tension – Essential Physical Therapy

July 8, 2020June 24, 2021

The Revolutionary Bone that No One Talks About

It was a beautiful sunny day, not too hot with a nice cool breeze. As I jogged along the trail that passes through the meadow by my house, taking in the thousands of bright blue chicory flowers, I reflected on how lucky I am to live in such a beautiful place, to have a healthy body…. OUCH!

My knee was bugging me again, as it sometimes does when I’ve been running a lot without much cross training. Not that long ago I may have endured it, knowing that I would do some manual therapy or soft tissue work when I got home to try and coax my body back into a better alignment. Maybe I would have checked out my running form-making sure my core was engaged, and that my cadence was just right.

But today I know more. Thanks to the postural restoration institute, or PRI for short, I have such a deeper understanding of how so many things affect our movement and anatomy. I knew that the best thing I could do was just be more aware of the left side of the trail as it whizzed past. As I did that, my knee instantly felt much better.

Wait whaaaat??? Yup. Seriously. I simply became more aware of my left peripheral vision, which made my knee feel better.

Little disclaimer here…this is not to say that everyone who goes running will instantly be painfree by looking to the left, everyone has unique needs and nuances.

That said… it is a good idea to be aware of your peripheral vision when running and in general…more on that later.

But WHY??? Why would what I’m doing with my eyes affect my knee pain?

It’s all because of this special bone at the center of our head called the sphenoid.

Before we get into what this could possibly have to do with my knee, we should first ask ourselves…

Why Is the Sphenoid Bone So Special?

Here are just a few reasons…

The sphenoid bone attaches to our jaw, our eyes, and our ears.
The nerves that tell us to rest or digest or fight or flee or freeze pass through this bone.
The main arteries that supply blood flow to your brain pass through this bone.
The position of this bone determines the amount of pressure on your brainstem, which contains the apparatus to help your body organize movement.
The pituitary gland, which performs life-sustaining functions, nestles nicely into a tiny protective saddle in the sphenoid bone.

I could keep going, but I think you get the point. This bone is responsible for a lot of important stuff!

Even just a tiny tweak in the position of the sphenoid could cause all sorts of repurcussions, many of which seem completely unrelated.

What Might Tweak a Sphenoid’s Position?

The way your teeth touch matters big time to your sphenoid.
- The sphenoid interacts with your top and bottom teeth via muscles and nerve endings, but even the bony position of your jaw and maxilla (the bone that holds your top teeth) push against the sphenoid in certain ways. Not to mention, the periodontal ligament is HIGHLY sensitive to pressure and gives you lots of reference as to where you are in space. This neural information is then processed by your BRAINSTEM (remember that guy?) And what’s between your teeth and your brainstem? The sphenoid.
- Have you ever had dental work done and had the position of your tooth end up just a little higher or lower? If you have, you know it. Your body knows it. Everything feels off, you can’t relax until that tooth is back to where you like it! That’s the sensitivity of the periodontal ligament and the sphenoid position at play.
Head injuries and concussions.
- I don’t think I really need to explain why a blow to the head can affect sphenoid position and surrounding function. But what most people don’t realize is that you don’t have to hit your head to get a concussion. Whiplash, blast exposure, falls, all these things can result in jostling the contents of the skull.
How you use your eyes.
- Remember, the muscles that move your eyes around attach to your sphenoid. If you use your eyes the same way most of the time (like staring at a screen, for example), this can pull on the sphenoid.
The neck.
- The poor head is at the whim of what the neck is doing. And the neck is at the whim of what the body is doing underneath it! Think of a house that is built on clay. When first built, everything is nice and level. But then, after a big rainstorm, different parts of the clay expand at different rates due to the moisture, and the foundation starts to shift and become unlevel. Of course everything above the foundation will also become unlevel. Similarly, if your body is imbalanced below your sphenoid, you will likely also have imbalance above.

Of course there are other situations where certain visual or dental changes (surgical or otherwise) can affect how you hold your body below, because, unlike a house, the body’s roof (the cranium) has just as much of an effect of where the foundation (rest of the body) sits due to all the sensory input we get from our head telling us where we are in space.

Don’t believe me? try standing on one foot. Got it? Good. Now try doing that with your eyes closed. Little harder? That’s because you’re getting information about where you are relative to the ground from your eyes, not just your feet.

Also, I have to say that if you had a head injury or dental work or vision work, this does not doom you to a life of a crooked sphenoid! It can certainly have an effect, but in most people it is manageable with the right program of manual therapy and movement techniques.

So back to my knee. Why did being aware of my left visual field help my knee?

At a purely structural level, there is some effect of letting my eye position change to pull on my sphenoid in a different way.

On a deeper, subtler, neurological level, being aware of the left does several powerful things.

Firstly, it reminds my body to become centered instead of pulling to the right, which I do (and most people do) because of our anatomy and the way our brains are wired. This is especially important for me since I have had a head injury which included broken facial bones.

Secondly, it opens up my left peripheral vision, which creates a sense of expansiveness in my body, thus allowing the sphenoid and surrounding bones to spread and widen. This takes pressure off of all those neural and vascular structures, and lets my body relax out of a state of tension.

When our bodies are held in a tense and protective state, we can’t rotate well through our torso. A side to side alternating activity like running absolutely requires the ability to rotate. If you can’t rotate at your trunk, your body will do it somewhere else. For me, it was my knee.

As soon as I let my left visual field soften and open, my body got a signal (or many signals, rather) to reposition itself into a more optimal position, subconsciously. I could rotate better, breathe better, and didn’t need to put any extra torque on my knee.

Well, I know this is a pretty heady conversation (get it? Heady? Skull? Ok I know, too punny) but it is one worth having.

Because sometimes you do all the right things and still aren’t feeling better or where you want to be with your sport, your breathing, your health, or your ability to do the things you want to do.

When that’s happening, it’s time to look at what’s happening from the neck up to determine if something there could be inhibiting your progress.

Here’s a simple but powerful technique to try that will help with restoring sphenoid position.

May 18, 2020August 19, 2020

Improve Your Breath to Improve Your Life

I used to hate hiking and running. I was always the slowest one, gasping for air, my neck and shoulders for some reason aching and killing me. I could really relate to the term “sucking wind.”

It just felt like I couldn’t get enough air.

Even when I would diligently hike and run more often, I never got a sense that I could breathe better. I was getting better conditioned, but it always felt very hard. I didn’t understand why, even though I trained regularly, friends of mine who hardly ran or hiked at all would zoom past me up the trail.

I thought, “there must be something wrong with me.”

After I had a pretty severe bike accident, my symptoms became much worse. Instead of just feeling out of breath, when I got left behind in the group my lungs would literally close up. I couldn’t breathe. I thought I might die. “Is this asthma?” I thought.

These days, I am the one zooming up the trail.

I surprise myself at how sometimes, even after I haven’t been training at all, I can easily hike or run without getting out of breath. I never get that feeling of my lungs closing up. Now it’s way more enjoyable to run and hike, and I look forward to it! I feel that I am getting fitter and can go further each week.

So what was going on with me?

Two things. The first was poor lung compliance and perfusion, a.k.a. my ribcage and therefore my lungs weren’t moving well, which didn’t allow me to exchange enough oxygen into my blood stream.

So, even though I was constantly exercising, my tissues weren’t getting the oxygen they needed. No wonder I always felt out of breath!

Turns out the reason my neck and shoulders hurt while hiking and running was because I was trying to pull air in with my neck! My ribcage, lungs and diaphragm weren’t working well together to pump air efficiently in and out, so my neck and shoulders decided to take over.

The second thing holding me back was trauma.

Since my bike accident, if I exerted myself too much, especially with other people around, my body would go into a state of “freeze.” I would check out mentally, close off socially, my lungs would seize up and I would have to sit on the floor and gasp until I could get up again. I think some people might call this a panic attack.

I know now that my ribcage mobility and my trauma were related.

Because I didn’t breathe well in the first place, it was harder for me to breathe and sense the fluctuating rhythms in my body.

Through a lot of trial and error, I eventually found that PRI techniques, in addition to working with a skilled somatic therapist, I was able to overcome both of these obstacles. And because of the huge impact it has had on my life, I now I help others do the same.

The way our bodies work is NOT like a mechanical machine.

We can’t pretend that a breathing issue only affects our lungs. We are constantly affected by what’s going on inside of us and around us, both physically and mentally. We need to be able to shift side to side in our lungs, our bodies, our minds, and our spirits. Stuck ribcages prevent lungs shifting. Stuck mindsets prevent bodies shifting. Stuck beliefs and trauma prevent our spirits from shifting.

The reason overcoming stuck patterns in the body and mind is difficult is because it’s about softening and letting go.

This means allowing air in and out instead of forcing our bodies to breathe a certain way. Releasing tension instead of holding on.

So many of my patients struggle with softening and letting go (myself included).

If I tell someone to tense a muscle, they can almost always do that. But if I ask them to soften and relax a muscle, it is much harder.

Similar to how our muscles become rigid, our minds can do the same thing. Here’s an example:

Someone asks you about an issue that you are strongly against. Very likely, you get worked up and talk fervently about all the reasons you think it is wrong. But if you are asked to see where the other person is coming from, and why they might feel the way they do, it will probably be much harder for you to give an answer.

This is just one way we become rigid- with our beliefs. It’s much harder to change the way we think about something than it is to keep thinking what we always have.

Can changing the way our lungs move help us overcome trauma?

Trauma is a state of being disconnected from our bodies. It’s a survival mode where there’s no room for feeling, because before our feelings were so terrifying and painful that we don’t want to risk going there again.

Trauma lives in our bodies, not in our thoughts.

We can’t think our way out of trauma. But we most certainly can feel our way out.

Sensing the breath is one way to sense our bodies again, which is the first step to overcoming trauma. We must learn to sense the ever-changing flow that is always occurring in our bodies. And at the center of our bodies lie our lungs, whose function is to manage flow. Flow of air in and out, flow of oxygen to our tissues, flow of byproducts back out into the world.

*Please note that sensing the breath is not appropriate for everyone who is working with trauma. So, if you find that noticing your breath feels uncomfortable for any reason, take a break for now and consult with a provider to help guide you in this process.

Our lungs remind us of how connected we are to everyone and everything around us.

We use our lungs to create air for our voice so that we can communicate with others. The carbon dioxide that we don’t need is expelled by the lungs to provide nourishment to trees and plants. And those very plants provide oxygen back to the bronchial trees within us.

As Pocahontas said,

“…we are all connected to each other
In a circle, in a hoop that never ends”

(Sorry, couldn’t resist the Disney reference!)

Do You Find Yourself Holding Your Breath?

When we don’t breathe, we don’t shift. When we don’t let go, we become rigid. Letting air out is an excellent way to start bringing flow back into your body via the breath.

Most people think of the inhale as the main part of the breath. But an inhale is only as good as the exhale before it.

Think of it this way. If you didn’t get all your air out, your next inhale will not bring in much fresh oxygen! There’s just not enough room with the lungs partially full of old air.

Furthermore, if you don’t exhale all the way, your lungs and ribcage don’t get to move through their full range of motion. Now you are working towards rigidity in a pattern of half full lungs, and you are reducing the amount of flow in your body.

The less your ribs move, the less your diaphragm moves, the less massaged your gut organs get by the movement of your diaphragm, and you become more rigid in your digestion.

The less air you get out, the more your body shifts into a state of fear and tension.

Think of your lungs as a balloon. If you never exhale completely, that balloon keeps getting more and more filled with air, and you feel like you’re floating away from the ground. We need a sense of the ground to feel stable, supported, and, well, grounded!

One way to start creating more flow and learning to let go is by letting air out.

Notice that I didn’t say FORCING air out (which is what most of us tend to do). It’s about allowing the lower front ribs to soften down instead of cramming them down.

Here is a short video on how to find an exhale breath that will get your ribs and lungs moving again.

Think of this breath as a sigh. Like you’re getting into a hot bath, or arriving home after a long day and sinking into a nice soft couch. “ahhhhhhh.” After that first delicious sip of an ice cold drink on a hot summer day, “ahhhhhh.”

If you like, take note of how you feel before and after doing this breath for about 5 rounds of 5 breaths. Has the quality of your breath changed? How about the quality of your mind? Your mood? You may be surprised by the results.

To take this a step further and work on sensing your body in addition to sensing your breath, practice also feeling the places where your body touches the chair, and/or where your feet touch the floor. Notice if you’re tensing your shoulders or your face, and see if you can soften there.

More and more throughout your day, be aware of what’s happening in your breath and your body.

Just noticing your breath, and not even trying to change it at all, is an incredibly powerful technique. You can watch your body find it’s rhythm again.

*Again, If doing this makes you feel anxious or uncomfortable, consult with a provider who can help you work through the process of getting back in touch with your body.

So if you’re like me, and you’ve been trying really hard to get better but things still don’t feel right, breathing and sensing might be the missing link.

Don’t underestimate the power of finding the flow in your lungs, your mind, your spirit. Trust me, I’ve been there, and I’ve made it to the other side. And I know that if I can do it, so can you!

If you want to work with me on this or just have questions on next steps, feel free to send me an email or leave a comment below. Derya@MyEssentalPT.com.

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.