the forum, and will recommend treatments that you can do at home. (Like rolling around on a tennis ball, using pressure to force the spasm to relax.) She used to live in New Jersey, and I actually had the masochistic pleasure of a massage with her a few years back. She’s since moved to Texas, so I finally broke down and bought her eBooks: Pain-Free Living and The Pain-Free Triathlete. They are full of diagrams and photos to make treatment easier.

So the answer to the pain shooting down my arm? The outside of my left shoulder was a little knotty. Underneath my collarbone, and towards the armpit, was too. But when I raised my left arm, on the back of my left shoulderblade I found a big ropy knot that hurt like hell. So I get to hold this monkey pose and torture myself for a while now, talk to you later.

Downward Facing Cat

The New York Times just had an article dispelling the well-worn advice to stretch before exercise:

“The old presumption that holding a stretch for 20 to 30 seconds — known as static stretching — primes muscles for a workout is dead wrong. It actually weakens them.”

Instead, we should prepare for athletics with 5-10 minutes of very light aerobic activity, and only 5 minutes of rest time before moving on to the workout.

The right warm-up should do two things: loosen muscles and tendons to increase the range of motion of various joints, and literally warm up the body. When you’re at rest, there’s less blood flow to muscles and tendons, and they stiffen… A well-designed warm-up starts by increasing body heat and blood flow.

Yoga is a great workout because it stretches as it strengthens. It seems it would also be a great warmup for other types of workouts:

Stretching muscles while moving… a technique known as dynamic stretching or dynamic warm-ups, increases power, flexibility and range of motion.

This is also a good reminder for teaching or practicing challenging poses: warm up all joints and connective tissue that will be used by starting with simple poses and/or repetitions.

Leslie Kaminoff at the Breathing Project

I just had to make a quick post about the open house I attended Wednesday at The Breathing Project. Leslie Kaminoff gave an amazing lecture on breathing and anatomy in yoga, I’m seriously considering signing up for his anatomy classes instead of heading for the Iyengar Institute. His approach is less detail-oriented than Iyengar’s; he says it’s “impossible” to manage a laundry list of alignment instructions while you’re doing a pose. “As soon as you’re focused on your right pinky, your left eyelid goes out of alignment.” So at the end, he says the guidelines for each pose have to come from inside. After all, “There’s no such thing as an asana — where are they right now? where are they stored? — there’s only people. Individuals. There’s Amy’s Down Dog, or John’s Down Dog, but there is no universal Down Dog.”

I think this approach is much more in line with the book I’m working on with Sabina Stahl, which is called Intuitive Lifestyle. It’s more about finding your intuition in asana practice, eating, and general life. So I’ve been reviewing a lot of anatomy notes, but wondering how precise and thorough we’re going to get. Also, in the four years since I did my teacher training, I’ve encountered some conflicting directions on anatomy, so I’ve been wondering how we’re going to reconcile those.

Leslie has a really interesting background. He started out at Sivananda in the seventies, when his father invited him to a class over on 25th Street. He ended up becoming a swami and heading up the LA center. “The early eighties were an interesting time to be a swami on the Sunset Strip.” Jane Fonda had her studio just down the road, it was the birth of the aerobics and body building movements, and the Nautilus machines allowed people to weight-train safely for the first time. He ended up leaving the ashram and working at a Sports Medicine center. There, they treated all the injuries associated with the exploding popularity of high-impact aerobics etc.; they treated Jane Fonda herself. He saw hundreds of x-rays of spines, and was startled to realized most spines don’t look anything like the nice straight columns we see in the books. The idea of asking these spines to do these yoga poses was terrifying, and he stopped teaching yoga for a few years. Eventually he went back to New York, to work for a famous osteopath, and then to the Krishnamacharya Yoga Mandiram in India. He would ask Desikachar WHY these poses had such profound effects, but no one there could answer his questions. So he began researching the anatomical basis for yoga’s benefits, and that study culminated in his book with Amy Matthews, Yoga Anatomy. The book is in its fifth printing in one year; there was “a real hunger” for this type of information.

It was also interesting to hear “you know, the study of yoga anatomy is only 30 years old. At Sivananda, it was ‘Now we will do Shoulder Stand. Do it.’ Maybe they would say ‘work the hands towards the middle back’ but that was it. Only when Mr. Iyengar landed in Ann Arbor did we start to get details.” Likewise, “the study of Bandhas is only 12 years old. Ashtanga was the first system to really make a big deal out of them,” so the precise study is still young.

One last nugget: “As a teacher, you can focus someone on a spatial goal, or on a spinal goal.” The former is trying to push them into a particular shape, the latter is more about the relationship between the parts.

Or one more: “Either we’re doing these postures to get them right, or to be free.” Eventually, we will lose any pose we’ve achieved (to age or infirmity), so we should aim for freedom and not achievement in the asanas.

Amy Matthews also taught a wonderful class about anatomy according to the Body-Mind Centering principles of Bonnie Bainbridge Cohen, and Jill Satterfield led us through a deliciously slow, mindfulness-meditation-oriented hatha class. Is New York City finally slowing down?

PS — All quotes are approximate.

I feel really centered, and for the first time I have an understanding of what that phrase is trying to express. I just returned from a 10-day yoga retreat, and it’s as if my scattered self has been swept into a much neater pile.

I went to the Sivananda Retreat in the Bahamas. It’s a quick, direct flight from NYC, so I’ve been there 3 times in the last 2 years. The daily schedule is meditation, kirtan, lectures, and yoga practice twice a day, with the middle of the day free for the beach or optional lectures. I love this schedule and have adapted it for my freelance life now that I’m back — albeit with much smaller doses. I’m trying to stick with 30–120 minutes of meditation/pranayama/yoga in the morning, 3–6 hours of work midday, and a couple hours of housework, socializing or reading at night.

The theme of the last weekend was “Deepening Meditation.” I am trying to maintain a regular meditation practice, and there were some helpful ideas in the meditation lectures:

• It doesn’t matter what you choose to meditate on. The most important thing is that you like the object you’ve chosen; your fascination will help to bring the mind back from its distractions.
• That said, you will eventually gain deep understanding of this object, so don’t pick something trite.
• Sivananda once said “I pity the fool who attaches to non-representational ideas of the infinite. Images, whether abstract or personified, are the door through which you will gain understanding.”

Here is a nice series of short meditations from Onkar S. that bring the senses under control (aka pratayahara). We did this series in a small group, and each person had a different favorite. The whole series takes about 20 minutes, but it felt like 5 minutes. These exercises are good for everyone to do occasionally; they will strengthen your silent meditation as well.

1. Choose a picture or a beautiful object. Focus the eyes near its center. Notice all the ideas, associations, and questions that come up. Notice the feelings and emotions that come up. (In yoga the mind is also considered a sense.)
2. Light a candle and place it at eye level. Focus the eyes on the flame. When your eyes tire, take short breaks to close the eyes and visualize the flame between the eyebrows.
3. Light a stick of incense. Close the eyes and focus the nose on the smell.
4. Close the eyes and repeat the word OM. (This sound vibrates your whole head: throat, soft palette, and lips.) Focus the ears on the vibration between the eyebrows.
5. Use the thumbs to close the ear flaps. The index fingers gently close the eyes, the middle fingers rest outside the nostrils, the ring fingers and pinkies close the lips. The symbolism, not the position/pressure of the fingers is most important. This is yoni mudra. Focus on the sound inside the right ear (for reasons unknown).

Onkar also spoke briefly on pain while sitting. (He teaches “Yoga for Pain” courses.) He said that the biggest point is to accept the body, and not fight it. Most often, we are angry at the injured part of the body, which only makes it contract further. Each part of the body has something like a mind, like a child, and we have to start a dialog with it. “Hello, foot, how are you doing? Is it ok if I put you like that? Oh, you hurt a little? You need a little massage? I’d hurt too if people were stepping on me all day!” When we fight the body — “I want you to be flexible! Go!” — we start a war. When we accept the body, the pain softens.

Here’s a basic overview of silent meditation:

• Find a comfortable seated position, with the hips higher than the knees. Even if you can do Lotus, sit on a pillow to help the knees.
• Gently straighten the spine by lifting the crown of the head. I often practice sitting against a wall, so that I know I am straight and I learn the correct sensation. The abdominal muscles can then relax. The chin relaxes slightly towards the chest.
• Let the eyelids relax, so that only a slit of light is seen at the bottom. Let the eye muscles relax so the eyes are hanging downward.
• Focus the attention (not the eye muscles) on the point between your eyebrows, or the right side of your heart; whichever is your natural tendency. You can imagine the breath moving in and out of this spot like a dolphin.
• Repeat the mantra OM OM OM OM OM and feel the vibration. (This can be done out loud at first, to get the attention of the mind, but the memory of the sound works just as well.)
• If thoughts enter the mind, let them flow straight out the other ear without attaching or judging or responding to them. Listen to the space between the thoughts instead, and return to your fascination with the forehead or heart.
• If you notice your mind has wandered off for a while, just estimate how long it was gone and then return to your focus.
• Let yourself fall into peace. You cannot force meditation, it is a state like sleep. You can only practice the habits that lead to meditation.

It took me 2 years before I could even sit at all. Before that my mind would jump with thoughts of “Why am I doing this? Nothing’s happening! I need to… I’m so bad at this! This is stupid!” until I gave myself a panic attack and jumped up. It was more helpful for me to do yoga poses, or play the drums, at that point in my life. But whatever minutes you spend practicing concentration are slowly adding up, and eventually meditation becomes more attractive. You start to get a physical buzz, and a clear mind, and you start to feel this way in your daily life as well. I went to a 45-minute silent meditation a few months ago, and it relaxed my jaw, which I hadn’t been able to close for 2–3 weeks. So you might persuade yourself to practice by knowing that there will at least be physical benefits, even if you aren’t feeling anything.

Confucius called it the great learning:

1. Awareness
2. Stopping
3. Stillness
4. Quietness
5. Vitality
6. Wisdom
7. Achievement

This sequence is explained really well in a “How to Meditate” PDF based on many types of meditation.