Yoga and Mindfulness – Essential Physical Therapy

September 14, 2020September 14, 2020

Lessons from the River: How to Let Go and Enjoy the Moment

The sun warms my skin as the canoe lazily sways as we float the wide Missouri River. Cows graze on either side, the sun bounces dramatically off the white cliffs in the background. It is so quiet that the sound of silence almost seems too loud, broken only by the occasional “moo” of a cow or the rustle of my dog, Hazel, as she readjusts her reclined position atop our dry bags.

While floating down the Missouri River last week, I realized a few important things- in the way that one can do only when taking time away from day to day life.

One thing I learned is how attached I have become to certain routines. Even healthy routines can be harmful if we become attached to them- meaning we don’t know how to emotionally regulate ourselves without them.

For me, this was running. I have come to love running, as a form of stress relief, socializing, being out in nature, and staying healthy cardiovascularly. Obviously getting in the habit of running is a very healthy thing to do.

But on this trip I realized how much I lean on running for my mental health and wellbeing, and I noticed that when the opportunity wasn’t there, a little part of my brain started to freak out…

This is a really common occurrence for runners, or anyone who has a physical activity routine that helps them be a more balanced person. However, it is also important to understand that the very thing making your more balanced can also pull you off kilter.

This “runners withdrawal” is something I am familiar with and can see coming. The way I manage it is by getting out of my “emotional brain” – which immediately will go to worst case scenario (“you’re going to feel awful, you won’t sleep well, you’re getting out of shape!”) – and switch on my rational brain (this is only a week, you can run when you get back, enjoy all that is around you, because in a week it will be gone!).

As you can see, the rational brain is, well, more rational. However, it’s really hard to go to this rational place when we are dealing with the loss of something that keeps us from freaking out. If the emotional brain is allowed to persist, it usually perpetuates a downward spiral.

I have seen this same syndrome in patients who have undergone a surgery or severe injury. Their rational brain knows that switching to biking until their surgery heals will ultimately get them back to running sooner and more healthily, but their emotional brain cries out to them to “just go run now, deal with the consequences later.”

Tapping into the rational brain stops the downward spiral of emotions in its tracks. It get’s you back on course, so instead of paddling upstream, you can just enjoy the ride.

So how do we tap into this rational brain? For me, the red flags for when I am going to my emotional “freak out” brain are certain bodily sensations. My head feels hot, I get a sinking feeling in my chest, and a tingling in my arms. When I notice those sensations, I ask myself,

“Okay, what is really going on here?”

“What would I say to a friend having the same thoughts/worries?”

This can be enough to click on your rational brain, and that can turn a potentially bad time into a good time! And who doesn’t want to have a good time?

So next time you notice you’re starting to go to a dark place with the loss of some physical activity that you love, or even a change to your routine that leaves you feeling muddled inside, follow these steps:

Notice your body sensations (the more you do this, the more quickly you will recognize your body shifting into the “emotional brain”)
Ask yourself, “what’s really going on here?” Or “What would I say to a friend having the same thoughts/worries?”
Rinse and repeat.

Even when you are in an idyllic situation- as I was, floating on a river with nowhere to be and a cold beverage in my hand, my internal climate was becoming a cloudy rainstorm. With the tools to manage my emotions and my reactions to those emotions, I was able to turn it around, enjoy the moment and return to my routine a week later feeling relaxed, restored, and ready to take on the world.

July 14, 2020August 19, 2020

The Most Misunderstood Molecule, and How to Harness Its Power

Deeper, quieter, regular, slower.

Those are the general guidelines for focusing our attention on the breath. This awareness makes us feel calmer, more relaxed, and releases tension from our bodies.

But How? Why does changing our breath change our mood, and many other factors?

Research has shown that slower, deeper breathing reduces heart rate and risk for cardiovascular disease, as well as improves athletic performance. (yes, all you athletes out there, breathe slower to go faster).

The reason all these magnificent changes occur within us when we deepen our breath, especially our exhales, is because of a very special molecule that usually gets a bad rap.

I’m talking about good old carbon dioxide, CO2.

I know what you’re thinking…is she talking about the very same carbon dioxide that we are trying to reduce in our atmosphere to slow global warming? The same carbon dioxide that is considered a waste product of our bodies- something useless to to be rid of as soon as possible?

Well, yes, I am.

But what if I told you that this special little molecule was not only a useful component in improving your health, but an essential one for you to be able to thrive?

You see, for our bodies to get oxygen from our lungs to our tissues, we need carbon dioxide. To get a proper inhale, our receptors in our neck need to sense a certain amount of carbon dioxide in our bodies.

Not to mention, carbon dioxide is stored as bicarbonate in your blood stream, which is essential for maintaining the pH balance of your whole body.

Did I mention that carbon dioxide is critical in weight loss? Most of your body mass lost is due to breathing out carbon dioxide. In fact, more than 80% of weight loss is due to breathing out CO2, and only 15% or so is lost via sweat and urine.

So, if you’ve been dieting, exercising, doing all the right things and still not losing weight… you may want to look at how you’re breathing.

Let’s explore some of these in a little detail…

Firstly, how the heck does carbon dioxide help your body get more oxygen?

Think of carbon dioxide as the Fedex guy, and oxygen as your packages. When outside air hits your lungs, it makes it’s way down to alveoli, the tiny air sacs that interface with the blood stream. The oxygen molecules (packages) get loaded from the alveoli onto the red blood cell, which in this analogy is the Fedex truck.

The truck travels all over the body, delivering oxygen to all the cells as they all need oxygen to survive and flourish. When exercising, certain muscles need even more oxygen more quickly.

This is where our good buddy carbon dioxide comes in.

Oxygen cannot get off the truck unless there is a carbon dioxide molecule there to unload it.

When the oxygen gets to its destination, the carbon dioxide triggers the packages (oxygen) to be unloaded off the Fedex Truck (red blood cell), and be delivered to the cells (your mailbox).

The more carbon dioxide present, the more efficiently the oxygen can be offloaded to cells.

So, when you’re exercising and you really need to get oxygen to those tissues, perhaps try breathing slower instead of faster.

Why does the amount of CO2 in your body determine how you inhale?

I’m constantly telling my patients, don’t worry about the inhale! If you get a good exhale, the inhale will just come.

This is for two reasons, the first of which is purely mechanical.

When you exhale completely, the lungs become essentially “empty” of air, which creates a vacuum. New air has to flow in. It must follow the laws of nature! It must flow from the higher pressure (outside your body) to the lower pressure (inside your lungs). You don’t have to use your accessory muscles (aka your neck) to pull air in, it just goes in! Easy.

The second reason is neurological.

Deep in the reptilian brain, the most primal part of our brain that was present when the first creature crawled out of the primordial goo and decided to walk on land, there is a simple neural network that says, “breathe.”

This network senses levels of oxygen and CO2 in your body to decide when to inhale or exhale. Basically, when your body senses a certain level of oxygen in your body, that circuit makes you exhale. Similarly, when a certain level of CO2 is sensed, the circuit makes your body inhale.

Unfortunately, for many of us, this circuit gets messed up.

We breathe shallowly because we are less active, or stressed, or both, and we do this so much that we end up overriding the part of the circuit that senses CO2 and tells you to inhale.

We get stuck in this cycle of inhaling without ever getting to the bottom of our breath; we lose that primal trigger to inhale, so our inhales get all wonky, a.k.a. you end up pulling your ribcage up with your neck.

In addition to all these important factors, carbon dioxide is the main reason that you feel relaxed with deeper breathing.

Carbon dioxide makes you chill out.

Think about it. What do they tell you to do when you’re having a panic attack? Breathe into a paper bag. You’re breathing back in the CO2 you exhaled. Get that CO2 flowin’ baby!

Carbon dioxide relaxes you by causing your blood vessels to relax, which allows blood to deliver oxygen to all your tissues more easily.

Also, as mentioned above, CO2 lets your body unload oxygen from red blood cells to tissues.

These two factors together mean that your brain gets more oxygen and blood flow. This tells your body that you are safe, and you feel calmer and, well, more chill!

So how to insure that you get more CO2, but not too much?

The answer is simple, and I think you know what I’m going to say.

Breathe deeper, quieter, regular, slower.

5-6 seconds for each inhale and exhale, resulting in about 5-6 breaths per minute, is the ideal for balancing the CO2 and O2 in your body.

Below is a short video on how to do just that and harness the power of this special molecule.

Are you ready to breathe better to move better, to improve the health and resiliency of your lungs without any medication or procedures? Click the button below to find out if will benefit from working with Dr. Derya.

Book a FREE WellBody Screening Session

References

Aakash K. Patel; Andrew Benner; Jeffrey S. Cooper. Physiology, Bohr Effect.
https://www.ncbi.nlm.nih.gov/books/NBK526028/

Anders Olsson Blog https://www.consciousbreathing.com/anders-olsson/carbon-dioxide-training-extremely-harmonious/

Nestor, James. Breath: The New Science of a Lost Art. May 14, 2020 http://www.pathwaymedicine.org/control-of-respiration

June 17, 2020June 24, 2020

“Be Balanced” FREE Summer Challenge: 3 Weeks to a Calmer, Happier You

Summer is fast approaching and what a whirlwind of a year 2020 has been already. There has been so much going on, viruses, economic downturns, political uprisings, and to top it all off…murder hornets!

No matter who you are, I am sure you have been affected in some way. And it is healthy to feel the icky feelings, because they encourage us to take action and make changes.

With so much going on, it is also helpful to have some strategies to find some balance emotionally, mentally and physically, especially when so many impactful events occur in close succession.

That’s why I decided to challenge myself to be more balanced this summer. Will you join me?

Each week for three weeks, I am going to put some energy and awareness into being just a little more present and a bit more in my body.

But the key to making it work, for me anyway, is that it has to be super simple! Because if it’s an elaborate 20 minute process each day, I’m probably not going to do it.

What I need are some things that I can quickly do throughout my day. And, in my experience, the little things we do all day are much more impactful than doing a big chunk of something now and then.

It’s like learning a language…

Usually, when learning a new language, you spend a few hours several times a week in focused study. But you quickly forget what you learned in that hour chunk of time and have to keep coming back and reviewing. This way, you will learn the language, but it will be slow and hard to apply.

But what if you were suddenly living in a country where they only spoke the language you were trying to learn? Over three weeks, you would learn the language much faster and in a much more practical way than you would if you were studying a book or taking a class a few times a week.

You are immersed in it, so you get it better and faster.

That is what I hope to do with this challenge! Each technique, one per week, will be simple, quick, and applicable throughout your day. You’ll be doing little bits all the time – it’s a DIY balanced lifestyle immersion.

It’s never a bad idea to learn how to be more in your body, and more at peace with your world. Especially now, the world could use a few more people who are acting from a place of calm and groundedness.

So, will you join me?

I’ll see you on the other side!

With love,

Derya

June 2, 2020June 4, 2020

What you Need to Know About Creating a Vibrant Life: How to Contract and Expand

Last year I was dealing with some health issues, and I felt that working long days was contributing to my symptoms. After much deliberation, I reduced my hours in hopes of finding some relief and more time for rest. At first it was great. I had more time to nap, rest, and do other things that felt restorative to me.

But it wasn’t long before I started filling that free time with more “stuff.”

Before I knew it, I had eaten up all that time with classes, volunteer work, and self-imposed deadlines and projects. I was just as busy (if not more so!) than before I reduced my hours!

Bewildered, I asked myself, “how did this happen?”

It was as if part of me could not STAND having time to be quiet and relax. There was an inherent guilt to resting, to having time that wasn’t “productive.”

All over again, I ended up giving away all of myself, to the point where it wasn’t sustainable.

It wasn’t my job that was draining me, it was my own inability to save a little of my power for ME.

You could even say that I was opening my heart TOO MUCH.

My life was missing a natural oscillation that is present in all of nature, that play of intensity and calm, of effort and ease.

It was seeming to me that my whole life, and the messages I was getting from the society around me, was all about effort and opening; doing as much as you possibly can…

without the bit about quieting, softening, and going inward.

Peter Levine, an industry leader in studying and treating trauma, describes this process as “pendulation.”

He believes that rediscovering expansion and contraction is the key to living a full and abundant life, with the ultimate goal of living a more expanded life.

Too much contraction is undesirable, this is established. Thinking too much, worry, fear, over planning, narrow focus (staring at a computer)… this creates a contracted state.

You can feel that contraction in your body- your neck, shoulders, face and maybe lower back become tense.

On the other hand, expansion is always desirable, and always the goal. This happens when you consciously relax your body, get a wider view (look out a window for 30 seconds and notice how your body changes), and settling into the present moment by noticing your breath and bodily sensations.

However, there is a trap that I call “FAKE expansion,” which is also undesirable and can even be harmful.

So what is “fake expansion?”

Over filling your life with STUFF and convincing yourself that it’s REALLY important (cringe, yup, that’s me!) at the expense of your own wellbeing.

Fake expansion is “opening your heart” in a situation where you feel exhausted and unbalanced.

It’s saying yes to so many things that you don’t leave any room to take care of yourself. It’s giving more than you have to give.

We do this ALL THE TIME. Sorry ladies, but women do this more than men, but the guys definitely do their fair share.

And maybe instead of asking how you can open your heart more, you should be asking “can you make space inside your heart for YOU before opening it up to everyone else?”

A.k.a. how do you keep some of that loving care and attention for yourself, so that when you give to and care for others, you can do it from a place of love and joy instead of burnout and martyrdom?

One way you can make space for your own heart is by physically changing the shape of your body to encourage more space in the BACK of the heart area.

Interestingly, as we open the back of our hearts physically, our decisions tend to reflect this and become more in support of self nurturing instead of over reaching.

Breathe into your Back

Our bodies are so fascinating. The sympathetic nerve ganglia, which is a fancy way of describing the nerves that make you feel anxious, stressed, worried, angry…generally amped up…live between the vertebrae in your upper back spine. So, if you are always “opening your heart” by pushing your chest up and trying to stand or sit up really straight and never going the other way (rounding your back) you’re going to have a heck of a time getting your brain and body to relax.

Not to worry! You can do a simple exercise to expand the back of your heart. Here’s how to open your upper back:

Re-Establish Physical Boundaries:

Another way to encourage healthy expansion is by re-discovering the boundaries of your physical body, which reminds the mind to keep a little of that loving energy for yourself.

By re-establishing the boundaries of our bodies, we learn to expand. Here are some ways to develop and be aware of the boundaries in your body. This embodiment of where you end and the rest of the world begins teaches your nervous system how to create healthy boundaries in your life.

Here’s how to establish the boundaries of your body:

Are you are needing to create a little (or a lot) more space in your heart for you, so that you can give from a whole and rested place? Or do you need to remind your nervous system what it means to have meaningful boundaries? Or perhaps you’re like me, and you really needed both.

Whatever the case, the fact is that our society drives us to do more, push harder, be better, all the time. And that doesn’t honor the law of nature, it doesn’t honor pendulation.

Try introducing a little more space for you into your life, and see if that allows you to expand a little more. We not only deserve some space for ourselves, we need it to be sustainable.

May 13, 2020July 14, 2020

How to Get Unstuck

You know that feeling you get when a moment is so perfect you just want to capture it forever? And then there’s that sadness when you realize that the reason the moment is so perfect is because of its impermanence, and ironically any attempts to capture it would suck out all the specialness of the situation.

This is the inherent, beautiful sadness associated with the understanding of impermanence.

I had this feeling earlier today, just now actually, driving home from work. It was a warm, hazy afternoon and everyone on the road had their windows rolled down including me. As I came upon a view of the mountains, the perfect moody, twangy, blues-ey cowboy song came on the radio and I so badly wanted to capture that moment. My inclination was to pull over and look up the song so that I could add it to a playlist and listen to this song and have this feeling over and over…

But that’s not how it works. So, instead of wasting this perfect moment searching on my phone, I turned up the volume and cruised.

I feel this same kind of sadness when I’m walking my dog, Hazel, and see hundreds of flowers popping up in unexpected places. Initially, this makes me so happy, and then I feel sad because they’re all going to go away as the seasons change, and part of me wants them to just stay. But I also know that if they were around forever, they wouldn’t be nearly as delightful.

It’s at these moments that I recall the core teaching of the buddha: everything is impermanent, and constantly changing.

By understanding impermanence, I can let go of wanting things to stay a certain way, because I know that it’s not the true nature of things. And by embracing change, we can smile when the flowers come, and also smile knowing that they will go. Because red and golden fall leaves and later pristine white blankets of snow will take their place. Instead of fretting about missing a moment, I can simply enjoy it.

Embracing change is not something that comes instinctively to us, and something we have to work on.

That’s because change means uncertainty, and uncertainty is scary. But, when you really think about it, nothing is certain. And pretending that we can be certain only breeds attachment and fear.

How Fear of Change Manifests in the Body

Our bodies were designed to oscillate and reciprocate, they were meant to shift from right to left and left to right, from front to back and top to bottom, and twist and turn in all different directions.

However, most of us get stuck in patterns that come from the way we always do things, and (maybe more so) the way we always think things. We assume what the next day will be like based on the days before, and if there has been the same thoughts, movements and emotions in the previous days, the brain and body will expect more of the same. And if something is different, we become fearful, worried, frustrated or angry.

Take for example your commute to work. Everyday you drive to work, and you expect your car to run the way it did the day before. But if for some reason your car breaks down or doesn’t start, this is extremely upsetting! It ruins your day, because it’s not what you had planned, what you predicted, what your brain and body is comfortable with.

Think about all the things you do in your day the same way. Always crossing one leg over the other. Always crossing one arm over the other. Mousing with the same hand at the computer. Driving the same route to work everyday. Feeling stressed about the same things at work. Getting in the same arguments with your significant other.

All of these actions pattern us physically, mentally, emotionally.

The more patterned we become, the more resistant we are to change. The more resistant we are to change, the more we suffer when something unexpected happens. And the more our bodies become hardened into certain patterns that don’t allow us to alternate and reciprocate, the more we get stuck. Stuckness creates imbalance, disease, and pain.

So How do I Get “Unstuck?”

Well, that’s “easy.” Easy because the changes aren’t that hard to do physically, but the quotes are there because change is hard! Everything about the way your brain and body are wired is designed to resist change. Your brain wants to keep you “safe,” and patterns feel nice and secure.

To get yourself unstuck, try doing things you usually wouldn’t do! Sleep on the other side of the bed. Cross the opposite arm in front. Take a different route to work. Cook something different for dinner. Stay up later. Wake up earlier. Put your watch on the other wrist. Get creative and find ways to mix it up.

The main source of where we get stuck is through our ribcage and lung field. By shifting the way we stand and move, we shift the way we breathe, so doing any of the above helps with that. You can also help create more mobility, shifting, and alternating in your life by doing specific exercises for your lungs.

That said, don’t disregard the power of inviting more change into your life. It is a simple way to create new patterns and break up old ones. You learn to be more comfortable with change, and maybe even enjoy and invite it into your life. It’s pretty amazing how when you let go of how you expect things to be, you see all the ways that things can be.

Noticing Change Through the Body

The body is the gateway to observing the changing nature of our existence. Your breath is always in flux, inhale to exhale. The heart is always beating, sensations are always changing (even though it seems that a sensation stays the same, when you pay close attention you will notice that it is indeed changing in subtle ways). When we can observe change in our body carefully and thoroughly, we start to understand impermanence on a visceral level, which is where the real change takes place. Just understanding impermanence on a cognitive, theoretical level is helpful, but it is not enough to shift your body into a new state of freedom and flow. To incite real and lasting change, we must experience at the physical level, at the level of the body.

Noticing change in the body is called “interoception.”

This 5 minute guided meditation will help you notice change in your body by practicing interoception.

So next time you find yourself feeling frustrated that something didn’t go the way you wanted, or sad that something won’t stay the way it is or was, remember that this moment can change you from the inside out if you let it. And to ease the pain of those moments, start making changes now! Try to switching up your routine whenever you can. Try something new and mix it up.

Your brain and body will thank you.

April 21, 2020April 22, 2020

Whiplash, Pain, and the Brain.

Earlier this week it snowed a lot. Then it melted, and froze overnight. And when I took my dog out for her morning walk, well, you can probably guess what happened. I didn’t make it 20 feet from my door before my feet slid out from under me on a patch of ice and I landed hard on my butt, with my head being painfully snapped back. I was, of course, a little stunned and went back to my house to survey the damage. No broken bones, just some bruises. Over the next few days I monitored myself for signs of concussion, which , thankfully, there were none, but what I did have was a painful stiffness and ache in my neck when I tried to move my head. “Oh great,” I thought. Whiplash.

When I first walked into my house after slipping on the ice, these were the thoughts in my head, “oh no, you have a delicate neck. This is going to be so bad. You are going to be dealing with this for months. What if you have another concussion? That’s going to really mess you up…” and on and on.

Luckily, I had the knowledge and training to know that these thoughts would be the most significant factor in my speed and completeness of my recovery. Even though it was hard, I started to change my self talk. I said to myself, “this is not that bad. You’ll get over it soon with a couple days for your strained muscles to heal. You didn’t hit your head, and there are no signs that anything is seriously wrong. You’re going to be ok.”

At first, I didn’t believe these words I told myself, but I kept up with it. And, over the course of the day, I started believing a little bit of it. But more importantly, my body felt less tense and guarded. Now, three days later, my neck pain is almost completely gone. I didn’t have to go to a chiropractor or have needles stuck in my neck. I didn’t have to do any special exercises except some breathing to calm my nervous system. I didn’t even have to change my daily activities and still did what I would usually do, including exercise.

Of course, it’s not always that easy, and it has not always been the case for me to get over neck pain that quickly. I have had many neck injuries of varying severity, and the pain of them has plagued me for many years of my life. I tried everything, acupuncture, chiropractic, and of course several physical therapists. Those all helped, but my neck pain never really went away until I changed the way I thought about my pain. I know, I know, it sounds like I’m saying, “it’s all in your head.” Which is just not true. But, it is true that a lot of it is in how your head and your body talk to each other.

Pain and the Brain

You see, the brain determines levels of threat, and sends signals to our body on what to do accordingly. When your brain perceives high threat, it starts emitting neurotransmitters that tell your body to tense, to breathe more shallowly, and halt healing processes.

This is actually really good. For example, let’s say you’re a wild human and you get attacked by a tiger. You find yourself bleeding and injured, and your brain knows that it needs to get your muscles tensed and ready to go so that you can hoof it back to your village before you die in the middle of the prairie. (Do tiger’s even live on prairies? Anyway, you get the idea). Your brain, in that moment, is not worried about healing. Healing occurs when you get back to the village and your wounds can be tended, you are safe.

But what if you never get to the village? What if the stress of getting attacked by a tiger is replaced with the stress and worry that’s associated with chronic neck pain, the fear that you will never get better, the threat of having to deal with a stiff neck on top of all the other things you are having to deal with in your life right now?

In this scenario, your body never gets a signal to relax, to soften your tensed muscles, to release a cascade of neurochemical transmitters that promote healing. You become caught in a troublesome feedback loop: your muscles get’s tense, which causes your brain to percieve threat. As a result of that percieved threat, your body get’s more tense. And on and on, until you find yourself dealing with months to years of pain with no one able to explain to you why it won’t go away.

Getting out of the Cycle of Pain

I have been there, in that loop. I have a tendency to go back there, maybe it’s just how I’m wired. I have to actively, consciously, change the way I think about my body and pain in order to subvert that loop. And it works. I also use relaxation techniques and mindfulness meditation practices to assist me in this process. But what has been so fascinating to me is that this is the missing link in healing from chronic pain, and, perhaps more importantly, preventing it in the first place.

This is not news to the medical community; there have been plenty of studies linking a patient’s outlook on recovery to how well they actually recover. This mind body connection is starting to become more popular in pain management, but in most cases it is not emphasized or even acknowledged in our healthcare system. Certainly, there are appropriate times to seek invasive modalities or even surgery, but shouldn’t we start with an intervention that is very low risk and potentially very high reward in regards to resolution of symptoms?

I have created some resources to help you manage your pain and to prevent yourself from developing chronic pain syndromes. It starts with being able to sense and feel your body, in a non-threatening way. This will allow your brain and body to get out of the cycle of threat and pain and back into fluid, alternating, reciprocating motion.

Getting Back in Your Body

A great place to start getting back in your body is with this simple 5 minute Guided Body Awareness Technique. (You should try it, it’s really relaxing!)

Five Minute Body Awareness Exercise.

Remember, pain is not just in your body, and it’s not just in your brain. Whoever says that mind and body are two separate things is just wrong. You can’t treat one and not the other and expect to change the patterns that we live in. If you find yourself in chronic pain, be kind and gentle with yourself. Reconnecting with the sensations in your body is the first step to letting go of these stuck patterns.

May you find ease in your body.

– Dr. Derya

April 16, 2020August 19, 2020

How do I Release Tension From My Body? 3 Quick And Easy Ways to Relax

It was my second year of physical therapy school, and I was sitting in the white and beige lecture hall. The room emulated the newness and grandeur of the medical campus, but lacked character or color. The course title, “Musculoskeletal 101,” was stamped in the top right of the slides, and today’s topic was Managing Dysfunction of the Cervical Spine. I was bent awkwardly over my desk, furiously taking notes when I had to take a break because my neck was just killing me.

The irony of this was not lost on me.

Even though in physical therapy school I was learning about all the cool ways to crack joints and push and pull on muscles, the tension in my neck was inescapable. I was seeing a physical therapist myself, who would stick needles in my ropey neck tissue, and I was spending my precious study time rolling all around on tennis balls and stretching in all the right directions to “loosen up” my neck. While these things helped for a short while (and some not at all)

I couldn’t help wondering if there was another reason I was getting so tense.

Did I mention that physical therapy school is one of the most stressful things I have ever done in my life? Long commutes, sleep deprivation, assignments that took longer than the hours I had to finish them, projects and social dynamics, constant testing, hours of note taking, clinical rotations with high expectations… you get the picture. I don’t regret any of it, it was an invaluable experience. But I DO regret not having the tools to help me manage my stress levels, because it was taking a huge toll on my body.

Why Do We Get Tense?

We tense our bodies as a way to protect ourselves. It just so happens that high stress levels cause your body to perceive threat and therefore seek protection. Another reason we get tense in our necks, lower backs and hips is to hold ourselves up when our core is not functioning well. Guess what? Stress triggers us to shunt blood away from our core and to our arms and legs (because if there’s a threat, you better be ready to run!)

This is what I call the stress-tension one-two punch.

It’s the double whammy that stress has on causing tension in our bodies. The first blow is the initial tension you get directly from the stress hormones in your body that are readying you to fight or flee. The second comes from the compensatory way your body carries itself when in a stress state.

Hold on a sec! My stressful scenario wasn’t one where I had to fight or flee, I was just bent over my computer hacking away at a keyboard like a madwoman on a diet of coffee and energy bars. Why would my body have to ready itself for anything?

Tension and Stress

The thing is that your body doesn’t know the difference between the stress of being chased by a mountain lion or the stress of your boss adding an extra pile of work to your already overflowing inbox.

Stress is stress! The same hormones are released, and the same responses occur.

Our systems to manage stress are a primal instinct, present since we were “wild humans,” if you will, and the threat of having to fight or flee for your life was a more common occurrence. The steady drip of minor stressors (emails, traffic, alarm clocks, board meetings) did not even exist yet.

We are designed to manage a stressor that is an immediate threat – it is something that we deal with and then it’s over.

You either get away from the saber toothed tiger chasing you down, or you kill it, or you die. Done. Your system takes a few minutes to an hour to return to relaxed muscles, deeper breathing, and an active core. You can rest, digest, and hold yourself up properly.

When we have that steady drip of stress, however, our body doesn’t know how to get back to that baseline “rest and digest” state anymore.

We’re constantly juiced with stress hormones that make our body tense, despite how many physical therapists or chiropractors poke our muscles or push on our backs. To get rid of that tension, we have to get to the source.

We have to help our nervous system relax.

A Nervous System Reset

Even though we can’t always change the world around us, we can certainly change ourselves. You may not be able to change your work situation, your commute, or your other stressors.

But you CAN take small actions that reprogram your nervous system to quickly get back to that place of calm, and by doing so let go of tension in your body.

There are lots of ways to reset your nervous system. Below are three of my favorites because they are:

Easy to do
Fast
Effective

One way is by balancing the right and left sides of the body with your breath.

Balancing Breath:

sit comfortably. Bring your right hand index and middle fingers down, leaving the right thumb, ring and small fingers up (see video below if this is tricky for you!)
Cover your right nostril with your thumb, and exhale completely through your left nostril.
Pause for a 4 count, then inhale through your left nostril.
Cover your left nostril with your ring finger, pause for a 4 count, then exhale completely through the right nostril.
Pause for a 4 count, then inhale through the right nostril.
Pause for a 4 count, then cover the right nostril with your right thumb and exhale completely through the left nostril.
Continue with this sequence for about 6 breath cycles. Then rest.
Do this 1-2x/day.

https://youtu.be/c6ay8f6bJHk

Alternate Nostril Breath: a simple way to balance the body

Notice how you feel before and after doing this exercise. With some practice you can do this quickly and easily to help your body relax and release tension.

Cupping the Eyes

Did you know that how you see the world affects how tense your body gets? No wonder most people who work at a computer all day develop back or neck pain (or both)!

By letting our eyes relax, our nervous system gets an immediate signal that we are safe, and our bodies relax as a result.

Here’s how to do it:

Lean your elbows on a desk or table. Place your head in your hands so that the perimeter of your palm rests on the orbit (boney part around the eye). You don’t want any pressure directly on your eye.
Close your eyes, and stare into the darkness behind your eyes.
Try to make your field of vision very wide, like you are trying to take in as much of the view behind your eyes as possible.
Notice the gradations of light behind your eyelids. You will notice that it is not all black, but rather that there are different grades of blackness and lightness.
Focus on the darkest areas, see if they get bigger.
Tip: if you don’t notice any different gradation of blackness, just keep focusing on the wide view behind your eyelids.
Stay for 2-5 minutes, then come back by lifting your head and slowly opening your eyes.
Do this 1-2x/day.

How to do it: Cupping the Eyes to Help your Body Relax

Notice how you feel after. Try to connect with and remember in that feeling of relaxation in your body.

Breathe!

When we are stressed, our breathing becomes shallow and rapid. Chances are, if you’ve been stressed for a while, you haven’t taken a full breath in a looooong time. And when I say a full breath, I don’t mean getting a lot of air in, I mean getting air OUT!

That’s right, when we are breathing shallowly, it’s the lack of complete exhales that prevents us from getting new, oxygen rich air to our brain and other tissues. If you can’t get the old stuff out, you can’t make space for something new (that’s a good metaphor for life, too)!

Here’s how to do it:

Sit comfortably.
Place one hand on your lower front ribs.
Inhale quietly through your nose.
Exhale completely through your mouth, making an “ahhhhh” sound.
Pause 1-3 seconds at the bottom of your exhale before inhaling again quietly through your nose.
Repeat 4 breaths. Rest and repeat 4 more cycles of 4 breaths.
Do this 1-2x/day.

Like I said, I wish I had known these ways to de-stress when I was in physical therapy school. I knew stress mattered, but I didn’t realize the incredible impact it was having on my body!

I hope this article prevents you from having to endure chronic tension in your body, and from having to constantly seek ways to release tension. If you can find the wellspring of calm and ease within, the body will follow.

April 13, 2020April 15, 2020

Why Can’t I Meditate? 6 Tips for When it’s Hard to Focus

The first time I sat to meditate I made it about two minutes before I somehow ended up in the kitchen making myself a sandwich. The current of my thoughts and “to-do’s” was so overwhelming I couldn’t justify sitting still for 10 minutes, let alone relax while doing it!

In my first year of yoga classes, I hated savasana, the pose where you lie still at the end of class. I literally could not wait for it to be over, and sometimes would just roll up my mat and walk out. If you have ADHD or trouble being still, you know what I mean. Meditation can seem like a daunting if not impossible task. It wasn’t until I started exploring different ways to approach meditation that I finally found a way to observe my body and sensations without hating every moment. I realized that I didn’t have to sit still for hours to get benefits, and in some ways it was harmful for me to force my body and mind into a box that didn’t fit. Once I became open to new ways to meditate, I started to develop a consistent meditation practice, and enjoy being with myself.

In this article you’ll find simple, actionable advice to help you get the benefits of meditation even if you have ADHD or any other condition that makes it hard for you to stay focused.

monk distracted from meditation — Do you get distracted when you should be meditating? It happens to the best of us.

Move

On my first meditation retreat I wanted to be the best meditator. I sat up straighter than everyone else, and for longer than everyone else. But I was miserable. Instead of letting go of my ego, I was feeding it by trying to be “the best,” instead of acknowledging my needs. The battle to not move became so distracting that I couldn’t meditate, defeating the whole purpose of why I was there! Thankfully, when I related this to my teacher on the retreat, she told me to go outside, and walk. And walk fast.

Getting up and moving is a great tool for meditation, because it allows you to experience the ever changing nature of reality directly. If you have trouble sitting still, try this walking meditation:

Go for a walk outside, or find a space where you can continually walk for about 5-10 minutes.
Walk slowly, sensing the ground under your feet.
Feel as much of your foot as you can as it touches the ground, starting from the heel, then midfoot, then toes.
If it is too hard to pay attention as you walk slowly, you can walk faster and instead feel the sensations in your legs. You could even jog and notice how alive your legs feel.

Change Your Perspective

Sitting in the meditation hall, deep in the torture of trying to observe my own thoughts and being constantly distracted, I opened my eyes a little and snuck a peek at the rest of the people in the hall. Lo and behold, everyone else is sitting still and quiet, like statues of buddha! I felt so terrible. I completely gave up on trying to meditate and spent the rest of the hour thinking about all the things I would do and eat when I got back from retreat.

I learned two very important things from that experience. I learned that no matter how peaceful others look on the outside, there is no way we can know the turmoil inside. And trust me, everyone has their own inner demons that they struggle with. Secondly, I learned that losing focus is not a bad thing, in fact it is a normal and necessary part of meditation. Instead of getting down on myself when I lost concentration or focus, I had to celebrate it!

Yes, you read that right. Whenever you lose touch with your object of focus, that is a wonderful moment! Because it means that you get to come back. And coming back, over and over again, is the real practice of meditation. Expert meditators who have been meditating for many years seem like they are able to sustain focus on one object for a very long time, but what they are actually doing is coming back to their object of focus very quickly, so it appears that they are continually focused.

The next time you realize you are lost in thought, try saying to yourself, “oh wonderful, an opportunity to come back!” Because every time you come back to your object of focus, you are making new neural connections that make you a better meditator.

Short Bursts of Practice

Meditation doesn’t mean that you have to sit still for hours at a time. In fact, there are some traditions of meditation where formal sitting is deemed not as effective as becoming quickly and immediately aware of the true nature of reality in the moment, with no preparation.

The purpose of meditation is to see things as they really are, constantly changing and impermanent. To start practicing this, take a moment several times in your day to observe your sensations. You may do this for 5 seconds or 2 minutes or 20 minutes, it doesn’t matter the length but all that matters is that you observe some sensation directly in the moment.

One place that I find it really easy to feel sensations is the tingling that is always present in my hands and feet. This is a good place to start.

Try this exercise right now to practice observing your sensations in the moment:

Close your eyes and just feel your fingertips or the soles of your feet.
Notice if you feel a tingling or buzzing sensation.
Keep paying attention to the tingling or buzzing for however long you feel like.
Do this regularly, for example every time you go to the bathroom, check your instagram, or have a drink of water.
Once you get good at this you won’t even have to close your eyes, you can observe your sensations without anybody even knowing that you’re meditating! (Pretty cool, huh?)

Pro Tip: If you can’t feel anything in your hands or feet, try rubbing your hands on your thighs or your feet on the floor briskly for 10 seconds, then stop and close your eyes and see what you feel. You will definitely notice some sensation in your hands or feet after that. You’re not looking for anything special! Just observe that sensation, and you’re meditating.

Exercise

Sometimes I sit to meditate after working at my desk all day, and my body refuses to be still. Our bodies need to move, and if you’ve been sitting all day, it will be hard to sit for meditation.

If your body has energy that it needs to expend, it will be more difficult to sit quietly to meditate. Try doing some vigorous exercise of your choice for 10-20 minutes before meditating. This could be running, swimming, jump roping, climbing, jumping jacks, whatever you like to do to release excess energy.

Set Achievable Goals

Achieving your goals can provide you the confidence and momentum you need to be able to stick with your meditation practice. But these goals have to be achievable!

If you have never meditated before, or have difficulty meditating due to ADHD, it is not a good idea to set a goal of meditating 1 hour every day. Pick something that you feel at least 80% confident that you can achieve. Your goal may be to do a walking meditation for 2 minutes a day for 1 week. Achieving this goal will give you the confidence you need to stick with it. And if you don’t achieve that goal, set another one that you can achieve! Being kind and patient with yourself is one of the greatest lessons in meditation, and in order to learn that lesson you have to start where you are.

Be Kind to Yourself

Meditation is a tool to help you develop greater understanding of your true self. Before you undertake a meditation practice, ask yourself, “why do I want to meditate?” Get clear on why this is important to you. Most likely, your goals for meditating are not to berate yourself and compare yourself to others. So be kind to yourself, and give yourself lots of space to experiment until you find what works for you.

As long as you are observing the reality of the present moment, you are meditating. Thoughts and doubts will always arise, but keep coming back to your object of focus in a kind and gentle way and over time it will become easier. If you are getting frustrated with your meditation it’s okay to take a break and try again later.

Meditation has helped me so much in my life, and I hope that this article makes it easier for you to find ease in your mind and body, too.

April 10, 2020May 1, 2020

Why Does Yoga Make My Back Hurt?

You got into yoga to relax and get some exercise. But, as you lie in corpse pose at the end of the class you find yourself wondering, “how the heck am I supposed to relax when my back is killing me?” You intended to be doing something good for your body, not hurting it!

This was me for a long time. Yoga has many wonderful health benefits, but it is also a common culprit in creating back pain. When I first started doing yoga, and actually many years into my practice, I loved the way it made me feel but couldn’t help noticing that my back pain was getting worse, not better. Many of my patients have been told by their doctors to try yoga for back pain, and end up with no change or even worse pain! In this article I’ll share with you the most common reason why yoga causes back pain and how to get rid of it. I’ve worked with many patients to get them back to yoga without back pain, and you can do it, too.

Breathe Better to Relieve Your Lower Back Pain

Modern yoga tends to have a lot more extension based postures (i.e. backward bends) compared with traditional yoga practices.

Yoga Postures that commonly cause back pain:

Upward facing dog pose
Bow pose
Camel pose
Basically any pose where your spine is arched back.

I am not sure why backward bends have taken a forefront in today’s yoga, maybe it’s because they look pretty? However, they can be very problematic to our backs for several reasons.

It’s not that backward bends are inherently bad, but rather they require a certain amount of stability and skill before they can be performed correctly. I was always very flexible, so it was easy for me to contort myself into all kinds of crazy postures. However, when you do back bends without the right stability, they create a lot of compression in you lower back which causes back pain and sometimes sciatica. Improper backward bending can also force us into bad breathing patterns.

Let’s maybe not go for this until we’re ready…

Ditch the Belly Breathing

One thing we need in order to bend backward without pain is a strong connection between our front lower ribs to our front upper pelvis. This means you need your abs to be working, and in the right way. And you need to be able to MAINTAIN that abdominal contraction as you inhale, i.e. no belly breathing!

Whaa???

You heard me right. Belly breathing is not good for you, especially not in a back bend. In fact, in a backward bend, it’s actually really bad for you! I know, everyone talks about all the amazing benefits of belly breathing, but hear me out.

Belly breathing (pushing your stomach out when you inhale) doesn’t allow you to maintain an abdominal contraction while you inhale, so your lower back has no support and basically gets way too compressed. This is painful and damaging if done repeatedly.

Secondly, belly breathing teaches you to breathe without moving your ribcage. When your ribcage becomes rigid, you are forced to move more from your lower back, creating it to be even more unstable and painful.

To breathe correctly in backward bends (and in general when doing physical activity) you should be able to move your ribcage and maintain some tone in your abdominal muscles, particularly the abdominals on the sides (obliques and transversus abdominus).

Exhale Focused Breathing for Back Bends:

pubic bone to demonstrate pelvis position to avoid lower back pain

Exhale completely and feel your lower front ribs drop down towards your pelvis and in towards your body.
Simultaneously draw your pubic slightly up towards your belly button.
Pause there, at the bottom of the exhale, for 3-5 seconds.
Then, quietly inhale without losing this ribs to pelvis connection. You should feel air move into your upper chest and maybe your upper back.

This breathing pattern teaches your core to turn on in the correct way, and stabilizes your back. Obviously, as you bend backwards, your abdominal region will lengthen, but you want to keep that action of lower ribs moving toward the front of your pelvis and the front of your pelvis curling up towards your ribs as you do so.

Some of us are already pretty arched in our lower back to begin with. If you are arching more on top of that to backward bend, you’re going to be in trouble. If you’re like me, and backward bending is really easy for you without much practice, you really need to work on developing some core stability before diving deep into backward bends.

Developing Core Strength

In forward bends and standing postures, keep trying to find that position of exhaling lower front ribs down and in, and bringing pubic bone up towards your belly button.

Use your Legs to Develop Core Strength for Back Bends:

In addition to exhale focused breathing, think about drawing your inner thighs towards one another, and rolling your inner thighs back behind you.
this is called hip adduction (together) and internal rotation (turning inward).
These actions are only helpful if you have the first concept of ribs down and pubic bone up, so if that is hard for you then work on that for a while before adding the leg actions.

These actions of hip adduction and internal rotation create spaciousness in your lower back and create stability in your stabilizing musculature, particularly in the pelvic floor muscles. the pelvic floor is a sling of muscles inside of your pelvis that assists your abdominals in stabilizing your lower back.

You can think of drawing your inner thighs together even when they are apart. Take anjaneyasana, or kneeling lunge, for example.

Instead of leaning forward into the lunge to stretch the front of your hip (and arching your back and losing all sense of internal stability) stay more upright, find ribs down and pubic bone up.
Then, draw inner thighs towards one another as if you were trying to close the gap between your legs without actually moving.
This may not look as pretty or as deep as in the picture, but it will feel a whole heck of a lot better, and will teach your body so much in regards to strength, true flexibility, and good habits.

Develop Good Habits

Before jumping into backward bending, spend some time in standing postures and forward bends, working on bringing your lower front ribs down and in, bringing your pubic bone up towards your belly button, feeling air in your upper back, and drawing inner thighs together and back. Only once you have this well established should you explore deeper backward bends.

Once you are ready to start experimenting with backward bending , a good place to start is with some gentle standing backward bends.

Start With a Gentle Back Bend:

Establish your lower front ribs down and in on an exhale, as well as pubic bone up.
Then, draw inner thighs together and roll inner thighs back.
From there, cactus your arms and see if you can gently arch your upper back WITHOUT letting your lower front ribs pop up or your pubic bone moving down away from your belly button.
You probably won’t go as far back and that’s okay, because now you’re actually lengthening your front body in a healthy way that supports your spine instead of just dumping into your lower back.

It’s always good to follow backward bending with a counter pose, which would be a forward bend. Child’s pose is great, or seated forward bend. However, try not to just flop into these poses, either. Remember the same actions from above (low ribs in, pubic bone up, inner thighs together and back) while forward bending as well.

Final Thoughts

The real practice of yoga is about being with ourselves in the moment. When we’re in a class, or even by ourselves, we may have ideas of how a pose should look or what we think we should be able to do. However, if we do not take time to establish a good foundation, or if we push our bodies beyond our limits, we will get feedback. In the case of excessive back bending, feedback will occur in the form of physical pain.

This is where the real yoga starts. Can you listen to your body and let go of what it’s “supposed to” look like, and meet yourself where you are? That is probably the biggest challenge, but will provide the greatest reward when you find that you can practice longer and more often because you are not limited by pain and injury.

March 2, 2020August 5, 2020

Balancing Two Sides of One Body

Most of our movements- the way we sit, stand, eat- are happening subconsciously. Furthermore, we all have preferences for doing things on one side or the other, and in one way or another. While handedness plays a role in this, our neurology and the way our brains are wired play a much larger role.

Most of us have heard that we have different functions for the right and left sides of the brain. As far as physical function, the right brain controls the left side of the body, and the left brain controls the right side of the body.

The perception of the two sides of the brain is a bit more nuanced. The right brain manages sustained, broad, and vigilant alertness. Conversely, the left brain has a narrow, sharp, and focused attention to detail. The right brain is more focused on the big picture, the surroundings, what’s going on in the background. The left brain is more alert to what’s right in front of us, the immediate task at hand, what’s next on the agenda, etc.

An example of how the two sides of the brain work together is driving a car. In this situation your left brain has focused attention on the road in front of you. While this is very important, it is also important to be aware of your surroundings. Your right brain is broadly scanning the environment for potential threats such as other cars, pedestrians, hazards, and so on.

sculpture of a head showing different functions of the left brain — Different sides of the brain have different functionality

The left brain contains the centers for speech and language. Since the left brain controls the right side of the body, the right arm becomes prominent in communication, growth, and development. Even in left handed people, there is a tendency for the right shoulder complex to be tipped forward and down as a physical representation of the interactive quality of the right side. This is because even though handedness is a strong driver of pattern, the brain and nervous system are far stronger.

This normal and natural asymmetry can be problematic when it is not balanced with left arm neurological and muscular activity, so in clinic we work on changing movement patterns at the level of the nervous system. My patients often tell me that when they do their exercises at home, they are not sure if they are doing it right and it feels hard to keep track of all the movements in the exercise. I always tell them this is exactly what we want, because we are trying to change a movement pattern, not just get stronger. You can go to the gym by yourself and lift weights if your goal is muscle mass. What you need from physical therapy is to learn how to change the wiring of brain and body, to become better balanced right to left in three dimensions. For this to occur, it will probably feel like your brain is working just as hard, if not harder, than your body when you do your home program.

Learning to change a movement pattern is like learning to drive a car. At your first driving lesson, there was an overwhelming amount to pay attention to: hands on the wheel, gas, brake, checking mirrors, road signs, and if you had a clutch then that’s a whole different animal. But now, you drive somewhere and think, “wow, I don’t even remember driving here, I’m just here!” That’s because the neurological and muscular systems have become automatic through repetition, but you had to start with a very “thinking heavy” process to get there. You had to pay attention in the beginning, and now it just happens naturally.

That is how we bring our body into balance, by literally re-wiring the neurological and muscular patterns in the body. We use conscious effort until it becomes unconscious. Because the reality is that so much of what we do in our day is unconscious; but if those daily patterns are not regulated by transitioning well from right to left and back again, we develop strong patterns that create structural weaknesses, instabilities, and pain syndromes like fibromyalgia.

One simple way to balance the left and right sides of the body is through a breathing technique called “nadi shodhana” in sanskrit, which we can loosely translate as “alternate nostril breathing.” This technique is simple and very soothing to the nervous system as it creates a deep sense of balance in the body at a neural and respiratory level. See the video below to try it out.